What happens if we add a DBT-informed program for teens and young adults at high-risk?
STUDY: Asarnow JR et al, J Am Acad Child Adolesc Psychiatry 2026
STUDY TYPE: Randomized controlled trial
FUNDING: National Institute of Mental Health
Background
This large trial added dialectical behavior therapy (DBT)-informed care, stratified by risk, to standard suicide-prevention care in teens and young adults.
The Study
- 301 youth ages 12 to 24 (80% white) with past suicidal behavior, ideation, or depression plus self-harm; 284 completed a follow-up over the year.
- Compared stratified stepped-care (DBT), triaged by risk level, with standard care (Zero Suicide quality improvement) alone (both groups received standard care).
Results
Suicide attempts, the primary outcome, were lower but not statistically different with the DBT-add on at 12 months (DBT 8.09% vs standard care 9.59%), possibly because the study was too small to detect the difference.
Total self-harm (attempts plus non-suicidal self-injury) was significantly lower: 54% less total self-harm with DBT than standard care (relative risk 0.46, p = .006), a number needed to treat of about 10.
Depression improved more with DBT (effect size = 0.41), and treatment satisfaction rose faster early on. No deaths occurred in either group.
Limitations
The trial was underpowered: usual-care attempt rates were lower than expected.
Practice Implications
- DBT-informed stepped care showed promising, but not definitive, benefits here.
- The intervention manual is available from the first author, listed here along with a podcast by the study authors.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
