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Cited by 616Personality Disorders and PsychopathologySuicide and Self-Harm StudiesBipolar Disorder and Treatment

Dialectical Behavior Therapy for Adolescents With Repeated Suicidal and Self-harming Behavior: A Randomized Trial

Open access
Mehlum, Lars, Tørmoen, Anita J., Ramberg, Maria, Haga, Egil, Diep, Lien M., Laberg, Stine, Larsson, Bo S., Stanley, Barbara H. +3 more·2014·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2014.07.003
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Abstract

Objective We examined whether a shortened form of dialectical behavior therapy, dialectical behavior therapy for adolescents (DBT-A) is more effective than enhanced usual care (EUC) to reduce self-harm in adolescents. Method This was a randomized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics who were randomly allocated to either DBT-A or EUC. Assessments of self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at baseline and after 9, 15, and 19 weeks (end of trial period), and frequency of hospitalizations and emergency department visits over the trial period were recorded. Results Treatment retention was generally good in both treatment conditions, and the use of emergency services was low. DBT-A was superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC. Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time. Conclusion DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior.…

Integrity signals

Registry

Crossref · 10.1016/j.jaac.2014.07.003

Cites

90 of 90 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

9 of 25 cited sources checked · 5 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Only 10% to 20% of adolescents who have self-harmed report receiving any kind of subsequent treatment.

    “Only 10% to 20% of adolescents who have self-harmed report receiving any kind of subsequent treatment.4”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] Ystgaard, 2009, Deliberate self-harm in adolescents: comparison between those who receive help following self-harm and those who do not, J Adolesc source

      The ‘Contact with health services and other sources of help’ passage (page unavailable) reports that 18.8% of adolescents who self-harmed received help from health services, within the claimed range. The study measured help received, not whether adolescents received treatment, so the treatment wording is not established. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Self-harm is a powerful predictor of completed suicide.

    “Self-harm is a powerful predictor of completed suicide.5”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [5] Owens, 2002, Fatal and non-fatal repetition of self-harm. Systematic review, Br J Psychiatry source
  • Premisereasoning

    The paucity of randomized controlled trials offers scarce evidence for effective treatments for self-harming adolescents.

    “The paucity of randomized controlled trials (RCTs) offers scarce evidence for effective treatments for self-harming adolescents.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [10] Wood, 2001, Randomized trial of group therapy for repeated deliberate self-harm in adolescents, J Am Acad Child Adolesc Psychiatry source
    • cites [13] Rossouw, 2012, Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial, J Am Acad Child Adolesc Psychiatry source
  • Premisecitation

    Wood et al.'s results were not replicated in 2 subsequent studies from the same group.

    “Wood et al. 10 developed a manual-based cognitive-behavioral therapy-oriented group therapy for adolescents that was shown to be more effective than treatment as usual (TAU) in reducing self-harm behaviors; however, these results were not replicated in 2 subsequent studies from the same group.11,12”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [11] Hazell, 2009, Group therapy for repeated deliberate self-harm in adolescents: failure of replication of a randomized trial, J Am Acad Child Adolesc Psychiatry source
    • cites [12] Green, 2011, Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation, BMJ source
  • Premisecitation

    In a recent RCT reported by Rossouw and Fonagy, mentalization-based treatment for adolescents was superior to TAU in reducing self-harm and depression.

    “In a recent RCT reported by Rossouw and Fonagy, 13 mentalization-based treatment for adolescents was superior to TAU in reducing selfharm and depression.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [13] Rossouw, 2012, Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial, J Am Acad Child Adolesc Psychiatry source
  • Classified as probably not a substantial claim. 30
  • May combine two claims. 27

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous DBT studies in adults have suggested that teaching specific behavioral skills may be an important factor in the reduction of self-harm and depression.

    “Previous DBT studies in adults have suggested that teaching specific behavioral skills may be an important factor in the reduction of self-harm and depression.43”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [43] Neacsiu, 2010, Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder, Behav Res Ther source

  • May combine two claims.

    Premisecitation

    Several uncontrolled studies have suggested that DBT-A could be effective at reducing self-harm while improving treatment compliance and satisfaction.

