1 - (IOP 3) Longitudinal Effects of Dialectical Behavior Therapy on Family Functioning in Sexual and Gender Minoritized Youth with Bipolar Spectrum Disorder

Sexual and gender minoritized (SGM) youth with bipolar spectrum disorder face substantially higher risk for poorer mental health compared with the general pediatric population, including greater frequency and severity of mood and anxiety symptoms and suicidal thoughts and behaviors, due to both identity and disorder-specific factors. The family environment is a critical contextual factor that may exacerbate a broad range of mental health symptoms. In particular, SGM/bipolar youth embedded within a family with high conflict and low cohesion may experience worse symptom course than environments perceived as more supportive and affirming. Thus, targeting family functioning via intervention is crucial for improving mental health outcomes for this high-risk population. Dialectical Behavior Therapy for Adolescents (DBT-A)—a multicomponent psychosocial intervention that involves family participation (e.g., family skills training, family therapy)—has potential to augment family functioning, although well-controlled studies are lacking.

We conducted a secondary data analysis of a randomized controlled trial of DBT-A adapted for adolescents (age 12-18) with bipolar spectrum disorder vs. standard of care psychotherapy (SOC) to examine treatment effects on family functioning. We examined parent- and child-reported data on family functioning collected over 24 months (baseline, 3-, 6-, 9-, 12-, 18-, and 24-month). Conflict behaviors between parent and child were assessed with the Conflict Behavior Questionnaire; Family adaptability and cohesion were assessed with the Family Adaptability and Cohesion Evaluation Scales II. Using mixed-effects modeling of data, we compared DBT-A (n=21) with SOC (n=29) in a subset of participants identifying as SGM (total n=50), based on self-reported sexual attraction and gender identity. Additionally, we explored if group differences in family functioning were influenced by the total number of study treatment sessions attended, including individual and family therapy (M=22.16, SD=16.54). Analyses included time, age, and sex at birth as covariates.

Results indicated no treatment group differences in parent and child-reported conflict behaviors over 24 months (ps > .05). However, there were significant treatment group differences in child-reported perceptions of family adaptability and cohesion over 24 months, but these effects depended on therapy attendance. Among those who attended more therapy sessions, DBT (vs. SOC) was associated with greater perceived family adaptability (p=.014) and cohesion (p=.035). Among parents, DBT (vs. SOC) was associated with greater perceived family adaptability (p=.045) but not cohesion (p>.05).

Overall, our results suggest that DBT-A positively impacts family functioning among SGM youth with bipolar spectrum disorder. Findings are consistent with the treatment framework of DBT-A. Whereas family conflicts may persist despite treatment, the skills taught in DBT-A may help to effectively manage family conflicts and, in turn, promote cohesion and adaptability. This may be particularly beneficial in augmenting perceptions of family support and affirmation for high-risk minoritized youth.