Health related quality of life for young people receiving dialectical behaviour therapy (DBT): a routine outcome-monitoring pilot.

M Swales,R A B Hibbs,L Bryning,R P Hastings

doi:10.1186/s40064-016-2826-9

Abstract

PurposeAdults presenting with borderline personality disorder (BPD) score poorly on measures of health related quality of life (HRQoL). Little is known about HRQoL in adolescents with BPD type presentations and how treatment impacts quality of life. Our primary aim was to use routinely collected quality-of-life outcome measures pre and post-treatment in dialectical behaviour therapy (DBT) for adolescents to address this gap. Secondary aims were to benchmark these data against EuroQol 5 dimensions (EQ-5D™) outcomes for clients treated in clinical trials and to assess the potential of the EQ-5D™ as a benchmarking tool.MethodFour adolescent DBT teams, routinely collecting outcome data using a pseudonymised secure web-based system, supplied data from consecutive discharges.ResultsYoung people in the DBT programmes (n = 43) had severely impaired HRQoL scores that were lower at programme admission than those reported in published studies using the EQ-5D™ in adults with a BPD diagnosis and in one study of adolescents treated for depression. 40 % of adolescents treated achieved Reliable Clinical Change. HRQoL improved between admission and discharge with a large effect size. These results were not statistically significant when clustering in programme outcomes was accounted for.ConclusionYoung people treated in NHS DBT programmes for BPD type presentations had poorer HRQoL than adults with a BPD diagnosis and adolescents with depression treated in published clinical trials. The EQ-5D™ detected reliable change in this group of adolescents. Programme outcome clustering suggests that both the measure and the web-based monitoring system provide a mechanism for benchmarking clinical programmes.

Highlights

Whilst borderline personality disorder (BPD) is most commonly diagnosed in adults, more recently clinicians and researchers have begun to consider the assessment and identification of personality disorders in adolescents (Miller et al 2008; Sharp and Fonagy 2015)
Young people in the dialectical behaviour therapy (DBT) programmes (n = 43) had severely impaired health related quality of life (HRQoL) scores that were lower at programme admission than those reported in published studies using the EQ-5DTM in adults with a BPD diagnosis and in one study of adolescents treated for depression. 40 % of adolescents treated achieved Reliable Clinical Change
Young people treated in NHS DBT programmes for BPD type presentations had poorer HRQoL than adults with a BPD diagnosis and adolescents with depression treated in published clinical trials

Summary

Introduction

Whilst borderline personality disorder (BPD) is most commonly diagnosed in adults, more recently clinicians and researchers have begun to consider the assessment and identification of personality disorders in adolescents (Miller et al 2008; Sharp and Fonagy 2015). DBT is an effective treatment for BPD in adults with robust evidence from randomised controlled trials demonstrating significant impacts on a number of important outcomes, including reduced suicidal and self-harming behaviours and service utilisation (Clarkin et al 2007; Koons et al 2001; Linehan et al 1991, 1999, 2002, 2006; McMain et al 2009; Verheul et al 2003). Results demonstrated moderate to large statistically significant effects for DBT over treatment as usual in reductions in suicidal and self-harm behaviours (SMD −0.54, 95 % CI −0.92 to −0.16); improvements in mental health (SMD 0.65, 95 % CI 0.07–1.24) and decreases in anger (SMD −0.83, 95 % CI −1.43 to −0.22). An earlier review reported that DBT had the potential for costeffectiveness (Brazier et al 2006)

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