Eficacia de los tratamientos psicológicos para los comportamientos autolesivos suicidas y no suicidas en adolescentes

  1. Miguel Ángel Carrasco 1
  2. Eva M. Carretero 1
  3. Luis Fernando López-Martínez 1
  4. Ana M. Pérez-García 1
  1. 1 Universidad Nacional de Educación a Distancia (UNED), España
Journal:
Revista de Psicología Clínica con Niños y Adolescentes

ISSN: 2340-8340

Year of publication: 2023

Issue Title: Estado de los tratamientos psicológicos infanto-juveniles

Volume: 10

Issue: 1

Type: Article

DIALNET GOOGLE SCHOLAR lock_openDialnet editor

More publications in: Revista de Psicología Clínica con Niños y Adolescentes

Abstract

Efficacy of psychological treatments for suicidal and non-suicidal self-injurious behaviors in adolescents. Self-injurious and suicidal behaviors in adolescents are nowadays a public health problem that requires effective interventions. In order to elucidate the psychological treatments that, to date, work best to reduce or eliminate these behaviors, a review of meta-analysis and systematic reviews was carried out in the PsycArticles, PsycInfo and MEDLINE databases. The established eligibility criteria allowed the final selection of 10 records. The results showed high heterogeneity and poor results for the psychological treatments with small to moderate effect sizes for self-injurious behaviors, suicidal ideation, suicidality and especially for suicidal attempts. These effects tended to weaken or disappear in the medium to long term. Dialectical Behavior Therapy (DBT) proved to be comparatively the best performing of the interventions analyzed. The limited scope of the results and the important methodological limitations alert us to the need for further research and the future design of specific interventions for this type of problems.

