Early-onset bipolar disorder conveys substantial risk for suicide. No psychosocial intervention for this population expressly targets suicidal behavior. The novel findings from a recently published trial in JAMA Psychiatry journal have shown effectiveness of Dialectical behavior therapy (DBT) as the first psychosocial intervention with demonstrated effects on suicidal behavior for adolescents with bipolar spectrum disorder.
To determine whether dialectical behavior therapy (DBT) for adolescents with bipolar spectrum disorder is more effective than standard of care (SOC) psychotherapy in decreasing suicide attempts over 1 year, authors Goldstein et al randomized 100 adolescents with bipolar spectrum disorder to receive either 1 year of DBT or SOC.
All youth received medication management via a flexible algorithm. Primary outcomes included suicide attempts over 1 year and mood symptoms and states (depression and hypomania/mania). Secondary analyses included moderation of DBT effects by history of suicide attempt and mediation through emotion dysregulation.
The study found that:
1. Both treatment groups demonstrated significant and similar improvement in mood symptoms and episodes over 1 year.
2. DBT and SOC participants reported similar suicide attempt rates at intake as measured on the Adolescent Longitudinal Follow-Up Evaluation.
3. DBT participants reported significantly fewer suicide attempts over follow-up compared with SOC participants
4. Decreased rate of suicide attempts in DBT was moderated by presence of lifetime history of suicide attempt and time and mediated by improvement in emotion dysregulation, particularly for those with high baseline emotion dysregulation.
To summarise, youth who received 1 year of DBT had fewer suicide attempts over 1 year. The groups displayed similar improvement in depression and hypomania and mania. These findings support DBT as the first psychosocial intervention with demonstrated effects on suicidal behavior for adolescents with bipolar spectrum disorder.
Source: JAMA Psychiatry: doi:10.1001/jamapsychiatry.2023.3399