    “Several uncontrolled studies have suggested that DBT-A could be effective at reducing self-harm while improving treatment compliance and satisfaction.[22][23][24][25][26][27]”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [22] Woodberry, 2008, Implementing dialectical behavior therapy with adolescents and their families in a community outpatient clinic, Cogn Behav Pract source
    • cites [23] James, 2008, A preliminary community study of dialectical behavior therapy (DBT) with adolescent females demonstrating persistent, deliberate self-harm (DSH), Child Adolesc Ment Health source
    • cites [24] Fleischhaker, 2011, Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up, Child Adolesc Psychiatry Ment Health source

      The Results report significantly less non-suicidal self-injury after DBT-A, and the Results and Discussion report that 75% completed treatment, consistent with the claim about self-harm and treatment compliance. The paper is an uncontrolled study, but the full-text passages do not report improved treatment satisfaction; completion and acceptance do not establish that specific outcome. The indexed copy provides section labels but no page numbers. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The use of emergency services was low.

    “Treatment retention was generally good in both treatment conditions, and the use of emergency services was low.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No mediation effects were found on the other outcomes or for total treatment time.

    “Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time.”
    • Also stated in: § Associations Between Outcomes and Intensity of Treatment · plain
      “whereas no mediation effects were found on the other outcomes or for total treatment time.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    For several outcome measures, differences between the treatment conditions increased toward the last third of the trial period; DBT-A patients continued their improvement, whereas EUC patients did not.

    “Interestingly, for several outcome measures, differences between the treatment conditions increased toward the last third of the trial period; DBT-A patients continued their improvement, whereas EUC patients did not.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    EUC patients reported a mean of 4.7 (SD 5.5) self-harm episodes in the first 9 weeks and 3.3 (SD 6.8) in the subsequent 6 weeks.

    “EUC patients reported a mean of 4.7 (SD ¼ 5.5) episodes in the first 9 weeks and 3.3 (SD ¼ 6.8) in the subsequent 6 weeks”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The average number of weeks receiving any treatment was 14.9 for DBT-A patients and 12.9 for EUC patients.

    “The average number of weeks (holiday absence omitted) receiving any treatment was 14.9 (SD ¼ 5.6) for DBT-A patients and 12.9 (SD ¼ 5.1) for EUC patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The DBT-A group reported reductions in hopelessness and borderline symptoms.

    “The DBT-A group reported reductions in hopelessness and borderline symptoms (Table 2)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    DBT-A patients reported a mean of 4.1 (SD 5.8) self-harm episodes in the first 9 weeks and 1.2 (SD 2.0) in the subsequent 6 weeks.

    “DBT-A patients reported a mean of 4.1 (SD ¼ 5.8) and 1.2 (SD ¼ 2.0) episodes in the corresponding time intervals.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Intraclass correlation was 0.42 for C-GAS, 0.76 for MADRS score, 0.99 for LPC, and 0.66 for SCID-II diagnostic criteria for BPD.

    “Intraclass correlation (ICC) was used to test IRR for C-GAS (ICC ¼ 0.42), MADRS score (ICC ¼ 0.76), LPC (IRR ¼ 0.99), and SCID-II diagnostic criteria for BPD (ICC ¼ 0.66).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Although some patients dropped out of treatment, all patients were followed from baseline to trial completion with no dropouts from the research.

    “Although some patients dropped out of treatment, all patients were followed from baseline to trial completion with no dropouts from the research.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    DBT-A patients continued to drop in suicidal ideation throughout the whole trial period, while EUC patients leveled off toward the end of the trial.

    “continuing to drop in DBT-A patients throughout the whole trial period, while leveling off toward the end of the trial in EUC patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    DBT adherence was within the adherent range, with mean individual therapy session score 4.11 and mean multifamily skills-training session score 4.18.

    “The mean score for individual therapy sessions was 4.11 (SD ¼ 0.14; range ¼ 3.43-4.37)and for multifamily skills-training sessions, 4.18 (SD ¼ 0.10; range ¼ 3.93-4.36),both within the adherent range.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There was a nonsignificant trend for DBT-A patients to have fewer emergency department visits.