Bibliographic References

  • Alfonso-Sánchez, J. L., Martín-Moreno, J. M., Martínez, I. M., & Martínez, A. A. (2019). Epidemiological study and cost analysis of suicide in Spain: Over 100 years of evolution. Archives of Suicide Research, 24:sup2, S356-S369. https://doi.org/10.1080/13811118.2019.1612802
  • Beck, A. T. (1993). Cognitive therapy: Nature and relation to behavior therapy. The Journal of Psychotherapy Practice and Research, 2(4), 342-356.
  • Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to meta-analysis. Wiley.
  • Bryan, C. J., Butner, J. E., May, A. M., Rugo, K. F., Harris, J. A., Oakey, D. N., Rozek, D. C., & Bryan, A. O. (2020). Nonlinear change processes and the emergence of suicidal behavior: A conceptual model based on the fluid vulnerability theory of suicide. New Ideas in Psychology, 57, 100758. https://doi.org/10.1016/j.newideapsych.2019.100758
  • Calear, A. L., Christensen, H., Freeman, A., Fenton, K., Busby Grant, J., van Spijker, B., & Donker, T. (2016). A systematic review of psychosocial suicide prevention interventions for youth. European Child & Adolescent Psychiatry, 25(5), 467–482. https://doi.org /10.1007/s00787-015-0783-4
  • Cha, C. B., & Nock, M. K. (2011). Nonsuicidal Self-Injury. Enciclopedia de la adolescencia, 2011-2017.
  • Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: A systematic review. Frontiers in Psychology, 8, 1946. https://doi.org/10.3389/ fpsyg.2017.01946
  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Erlbaum.
  • Cook, N. E., & Gorraiz, M. (2016). Dialectical behavior therapy for nonsuicidal self‐injury and depression among adolescents: Preliminary meta‐analytic evidence. Child and Adolescent Mental Health, 21(2), 81-89. https://doi.org/10.1111/camh.12112
  • Corcoran, J., Dattalo, P., Crowley, M., Brown, E., & Grindle, L. (2011). A systematic review of psychosocial interventions for suicidal adolescents. Children and Youth Services Review, 33(11), 2112–2118. https://doi. org/10.1016/j.childyouth.2011.06.017
  • Faura-García, J., Calvete, E., & Orue, I. (2021). Autolesión no suicida: conceptualización y evaluación clínica en población hispanoparlante. Papeles del Psicólogo, 42(3), 207-214. https://dx.doi.org/10.23923/pap.psicol.2964
  • Fox, K. R., Huang, X., Guzman, E. M., Funsch, K. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2020). Intervenciones para el suicidio y la autolesión: A meta-analysis of randomized controlled trials across nearly 50 years of research. Psychological Bulletin, 146(12), 1117-1145. https://doi.org/ 10.1037/bul0000305.
  • Fusar-Poli, P., & Radua, J. (2018). Ten simple rules for conducting umbrella reviews. Evidence Based Mental Health, 21(3), 95-100. https://dx.doi. org/10.1136/ebmental-2018-300014
  • Hamza C. A, Stewart S. L., & Willoughby T. (2012). Examining the link between nonsuicidal self-injury and suicidal behavior: A review of the literature and an integrate model. Clinical Psychology Review, 32, 482-95. https://doi.org/10.1016/j.cpr.2012.05.003
  • Harris, R. P., Helfand, M., Woolf, S. H., Lohr, K. N., Mulrow, C. D., Teutsch, S. M., Atkins, D., & Methods Word Group. Third US Preventive Services Task Force (2001). Current methods of the US Preventive Services Task Force: A review of the process. American Journal of Preventive Medicine, 20 (supl. 3), 21-35. https://doi.org/10.1016/s0749-3797(01)00261-6
  • Higgins, J. P. T., & Green, S. (2011). Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration. http://www. cochrane-handbook.org
  • Higgins, J. P. T., Altman, D. G., Gøtzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., & Cochrane Bias Methods Group, Cochrane Statistical Methods Group. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. BMJ, 343. https://doi.org/10.1136/bmj.d5928
  • Hunnicutt Hollenbaugh, K. M., & Lenz, A. S. (2018). Preliminary evidence for the effectiveness of dialectical behavior therapy for adolescents. Journal of Counseling & Development, 96(2), 119–131. https://doi.org/10.1002/jcad.12186
  • Instituto Nacional de Estadística (2022). Defunciones según la causa de muerte. https://www.ine.es/jaxiT3/Datos.htm?t=7947#!tabs-tabla
  • Itzhaky, L., Davaasambuu, S., Ellis, S. P., Cisneros-Trujillo, S., Hannett, K., Scolaro, K., Stanley, B. H., Mann, J. J., Wainberg, M. L., Oquendo, M. A., & Sublette, M. E. (2022). Twenty-six years of psychosocial interventions to reduce suicide risk in adolescents: Systematic review and meta-analysis. Journal of Affective Disorders, 300, 511-531. https://doi.org/10.1016/j. jad.2021.12.094
  • Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J., Gavaghan, D. J., & McQuay, H. J. (1996). Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clinical Trials, 17(1), 1-12. https://doi.org/10.1016/0197-2456(95)00134-4
  • Klonsky, E. D., & May, A. M. (2015). The three-step theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy, 8(2), 114-129. https://psycnet.apa.org/ doi/10.1521/ijct.2015.8.2.114
  • Klonsky, E. D., Qiu, T., & Saffer, B. Y. (2017). Recent advances in differentiating suicide attempters from suicide ideators. Current Opinion in Psychiatry, 30(1), 15-20. https://doi.org/10.1097/yco.0000000000000294
  • Kothgassner, O. D., Goreis, A., Robinson, K., Huscsava, M. M., Schmahl, C., & Plener, P. L. (2021). Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: A systematic review and meta-analysis. Psychological Medicine, 51(7), 1057–1067. https://doi.org/10.1017/ S0033291721001355
  • Kothgassner, O. D., Robinson, K., Goreis, A., Ougrin, D., & Plener, P. L. (2020). ¿Importa el método de tratamiento? A meta-analysis of the past 20 years of research on therapeutic interventions for self-harm and suicidal ideation in adolescents. Borderline Personality Disorder and Emotion Dysregulation, 7, 9. https://doi.org/10.1186/s40479-020-00123-9
  • Labelle, R., Pouliot, L., & Janelle, A. (2015). A systematic review and meta-analysis of cognitive behavioural treatments for suicidal and self-harm behaviours in adolescents. Canadian Psychology/Psychologie Canadienne, 56(4), 368–378. https://doi.org/10.1037/a0039159
  • Leavey, K., & Hawkins, R. (2017). Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face-to-face or via e-health? A systematic review and meta-analysis. Cognitive Behaviour Therapy, 46(5), 353-374. https://doi.org/10.1080/16506073.2017.1332095
  • Lim, K., Wong, C., McIntyre, R., Wang, J., Zhang, Z., Tran, B., Wanqiu, T., Ho, C., & Ho, R. (2019). Global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents between 1989 and 2018: A meta-analysis. International Journal of Environmental Research and Public Health, 16(22), 4581. https:// doi.org/10.3390/ijerph16224581
  • Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press. Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Sage. Lynch, T.R., Trost, W.T., Salsman, N., & Linehan, M.M. (2007). Dialectical behavior therapy for borderline personality disorder. Annual Review of Clinical Psychology, 3, 181–205. https://doi.org/10.1146/annurev. clinpsy.2.022305.095229
  • MacPherson, H. A., Cheavens, J. S., & Fristad, M. A. (2013). Dialectical behavior therapy for adolescents: Theory, treatment adaptations, and empirical outcomes. Clinical Child and Family Psychology Review, 16(1), 59-80. https://doi.org/10.1007/s10567-012-0126-7
  • Mehlum, L., Tørmoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, S., Larsson, B. S., Stanley, B. H., Miller, A. L., Sund, A, M., & Grøholt, B. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: A randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 53(10), 1082-1091. https://doi. org/10.1016/j.jaac.2014.07.003
  • Methley, A. M., Campbell, S., Chew-Graham, C., McNally, R., & Cheraghi-Sohi, S. (2014). PICO, PICOS and SPIDER: A comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Service Research, 14(579). https://doi.org/10.1186/ s12913-014-0579-0
  • Miller, A. L., Rathus, J. H., & Linehan, M. M. (2017). Dialectical behavior therapy with suicidal adolescents. Guilford Press
  • Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6, 339–363. https://doi.org/10.1146/annurev.clinpsy.121208.131258
  • Nock, M. K., Joiner, T. E., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Nonsuicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65–72. https://doi.org/10.1016/j.psychres.2006.05.010
  • *O’Connor, E., Gaynes, B. N., Burda, B. U., Soh, C., & Whitlock, E. P. (2013). Screening for and treatment of suicide risk relevant to primary care: a systematic review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 158(10), 741–754. https://doi.org/10.7326/0003-4819- 158-10-201305210-00642
  • O’Connor, R. C. (2011). Towards an integrated motivational–volitional model of suicidal behaviour. En R. C. O’Connor, S. Platt, & J. Gordon (Eds), International handbook of suicide prevention: Research, policy and practice 1 (pp. 181-198). John Wiley & Sons.
