Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation

Abstract

Objective To examine the effectiveness and costeffectiveness of group therapy for self harm in young people. Design Two arm, single (assessor) blinded parallel randomised allocation trial of a group therapy intervention in addition to routine care, compared with routine care alone. Randomisation was by minimisation controlling for baseline frequency of self harm, presence of conduct disorder, depressive disorder, and severity of psychosocial stress. Participants Adolescents aged 12-17 years with at least two past episodes of self harm within the previous 12 months. Exclusion criteria were: not speaking English, low weight anorexia nervosa, acute psychosis, substantial learning difficulties (defined by need for specialist school), current containment in secure care. Setting Eight child and adolescent mental health services in the northwest UK. Interventions Manual based developmental group therapy programme specifically designed for adolescents who harm themselves, with an acute phase over six weekly sessions followed by a booster phase of weekly groups as long as needed. Details of routine care were gathered from participating centres. Main outcome measures Primary outcome was frequency of subsequent repeated episodes of self harm. Secondary outcomes were severity of subsequent self harm, mood disorder, suicidal ideation, and global functioning. Total costs of health, social care, education, and criminal justice sector services, plus family related costs and productivity losses, were recorded. Results 183 adolescents were allocated to each arm (total n=366). Loss to follow-up was low (<4%). On all outcomes the trial cohort as a whole showed significant improvement from baseline to follow-up. On the primary outcome of frequency of self harm, proportional odds ratio of group therapy versus routine care adjusting for relevant baseline variables was 0.99 (95% confidence interval 0.68 to 1.44, P=0.95) at 6 months and 0.88 (0.59 to 1.33, P=0.52) at 1 year. For severity of subsequent self harm the equivalent odds ratios were 0.81 (0.54 to1.20, P=0.29) at 6 months and 0.94 (0.63 to 1.40, P=0.75) at 1 year. Total 1 year costs were higher in the group therapy arm (£21 781) than for routine care (£15 372) but the difference was not significant (95% CI −1416 to 10782, P=0.132). Conclusions The addition of this targeted group therapy programme did not improve self harm outcomes for adolescents who repeatedly self harmed, nor was there evidence of cost effectiveness. The outcomes to end point for the cohort as a whole were better than current clinical expectations. Trial registration ISRCTN 20496110

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

“…More than 80% of the studies related to interventions focusing on school-age children (5-16 years), with only four studies (Green 2011; 72 All of the interventions were delivered face to face; none made use of technology, even technology as simple and ubiquitous as the telephone. Sixteen of the interventions were individual child/young person or individual family interventions; 48,65,[69][70][71]74,[83][84][85][86][87][95][96][97][98]111,[121][122][123][124][125][126][127][129][130][131]133,135 the remainder were group interventions or group interventions with occasional individual sessions.…”

“…Descriptive data for the 71 60,70,71,92,115-117, 120,134,136 There were relatively few studies focusing on post-traumatic stress disorder (PTSD) (n = 2), 86,128 self-harm (n = 4) 72,74,78,137 and generic mental health problems (i.e. interventions designed for any mental health problem; n = 3).…”

“…Table 4, the majority of outcome measures focused on mental health symptomatology in the CYP, whether directly or indirectly related to the condition of interest. General functioning was measured in a sizeable number (n = 28; 39%) of the papers 51,[53][54][55]65,66,[70][71][72]74,78,[85][86][87]91,[95][96][97][98][99][100][101][102]104,106,[108][109][110][111]113,114,[116][117][118][119][128][129][130][131] but few focused on CYP's resilience, general well-being or self-esteem. Most of the outcome measures were obtained directly from the CYP with clinicians or parents being the most frequent secondary source.…”

“…running summer camps and liaising with teachers (MTA 1999 95 ), or facilitating the child in the home-school environment (Pfiffner 2007 102 ). In three-quarters (53/71) of the studies, the agents were trained specifically for the intervention, 39,[45][46][47][48][49][50][51][53][54][55][56][57][58][59][62][63][64][65][66][67][68][72][73][74][77][78][79][82][83][84][85][86][87][88][89][90]93,94,99,100,[103][104][105][106][108][109]…”

Cost-Effectiveness of a Rapid Response Team Intervention for Suicidal Youth Presenting at an Emergency Department

“…Health care costs associated with inpatient care of youth suicidal behaviour can be substantial. 23 Among 4 studies that examined the costs of treatment alternatives to hospitalization for youth in psychiatric crisis, 12,[23][24][25] only 2 investigated the cost-effectiveness of community treatment for suicidal youth, but 1 focused exclusively on children who intentionally poisoned themselves, 24 and the other focused on self-harm with and without suicidal intent. 25 Using data collected alongside a clinical trial, 13 the objective of our study was to report on the cost-effectiveness of an RRT, compared with UC, for treating adolescents presenting for suicide attempt at an ED.…”