Citation

Mehlum L, Ramleth RK, Tørmoen AJ, Haga E, Diep LM, Stanley BH, Miller AL, Larsson B, Sund AM, Grøholt B. J. Child Psychol. Psychiatry 2019; 60(10): 1112-1122.

Copyright

(Copyright © 2019, John Wiley and Sons)

DOI

10.1111/jcpp.13077

PMID

31127612

Abstract

BACKGROUND: Knowledge is lacking on the long-term outcomes of treatment for adolescents with repetitive suicidal and self-harming behavior. Furthermore, the pathways through which treatment effects may operate are poorly understood. Our aims were to investigate enduring treatment effects of dialectical behavior therapy adapted for adolescents (DBT-A) compared to enhanced usual care (EUC) through a prospective 3-year follow-up and to analyze possible mediators of treatment effects.
METHODS: Interview and self-report data covering the follow-up interval were collected from 92% of the adolescents who participated in the original randomized trial.
TRIAL REGISTRATION NUMBER: NCT01593202 (www.ClinicalTrials.gov).
RESULTS: At the 3-year follow-up DBT-A remained superior to EUC in reducing the frequency of self-harm, whereas for suicidal ideation, hopelessness and depressive and borderline symptoms and global level of functioning there were no inter-group differences, with no sign of symptom relapse in either of the participant groups. A substantial proportion (70.8%) of the effect of DBT-A on self-harm frequency over the long-term was mediated through a reduction in participants' experience of hopelessness during the trial treatment phase. Receiving more than 3 months follow-up treatment after completion of the trial treatment was associated with further enhanced outcomes in patients who had received DBT-A.
CONCLUSIONS: There were on average no between-group differences at the 3-year follow-up in clinical outcomes such as suicidal ideation, hopelessness, depressive and borderline symptoms. The significantly and consistently larger long-term reduction in self-harm behavior for adolescents having received DBT-A compared with enhanced usual care, however, suggests that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior.

Language: en

Keywords

Humans; Female; Male; Adolescent; Adolescent Behavior; Self-Injurious Behavior; Suicidal Ideation; attempted suicide; psychotherapy; Self-harm; Suicide Prevention; Follow-Up Studies; Outcome Assessment, Health Care; longitudinal; Dialectical Behavior Therapy; Psychotherapeutic Processes