    “although there was a nonsignificant trend for DBT-A patients to have fewer visits.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cutting is the most commonly reported method of self-harm among adolescents.

    “According to population studies, between 5% and 10% of adolescents report past-year self-harm, with cutting as the most commonly reported method.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Between 5% and 10% of adolescents report past-year self-harm.

    “According to population studies, between 5% and 10% of adolescents report past-year self-harm, with cutting as the most commonly reported method.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    To ensure the integrity of blinding, a nonblinded project coordinator made all of the practical arrangements for follow-up interviews and collected treatment history data.

    “To ensure the integrity of blinding, a nonblinded project coordinator made all of the practical arrangements for follow-up interviews and collected treatment history data.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Assessments were performed by independent interviewers blind to treatment allocation.

    “Assessments were performed by independent interviewers blind to treatment allocation at baseline (interview and self-report) before randomization and then at 9 (self-report), 15 (self-report), and 19 weeks (interview and self-report) after the first treatment session.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Adherence to DBT continued to be assessed throughout the trial.

    “Adherence to DBT continued to be assessed throughout the trial.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The study's sample size was justified by a power analysis that anticipated a 50% repetition rate for EUC and 25% for DBT-A, requiring 150 patients, and a revised mid-study power analysis reduced the necessary number to 80.

    “With an a error level of 0.05, a sample of 150 patients (75 in each group) would be required to provide 80% power with a 2-tailed test.”
    • Also stated in: § Statistical Analysis · plain
      “This analysis, using a more stringent nominal significance level (0.029) according to the recommendations by Pocock, 40 conducted after completion of the first 40 patients where no research dropouts had been observed, and with a self-harm repetition of 30% for DBT patients and 83% for EUC patients, revealed that the necessary number of patients to be included could be reduced to 80 (40 in each”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Pocock, 1983

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All study therapists received suicide risk assessment and management training before patient treatment commenced.

    “All study therapists received suicide risk assessment and management training before patient treatment commenced.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Participants were randomly allocated in a 1:1 ratio stratified according to gender, presence of major depression, and presence of suicide intent during the most serious episode of self-harm behavior within the 16 weeks before enrollment.

    “Participants were randomly allocated (Figure 1) to receive either treatment at 1 of the participating child and adolescent psychiatric outpatient clinics in a 1:1 ratio stratified according to gender, presence of major depression, and presence of suicide intent during the most serious episode of self-harm behavior within the 16 weeks before enrollment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Interrater reliability of diagnoses and outcome variables was checked by a child and adolescent psychiatrist expert in the relevant assessment instruments.

    “All interviews were audio-taped, and interrater reliability (IRR) of diagnoses and outcome variables was checked by a child and adolescent psychiatrist (A.M.S.) who was expert in the relevant assessment instruments.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    DBT was found, in several RCTs at independent sites, to be superior to comparison treatments in improving outpatient treatment completion, global and social adjustment, and personality functioning in adults with BPD.

    “it was found, in several RCTs at independent sites, to be superior to comparison treatments in reducing suicidal and nonsuicidal self-harm, emergency department visits, and hospitalizations, improving outpatient treatment completion, global and social adjustment, and personality functioning.[15][16][17][18][19][20]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [15] Carter, 2010, Hunter DBT project: randomized controlled trial of dialectical behaviour therapy in women with borderline personality disorder, Aust NZ J Psychiatry source
    • cites [16] Clarkin, 2007, Evaluating three treatments for borderline personality disorder: a multiwave study, Am J Psychiatry source
    • cites [17] Koons, 2001, Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder, Behav Ther source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    This was a single-blind randomized trial comparing DBT-A with enhanced usual care (EUC).

    “This was a single-blind randomized trial comparing DBT-A with enhanced usual care (EUC).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    EUC was not manualized or checked for fidelity.

    “EUC was not manualized or checked for fidelity, and was either psychodynamically oriented therapy or cognitivebehavioral therapy combined with psychopharmacological treatment as needed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Wood et al.'s manual-based cognitive-behavioral therapy-oriented group therapy was shown to be more effective than treatment as usual (TAU) in reducing self-harm behaviors.

