Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis

Oswald D Kothgassner, Andreas Goreis, Kealagh Robinson, Mercedes M Huscsava, Christian Schmahl, Paul L Plener, Oswald D Kothgassner, Andreas Goreis, Kealagh Robinson, Mercedes M Huscsava, Christian Schmahl, Paul L Plener

Abstract

Background: Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical.

Methods: We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12-19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7.

Results: Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = -0.44; 95% CI -0.81 to -0.07) and suicidal ideation (g = -0.31, 95% CI -0.52 to -0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = -0.98, 95% CI -1.15 to -0.81; suicidal ideation: g = -1.16, 95% CI -1.51 to -0.80; BPD symptoms: g = -0.97, 95% CI -1.31 to -0.63).

Conclusions: DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

Keywords: Adolescence; DBT-A; borderline personality disorder; self-harm; self-injury; suicidal ideation.

Conflict of interest statement

None of the authors declare any conflict of interest with regard to this manuscript. Paul Plener has received research funding from the German Federal Institute for Drugs and Medical Devices (BfArM), German Federal Ministry of Education and Research (BMBF), VW-Foundation, Baden-Württemberg Foundation, Lundbeck, and Servier. He received a speaker's honorarium from Shire.

Figures

Fig. 1.
Fig. 1.
PRISMA flowchart showing the screening, exclusion, and inclusion criteria.
Fig. 2.
Fig. 2.
Forest plot of trials comparing the effect of DBT-A and controls on symptoms of self-harm.
Fig. 3.
Fig. 3.
Forest plot of trials comparing the effect of DBT-A and controls on symptoms of suicidal ideation.

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