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Open Access Study protocol

The DiaS trial: dialectical behavior therapy versus collaborative assessment and management of suicidality on self-harm in patients with a recent suicide attempt and borderline personality disorder traits - study protocol for a randomized controlled trial

Kate Andreasson15*, Jesper Krogh1, Bent Rosenbaum2, Christian Gluud3, David A Jobes4 and Merete Nordentoft1

Author Affiliations

1 Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark

2 Mental Health Services, Copenhagen and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

3 Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshopitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark

4 Department of Psychology, The Catholic University of America, Washington, DC, USA

5 Research Unit, Mental Health Centre, Bispebjerg bakke 23, Building 14, DK-2400 Copenhagen, NV, Denmark

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Trials 2014, 15:194  doi:10.1186/1745-6215-15-194

Published: 29 May 2014

Abstract

Background

In Denmark 8,000 to 10,000 people will attempt suicide each year. The Centre of Excellence in Suicide Prevention in the Capital Region of Denmark is treating patients with suicidal behavior, and a recent survey has shown that 30% of the patients are suffering from borderline personality disorder. The majority of patients (70% to 75%) with borderline personality disorder have a history of deliberate self-harm and 10% have a lifetime risk to die by suicide. The DiaS trial is comparing dialectical behavior therapy with collaborative assessment and management of suicidality-informed supportive psychotherapy, for the risk of repetition of deliberate self-harm in patients with a recent suicide attempt and personality traits within the spectrum of borderline personality disorder. Both treatments have previously shown effects in this group of patients on suicide ideation and self-harm compared with treatment as usual.

Methods/Design

The trial is designed as a single-center, two-armed, parallel-group observer-blinded randomized clinical superiority trial. We will recruit 160 participants with a recent suicide attempt and at least two traits of the borderline personality disorder from the Centre of Excellence in Suicide Prevention, Capital Region of Denmark. Randomization will be performed though a centralized and computer-generated approach that conceals the randomization sequence. The interventions that are offered are a modified version of a dialectical behavior therapy program lasting 16 weeks versus collaborative assessment and management of suicidality-informed supportive psychotherapy, where the duration treatment will vary in accordance with established methods up to 16 weeks. The primary outcome measure is the ratio of deliberate self-harming acts including suicide attempts measured at week 28. Other exploratory outcomes are included such as severity of symptoms, suicide intention and ideation, depression, hopelessness, self-esteem, impulsivity, anger, and duration of respective treatments.

Trial registration

Clinical Trial.gov: NCT01512602.

Keywords:
suicide prevention; deliberate self-harm; borderline personality disorder traits; BPD; dialectical behavior therapy; DBT; collaborative assessment and management of suicidality; CAMS