  • Ougrin, D., Tranah, T., & Asarnow, J. R. (2015). Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 54 (2), 97-107. https://doi.org/10.1016/j.jaac.2014.10.009
  • Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Medicine 18(3): e1003583. https://doi.org/10.1371/journal.pmed.1003583
  • Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis. Clinical Psychology Review, 31(6), 1032–1040. https://doi.org/10.1016/j.cpr.2011.05.002
  • Rathus, J. H., & Miller, A. L. (2015). DBT skills manual for adolescents. Guilford Publications.
  • Rudd, M. D. (2006). Fluid vulnerability theory: A cognitive approach to understanding the process of acute and chronic risk. En T. E. Ellis (Ed.), Cognition and suicide: Theory, research, and therapy (pp. 355–368). American Psychological Association.
  • Rudd, M. D. (2021). Recognizing flawed assumptions in suicide risk assessment research and clinical practice. Psychological Medicine 1–2. https:// doi.org/10.1017/S0033291721002750
  • Sánchez-Teruel, D., Robles-Bello, M. A., & Camacho-Conde, J.A. (2020). Self-inflicted injuries in adolescents and young adults: A longitudinal approach. Psicothema, 32(3), 322-328. https://doi.org/10.7334/psicothema2019.347
  • Solis, M., & Gómez-Peresmitré, G. (2020). Cuestionario de Riesgo de Autolesión (CRA): propiedades psicométricas y resultados en una muestra de adolescentes. Revista Digital Internacional de Psicología y Ciencia Social 6,1. http://dx.doi.org/10.22402/j.rdipycs.unam.6.1.2020.206.123-141
  • Spirito, A., Webb, M., Cheek, S., Wolff, J., & Esposito-Smythers, C. (2021). An update on the latest treatment approaches with suicidal adolescents. Current Treatment Options in Psychiatry, 8(2), 64-76. https://doi. org/10.1007/s40501-021-00239-x
  • Substance Abuse and Mental Health Services Administration (SAMHSA) (2020). Treatment for Suicidal Ideation, Self-harm, and Suicide Attempts Among Youth. SAMHSA Publication No. PEP20-06-01-002 Rockville, MD: National Mental Health and Substance Use Policy Laboratory.
  • Tarrier, N., & Wykes, T. (2004). Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? Behaviour Research and Therapy, 42, 1377–1401. http://dx.doi. org/10.1016/j.brat.2004.06.020
  • Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner Jr, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575. https://doi.org/10.1037/a0018697
  • Vega, D., Sintes, A., Fernández, M., Puntí, J., Soler, J., Santamarina, P., Soto, A.,Lara, A, Méndez, I., Martínez-Giménez, R., Romero, S., & Pascual, J. C. (2018). Revisión y actualización de la autolesión no suicida: ¿quién, cómo y por qué? Actas Españolas de Psiquiatría, 46(4), 146-155.
  • Vega, D., Torrubia, R., Soto, À., Ribas, J., Soler, J., Pascual, J. C., Rodríguez-Fornells, A., & Marco-Pallarés, J. (2017). Exploring the relationship between non suicidal self-injury and borderline personality traits in young adults. Psychiatry Research, 256, 403-411. https://doi.org/10.1016/j. psychres.2017.07.008
  • Viswanathan, M., Patnode, C. D., Berkman, N. D., Bass, E. B., Chang, S., Hartling, L., Murad, M. H., Treadwell, J. R., & Kane, R. L. (2018). Recommendations for assessing the risk of bias in systematic reviews of health-care interventions. Journal of Clinical Epidemiology, 97, 26–34. https://doi. org/10.1016/j.jclinepi.2017.12.004
  • Wells, G. A., Shea, B., O’Connell, D., Peterson, J., Welch, V., Losos, M., & Tugwell, P. (n.d). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. The Ottawa Hospital Research Institute website: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
  • Whiting, P., Rutjes, A. W., Reitsma, J. B., Bossuyt, P. M., & Kleijnen J. (2003). The development of QUADAS: A tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology, 3:25. https://doi.org/10.1186/1471-2288-3-25
  • Witt, K. G., Hetrick, S. E., Rajaram, G., Hazell, P., Taylor Salisbury, T. L., Townsend, E., & Hawton, K. (2021). Interventions for self-harm in children and adolescents. The Cochrane Database of Systematic Reviews, 3(3), CD013667. https://doi.org/10.1002/14651858.CD013667.pub2
  • Wong, J., Bahji, A., & Khalid-Khan, S. (2020). Psychotherapies for adolescents with subclinical and borderline personality disorder: A systematic review and meta-analysis. The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie, 65(1), 5–15. https://doi. org/10.1177/0706743719878975
Data source: Dialnet