Adapted Dialectical Behavior Therapy for Adolescents with a High Risk of Suicide in a Community Clinic: A Pragmatic Randomized Controlled Trial.

ObjectiveThis study is a pragmatic randomized controlled trial, which compares the effectiveness of an adapted form of Dialectical Behavior Therapy for Adolescents (DBT‐A) and treatment as usual plus group sessions (TAU + GS) to reduce suicidal risk for adolescents in a community health mental clinic.MethodThirty‐five adolescents from a community outpatient clinic, with repetitive NSSI alone or with SA over the last 12 months and with current high suicide risk as assessed by the Columbia‐Suicide Severity Rating Scale (C‐SSRS), were enrolled. Participants were randomly assigned to undergo either DBT‐A (n = 18) or TAU + GT (n = 17) treatments over a 16‐week period. Primary outcomes were the difference between NSSI and SA recorded during the first 4 weeks and the final 4 weeks of treatment. Secondary outcomes included changes in Children’s Global Assessment Scale (C‐GAS), Suicidal Ideation Questionnaire (SIQ‐JR), and Beck Depression Inventory‐II (BDI‐II).ResultsDialectical Behavior Therapy for Adolescents was more effective than TAU + GS at reducing NSSI, use of antipsychotics, and improving C‐GAS. No SAs were reported in the two groups at the end of the treatment. Both treatments were equally effective in decreasing SIQ‐JR and BDI‐II scores.ConclusionsThese findings support the feasibility and effectiveness of DBT‐A for adolescents at high risk of suicide in community settings.