Psychosocial interventions for self-harm in low-income and middle-income countries: systematic review and theory of change

Abstract

Purpose-To synthesise the evidence on effectiveness, acceptability and the delivery mechanisms of psychosocial interventions for self-harm in low and middle income countries and to develop a pathway of change specific for self-harm interventions.Method-Studies reporting one or more patient or implementation outcomes of a psychosocial intervention targeting self-harm and conducted in low-and middle-income countries were included. Taxonomy of treatment components and a theory of change map was created using information from the studies.Results-We identified thirteen studies including nine randomised controlled trials (RCT), three non-RCTs, and a single experimental case design study. A single study using postcard contact and another using cognitive behaviour therapy (CBT) reported a reduction in self-harm attempts. Suicidal ideations were significantly reduced with CBT, volitional help sheets and postcard contact in different studies. Suicide risk assessment, problem solving and self-validation were the most frequently used elements in interventions. Goal-setting was the technique used most commonly. Cultural adaptations of psychotherapies were used in two studies. High attrition rates in psychotherapy trials, limited benefit of the delivery of treatment by non-specialist providers, and variable benefit observed using phone contact as a means to deliver intervention were other important findings.

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