2019/05/25 by Lars Mehlum, Ruth‐Kari Ramleth, Anita Johanna Tørmoen +11 · 142 citations
Medicine · Psychology · #Borderline personality disorder #Child and Adolescent Psychosocial and Emotional Development #Clinical psychology #Dialectical behavior therapy #Injury prevention #Internal medicine #Medicine #Personality Disorders and Psychopathology #Poison control #Psychiatry #Psychology #Randomized controlled trial #Suicidal ideation #Suicide and Self-Harm Studies #Suicide prevention
paper · open access · doi:10.1111/jcpp.13077
published in Journal of Child Psychology and Psychiatry 60(10), 1112-1122 (Wiley)
openalex publication_date 2019/05/25 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/05
BACKGROUND: Knowledge is lacking on the long-term outcomes of treatment for adolescents with repetitive suicidal and self-harming behavior. Furthermore, the pathways through which treatment effects may operate are poorly understood. Our aims were to investigate enduring treatment effects of dialectical behavior therapy adapted for adolescents (DBT-A) compared to enhanced usual care (EUC) through a prospective 3-year follow-up and to analyze possible mediators of treatment effects. METHODS: Interview and self-report data covering the follow-up interval were collected from 92% of the adolescents who participated in the original randomized trial. TRIAL REGISTRATION NUMBER: NCT01593202 (www.ClinicalTrials.gov). RESULTS: At the 3-year follow-up DBT-A remained superior to EUC in reducing the frequency of self-harm, whereas for suicidal ideation, hopelessness and depressive and borderline symptoms and global level of functioning there were no inter-group differences, with no sign of symptom relapse in either of the participant groups. A substantial proportion (70.8%) of the effect of DBT-A on self-harm frequency over the long-term was mediated through a reduction in participants' experience of hopelessness during the trial treatment phase. Receiving more than 3 months follow-up treatment after completion of the trial treatment was associated with further enhanced outcomes in patients who had received DBT-A. CONCLUSIONS: There were on average no between-group differences at the 3-year follow-up in clinical outcomes such as suicidal ideation, hopelessness, depressive and borderline symptoms. The significantly and consistently larger long-term reduction in self-harm behavior for adolescents having received DBT-A compared with enhanced usual care, however, suggests that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior.