Randomized Trial of a Home-Based Family Intervention for Children Who Have Deliberately Poisoned Themselves

Abstract

Objective: To establish whether an intervention given by child psychiatric social workers to the families of children and adolescents who had attempted suicide by taking an overdose reduced the patients' suicidal feelings and improved family functioning.Method: One hundred sixty-two patients, aged 16 or younger, who had deliberately poisoned themselves were randomly allocated to routine care (n = 77) or routine care plus the intervention (n = 85). The intervention consisted of an assessment session and four home visits by the social workers to conduct family problem-solving sessions. The control group received no visits. Both groups were assessed at the time of recruitment and 2 and 6 months later. The primary outcome measures were the Suicidal Ideation Questionnaire, the Hopelessness Scale, and the Family Assessment Device.Results: There were no significant differences in the primary outcomes between the intervention and control groups at either of the outcome assessments. Parents in the intervention group were more satisfied with treatment (mean difference 1.4 [95% confidence interval 0.6 to 2.1]). A subgroup without major depression had much less suicidal ideation at both outcome assessments (analysis of covariance p < .01) compared with controls.Conclusions: The home-based family intervention resulted in reduced suicidal ideation only for patients without major depression. J. Am. Acad. Child Adolesc. Psychiatry, 1998, 37(5):512-518.

Self-harm in adolescents

“…Repetition rates vary but are reported as between 6 and 30% depending on sample selection/size, length of follow-up and location (Hawton 1982; NHS Centre for Reviews and Dissemination 1998). Harrington et al (2006) published their 6-year follow-up of adolescents participating in a randomised controlled trial of a brief family intervention (Harrington 1998). Patients were compared with matched controls identified via general practitioner surgeries.…”

“…A brief home-based family intervention was devised and delivered as part of a randomised controlled trial (Harrington 1998). Following admission for self-poisoning, patients were allocated to routine care or to routine care plus the intervention.…”

Randomized Trial of Group Therapy for Repeated Deliberate Self-Harm in Adolescents

“…In previous randomized trials with depressed or suicidal adolescents, we have tested relatively brief forms of intervention (Harrington et al, 1998;Wood et al, 1996). The rationale for studying brief treatments was that if they worked, they could be easily implemented in routine clinical practice.…”

“…The therapy is "developmental" in that it was designed to meet the needs of adolescents and has a focus on the adolescent growing through difficulties by using positive corrective therapeutic relationships. It brings together techniques from a variety of other therapies, including the problem-solving and cognitive-behavioral interventions that we have previously used with depressed or suicidal adolescents and their families (Harrington et al, 1998;Kroll et al, 1996;Wood et al, 1996), dialectical behavior therapy (Linehan et al, 1991), and psychodynamic group psychotherapy. The intervention comprises an initial assessment phase, attendance at six "acute" group sessions, followed by weekly group therapy in a "long-term group," which can continue until the young person feels ready to leave.…”

Suicidal ideation and behaviour

“…Family-based cognitive therapy aims to reframe the family's understanding of their problems, to alter the family's maladaptive problem-solving techniques, and to encourage positive family interactions (Rotheram-Borus et al, 1994). Harrington et al (1998) found that a time-limited home-based intervention for suicidal children and adolescents had limited efficacy for children and adolescents without major depressive disorder. Psychoeducational approaches can help parents clarify their understanding of childhood and adolescent suicidal behavior, identify changes in mental state that may herald a repetition, and reduce the extent of expressed emotion or anger (Brent et al, 1993d).…”