Outpatient Psychiatric Care for Youth with Suicide Risk: Who is Offered Dialectical Behavioural Therapy?

Abstract

Background

Dialectical behaviour therapy for adolescents (DBT-A) has recently been adapted and tested as an intervention for suicidal youth in randomized trials. Although studies have demonstrated the efficacy of this intervention for suicidal behaviours, research examining which youth get offered DBT-A in clinical practice is lacking.

Objective

This study aimed to determine the proportion of suicidal youth that were offered DBT-A in a child and youth psychiatric outpatient clinic, and how selected clinical features differ between youth offered and not offered DBT-A.

Method

Medical records of 44 youth were reviewed based on: (1) initial mental health intake assessment between January and June 2015, (2) age 13–16 years, and (3) active suicidal ideation (SI) with or without recent non-suicidal self-injury (NSSI)-or suicide attempt (SA). Twenty-four consecutive months of demographic, diagnostic, and treatment data were reviewed retrospectively.

Results

79.5% (n = 35) of the sample endorsed SI, 63.6% (n = 28) endorsed NSSI, and 47.7% (n = 21) reported a past SA. 47.7% (n = 21) were offered DBT-A. There was a significant relationship between offering of DBT-A and endorsement of multiple suicidal risk symptoms at baseline. Youth offered DBT-A reported significantly more types of adverse childhood experiences than those not offered DBT-A.

Conclusion

Youth mental health clinicians appear to preferentially offer DBT-A to youth who report multiple suicidal risk symptoms and adverse childhood experiences. This profile is consistent with populations of youth enrolled in randomized trials of DBT-A. A large proportion of suicidal youth are not offered DBT-A, suggesting that clinicians consider multiple factors in treatment decision-making.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. Adrian, M., McCauley, E., Berk, M. S., Asarnow, J. R., Korslund, K., Avina, C., … & Linehan, M. M. (2019). Predictors and moderators of recurring self-harm in adolescents participating in a comparative treatment trial of psychological interventions. Journal of Child Psychology and Psychiatry,60(10), 1123–1132.

    Article  Google Scholar 

  2. Asarnow, J. R., & Ougrin, D. (2019). Suicide and self-harm: Advancing from science to preventing deaths. Journal of Child Psychology and Psychiatry,60(10), 1043–1045.

    Article  Google Scholar 

  3. Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., … & Mayes, T. (2011). Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA study. Journal of the American Academy of Child and Adolescent Psychiatry,50(8), 772–781.

    Article  Google Scholar 

  4. Baiden, P., Stewart, S. L., & Fallon, B. (2017). The role of adverse childhood experiences as determinants of non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings. Child Abuse and Neglect,69, 163–176.

    Article  Google Scholar 

  5. Carter, G., Page, A., Large, M., Hetrick, S., Milner, A. J., Bendit, N., … & Burns, J. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm. Australian and New Zealand Journal of Psychiatry,50(10), 939–1000.

    Article  Google Scholar 

  6. Czyz, E. K., & King, C. A. (2015). Longitudinal trajectories of suicidal ideation and subsequent suicide attempts among adolescent inpatients. Journal of Clinical Child & Adolescent Psychology,44(1), 181–193.

    Article  Google Scholar 

  7. DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behavior Therapy,50(1), 60–72.

    Article  Google Scholar 

  8. Du Roscoät, E., Legleye, S., Guignard, R., Husky, M., & Beck, F. (2016). Risk factors for suicide attempts and hospitalizations in a sample of 39,542 French adolescents. Journal of Affective Disorders,190, 517–521.

    Article  Google Scholar 

  9. Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., & Giles, W. H. (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the Adverse Childhood Experiences Study. Journal of the American Medical Association,286(24), 3089–3096.

    Article  Google Scholar 

  10. Freedenthal, S. (2007). Racial disparities in mental health service use by adolescents who thought about or attempted suicide. Suicide and Life-Threatening Behavior,37(1), 22–34.

    Article  Google Scholar 

  11. Goldstein, A. B., Frosch, E., Davarya, S., & Leaf, P. J. (2007). Factors associated with a six-month return to emergency services among child and adolescent psychiatric patients. Psychiatric Services,58(11), 1489–1492.

    Article  Google Scholar 

  12. Groves, S., Backer, H. S., van den Bosch, W., & Miller, A. (2012). Dialectical behaviour therapy with adolescents. Child and Adolescent Mental Health,17(2), 65–75.

    Article  Google Scholar 

  13. Haga, E., Aas, E., Grøholt, B., Tørmoen, A. J., & Mehlum, L. (2018). Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm. Child and Adolescent Psychiatry and Mental Health,12(1), 22.

    Article  Google Scholar 

  14. Husky, M. M., Olfson, M., He, J. P., Nock, M. K., Swanson, S. A., & Merikangas, K. R. (2012). Twelve-month suicidal symptoms and use of services among adolescents: Results from the National Comorbidity Survey. Psychiatric Services,63(10), 989–996.

