Outpatient Psychiatric Care for Youth with Suicide Risk: Who is Offered Dialectical Behavioural Therapy?
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Outpatient Psychiatric Care for Youth with Suicide Risk: Who is Offered Dialectical Behavioural Therapy? Jia Lu1 · Lisa Dyce2 · Debra Hughes3 · Tony DeBono3,4 · Jennifer Cometto3,4 · Khrista Boylan3,4,5
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Dialectical behaviour therapy for adolescents (DBT-A) has recently been adapted and tested as an intervention for suicidal youth in randomized trials. Although studies have demonstrated the efficacy of this intervention for suicidal behaviours, research examining which youth get offered DBT-A in clinical practice is lacking. Objective This study aimed to determine the proportion of suicidal youth that were offered DBT-A in a child and youth psychiatric outpatient clinic, and how selected clinical features differ between youth offered and not offered DBT-A. Method Medical records of 44 youth were reviewed based on: (1) initial mental health intake assessment between January and June 2015, (2) age 13–16 years, and (3) active suicidal ideation (SI) with or without recent non-suicidal self-injury (NSSI)-or suicide attempt (SA). Twenty-four consecutive months of demographic, diagnostic, and treatment data were reviewed retrospectively. Results 79.5% (n = 35) of the sample endorsed SI, 63.6% (n = 28) endorsed NSSI, and 47.7% (n = 21) reported a past SA. 47.7% (n = 21) were offered DBT-A. There was a significant relationship between offering of DBT-A and endorsement of multiple suicidal risk symptoms at baseline. Youth offered DBT-A reported significantly more types of adverse childhood experiences than those not offered DBT-A. Conclusion Youth mental health clinicians appear to preferentially offer DBT-A to youth who report multiple suicidal risk symptoms and adverse childhood experiences. This profile is consistent with populations of youth enrolled in randomized trials of DBT-A. A large proportion of suicidal youth are not offered DBT-A, suggesting that clinicians consider multiple factors in treatment decision-making. Keywords Dialectical behaviour therapy · Adolescents · Self-harm · Suicidal ideation · Suicide attempt
* Khrista Boylan [email protected] Extended author information available on the last page of the article
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Child & Youth Care Forum
Introduction One of the most common mental health interventions in adolescents is the prevention of suicide and repeated self-harm. In Canada, suicide is the first and second leading cause of death among those aged 10 to 14 and 15 to 34, respectively (Statistics Canada 2016). There is a large body of research demonstrating that non-suicidal self-injury (NSSI), suicidal ideation (SI), depression, adverse childhood experiences (ACEs), and substance abuse are important predictors of suicide attempts (SAs) in adolescents (Asarnow et al. 2011; Baiden et al. 2017; Czyz and King 2015; Dube et al. 2001; Du Roscoät et al. 2016; Klonsky et al. 2013; Knorr et al. 2016). By targeting each or all of these factors in intervention efforts, it may be possible to redu
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