BackgroundTo investigate the outcome of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) in terms of reducing suffering and increasing functional adjustment among self-harming and/or suicidal adolescents with high symptom loads and their families.MethodsForty-nine self-harming and/or suicidal adolescents, Mage = 14.6, of predominantly Swedish origin and female gender (85.7%) participated with their parents. The study had a within group design with repeated measures at pre- and post-treatment, as well as six- and twelve-months follow-ups. Self-reports were used for the main outcomes; self-harm rates, suicide attempts, parent-reported days of inpatient/institutional care, internalized and externalized symptoms, perceived stress, emotion regulation, school hours and adjustment. Secondary outcomes were levels of reported expressed emotions within family dyads, as well as parental anxiety, depression and stress.ResultsFrom pre- to post-assessment, the adolescents reported significant reductions of self-harm (p = .001, d = 0.54) and suicide attempts (p < .0001, d = 1.38). Parent-reported days of inpatient/institutional care were reduced, as well as parent- and adolescent-reported internalizing and externalizing symptoms. Furthermore, school attendance and adjustment were improved, and the adolescents reported experiencing less criticism while parents reported less emotional over-involvement. The results were maintained at follow-ups.ConclusionsThe adolescents and the parents reported improvements for the main outcomes. This treatment appears promising in keeping the families in treatment and out of hospital, suggesting that an integrative approach may be beneficial and feasible for this group.Trial registrationThis study has been approved 19/12 2011, by the regional review board in Stockholm (Dnr 2011/1593–31/5).

Background Self-harming behaviors in adolescents cause great suffering and can lead to considerable costs to the healthcare system. The aim of the current study was to investigate the cost of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) and to compare the adolescent’s healthcare consumption 1 year before and 1 year after treatment. Method The study had a within group design with repeated measures. The clinical outcomes and the cost of ICT treatment are based on a sample of 49 participants who were previously enrolled in an intervention trial. Participants with significantly improved clinical outcomes (self-harm behavior, or general mental health symptoms) were defined as treatment responders. Calculation of changes in healthcare consumption is based on 25 participants who gave their consent to participate in a retrospective collection of healthcare data from medical records, including inpatient and outpatient care, and prescribed medication. Results The average estimated cost of ICT per person was €5293. There were no significant differences between the cost of healthcare consumption 1 year before and after ICT, but the results suggested that the adolescents consumed less inpatient and specialized care after treatment. There was a significantly higher cost of psychotropic medication after treatment explained by a higher consumption of central stimulants. Treatment responders (general mental health problems) reduced their consumption of healthcare resources significantly more than non-responders, especially regarding hospital visits and total health care costs. Conclusions Good response to the ICT in terms of improved general mental health symptoms seems to be associated with reduced healthcare consumption during the post-treatment period. However, controlled studies with larger sample sizes are needed to draw causal conclusions. The results of this study should be interpreted with caution as it is based on a small sample and attrition rate was high. Trial registration This study has been registered with the ISRCTN: 15885573.

Background: Self-harm is a major public healh concern and it is particularly prevalent among adolescents. The functions of self-harm are diverse, but can be devided into interpersonal and intrapersonal. Linehan’s Biosocial Theory suggests that there is a transaction between the indivduals’ emotional vulnurablity and an invalidating environment, which in turn results in maladptive and often self-destructive behaviors. This paper examines the associations between self-harm, emotion dysregulation and percieved validation/invalidation. Methods: A total of 1910 (M age = 17.2, 86.9% female gender identity) respondents completed questionnaires in an anonymous Web-based survey. We used well-established questionnairs for assessing self-harm and emotion dysregulation, and for the assessment of perceived validation/invalidation we used a novel instrument “Responses to my Emotion, Thoghts and Actions, REMTA”. Results: Validation/invalidation correlated with self-harm and to an even larger extent to emotional dysregulation. A lagre and significat part of the association between self-harm and perceived validation/inavldiation was also mediated by emotion regulation. Validation/invalidation from family members had a higher impact on both self-harm and emotion dysregulation than from non-relatives. Those reporting high levels of invalidation also reported significantly more difficulties in emotion regulation. Conclusions: The present study contributes to the understanding validation in the ethiology of self-harm. The results also provide additional support for the Biosocial Theory and has implication assessment and treatment of self-harm. Trial registration: The study was approved by the Regional Ethics Board in Stockholm (Dnr. 2015/815-31/5).

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