    “Wood et al. 10 developed a manual-based cognitive-behavioral therapy-oriented group therapy for adolescents that was shown to be more effective than treatment as usual (TAU) in reducing self-harm behaviors; however, these results were not replicated in 2 subsequent studies from the same group.11,12”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Wood, 2001, Randomized trial of group therapy for repeated deliberate self-harm in adolescents, J Am Acad Child Adolesc Psychiatry source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Ten independent assessors, blinded to treatment allocation and to results from baseline interviews, conducted interviews at trial completion.

    “Ten independent assessors, blinded to treatment allocation and to results from baseline interviews, conducted interviews at trial completion.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Personality traits and disorders in youth are highly predictive of adult personality disorders and are associated with increased long-term impairment, morbidity, and mortality.

    “Such traits are highly predictive of adult personality disorders and are associated with increased long-term impairment, morbidity, and mortality.9”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Winograd, 2008, Adolescent borderline symptoms in the community: prognosis for functioning over 20 years, J Child Psychol Psychiatry source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Data analysis was by intention to treat.

    “Data analysis was by intention to treat.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Diagnostic assessments were made by experienced clinicians blinded to treatment allocation.

    “Diagnostic assessments were made by experienced clinicians blinded to treatment allocation.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Treatment allocation was based on a permuted block randomization procedure with an undisclosed and variable blocking factor, and daily management of the randomization procedures was performed by an external group.

    “Treatment allocation of participants after baseline assessments was based on a permuted block randomization procedure with an undisclosed and variable blocking factor, and daily management of the randomization procedures was performed by an external group.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Two child and adolescent psychiatrists and 2 doctoral-level clinicians, blinded to treatment allocation, conducted the baseline interviews.

    “Two child and adolescent psychiatrists and 2 doctorallevel clinicians, blinded to treatment allocation, conducted the baseline interviews.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Treatment retention in this study was generally good, with no differences between the 2 treatment conditions.

    “Treatment retention in this study was generally good, with no differences between the 2 treatment conditions.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All patients were instructed not to disclose any information about their treatment.

    “All patients were instructed not to disclose any information about their treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    DBT was superior to EUC in reducing frequency of self-harm, severity of suicidal ideation, and depressive symptoms, with generally large effect sizes for outcomes in the DBT-A condition, but weak or moderate outcomes in the EUC condition.

    “DBT was superior to EUC in reducing frequency of self-harm, severity of suicidal ideation, and depressive symptoms, with generally large effect sizes for outcomes in the DBT-A condition, but weak or moderate outcomes in the EUC condition.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    DBT therapists were trained through an 80-hour seminar with an additional 12 months of supervised practice on clinical training cases and were rated for adherence to DBT-A treatment principles.

    “Fifteen psychologists and psychiatrists previously unfamiliar with DBT were recruited for the purpose of the trial and were trained through an 80-hour seminar with an additional 12 months of supervised practice on clinical training cases, and were rated for adherence to DBT-A treatment principles.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Early monitoring and explicit targeting of self-harm throughout the 19 weeks of DBT-A may have represented an important treatment component.

    “Early monitoring and explicit targeting of self-harm throughout the 19 weeks of DBT-A may also have represented an important treatment component.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    DBT-A is an effective treatment for self-harming adolescents with traits of borderline personality disorder in terms of reducing self-harm behavior, suicidal ideation, and depressive symptoms.

    “DBT-A is an effective treatment for self-harming adolescents with traits of borderline personality disorder in terms of reducing self-harm behavior, suicidal ideation, and depressive symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    This first randomized trial of DBT-A suggests that it is indeed possible for adolescents to be engaged, retained, and treated successfully and safely.

    “This first randomized trial of DBT-A suggests that it is indeed possible for adolescents to be engaged, retained, and treated successfully and safely.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: This was the first randomized trial of the efficacy of a short version of DBT adapted for the treatment of multi-problem self-harming adolescents with BPD features.

  • May combine two claims.

    Study design and conductnone given

    There was integrity of ratings and blinding.

