Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions
Abstract
Background: In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self‐harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST. Methods: Adolescents ( N = 173) were included in the intent‐to‐treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self‐injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self‐Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes. Results: Adolescents with higher family conflict, more extensive self‐harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post‐treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post‐treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals. Conclusions: These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self‐harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT.
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Preliminary research provides tentative support for mechanisms of change in DBT-A.
“Preliminary research provides tentative support for these mechanisms of change.”
From Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis (2021) · cites this paper as Adrian et al., 2019
The Discussion (page unavailable) says that adolescents and parents with higher baseline emotion dysregulation responded better to DBT than to supportive therapy, a finding the authors describe as aligning with DBT theory. This offers tentative, indirect support for a proposed mechanism, but the study tested baseline moderators of treatment response, not whether changes in those mechanisms caused improvement. (LLM, conf=0.82)
Experimental — accuracy not yet measuredDBT was associated with a better rate of improvement from baseline to post-treatment for adolescents who identified as Latinx, compared with their white counterparts.
“For example, DBT was associated with a better rate of improvement from baseline to post-treatment for adolescents who identified as Latinx, compared with their white counterparts.143”
From Suicide in young people: screening, risk assessment, and intervention (2023) · cites this paper as [143]
The Results (Moderators) report a greater reduction in suicide attempts among Latino adolescents receiving DBT than among non-Latino adolescents receiving DBT (86.9% versus 67.5%). But the paper groups the comparison adolescents as non-Latino, not white, and its significant moderation finding compares DBT with IGST across ethnicity groups. It does not establish the stated comparison specifically with white counterparts. (LLM, conf=0.85)
Experimental — accuracy not yet measuredSecondary analysis of McCauley et al. (2018) revealed that adolescents who reported higher emotion dysregulation at baseline, and whose parents reported greater psychopathology and emotion dysregulation, demonstrated greater reduction in self-harm following 6-months of DBT-A treatment.
“Secondary analysis of McCauley et al. (2018) revealed that adolescents who reported higher emotion dysregulation at baseline, and whose parents reported greater psychopathology and emotion dysregulation demonstrated greater reduction in self-harm following 6-months of DBT-A treatment (Adrian et al., 2019).”
From Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis (2021) · cites this paper as Adrian et al., 2019
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Cites
Littell, R. C. (1996) · Medical Entomology and Zoology · Cited by 10,345 · see citing works
KAUFMAN, J., BIRMAHER, B., BRENT, D., RAO, U., FLYNN, C., MORECI, P., WILLIAMSON, D., & RYAN, N. (1997) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199707000-00021 · Cited by 10,148 · see citing works
Gratz, K. L., & Roemer, L. (2004) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/b:joba.0000007455.08539.94 · Cited by 8,942 · cited 1× · see citing works
“The Difficulties with Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) is a 36-item multidimensional self-report measure assessing individuals’ characteristic patterns of emotion dysregulation (e.g., “When I’m upset, I lose control over my behaviors.”).”
BackgroundThe brief symptom inventory: an introductory report.
Derogatis, L. R., & Melisaratos, N. (1983) · Psychological Medicine · doi:10.1017/s0033291700048017 · Cited by 6,650 · see citing works
No adjustments are needed for multiple comparisons.
Rothman, K. J. (1990) · Epidemiology · doi:10.1097/00001648-199001000-00010 · Cited by 5,965 · see citing works
Small sample inference for fixed effects from restricted maximum likelihood
Kenward, M. G., & Roger, J. H. (1997) · Biometrics · doi:10.2307/2533558 · Cited by 4,552 · see citing works
Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017) · Psychological Bulletin · doi:10.1037/bul0000084 · Cited by 3,784 · see citing works
(1997) · American Psychiatric Press eBooks · Cited by 3,056 · see citing works
Fleiss, J. L., & Agresti, A. (1991) · Journal of the American Statistical Association · doi:10.2307/2290537 · Cited by 2,677 · see citing works
Adolescent suicide and suicidal behavior
Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2006.01615.x · Cited by 1,361 · see citing works
Youth Suicide Risk and Preventive Interventions: A Review of the Past 10 Years
Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000046821.95464.cf · Cited by 1,264 · see citing works
The University of California at Los Angeles post-traumatic stress disorder reaction index
Steinberg, A. M., Brymer, M. J., Decker, K. B., & Pynoos, R. S. (2004) · Current Psychiatry Reports · doi:10.1007/s11920-004-0048-2 · Cited by 1,212 · see citing works
Bridge, J. A., Iyengar, S., Salary, C. B., Barbe, R. P., Birmaher, B., Pincus, H. A., Ren, L., & Brent, D. A. (2007) · JAMA · doi:10.1001/jama.297.15.1683 · Cited by 1,086 · see citing works
Reducing Suicide--A National Imperative
(2002) · PsycEXTRA Dataset · doi:10.1037/e719942007-001 · Cited by 947 · see citing works
Application of random-effects pattern-mixture models for missing data in longitudinal studies.
