Young people with bipolar spectrum disorder who received dialectical behavior therapy (DBT) had significantly fewer suicide attempts compared with young people who received standard psychotherapy, according to a report in JAMA Psychiatry. DBT is an evidence-based treatment that focuses on emotional regulation, and one of its uses is for suicidal behavior.
“Up to 50% of youth with bipolar spectrum disorder attempt suicide,” wrote Tina Goldstein, Ph.D., of the University of Pittsburgh and colleagues. For up to 60% of individuals, their first suicide attempt is lethal, and for those who survive, the risk of death increases with each successive attempt. “Thus, the capacity to predict first attempt among youth with BP and provide a potentially preventive intervention like DBT offers a compelling future direction.”
Adolescents aged 12 to 18 years diagnosed with bipolar spectrum disorder were recruited from a specialty outpatient psychiatric clinic at the University of Pittsburgh Medical Center between November 2014 and September 2019. Forty-seven were randomized to receive 37 sessions of DBT over one year, and 53 were randomized to receive standard psychotherapy (for example, sessions focused on cognitive strategies and behavioral approaches). All youth received medication from study psychiatrists according to a treatment algorithm. By the study’s end, 28 youth had withdrawn from the study, and eight were lost to follow-up.
Primary outcomes included suicide attempts over one year and mood symptoms and episodes of depression and hypomania/mania. Suicide attempts were assessed using the Columbia Suicide Severity Rating Scale and the ALIFE Self-Injurious/Suicidal Behavior Scale. The researchers also assessed emotional regulation using the self-reported Difficulties With Emotion Regulation Scale. Over the year-long study, youth who had received DBT reported significantly fewer suicide attempts compared with those who had received standard psychotherapy. “[S]uicide attempts declined to a greater extent over time among those receiving DBT compared with those receiving [standard] psychotherapy, particularly among participants with a recent and/or lifetime history of suicide attempt,” the authors noted.
While the groups displayed similar improvements in symptoms of depression and episodes of hypomania and mania, those who received DBT experienced greater improvement in emotional regulation. Improvement in emotional regulation was associated with decreased suicide risk, particularly among those with high baseline emotion dysregulation.
The authors concluded: “Adolescents with bipolar disorder at elevated risk of suicidal behavior and those exhibiting high emotion dysregulation stand to benefit most from DBT’s effects on decreasing suicide attempt risk through enhancing emotion regulation.”
For related information, see the Psychiatric News article “We Must Continue Screening Youth for Suicide Risk.”
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