Relationships between Dialectical Behavior Therapy, psychiatric emergency room visits, and suicide attempts: A secondary analysis

Abstract

Previous research has demonstrated a strong relationship between inpatient psychiatric hospitalization and subsequent death by suicide, and recent research suggests that this correlation may extend to include psychiatric emergency room (ER) visits as well. Additionally, although Dialectical Behavior Therapy (DBT) minimally employs the use of these forms of crisis management, this intervention characteristic and its impact on DBT’s effectiveness have gone unstudied. Thus we performed secondary analyses in the context of a large DBT RCT (n = 101) to explore the relationships between DBT, psychiatric ER visits utilized during the treatment year, and suicide attempts that occurred during the year of follow-up assessment. Using the SASII to assess suicide attempts, the SBQ to measure suicide ideation, and the THI to assess ER visits, negative binomial GLM analyses demonstrated that (1) pre-treatment psychiatric ER visits predicted treatment-year ER visits (2) only treatment-year ER visits predicted suicide attempts during follow-up and (3) treatment condition dropped to non-significance in predicting follow-up suicides when treatment-year ER visits were included in the model. This study provides evidence that, in this population and treatment context, pre-existing clinical severity is unlikely to explain the relationship between psychiatric ER utilization and subsequent suicide. Implications of the findings are discussed.