Teen suicide risk may be lower with intense team-based therapy

Adolescents who have harmed themselves or tried to commit suicide may be less likely to do it again when they participate in an intense therapy program focused on both individual and family treatment, a US study suggests.

The research focused on what’s known as dialectical behaviour therapy. This involves a combination of individual sessions for teens and their parents as well as family counseling. The goals include helping teens eliminate behaviour that leads to self-harm, suicide, or reduced quality of life; teaching skills like mindfulness and emotion regulation; and helping teens and families change behaviours.

The study included 173 adolescents, ages 12 to 18, who had at least three previous episodes of self-harm, attempted suicide, or suicidal thoughts. Researchers randomly assigned teens to receive either six months of dialectal behaviour therapy (DBT) or supportive therapy, which wasn’t as intense.

After six months of treatment, patients who received DBT were 70 percent less likely to attempt suicide and 67 percent less likely to harm themselves than teens who received supportive therapy, the study found.

“We already had strong evidence across multiple studies that DBT was effective at reducing suicidal and self-harm behaviours in adults, and there was a lot of hope in the field that DBT could be similarly effective for teens, given the high risk of suicide in this age group,” said study co-author Michele Berk, a psychiatry researcher at Stanford University in California.

“We finally have a treatment for adolescents that meets the gold standard for a 'well-established’ evidence-based treatment for youth at high risk for suicide,” Berk said by email.

Teens were almost 15 years old on average at the start of the study and most were female.

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Youth who received dialectical behaviour therapy had weekly individual psychotherapy, group therapy sessions and skills training for families, youth and parent telephone coaching, and weekly consultations with teams of therapists involved in treatment of teens and their parents or other family members.

Overall, about 46 percent of teens in the DBT group completed at least 24 individual therapy sessions, compared with 16 percent of the youth in supportive therapy.

By the end of the six-month treatment period, 65 of 72 teens, or 90 percent, receiving DBT had no additional suicide attempts, compared with 51 of 65, or 78 percent, receiving supportive therapy, the study found.

In addition, 39 teens in the DBT group, or 54 percent, had no episodes of self-harm, compared with 24, or 37 percent of adolescents in supportive therapy.

After one year, however, there were no longer meaningful differences between treatment groups in suicide attempts or self-harm episodes.

One limitation of the study is the lack of male patients. Although teen girls are more likely to attempt suicide, adolescent boys are more likely to die, researchers note in JAMA Psychiatry. It’s not clear if results in female patients would apply to males.

Even so, the results build on some previous research suggesting that DBT might be effective for teens as well as for adults, said Dr. Paul Wilkinson, author of an accompanying editorial and a psychiatry researcher at the University of Cambridge in the UK.

“This is the second (and largest) randomized controlled trial that has shown DBT to be better than treatment as usual for adolescents with repeated self-harm,” Wilkinson said by email. “I think DBT worked because it was a more complex in-depth therapy, that was better at teaching adolescents and families strategies to reduce self-harm, and the feelings that lead to self-harm.”