Multiple secondary data analyses of TORDIA have identified important predictors of treatment response and relapse .
To up date a comparative effectiveness review ( 1980–2011 ) of treatments for adolescents whose depressive episode or disorder ( MDE/MDD ) did not respond to one or more trials of SSRI antidepressants .
Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial
Importance Suicide is a leading cause of death among 10- to 24-year-old individuals in the United States ; evidence on effective treatment for adolescents who engage in suicidal and self-harm behaviors is limited . Objective To evaluate the efficacy of dialectical behavior therapy ( DBT ) compared with individual and group supportive therapy ( IGST ) for reducing suicide attempts , nonsuicidal self-injury , and overall self-harm among high-risk youths . Design , Setting , and Participants This r and omized clinical trial was conducted from January 1 , 2012 , through August 31 , 2014 , at 4 academic medical centers . A total of 173 participants ( pool of 195 ; 22 withdrew or were excluded ) 12 to 18 years of age with a prior lifetime suicide attempt ( ≥3 prior self-harm episodes , suicidal ideation , or emotional dysregulation ) were studied . Adaptive r and omization balanced participants across conditions within sites based on age , number of prior suicide attempts , and psychotropic medication use . Participants were followed up for 1 year . Interventions Study participants were r and omly assigned to DBT or IGST . Treatment duration was 6 months . Both groups had weekly individual and group psychotherapy , therapist consultation meetings , and parent contact as needed . Main Outcomes and Measures A priori planned outcomes were suicide attempts , nonsuicidal self-injury , and total self-harm assessed using the Suicide Attempt Self-Injury Interview . Results A total of 173 adolescents ( 163 [ 94.8 % ] female and 97 [ 56.4 % ] white ; mean [ SD ] age , 14.89 [ 1.47 ] years ) were studied . Significant advantages were found for DBT on all primary outcomes after treatment : suicide attempts ( 65 [ 90.3 % ] of 72 receiving DBT vs 51 [ 78.9 % ] of 65 receiving IGST with no suicide attempts ; odds ratio [ OR ] , 0.30 ; 95 % CI , 0.10 - 0.91 ) , nonsuicidal self-injury ( 41 [ 56.9 % ] of 72 receiving DBT vs 26 [ 40.0 % ] of 65 receiving IGST with no self-injury ; OR , 0.32 ; 95 % CI , 0.13 - 0.70 ) , and self-harm ( 39 [ 54.2 % ] of 72 receiving DBT vs 24 [ 36.9 % ] of 65 receiving IGST with no self-harm ; OR , 0.33 ; 95 % CI , 0.14 - 0.78 ) . Rates of self-harm decreased through 1-year follow-up . The advantage of DBT decreased , with no statistically significant between-group differences from 6 to 12 months ( OR , 0.65 ; 95 % CI , 0.12 - 3.36 ; P = .61 ) . Treatment completion rates were higher for DBT ( 75.6 % ) than for IGST ( 55.2 % ) , but pattern-mixture models indicated that this difference did not informatively affect outcomes . Conclusions and Relevance The results of this trial support the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents . On the basis of the criteria of 2 independent trials supporting efficacy , results support DBT as the first well-established , empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths . Trial Registration Clinical Trials.gov Identifier : NCT01528020
Multiple secondary data analyses of TORDIA have identified important predictors of treatment response and relapse .
To up date a comparative effectiveness review ( 1980–2011 ) of treatments for adolescents whose depressive episode or disorder ( MDE/MDD ) did not respond to one or more trials of SSRI antidepressants .