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.
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.
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.
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.
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.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Koerner, K. (2011). Doing dialectical behaviour therapy: A practical guide. New York: Guilford press.
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.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford.
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.
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.
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.
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.
Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York, NY: Guilford Press.
National Collaborating Centre for Mental Health (UK). (2012). Self-harm: Longer-term management. Leicester: British Psychological Society.
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.
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.
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.
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.
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.
The authors wish to acknowledge the early collaboration and project development support of Christopher Conley, MSW, LCSW.
The study was funded by the Hamilton Health Sciences, Health Professional Investigator Operating Grant (HPI).
Conflict of interest
The authors declared no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
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
- Dialectical behaviour therapy
- Suicidal ideation
- Suicide attempt