Comparative Efficacy and Acceptability of Psychotherapies for Self-harm and Suicidal Behavior Among Children and Adolescents

Abstract

Key Points Question What are the comparative efficacies and acceptability of psychosocial interventions for the treatment of self-harm and suicidality among children and adolescents? Findings In this systematic review and network meta-analysis of pooled data from 44 randomized clinical trials of psychotherapies for children and adolescents that involved 5406 total participants, the investigated psychotherapies were found to be acceptable to patients, but the evidence was inconsistent with regard to self-harm and suicidality measures across therapeutic modalities. Meaning The findings indicate that, although some psychotherapeutic modalities appeared to be acceptable and efficacious for reducing self-harm and suicidality among children and adolescents, methodological issues and high risk of bias suggest a need for additional randomized clinical trials.

Comparing the predictive value of screening to the use of electronic health record data for detecting future suicidal thoughts and behavior in an urban pediatric emergency department: A preliminary analysis

“…Potential interventions that could be linked to these strategies include safety planning (Stanley et al, 2018), brief contact interventions (Milner et al, 2015), and more intensive therapeutic interventions. While these types of interventions hold promise, robust evidence on any single approach or how these work in combination among youth is still emerging (Bahji et al, 2021;Mann et al, 2021). Due to our outcome classification, our results also indicate a need for interventions that address a range of suicidal thoughts and behaviors that place individuals at risk for future suicide-related ED visit.…”

Effectiveness of distance-based suicide interventions: multi-level meta-analysis and systematic review

“…When comparing the results of our meta-analysis on DBI with the results of the nine meta-analyses on face-to-face interventions, we found three meta-analyses with significantly higher results, whereas six meta-analyses reported non-significant differences. Two of the three meta-analyses reporting significantly higher results were comprised of adolescent samples 35,36 and used ‘self-harm’ as an outcome. Compared to our DBI effect sizes, both show significantly higher reductions in ‘self-harm’ through dialectical behavioural therapy.…”

“…35 In addition, eclectic therapy led to a significantly higher effectiveness at post-treatment compared with DBIs, but also to an increase in ‘self-harm’ at follow-up. 35 The third meta-analysis reporting significantly stronger results than our DBI effect sizes included only psychoanalytic approaches 38 and used ‘suicide attempts’ and ‘self-harm’ as outcomes. Psychoanalytic approaches reduced ‘self-harm’ significantly at 6-month follow-up, although their effects were non-significant at 12-month follow-up.…”

Effects of polygenic risk for suicide attempt and risky behavior on brain structure in young people with familial risk of bipolar disorder

“…Currently available clinical models of SA have demonstrated poor predictive value, precipitating the search for viable biomarkers that will reliably predict suicidal behaviors and illuminate the ideation-to-action pathway. The identification of biological features and their interactions associated with SA represents an important target for reducing the mortality gap in BD, facilitating future identification of high risk individuals who may benefit most from prevention strategies (reviewed in Bahji et al, 2021;Katz et al, 2013;Mann et al, 2005;Robinson et al, 2018) and thereby reducing suicide mortality within vulnerable populations. Through the examination of associations between regional brain structure and polygenic risk for SA and risky behavior, the present study provides tentative evidence for the role of the anterior cingulate, parahippocampal, and cuneus structures in SA.…”