Interventions for self-harm in children and adolescents

Abstract

There are relatively few trials of interventions for children and adolescents who have engaged in SH, and only single trials contributed to all but two comparisons in this review. The quality of evidence according to GRADE criteria was mostly very low. There is little support for the effectiveness of group-based psychotherapy for adolescents with multiple episodes of SH based on the results of three trials, the evidence from which was of very low quality according to GRADE criteria. Results for therapeutic assessment, mentalisation, and dialectical behaviour therapy indicated that these approaches warrant further evaluation. Despite the scale of the problem of SH in children and adolescents there is a paucity of evidence of effective interventions. Further large-scale trials, with a range of outcome measures including adverse events, and investigation of therapeutic mechanisms underpinning these interventions, are required. It is increasingly apparent that development of new interventions should be done in collaboration with patients to ensure that these are likely to meet their needs. Use of an agreed set of outcome measures would assist evaluation and both comparison and meta-analysis of trials.

Psychosocial interventions for self-harm, suicidal ideation and suicide attempt in children and young people: What? How? Who? and Where?

“…Four SRs met the criteria for this review 23 24 33 34. In many cases, these SRs included the same trials, however, owing to differences in the inclusion criteria, methods of analysis and the databases searched, it was decided that all four SRs were worthy of inclusion and exploration within this review.…”

“…Two SRs focused on young people who had presented to clinical services as a result of SH17 or SRBs including passive SI,23 and another SR focused on web-based and mobile psychosocial suicide interventions for young people. Three of the reviews included trials with young people aged between 12 and 25 years23 33 34 and one included trials with participants up to the age of 18 years 24. See table 1 for the characteristics of trials included in this review.…”

“…This clinical review identified 16 RCTs from four SRs that have investigated the effectiveness of individual psychosocial interventions for SRBs 23 24 33 34. Generally, the sample sizes of the trials were small and thus lacked power.…”

“…Individual, group-based and family oriented interventions are all treatment options for SRBs in young people 23 24. The family can be involved as a target of intervention by educating them about the signs of suicide in young people, involving them in planning for crises (eg, by reducing access to means) and assisting them to access services and attend appointments with their child 25.…”

Interventions to prevent self-harm: what does the evidence say?

“…In their third Cochrane review Hawton et al 15 identified only 11 trials of interventions for SH in children and adolescents. This was a surprisingly low number of trials, given that under 18s are a key target age group for SH interventions and suicidality is a relevant clinical issue in child and adolescent psychiatry 31 32.…”