National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway.
National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway.
J Am Acad Child Adolesc Psychiatry. 2014 Oct;53(10):1082-91. doi: 10.1016/j.jaac.2014.07.003. Epub 2014 Jul 22.
We examined whether a shortened form of dialectical behavior therapy, dialectical behavior therapy for adolescents (DBT-A) is more effective than enhanced usual care (EUC) to reduce self-harm in adolescents.
This was a randomized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics who were randomly allocated to either DBT-A or EUC. Assessments of self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at baseline and after 9, 15, and 19 weeks (end of trial period), and frequency of hospitalizations and emergency department visits over the trial period were recorded.
Treatment retention was generally good in both treatment conditions, and the use of emergency services was low. DBT-A was superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC. Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time.
DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior. Clinical trial registration information-Treatment for Adolescents With Deliberate Self Harm; http://ClinicalTrials.gov/; NCT00675129.
本研究旨在检验缩短版辩证行为疗法（辩证行为疗法治疗青少年版，DBT-A）相较于增强型常规护理（EUC），是否能更有效地减少青少年的自伤行为。
本研究为一项随机研究，共纳入 77 名近期存在且反复发作自伤行为的青少年，他们均在社区儿童和青少年精神病门诊接受治疗，并被随机分配至 DBT-A 组或 EUC 组。分别于基线、9、15、19 周（试验结束时）对自伤、自杀意念、抑郁、绝望和边缘型人格障碍症状进行评估，并记录试验期间的住院和急诊就诊次数。
两种治疗条件下的治疗保留率总体良好，且急诊服务的使用频率较低。DBT-A 在减少自伤、自杀意念和抑郁症状方面优于 EUC。DBT-A 组患者的治疗结局具有较大的效应量，而 EUC 组患者的治疗结局则具有较小的效应量。在接受 DBT-A 治疗的患者中，治疗接触次数与自杀意念严重程度变化之间存在部分中介效应，而在接受 EUC 治疗的患者中，未发现治疗结局或总治疗时间存在中介效应。
DBT-A 可能是一种有效的干预措施，可减少具有反复发作自伤行为的青少年的自伤、自杀意念和抑郁。
青少年故意自伤的治疗；http://ClinicalTrials.gov/；NCT00675129。
