Does Dialectical Behaviour Therapy for adolescents affect suicidal ideation and use of coping skills in adulthood? A...

Emotion regulation capacity in adolescence is predictive of improved adult mental health and functioning. In the absence of access to functional coping skills, suicidal ideation can be understood as an attempt at emotion regulation. Dialectical Behavioural Therapy adapted for adolescents (DBT-A) targets suicidal ideation directly, partly through teaching of coping skills. Although prior studies have demonstrated DBT-A's effectiveness in reducing suicidal thoughts and behaviour, such studies lack long-term follow-up and often rely on self-reports at single time-points, reducing the capacity to capture variations over time.

To examine whether having received DBT-A in adolescence was associated with differences in suicidal ideation, negative affect and coping skills use measured in daily life, 12.4 years after treatment.

Adolescents (N = 54) who participated in an RCT of DBT-A vs. Enhanced Usual Care (EUC), were followed up 12.4 years later and provided bihourly real-time reports of positive and negative affect, suicidal ideation and use of coping skills collected six times daily for seven consecutive days through the use of mobile phones. Mixed effect models were used to investigate treatment group differences longitudinally and generalized linear models to examine group differences in suicidal ideation occurrence. Concurrent Major Depression or Borderline Personality Disorder (BPD) as well as time measures were included as potential moderators.

https://clinicaltrials.gov/study/NCT04298190.

To have received DBT-A was associated with lower odds (OR = .16, 95 %CI: .02 - .89) of reporting any suicidal ideation, independently of concurrent BPD or Major Depression. There were statistically significant within-person interaction effects on negative affect by use of specific coping skills depending on treatment condition. Only participants who received EUC reported higher levels of negative affect after having used more cognitive coping skills. Participants in both groups reported higher levels of negative affect after having used a breathing exercise, and this effect was significantly higher in the DBT-A group.

Young adults who received DBT-A as adolescents had lower probability of reporting suicidal ideation 12.4 years after treatment, independently of concurrent psychiatric morbidity. In addition, the relationship between negative affect and use of coping skills was different in participants who had received DBT-A vs EUC. These findings suggest that DBT-A in adolescence has a long-term impact on suicidal ideation and coping skills use over a decade later.