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This systematic meta\u2010analysis examined the effectiveness of DBT in reducing suicidality\u2010related outcomes when delivered in usual care settings. A systematic search was conducted and studies were identified for inclusion if they evaluated a DBT\u2010based intervention with original, quantitative data reflecting pre\u2010 and post\u2010treatment measurement of at least one of the three suicidality\u2010related outcomes: (i) self\u2010directed violence (SDV), (ii) crisis service use (CSU), and (iii) suicidal ideation (SI). Random effects models were used to estimate pooled effects. Meta\u2010regression analyses were used to compare pooled effects across usual care and non\u2010usual care settings and to examine the differential effects of theoretical predictors often involved in treatment modification. The final sample included 83 studies. In uncontrolled studies, DBT was associated with a large reduction in SDV and medium reductions in CSU and SI. In controlled studies, DBT demonstrated a significant effect for SDV but not for CSU or SI. Adjustment for publication bias attenuated the CSU findings. No differences were observed between usual care and non\u2010usual care settings. Substantial heterogeneity was observed across models. In uncontrolled studies, positive associations emerged between therapist training and SDV reduction, adherence reporting and CSU reduction, and outpatient setting and SI reduction. Results provide the strongest support for the effectiveness of DBT in reducing SDV, with more limited and variable evidence for CSU and SI. Results should be interpreted with caution given heterogeneity and evidence of publication bias.<\/jats:p>","DOI":"10.1002\/jclp.70195","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T16:06:38Z","timestamp":1785600398000},"page":"1699-1743","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effectiveness of Dialectical Behavior Therapy in Reducing Self\u2010Directed Violence and Suicidality in Usual Care Settings: A Meta\u2010Analysis"],"prefix":"10.1002","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5922-2730","authenticated-orcid":false,"given":"Colleen A.","family":"Maxwell","sequence":"first","affiliation":[{"name":"Department of Psychology and Neuroscience Temple University Philadelphia Pennsylvania USA"},{"name":"Department of Psychiatry University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA"},{"name":"Department of Child 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