    “the integrity of ratings and blinding”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The study was adequately powered.

    “The study was adequately powered”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The sample size was small, and findings should be interpreted with caution.

    “however, the sample size was small, and findings should be interpreted with caution.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Only DBT-A patients received skills-training group sessions; this implied a significant difference in the treatment intensity between interventions.

    “Only DBT-A patients received skills-training group sessions; this implied a significant difference in the treatment intensity between interventions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    DBT-A has a substantially shorter duration than most comparable psychotherapeutic interventions targeting self-harming adolescents.

    “DBT-A has a substantially shorter duration than most comparable psychotherapeutic interventions targeting self-harming adolescents.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    There was independence of raters.

    “and the independence of raters.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Both DBT-A individual therapy sessions and the multifamily skills training were rated within the adherent range.

    “Both DBT-A individual therapy sessions and the multifamily skills training were rated within the adherent range”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    As in most trials of self-harm, the patient sample was mostly female.

    “As in most trials of self-harm, the patient sample was mostly female”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Rigorous procedures for data collection were applied.

    “the application of rigorous procedures for data collection”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The control condition, EUC, was not a manualized treatment, and EUC therapists were not monitored for fidelity.

    “The control condition, EUC, was not a manualized treatment, and EUC therapists were not monitored for fidelity.”
    Quote in the paperSubstantial claim
50 of 50

  • The paper relies on this without support.

    The trial sample of adolescents with repetitive self-harming behavior is representative of the broader population of such adolescents.

    “DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior.”

  • The paper relies on this without support.

    Despite the high population prevalence of self-harm in adolescents, little evidence of effective treatments exists.

    “Despite the high population prevalence of selfharm in adolescents, little evidence of effective treatments exists.”

  • The paper relies on this without support.

    Adolescents with borderline traits and repetitive self-harm are a difficult-to-treat patient population because of their reluctance to accept treatment, tendency to drop out early, and patient safety issues.

    “Adolescents with borderline traits and repetitive self-harm have usually been considered a difficult-to-treat patient population because of their reluctance to accept treatment and their tendency to drop out early, and because of patient safety issues.”

  • The paper relies on this without support.

    This was the first randomized trial of the efficacy of a short version of DBT adapted for the treatment of multi-problem self-harming adolescents with BPD features.

    “This was the first randomized trial of the efficacy of a short version of DBT adapted for the treatment of multi-problem self-harming adolescents with BPD features.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • When the Mehlum 2014 authors used a longitudinal analysis of SMFQ scores, it suggested significant positive benefits of DBT-A on depression.

    “However, again when the authors of the Mehlum 2014 trial used a longitudinal analysis based on scores from the SMFQ, it suggested significant positive benefits of DBT-A on depression.”

    From Interventions for self-harm in children and adolescents (2021) · cites this paper as Mehlum 2014

    Table 2 reports a significant decline in SMFQ depression scores within the DBT-A group, but also within the enhanced-usual-care group; the between-group difference in SMFQ trends was not significant (p = .179). The Depressive Symptoms section says the significant between-group difference was for interviewer-rated depression, not the self-reported SMFQ scores. The indexed passages provide no page numbers. (LLM, conf=0.88)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • Adolescents who cut themselves were part of many trials, particularly those in which most or all participants had multiple prior self-harm episodes at entry.

    “However, such patients were included in many of the trials, especially those where a large proportion (or all) of the participants had a history of multiple episodes of SH at trial entry (e.g., Green 2011; Hazell 2009; Mehlum 2014; Rossouw 2012a; Wood 2001a).”

    From Interventions for self-harm in children and adolescents (2021) · cites this paper as Mehlum 2014

    The Participants section (page unavailable) confirms that all 77 adolescents in this trial had at least two prior self-harm episodes, and that eligible self-harm included self-injury. The copy does not establish that any enrolled participant specifically cut themselves; its statement that cutting is common refers to population studies, not this trial. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • For Mehlum 2014, correspondence indicated that among participants followed to the correspondence date, none had died by suicide.

