Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition

Abstract

The difference may be partly accounted for by the factors that influence infectivity of the two viruses. Hepatitis B is much more likely to be transmitted from mother to infant if there is a high concentration of the virus in the mother's blood. This explains the ethnic differences that are observed-for example, the transmission rate is over 70% in Chinese women but less than 10% in white women. This ethnic difference does not seem to apply to hepatitis C infection.Alcohol intake and obesity are both thought to be associated with more severe hepatitis C, although the exact interaction is unknown. Advanced liver disease, for example, is far worse in people infected with hepatitis C who also have a high alcohol intake than in those with a low intake. AbstractObjective: To identify and synthesise the findings from all randomised controlled trials that have examined the effectiveness of treatments of patients who have deliberately harmed themselves. Design: Systematic review of randomised controlled trials of psychosocial and physical treatments. Studies categorised according to type of treatment. When there was more than one investigation in a particular category a summary odds ratio was estimated with the Mantel-Haenszel method. Setting: Randomised trials available in electronic databases in 1996, in the Cochrane Controlled Trials Register in 1997, and from hand searching of journals to 1997. Subjects: Patients who had deliberately harmed themselves shortly before entry into the trials with information on repetition of behaviour. The included trials comprised 2452 randomised participants with outcome data. Main outcome measure: Repetition of self harm. Results: 20 trials reported repetition of self harm as an outcome variable, classified into 10 categories. Summary odds ratio (all for comparison with standard aftercare) indicated reduced repetition for problem solving therapy (0.73; 95% confidence interval 0.45 to 1.18) and for provision of an emergency contact card in addition to standard care (0.45; 0.19 to 1.07). The summary odds ratios were 0.83 (0.61 to 1.14) for trials of intensive aftercare plus outreach and 1.19 (0.53 to 2.67) for antidepressant treatment compared with placebo. Significantly reduced rates of further self harm were observed for depot flupenthixol versus placebo in multiple repeaters (0.09; 0.02 to 0.50) and for dialectical behaviour therapy versus standard aftercare (0.24; 0.06 to 0.93). Conclusion: There remains considerable uncertainty about which forms of psychosocial and physical treatments of patients who harm themselves are most effective. Further larger trials of treatments are needed.

Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis

“…We have considerably expanded the range of outcome variables compared with the original version of our review. 11 This often required correspondence with authors to obtain unpublished data. Different measures were used in the assessment of some outcome variables which may have impacted on the results.…”

“…10 Given the size of the problem of self-harm, the frequency with which it is repeated, and the risk of subsequent suicide, it is important that effective treatment interventions are developed for this patient population. We previously published a systematic review and meta-analysis of both psychosocial and pharmacological treatment studies across the age spectrum in 1998, 11 which was subsequently updated in an official guideline in 2011. 12 We have recently conducted a major update of this review in conjunction with the Cochrane Collaboration.…”

Suicide among Italian adolescents: 1970–2002

“…One valuable approach to understanding the dynamics of suicide has been the use of psychological autopsies [14]. Based on interviews of relatives of the deceased and evidence from medical, criminal and social services records, psychological autopsy studies suggest that more than 90% of young suicide deaths are associated with mental health disorders, and high rates of comorbid mental health, addictive and physical disorders [5,25,27].…”

The challenge of evaluating the effectiveness of treatments for deliberate self-harm

“…Repetition itself increases the risk of a fatal outcome (Sakinofsky, 2000). The results of both psychosocial and pharmacological interventions to prevent repetition have been fairly disappointing (Hawton et al 1998, although the findings of treatment trials have not all been negative. Dialectical behaviour therapy had a substantial initial impact on repetition of self-harm, although this did not persist in a treatment study of female patients with borderline personality disorders (Linehan et al 1991) and depot flupenthixol reduced repetition in frequent self-harmers (Montgomery, 1987).…”

“…One of the main drawbacks of most treatment studies to date involving DSH patients has been their relatively small size and hence limited power (Hawton et al 1998). Given the large number of DSH patients presenting to general hospitals (Kapur & House, 1998;Wilkinson et al 2002) and the need to target this population as part of national suicide prevention strategies, for example the Department of Health in the UK in 2002, there is a need for robust information from large trials of pragmatic treatments suitable for application in NHS settings.…”