Outcome Patterns of SPT-SAFE and DBT-BI in Adolescents with Suicidal Ideation and Non-Suicidal Self-Injury: A Retrospective School-Based Study.

BACKGROUND/

objectivesAdolescent suicidal ideation and non-suicidal self-injury (NSSI) are major public health concerns, yet differences between active interventions are often modest. This retrospective study provides preliminary descriptive evidence regarding short-term symptom change across two school-based intervention pathways-Sandplay Therapy with Suicidal ideation and Self-injury Focused Engagement (SPT-SAFE) and a Dialectical Behavior Therapy-informed Brief Intervention (DBT-BI)-in a clinical sample of middle- and high-school adolescents with suicidal ideation and NSSI.

methodsArchival clinical records from 112 adolescents treated in a school-based suicide prevention center were analyzed retrospectively. The sample included 52 adolescents who received SPT-SAFE and 60 who received DBT-BI. Outcomes included suicidal ideation, NSSI frequency, depressive symptoms, anxiety, aggression, impulsiveness, and self-concept. Pre-post changes were examined using mixed-design ANOVAs, with baseline-adjusted ANCOVAs conducted as supplementary analyses. Given the retrospective and clinically assigned design, findings were interpreted as observational associations rather than causal treatment effects.

resultsBoth intervention groups showed significant pre-post improvements across multiple outcome domains. Overall between-group differences were limited. A nominal, uncorrected Group × Time interaction was observed for impulsiveness, with the DBT-BI group showing a descriptively larger pre-post decrease than the SPT-SAFE group. However, this effect was small and did not remain statistically significant after Bonferroni correction or Benjamini-Hochberg false discovery rate correction across the seven interaction tests. No other outcome showed a multiplicity-adjusted Group × Time interaction.

conclusionsThe present study did not provide robust multiplicity-adjusted evidence for differential treatment effects between SPT-SAFE and DBT-BI. The nominal impulsivity finding should be interpreted only as a small, uncorrected exploratory signal for future hypothesis generation. The contribution of this study is therefore descriptive and preliminary, characterizing short-term symptom change in a treatment-engaged adolescent completer sample within a routine school-based service system, rather than supporting domain-specific comparative efficacy or domain-sensitive intervention planning.