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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering

Long term effectiveness of dialectical behaviour therapy vs enhanced usual care for adolescents with self-harming and suicidal behaviours

Awarded: NOK 4.5 mill.

Self-harming individuals frequently report high levels of depressive symptoms which are not always reflected in the clinicians' assessments. Studies on adults suggest that comorbid Borderline Personality Disorder (BPD) has an effect on the presentation and outcome of depression. BPD as a diagnosis is still somewhat controversial in the field of child- and adolescentpsychiatry, thus less is known about the effect of comorbidity with BPD in this population. We have examined the levels of depressive symptoms in self-harming adolescents with and without comorbid BPD before and after treatment with Dialectical Behaviour Therapy (DBT) or enhanced usual care. We found that whereas there were no differences between the two groups with respect to levels of clinician-rated depressive symptoms, the self-reported depressive symptoms as well as the suicidal ideation were significantly higher in the adolescents with BPD. At trial completion the depressive symptoms were significantly redused only in the adolescents without comorbid BPD. Furthermore, the global level of functioning was significantly lower in the adolescents with comorbid BPD compared to those without BPD. The adolescents who received DBT had a greater reduction in depressive symptoms compared to those who received enhanced usual care. The results suggest that clinicians should be aware of the impact comorbid BPD may have on self-reported depressive symptoms and treatment outcome in self-harming adolescents with depression.

Suicide attempts and self harm represent severe health problems peaking in prevalence in the middle and late adolescence. A pattern of repetitive self harm is often linked to borderline personality disorder even in adolescence and is associated with a hig h risk of completed suicide. Very few controlled intervention trials have been conducted for self-harming and suicidal adolescents and the long term course and outcome after psychotherapy in adolescents is very sparingly researched. The objective of this study is to investigate the long-term (2 year after treatment) effectiveness of a novel adaptation of Dialectical behaviour therapy (DBT-A) for adolescents (12-18 yrs) compared to enhanced usual care (EUC), both treatment types delivered at five Child and Adolescent Outpatient Clinics in Oslo. DBT-A aims to reduce self-harm and suicidal behaviour in adolescents with emotion dysregulation linked to borderline personality traits through enhancing adolescents' social skills, emotion regulation skills and oth er coping resources through individual psychotherapy, multifamily skills training groups, family interventions and tailor made telephone coaching to generalize skills to real life. Patients included in this randomized controlled trial commonly have depres sive disorders, substance abuse, PTSD and traits from borderline personality disorder. In this study 80 patients who have received either DBT-A or EUC are followed up two years after completion of the treatment. The study utilises a rich data set collecte d at altogether 6 time points by raters blinded to treatment condition allowing for the study of predictors of the long term course and development of the clinical disorders under study. The research is carried out at the National Centre for Suicide Resea rch and Prevention at the University of Oslo in close collaboration with the five clinical units and a group of national and international experts in suicide research and psychotherapy research.

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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering