Effective psychological and psychosocial approaches to reduce repetition of self-harm: a systematic review, meta-analysis and meta-regression

Abstract

ObjectiveTo examine the efficacy of psychological and psychosocial interventions for reductions in repeated self-harm.DesignWe conducted a systematic review, meta-analysis and meta-regression to examine the efficacy of psychological and psychosocial interventions to reduce repeat self-harm in adults. We included a sensitivity analysis of studies with a low risk of bias for the meta-analysis. For the meta-regression, we examined whether the type, intensity (primary analyses) and other components of intervention or methodology (secondary analyses) modified the overall intervention effect.Data sourcesA comprehensive search of MEDLINE, PsycInfo and EMBASE (from 1999 to June 2016) was performed.Eligibility criteria for selecting studiesRandomised controlled trials of psychological and psychosocial interventions for adult self-harm patients.ResultsForty-five trials were included with data available from 36 (7354 participants) for the primary analysis. Meta-analysis showed a significant benefit of all psychological and psychosocial interventions combined (risk ratio 0.84; 95% CI 0.74 to 0.96; number needed to treat=33); however, sensitivity analyses showed that this benefit was non-significant when restricted to a limited number of high-quality studies. Meta-regression showed that the type of intervention did not modify the treatment effects.ConclusionsConsideration of a psychological or psychosocial intervention over and above treatment as usual is worthwhile; with the public health benefits of ensuring that this practice is widely adopted potentially worth the investment. However, the specific type and nature of the intervention that should be delivered is not yet clear. Cognitive–behavioural therapy or interventions with an interpersonal focus and targeted on the precipitants to self-harm may be the best candidates on the current evidence. Further research is required.

Accuracy of Clinician Predictions of Future Self‐Harm: A Systematic Review and Meta‐Analysis of Predictive Studies

“…A recent systematic review estimated that the absolute risk reduction for any repeat self‐harm for all psychosocial interventions combined was 2.5% (18.0% vs. 20.5%). Even when this estimate was restricted to the most effective intervention (five cognitive behavioral therapy [CBT] studies), the absolute risk reduction was 9.9% (31.2% vs. 41.1%; Hetrick et al., ). Even a 10% absolute reduction in repetition for the 7.6%–19.9% of patients allocated to the high‐risk group in our studies would only increase the overall prevalence in repetition of self‐harm by 1%–2%.…”

“…An excellent summary of the evidence base and potentially useful interventions has been proposed by the US Center for Disease Control (Stone et al., ). After‐care interventions for those discharged home should be aimed at meeting patient needs and by working with relevant community‐based services (e.g., safety plans, personal support, resolution of interpersonal difficulties, social function, occupational function, vocational support, housing and financial needs); reducing exposure to modifiable clinical risk factors for self‐harm and repeat self‐harm (e.g., mental illness, substance misuse, personality disorder); and specific psychosocial therapies for reducing repetition of self‐harm (Hetrick et al., ; National Health and Medical Research Council, ).…”

“…Given the low prevalence of future self‐harm as an outcome, even in clinically high‐risk populations, prediction by any method will not be clinically useful at the individual patient level. Instead we would recommend three approaches to allocation of clinical after‐care: (1) an individual needs‐based assessment aimed at reducing exposure to modifiable risk factors (Carter et al., ; Ryan & Large, ); (2) allocation of proven interventions for particular selected high‐risk subpopulations, for example, those with borderline personality disorder (National Health and Medical Research Council, ); and (3) allocation of proven interventions that can be delivered to unselected high‐risk clinical populations (Hetrick et al., ; Milner, Carter, Pirkis, Robinson, & Spittal, ). There is currently no sufficiently accurate way to determine which patient is safe for discharge, whether the outcome of interest is suicide or self‐harm.…”

A brief psychological intervention to reduce repetition of self-harm in patients admitted to hospital following a suicide attempt: a randomised controlled trial

“…Psychosocial interventions targeted at those who self-harm offer promise in terms of reducing self-harm repetition and suicide risk 2, 3. Although there is growing evidence for the effectiveness of long-term psychological therapies to reduce self-harm (usually in outpatient psychiatric care), 3 few interventions have been developed specifically for acute settings.…”

A Novel Therapy for People Who Attempt Suicide and Why We Need New Models of Suicide

“…A number of psychotherapeutic treatments, including Cognitive Behaviour Therapy (CBT), Dialectical Behavior Therapy (DBT), and Collaborative Assessment and Management of Suicidality (CAMS), have shown a reduction in repeated suicidal behaviour [16,17,18,19], but due to small numbers and the lack of replication studies, the evidence so far is limited [20,21]. …”