CoChat
Sign Up
Cited by 82Personality Disorders and PsychopathologySuicide and Self-Harm StudiesPsychiatric care and mental health services

On the potential for iatrogenic effects of psychiatric crisis services: The example of dialectical behavior therapy for adult women with borderline personality disorder.

Open access
Coyle, Trevor N., Shaver, Jennifer A., Linehan, Marsha M.·2018·Journal of Consulting and Clinical Psychology
DOI 10.1037/ccp0000275
Open this paper in CoChat — free account

Abstract

OBJECTIVE: Although previous research has suggested that people with a history of using psychiatric crisis services are at higher risk for suicide, it is unclear whether this link is attributable to individual risk factors or iatrogenic effects of service utilization. We examined this question by analyzing data from a randomized controlled trial of dialectical behavior therapy (DBT), a treatment for highly suicidal individuals in which patients took advantage of crisis services less than those in the comparison condition. We hypothesized that crisis-service utilization during a treatment year, rather than pretreatment indicators of suicide risk, would be associated with higher suicide risk after treatment, and that DBT's treatment effects would be partially attributable to this association. METHOD: Participants were 101 women (Mage = 29.3, 87% Caucasian) with recent suicidal and self-injurious behaviors meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association [APA], 1994) criteria for borderline personality disorder. We examined relationships between suicidal ideation (using the Suicide Behaviors Questionnaire; Linehan, 1981), number of suicide attempts (using the Suicide Attempt Self-Injury Interview; Linehan, Comtois, Brown, Heard, & Wagner, 2006), and number of psychiatric inpatient admissions and psychiatric emergency-room (ER) visits (using the Treatment History Interview; Linehan & Heard, 1987) from the years prior to, during, and following treatment. RESULTS: Treatment-year psychiatric ER visits were the sole predictor of the number of follow-up year suicide attempts. Treatment condition and pretreatment inpatient admissions predicted treatment-year psychiatric ER visits. Finally, there was evidence that DBT resulted in fewer suicide attempts at follow-up, in part because getting DBT led to fewer psychiatric ER visits. CONCLUSION: In this population and context, data suggest that crisis-service utilization conveys risk for suicide. DBT may reduce suicide risk in part by reducing use of these services. (PsycINFO Database Record

Integrity signals

Registry

Crossref · 10.1037/ccp0000275

Cites

40 of 40 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

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?

Cites

Flagged first, then by citations

2 of the 42 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Coyle, T. N., Shaver, J. A., & Linehan, M. M.
Affiliations
University of Washington (US)
ORCID
Linehan, Marsha M.
Venue
Journal of Consulting and Clinical Psychology
Publisher
American Psychological Association (APA)
Published
2018-02
Volume
86
Issue
2
Pages
116-124
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
DOI
10.1037/ccp0000275
OpenAlex
W2784951053
Cited by
82
References
42
Citations by year
2026: 4 · 2025: 5 · 2024: 5 · 2023: 10 · 2022: 10 · 2021: 16 · 2020: 14 · 2019: 11 · 2018: 6
FWCI
13.83
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (MH34486 and MH01593)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
iatrogenic disease, dialectical behavior therapy, borderline personality disorder, suicide risk, suicide attempts, psychiatric hospital admissions, women, self-harm, suicidal ideation, treatment discontinuation
MeSH terms
Dialectical Behavior Therapy, Adult, Borderline Personality Disorder, Emergency Services, Psychiatric, Female, Hospitalization, Humans, Iatrogenic Disease, Suicide, Attempted, Suicidal Ideation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review