Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide A Randomized Clinical Trial
Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide A Randomized Clinical Trial
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DOI：
10.1001/jamapsychiatry.2018.1109
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发表时间：
2018-08-01
期刊：
影响因子：
25.8
通讯作者：
Linehan, Marsha M.
中科院分区：
文献类型：
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作者：
McCauley, Elizabeth;Berk, Michele S.;Linehan, Marsha M.
自杀是美国10至24岁人群的主要死因;对有自杀和自伤行为的青少年进行有效治疗的证据是有限的。目的评价辩证行为疗法（DBT）与个体和团体支持疗法（IGST）相比在减少自杀企图、非自杀自伤、设计、设置和参与者这项随机临床试验于2012年1月1日至2014年8月31日在4个学术医学中心进行。共研究了173名参与者（195人; 22人退出或被排除），年龄为12至18岁，既往有自杀企图（≥ 3次既往自残事件，自杀意念或情绪失调）。适应性随机化根据年龄、既往自杀企图次数和精神药物使用情况在研究中心内的不同条件下平衡参与者。干预研究参与者被随机分配到DBT或IGST。治疗持续时间为6个月。两组每周进行个人和团体心理治疗，治疗师咨询会议，并根据需要与家长联系。主要结果和措施先验计划的结果是自杀企图，非自杀自伤，总自伤使用自杀企图自伤访谈评估。（163例[94.8%]女性和97例[56.4%]白色;平均[SD]年龄，14.89 [1.47]岁）。DBT在治疗后的所有主要结局方面均具有显著优势：自杀企图（接受DBT的72人中有65人[90.3%] vs接受IGST的65人中有51人[78.9%]无自杀企图;比值比[OR]为0.30; 95% CI，0.10-0.91），非自杀性自伤DBT组72例中41例[56.9%]，IGST组65例中26例[40.0%]，无自伤; OR，0.32; 95% CI，0.13-0.70）和自我伤害（接受DBT的72例患者中有39例[54.2%]，接受IGST的65例患者中有24例[36.9%]，无自我伤害; OR，0.33; 95% CI，0.14-0.78）。1年随访期间，自我伤害发生率下降。DBT的优势下降，6至12个月的组间差异无统计学意义（OR，0.65; 95% CI，0.12-3.36; P= 0.61）。治疗完成率较高的DBT（75.6%）比IGST（55.2%），但模式混合模型表明，这种差异并没有信息影响outcomes.CONCLUSIONS和相关性-本试验的结果支持DBT的疗效，减少自我伤害和自杀企图在高度自杀自我伤害的青少年。根据2项独立试验支持疗效的标准，结果支持DBT作为第一个成熟的、经验支持的治疗方法，用于减少青少年的重复自杀企图和自我伤害。
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 randomized 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 randomization 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 randomly 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.