Early remission of deliberate self-harm predicts emotion regulation capacity in adulthood: 12.4 years follow-up of a randomized controlled trial of adolescents with repeated self-harm and borderline features.

IF 6 2区 医学 Q1 PEDIATRICS
Iselin Solerød Dibaj, Anita Johanna Tørmoen, Ole Klungsøyr, Katharina Teresa Enehaug Morken, Egil Haga, Kine Johansen Dymbe, Lars Mehlum
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引用次数: 0

Abstract

Emotion regulation capacity, critical for adult functioning and mental health, develops strongly during adolescence in healthy individuals. Deficits in emotion regulation is often referred to as emotion dysregulation [ED] and is associated with various mental health problems, including repeated deliberate self-harm [DSH] which peaks in adolescence. Dialectical Behaviour Therapy for adolescents [DBT-A] systematically targets ED through strategies such as changing coping behaviours and has previously been shown to effectively induce DSH remission in adolescents. However, whether such remission is associated with improved emotion regulation capacity in adulthood, and whether this effect is mediated by changes in use of coping strategies has not been previously studied. Prospective long-term follow-up study of an RCT comparing DBT-A with enhanced usual care [EUC] for adolescents presenting to community child and adolescent psychiatric outpatient clinics with borderline personality features and repeated self-harm. Assessments included both structured interviews and self-report at baseline and 1.6, 3.1 and 12.4 years follow-up. In the final follow-up, adult ED was measured and data were collected for 61 (80%) of the original 77 participants. DSH remission was assessed at 1.6 years follow-up, and use of coping strategies at 3.1 and 12.4 years follow-ups. A mediation analysis was conducted within a causal inference framework. Both treatment groups increased their use of functional coping skills from adolescence to adulthood, while only DBT-A was associated with decreases in dysfunctional coping. There was a direct effect of DSH remission 1 year after treatment on adult ED, particularly for participants who did not receive DBT-A. There was a negative association between reductions in dysfunctional coping and adult ED, however this did not mediate the effect of DSH remission. This is the first study to report that early DSH remission in adolescence predicted lower ED in adulthood. These results highlight the importance of early DSH remission and provides new insight into the long-term relationship between DSH and ED. Clinical trial registration information: "Treatment for Adolescents with Deliberate Self-harm"; http://ClinicalTrials.gov/;NCT00675129.

故意自残行为的早期缓解预示着成年后的情绪调节能力:对具有反复自残和边缘化特征的青少年进行的随机对照试验的 12.4 年随访。
情绪调节能力对成年人的功能发挥和心理健康至关重要,而健康人的情绪调节能力在青春期发育得很强。情绪调节能力的缺陷通常被称为情绪失调(ED),与各种心理健康问题有关,包括在青春期达到高峰的反复故意自残(DSH)。针对青少年的 "辩证行为疗法"(DBT-A)通过改变应对行为等策略,系统性地解决情绪失调问题。然而,这种缓解是否与成年后情绪调节能力的提高有关,以及这种效果是否由应对策略的使用变化所介导,以前还没有研究过。一项RCT前瞻性长期随访研究比较了DBT-A与增强型常规护理[EUC],研究对象为前往社区儿童与青少年精神科门诊就诊的具有边缘型人格特征且反复自残的青少年。评估包括基线时的结构化访谈和自我报告,以及 1.6 年、3.1 年和 12.4 年的随访。在最后一次随访中,对成人 ED 进行了测量,并收集了最初 77 名参与者中 61 人(80%)的数据。在 1.6 年的随访中评估了 DSH 缓解情况,在 3.1 年和 12.4 年的随访中评估了应对策略的使用情况。在因果推论框架内进行了中介分析。从青春期到成年期,两个治疗组都增加了功能性应对技能的使用,而只有 DBT-A 与功能失调应对的减少有关。治疗一年后,DSH缓解对成人ED有直接影响,尤其是对未接受DBT-A治疗的参与者。功能失调应对的减少与成人 ED 之间存在负相关,但这并不影响 DSH 缓解的效果。这是第一项报告青春期早期 DSH 缓解预示着成年后 ED 会降低的研究。这些结果凸显了早期DSH缓解的重要性,并为DSH和ED之间的长期关系提供了新的视角。临床试验注册信息:"青少年故意自残治疗"; http://ClinicalTrials.gov/;NCT00675129.
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来源期刊
CiteScore
12.80
自引率
4.70%
发文量
186
审稿时长
6-12 weeks
期刊介绍: European Child and Adolescent Psychiatry is Europe''s only peer-reviewed journal entirely devoted to child and adolescent psychiatry. It aims to further a broad understanding of psychopathology in children and adolescents. Empirical research is its foundation, and clinical relevance is its hallmark. European Child and Adolescent Psychiatry welcomes in particular papers covering neuropsychiatry, cognitive neuroscience, genetics, neuroimaging, pharmacology, and related fields of interest. Contributions are encouraged from all around the world.
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