Stanford University, California.
West Chester University of Pennsylvania, West Chester.
J Am Acad Child Adolesc Psychiatry. 2022 Sep;61(9):1119-1130. doi: 10.1016/j.jaac.2022.01.010. Epub 2022 Feb 2.
To examine trajectories of treatment response in suicidal youth who participated in a randomized controlled trial comparing dialectical behavior therapy (DBT) and individual and group supportive therapy.
Using latent class analysis across both treatment conditions, secondary analyses were conducted of data from a multisite randomized controlled trial comprising 173 youths ages 12-18 with repetitive self-harm (SH) (including ≥1 lifetime suicide attempts) and elevated suicidal ideation (SI). The sample was 95% female, 56.4% White, and 27.49% Latina. Participants received 6 months of DBT or individual and group supportive therapy and 6 months of follow-up. Primary outcomes were SH and SI.
Of the sample, 63% and 74% were members of latent classes that showed improvement in SI and SH, respectively; 13% were total nonresponders, with no improvement in SI or SH. SH nonresponse emerged at the midpoint of treatment (3 months), with nonresponders showing a sharp increase in SH over the remainder of treatment and follow-up. Youth receiving DBT were significantly more likely to be an SH responder vs nonresponder than youths in individual and group supportive therapy (ꭓ = 6.53, p = .01). An optimal threshold cut point using multivariate predictors of total nonresponse (White, externalizing symptoms, total SH, and SI) predicted total nonresponders to DBT with 100% accuracy.
This is the first study to identify trajectories of both SI and SH response to treatment in a sample of adolescents at risk of suicide. Results may inform personalized treatment approaches.
Collaborative Adolescent Research on Emotions and Suicide (CARES); https://www.
gov/; NCT01528020.
研究参加一项比较辩证行为疗法（DBT）与个体和团体支持性治疗的随机对照试验的自杀青少年的治疗反应轨迹。
在两种治疗条件下使用潜在类别分析，对一项多地点随机对照试验的数据进行二次分析，该试验包括 173 名年龄在 12-18 岁之间、有重复自伤（SH）（包括至少 1 次终生自杀企图）和升高的自杀意念（SI）的青少年。该样本中 95%为女性，56.4%为白人，27.49%为拉丁裔。参与者接受了 6 个月的 DBT 或个体和团体支持性治疗以及 6 个月的随访。主要结局是 SH 和 SI。
在样本中，分别有 63%和 74%的参与者属于 SI 和 SH 改善的潜在类别；13%是完全无反应者，SI 或 SH 没有改善。SH 无反应出现在治疗的中点（3 个月），无反应者在治疗和随访的其余时间内 SH 急剧增加。与个体和团体支持性治疗相比，接受 DBT 的青少年成为 SH 反应者而非无反应者的可能性显著更高（ꭓ=6.53，p=0.01）。使用对总无反应的多变量预测因子（白人、外化症状、总 SH 和 SI）的最佳阈值截断点，对 DBT 的总无反应者的预测准确率为 100%。
这是第一项在有自杀风险的青少年样本中识别 SI 和 SH 治疗反应轨迹的研究。结果可能为个性化治疗方法提供信息。
协作青少年情绪与自杀研究（CARES）；https://www.clinicaltrials.gov/；NCT01528020。
