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

Abstract

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. 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. 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. 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. 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.