Dialectical Behavior Therapy Versus Serotonin Reuptake Inhibitor Treatment for Suicidal Behavior in Borderline Personality Disorder: A Randomized Controlled Trial.

Abstract

The authors compared the efficacy of 6 months of dialectical behavior therapy (DBT) to 6 months of selective serotonin reuptake inhibitors with clinical management (SSRI/M) in reducing suicide-related events (SREs), suicide attempts, nonsuicidal self-injury (NSSI), and related clinical outcomes in individuals diagnosed with borderline personality disorder. The study sample comprised 84 individuals with borderline personality disorder; more than one suicide attempt, SRE, or NSSI episode in the past 6 months; and another of these behaviors in the past year. Two-thirds had comorbid major depressive disorder. Participants were randomly assigned to receive DBT or SSRI/M. Poisson models were used to analyze numbers of suicide attempts and SREs, and a zero-inflated Poisson model was used for NSSI behaviors. Survival analysis was performed with the log-rank test for time to first suicide attempt or SRE. Follow-up assessments at 12 months were analyzed in a separate model. Mixed-effects regression was used to compare quantitative outcomes. Significantly fewer SREs occurred in the DBT arm compared with the SSRI/M arm during the 6-month treatment phase. Significantly fewer suicide attempts occurred in the DBT arm compared with the SSRI/M arm. Survival analysis indicated significantly lower risk for having any SRE in the DBT arm compared with the SSRI/M arm, but no difference in risk of suicide attempt. DBT participants had significantly lower NSSI counts than SSRI/M participants. Severity of depression and suicidal ideation decreased comparably in both treatment groups. After 6 months of treatment, the rate of major depressive disorder was significantly lower in the SSRI/M arm compared with the DBT arm. At 12-month follow-up (6 months after completion of the treatment phase), outcomes were comparable between the two groups. Six months of DBT showed greater efficacy than 6 months of SSRI/M in reducing SRE and NSSI behaviors in patients with borderline personality disorder.