Hedeker, D., & Gibbons, R. D. (1997) · Psychological Methods · doi:10.1037/1082-989x.2.1.64 · Cited by 907 · see citing works
Adjust for multiple comparisons? It’s not that simple
Althouse, A. D. (2016) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2015.11.024 · Cited by 825 · see citing works
MULTIVARIATE ASSESSMENT OF CONFLICT IN DISTRESSED AND NONDISTRESSED MOTHER‐ADOLESCENT DYADS
Prinz, R. J., Foster, S. L., Kent, R. N., & O’Leary, K. D. (1979) · Journal of Applied Behavior Analysis · doi:10.1901/jaba.1979.12-691 · Cited by 760 · see citing works
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., et al. (2014) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2014.07.003 · Cited by 616 · cited 1× · see citing works
“Dialectical Behavior Therapy (DBT) is the only treatment for adolescents that has replicated effects in decreasing self-harm behaviors across two randomized controlled trials (McCauley et al., 2018; Mehlum et al., 2014, 2016).”
BackgroundChmura Kraemer, H., Kiernan, M., Essex, M., & Kupfer, D. J. (2008) · Health Psychology · doi:10.1037/0278-6133.27.2(suppl.).s101 · Cited by 600 · see citing works
McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., Avina, C., Hughes, J., Harned, M., Gallop, R., et al. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.1109 · Cited by 531 · see citing works
Self-citationState of the Science on Psychosocial Interventions for Ethnic Minorities
Miranda, J. M., Bernal, G., Lau, A. S., Kohn, L. P., Hwang, W., & LaFromboise, T. D. (2005) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.1.102803.143822 · Cited by 524 · see citing works
Ougrin, D., Tranah, T., Stahl, D., Moran, P., & Asarnow, J. R. (2015) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2014.10.009 · Cited by 508 · see citing works
Self-citationLinehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., & Wagner, A. (2006) · Psychological Assessment · doi:10.1037/1040-3590.18.3.303 · Cited by 486 · see citing works
Self-citationCurry, J. F., Rohde, P., Simons, A. D., Silva, S. G., Vitiello, B., Kratochvil, C. J., Reinecke, M. A., Feeny, N. C., Wells, K., Pathak, S., et al. (2006) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000240838.78984.e2 · Cited by 432 · see citing works
The Interpersonal Theory of Suicide: Guidance for Working with Suicidal Clients
Joiner, T. E., Orden, K. V. V., Witte, T., & Rudd, M. (2009) · American Psychological Association eBooks · doi:10.1037/11869-000 · Cited by 417 · see citing works
Evidence-Based Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth
Glenn, C. R., Franklin, J. C., & Nock, M. K. (2015) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2014.945211 · Cited by 288 · see citing works
Brent, D. A., Greenhill, L. L., Compton, S., Emslie, G., Wells, K., Walkup, J. T., Vitiello, B., Bukstein, O., Stanley, B., Posner, K., et al. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3181b5dbe4 · Cited by 262 · see citing works
Mehlum, L. I., Ramberg, M., Tørmoen, A. J., Haga, E., Diep, L. M., Stanley, B., Miller, A. L., Sund, A. M., & Grøholt, B. (2016) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2016.01.005 · Cited by 253 · see citing works
Youth-Nominated Support Team for suicidal adolescents (Version 1): A randomized controlled trial.
