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Outpatient Psychiatric Care for Youth with Suicide Risk: Who is Offered Dialectical Behavioural Therapy?

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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.

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Acknowledgements

The authors wish to acknowledge the early collaboration and project development support of Christopher Conley, MSW, LCSW.

Funding

The study was funded by the Hamilton Health Sciences, Health Professional Investigator Operating Grant (HPI).

Author information

Authors and Affiliations

  1. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Jia Lu

  2. Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada

    Lisa Dyce

  3. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada

    Debra Hughes, Tony DeBono, Jennifer Cometto & Khrista Boylan

  4. Child and Youth Mental Health Program, McMaster Children’s Hospital, Hamilton, ON, Canada

    Tony DeBono, Jennifer Cometto & Khrista Boylan

  5. Offord Centre for Child Studies, 175 Longwood Rd S Suite 201A, Hamilton, ON, L8P 0A1, Canada

    Khrista Boylan

Authors
  1. Jia Lu
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  2. Lisa Dyce
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  3. Debra Hughes
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  4. Tony DeBono
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  5. Jennifer Cometto
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  6. Khrista Boylan
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Correspondence to Khrista Boylan.

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Lu, J., Dyce, L., Hughes, D. et al. Outpatient Psychiatric Care for Youth with Suicide Risk: Who is Offered Dialectical Behavioural Therapy?. Child Youth Care Forum 49, 839–852 (2020). https://doi.org/10.1007/s10566-020-09560-7

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  • DOI: https://doi.org/10.1007/s10566-020-09560-7

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