DBT outclasses SSRI/M in reducing suicide among borderline personality disorder patients

Six months of dialectical behaviour therapy (DBT) is more efficacious than 6 months of selective serotonin reuptake inhibitors with clinical management (SSRI/M) in the reduction of suicide-related events (SREs) and nonsuicidal self-injury (NSSI) behaviours in patients with borderline personality disorder, reports a study.

Eighty-four individuals with borderline personality disorder; more than one suicide attempt, SRE, or NSSI episode in the past 6 months; and another of these behaviours in the past year were included in this study. Of these, two-thirds had comorbid major depressive disorder.

The investigators randomized participants to either the DBT or SSRI/M group. They used Poisson models to assess the number of suicide attempts and SREs, as well as a zero-inflated Poisson model to analyse NSSI behaviours.

Sensitivity analysis was carried out with the log-rank test for time to first suicide attempt or SRE. A separate model was used to analyse follow-up assessments at 12 months. Finally, quantitative outcomes were compared using mixed-effects regression.

SREs were significantly fewer with DBT than with SSRI/M during the 6-month treatment phase. Suicide attempts were likewise less frequent in the DBT arm compared with the SSRI/M arm. In survival analysis, DBT was associated with a significantly lower risk for having any SRE, but there was no difference in the risk of suicide attempt. NSSI counts were also significantly lower among DBT than SSRI/M participants.

On the other hand, the two treatments arms showed a similar decrease in the severity of depression and suicidal ideation. After 6 months of treatment, the SSRI/M arm had a significantly lower rate of major depressive disorder than the DBT arm.

Finally, outcomes did not significantly differ between groups at 12-month follow-up.