    “Correspondence with study authors for Mehlum 2014 further indicated that although information on outcomes over a 24 month follow-up period are still being collected, of those participants followed until the date of correspondance, none had died by suicide.”

    From Interventions for self-harm in children and adolescents (2021) · cites this paper as Mehlum 2014

    The “Suicidal and Self-harm Behaviors and Suicidal Ideation” section reports no suicides during the trial period. The “Outcome Measures” section describes assessments through 19 weeks; our copy does not report the claimed author correspondence or establish that no participants followed to the correspondence date had died by suicide. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • For dialectical behaviour therapy for adolescents, repetition of self-harm after the intervention did not differ significantly from control (subtotal OR 0.72, 95% CI 0.12 to 4.40; P=0.73).

    “1 DBT-A Cooney 2010 2/13 1/15 34.9 % 2.55 [ 0.20, 31.86 ] Mehlum 2014 3/39 7/38 65.1 % 0.37 [ 0.09, 1.55 ] Subtotal (95% CI) 52 53 100.0 % 0.72 [ 0.12, 4.40 ] Total events: 5 (DBT-A/Mentalisaiton), 8 (Control) Heterogeneity: Tau 2 = 0.77; Chi 2 = 1.70, df = 1 (P = 0.19); I 2 =41% Test for overall effect: Z = 0.35 (P = 0.73)”

    From Interventions for self-harm in children and adolescents (2021) · cites this paper as Mehlum 2014

    The paper’s Other Outcomes section reports three DBT-A patients and seven enhanced-usual-care patients with a hospitalization or emergency-department visit for self-harm during the trial, and says these differences were not statistically significant. It does not report repetition after the intervention or the quoted subtotal OR, confidence interval, and P value, which pool this trial with another study. For its separate measure of self-harm episode frequency during treatment, Figure 2 reports a statistically significant between-group difference. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • DBT-A did not reduce the proportion of adolescents who repeated self-harm relative to TAU or enhanced usual care (n=104; k=2; OR 0.72, 95% CI 0.12 to 4.40; low quality evidence).

    “DBT-A was not associated with a reduction in the proportion of adolescents repeating SH when compared to either TAU or enhanced usual care (n = 104; k = 2; OR 0.72, 95% CI 0.12 to 4.40; GRADE: low quality).”

    From Interventions for self-harm in children and adolescents (2021) · cites this paper as Mehlum 2014

    The Method section confirms a DBT-A versus enhanced usual care comparison. But this single trial enrolled 77 adolescents, not the claimed pooled 104 across two studies; its Suicidal and Self-harm Behaviors results report a significant reduction in the frequency of self-harm episodes, not the proportion of adolescents who repeated self-harm. The stated odds ratio, confidence interval, and GRADE rating are not reported in our copy. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

Cites

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2 of the 92 references couldn’t be matched to a known paper.

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  1. Pearson, 2001

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Authors
Mehlum, L., Tørmoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, S., Larsson, B. S., Stanley, B. H., Miller, A. L., Sund, A. M., & Grøholt, B.
Affiliations
  • University of Oslo (NO)
  • Norwegian University of Science and Technology (NO)
  • Albert Einstein College of Medicine (US)
Corresponding author
Mehlum, Lars
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2014-10
Volume
53
Issue
10
Pages
1082-1091
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2014.07.003
OpenAlex
W1991550933
Cited by
616
References
92
Citations by year
2026: 41 · 2025: 45 · 2024: 56 · 2023: 57 · 2022: 48 · 2021: 100 · 2020: 66 · 2019: 44 · 2018: 44 · 2017: 40 · 2016: 24 · 2015: 39 · 2014: 9 · 2013: 3
FWCI
44.07
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Funders
  • Universitetet i Oslo
  • Medisinske fakultet, Universitetet i Oslo
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
dialectical behavior therapy for adolescents, self-harm, suicidal ideation, adolescents, depression, hopelessness, borderline personality disorder, treatment retention, emergency department visits, hospitalization, outpatient psychiatric care
MeSH terms
Adolescent, Behavior Therapy, Child, Female, Humans, Male, Suicide, Attempted, Single-Blind Method, Self-Injurious Behavior, Treatment Outcome

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