King, C. A., Kramer, A., Preuss, L. J., Kerr, D., Weisse, L., & Venkataraman, S. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.1.199 · Cited by 171 · see citing works
King, C. A., Klaus, N. M., Kramer, A., Venkataraman, S., QUINLAN, P. E., & Gillespie, B. W. (2009) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0016552 · Cited by 157 · see citing works
Piña, A., Silverman, W. K., Fuentes, R., Kurtines, W. M., & Weems, C. F. (2003) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200310000-00008 · Cited by 116 · see citing works
Tarter, R. E., & Hegedus, A. M. (1991) · Alcohol health and research world · Cited by 83 · see citing works
Piña, A., Zerr, A. A., Villalta, I. K., & Gonzales, N. A. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0029460 · Cited by 69 · see citing works
The Interpersonal Theory of Suicide: Guidance for Working With Suicidal Clients
Chessick, C. A. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09050679 · Cited by 56 · see citing works
Conducting Research on Adolescent Suicide Attempters: Dilemmas and Decisions.
Berk, M. S., Adrian, M. C., McCauley, E., Asarnow, J. R., Avina, C., & Linehan, M. M. (2014) · PubMed · Cited by 18 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- SAS Institute Inc. (2015). SAS® 9.4 Language Reference: Concepts, 5th Edition,. Cary, NC: SAS Institute Inc
Cited by
Sorted by citations
Kothgassner, O. D., Goreis, A., Robinson, K., Huscsava, M. M., Schmahl, C., & Plener, P. L. (2021) · Psychological Medicine · doi:10.1017/s0033291721001355 · Cited by 288 · see citing works
“(2018) revealed that adolescents who reported higher emotion dysregulation at baseline, and whose parents reported greater psychopathology and emotion dysregulation demonstrated greater reduction in self-harm following 6-months of DBT-A treatment (Adrian et al., 2019).”
Interventions for self-harm in children and adolescents
Witt, K. G., Hetrick, S. E., Rajaram, G., Hazell, P., Taylor Salisbury, T. L., Townsend, E., & Hawton, K. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013667.pub2 · Cited by 149 · see citing works
Suicide in young people: screening, risk assessment, and intervention
Hughes, J. L., Horowitz, L. M., Ackerman, J. P., Adrian, M. C., Campo, J. V., & Bridge, J. A. (2023) · BMJ · doi:10.1136/bmj-2022-070630 · Cited by 135 · see citing works
Self-citationAsarnow, J. R., & Mehlum, L. (2019) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13130 · Cited by 100 · see citing works
Self-citationReview of family‐based treatments from 2010 to 2019 for suicidal ideation and behavior
Frey, L. M., Hunt, Q. A., Russon, J. M., & Diamond, G. (2022) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12568 · Cited by 32 · see citing works
- Authors
- Adrian, M., McCauley, E., Berk, M. S., Asarnow, J. R., Korslund, K., Avina, C., Gallop, R., & Linehan, M. M.
- Affiliations
- University of Washington (US)
- Stanford University (US)
- University of California, Los Angeles (US)
- West Chester University (US)
- Corresponding author
- Adrian, Molly
- ORCID
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2019-07-30
- Volume
- 60
- Issue
- 10
- Pages
- 1123-1132
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- PMC
- PMC6849475
- OpenAlex
- W2964756638
- Semantic Scholar
- 0fa6ea9bfa75b8c21137da3e6ee81e560a3d3bff
- Cited by
- 68
- References
- 35
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 9 · 2023: 16 · 2022: 11 · 2021: 13 · 2020: 4 · 2019: 3
- FWCI
- 9.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (5R01MH090159, R01MH93898)
- Agency for Healthcare Research and Quality (K12022982)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- self-harm, adolescents, dialectical behavior therapy, suicide attempts, non-suicidal self-injury, emotional dysregulation, family conflict, externalizing problems, parental psychopathology, borderline personality disorder, ethnicity, suicidal adolescents
- MeSH terms
- Problem Behavior, Dialectical Behavior Therapy, Adolescent, Adolescent Behavior, Female, Humans, Male, Psychotherapy, Psychotherapy, Group, Recurrence, Severity of Illness Index, Self-Injurious Behavior, Outcome Assessment, Health Care, Family Conflict
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