    Article  Google Scholar 

  15. Iyengar, U., Snowden, N., Asarnow, J. R., Moran, P., Tranah, T., & Ougrin, D. (2018). A further look at therapeutic interventions for suicide attempts and self-harm in adolescents: An updated systematic review of randomized controlled trials. Frontiers in Psychiatry,9, 583.

    Article  Google Scholar 

  16. Kaess, M., Parzer, P., Mattern, M., Plener, P. L., Bifulco, A., Resch, F., et al. (2013). Adverse childhood experiences and their impact on frequency, severity, and the individual function of nonsuicidal self-injury in youth. Psychiatry Research,206(2–3), 265–272.

    Article  Google Scholar 

  17. Kam, S. E., & Midgley, N. (2006). Exploring ‘clinical judgement’: How do child and adolescent mental health professionals decide whether a young person needs individual psychotherapy? Clinical Child Psychology and Psychiatry,11(1), 27–44.

    Article  Google Scholar 

  18. Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples. Journal of Abnormal Psychology,122(1), 231.

    Article  Google Scholar 

  19. Knorr, A. C., Tull, M. T., Anestis, M. D., Dixon-Gordon, K. L., Bennett, M. F., & Gratz, K. L. (2016). The interactive effect of major depression and nonsuicidal self-injury on current suicide risk and lifetime suicide attempts. Archives of Suicide Research,20(4), 539–552.

    Article  Google Scholar 

  20. Koerner, K. (2011). Doing dialectical behaviour therapy: A practical guide. New York: Guilford press.

    Google Scholar 

  21. LeCloux, M., Maramaldi, P., Thomas, K., & Wharff, E. (2017). Health care resources and mental health service use among suicidal adolescents. Journal of Behavioral Health Services & Research,44(2), 195–212.

    Article  Google Scholar 

  22. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford.

    Google Scholar 

  23. Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine,37(8), 1183–1192.

    Article  Google Scholar 

  24. McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., et al. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: A randomized clinical trial. JAMA Psychiatry,75(8), 777–785.

    Article  Google Scholar 

  25. Mehlum, L., Ramberg, M., Tørmoen, A. J., Haga, E., Diep, L. M., Stanley, B. H., et al. (2016). Dialectical behavior therapy compared with enhanced usual care for adolescents with repeated suicidal and self-harming behavior: Outcomes over a one-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry,55(4), 295–300.

    Article  Google Scholar 

  26. Mehlum, L., Tørmoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, S., et al. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: A randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry,53(10), 1082–1091.

    Article  Google Scholar 

  27. Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York, NY: Guilford Press.

    Google Scholar 

  28. National Collaborating Centre for Mental Health (UK). (2012). Self-harm: Longer-term management. Leicester: British Psychological Society.

    Google Scholar 

  29. Nestor, B. A., Cheek, S. M., & Liu, R. T. (2016). Ethnic and racial differences in mental health service utilization for suicidal ideation and behavior in a nationally representative sample of adolescents. Journal of Affective Disorders,202, 197–202.

    Article  Google Scholar 

  30. Ougrin, D., Tranah, T., Stahl, D., Moran, P., & Asarnow, J. R. (2015). Therapeutic interventions for suicide attempts and self-harm in adolescents: Systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry,54(2), 97–107.

    Article  Google Scholar 

  31. Pirkis, J. E., Irwin, C. E., Jr., Brindis, C. D., Sawyer, M. G., Friestad, C., Biehl, M., et al. (2003). Receipt of psychological or emotional counseling by suicidal adolescents. Healthcare,5, 10.

    Google Scholar 

  32. Statistics Canada. (2016). Deaths and age-specific mortality rates, by selected grouped causes. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039201&pickMembers%5B0%5D=2.1&pickMembers%5B1%5D=3.1. Accessed April 21, 2019.

  33. Suominen, K., Isometsä, E., Martunnen, M., Ostamo, A., & Lönnqvist, J. (2004). Health care contacts before and after attempted suicide among adolescent and young adult versus older suicide attempters. Psychological Medicine,34(2), 313–321.

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to acknowledge the early collaboration and project development support of Christopher Conley, MSW, LCSW.

Funding

The study was funded by the Hamilton Health Sciences, Health Professional Investigator Operating Grant (HPI).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Khrista Boylan.

Ethics declarations

Conflict of interest

The authors declared no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lu, J., Dyce, L., Hughes, D. et al. Outpatient Psychiatric Care for Youth with Suicide Risk: Who is Offered Dialectical Behavioural Therapy?. Child Youth Care Forum (2020). https://doi.org/10.1007/s10566-020-09560-7

Download citation

Keywords

  • Dialectical behaviour therapy
  • Adolescents
  • Self-harm
  • Suicidal ideation
  • Suicide attempt