Does treatment method matter? A meta-analysis of the past 20 years of research on therapeutic interventions for self-harm and suicidal ideation in adolescents

Abstract

Background: Self-harm is a clinically relevant and prevalent behaviour which peaks in adolescence. Given the high prevalence of self-harm, the high levels of psychiatric comorbidity, and its role as a risk factor for suicide, delivering evidence-based care is critical. Methods: We conducted a systematic review and meta-analysis of the literature on treating self-harm in adolescents (12-19 years) published in the last 20 years, identifying 25 randomised controlled trials. We calculated the effect of treatment interventions relative to active control conditions in reducing self-harm, suicidal ideation and depressive symptoms. Results: Overall, treatment interventions fared slightly better than active controls in decreasing self-harm (d = 0.13, 95% CI 0.04-0.22, p = .004), suicidal ideation (d = 0.31, 95% CI 0.12-0.50, p = .001) and depressive symptoms (d = 0.22, 95% CI 0.07-0.38, p = .006). Subgroup analysis of specific therapies revealed moderate effects of DBT-A in reducing self-harm (d = 0.51, 95% CI 0.18-0.85, p = .002) and suicidal ideation (d = 0.48, 95% CI 0.17-0.80, p = .003), as well as moderate effects of family-centred therapy in the treating suicidal ideation (d = 0.58, 95% CI 0.01-1.15, p = .049).

Nonsuicidal self-injury thoughts and behavioural characteristics: Associations with suicidal thoughts and behaviours among community adolescents

“…Recent meta-analytic evidence suggests that psychosocial interventions, particularly Dialectical Behaviour Therapy for Adolescents, are effective at reducing adolescent self-injury and suicidal ideation (Kothgassner, Robinson, Goreis, Ougrin, & Plener, 2020). However, public mental health resources are finite, and thus the high prevalence of self-injury and suicidal ideation raises questions about how to assess risk and allocate resources based on need so that those most at risk of negative outcomes receive the most resource-intensive treatment.…”

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

“…Previous authors of systematic reviews have cited the small number of RCTs, limited direct comparisons between treatments, low quality of evidence, and lack of independent replication of individual RCT findings as key limitations. 2 , 8 Given the inconsistency across previous reviews, the most appropriate type of psychotherapy for the treatment of adolescents who present with self-harm or suicidality remains unclear.…”

Pandemic-Related Emergency Psychiatric Presentations for Self-Harm of Children and Adolescents in 10 Countries (PREP-Kids): A Retrospective International Cohort Study

“…There has been some progress in the treatment of young people with self-harm [7,8], but many challenges remain [9]. Post mortem analyses following youth suicide suggest that up to 40% had no prior mental health access [10], and at least three quarters of children and adolescents with selfharm do not access any health services [11].…”