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Up to 50% of youth with bipolar spectrum disorder attempt suicide, and of all psychiatric diagnoses, bipolar spectrum disorder imparts the greatest risk of death by suicide in adolescents. Although multiple psychosocial interventions are effective for mood stabilization and for decreasing the risk of mood episode recurrence, no treatment specifically targets suicidal behavior in youth with bipolar spectrum disorder.

Investigators from the University of Pittsburgh including Tina Goldstein, PhD (Pittsburgh Foundation Endowed Professor in Psychiatry Research and Associate Professor of Psychiatry and Psychology); Danella Hafeman, MD, PhD (Associate Professor of Psychiatry); Rasim Diler, MD (Professor of Psychiatry); Dara Sakolsky, MD, PhD (Associate Professor of Psychiatry); Peter Franzen, PhD (Associate Professor of Psychiatry and Clinical and Translational Science); and Boris Birmaher, MD (Distinguished Professor of Psychiatry and Endowed Chair in Early Onset Bipolar Disease), studied the effectiveness of dialectical behavior therapy—an evidence-based psychosocial treatment that can decrease suicidal behavior in adults with borderline personality disorder—compared with standard of care psychotherapy for adolescents with bipolar spectrum disorder.

The team recruited adolescents (ages 12-18 years old) with bipolar disorder, then randomly assigned them to either 36 sessions of dialectical behavior therapy (18 individual dialectical behavior therapy sessions and 18 family skills training sessions conducted with the family unit), or standard of care psychotherapy, for one year. All participants also received medication management with a study-affiliated psychiatrist. Participants and parents completed assessments quarterly with an independent evaluator.

In a paper published in JAMA Psychiatry, the investigators reported that study participants who received dialectical behavior therapy were less likely to attempt suicide over the follow-up year, and also had fewer suicide attempts over the year. Decreased risk of suicide attempt in dialectical behavior therapy was mediated by improvement in emotion dysregulation, particularly for those with high baseline emotion dysregulation.

“These findings offer so much hope for youth with bipolar spectrum disorder and their families, as well as treating clinicians. For the first time, we can offer a treatment with demonstrated efficacy in decreasing suicide risk for these vulnerable youth,” said Dr. Goldstein, the study’s corresponding author.

Dialectical Behavior Therapy for Adolescents with Bipolar Disorder
Goldstein TR, Merranko J, Rode N, Sylvester R, Hotkowski N, Fersch-Podrat R, Hafeman DM, Diler R, Sakolsky D, Franzen P, Birmaher B.
JAMA Psychiatry. 2024;81(1):15-24. doi:10.1001/jamapsychiatry.2023.3399