Psychosocial Interventions for People Who Self-Harm: Methodological Issues Involved in Trials to Evaluate Effectiveness

Abstract

We have assessed the methodological quality of randomized controlled trials (RCTs) of interventions to prevent self-harm repetition and suicide. Trials were identified in two systematic reviews of RCTs of psychosocial treatments following a recent (within six months) episode of self-harm indexed in any of five electronic databases (CCDANCTR-Studies and References, CENTRAL, Medline, Embase, and PsycINFO) between 1 January, 1998 and 29 April, 2015. A total of 66 trials were included, 55 in adults and 11 in children and adolescents. While evidence for efficacy of some approaches has grown, there were few trials from low-to-middle income countries, little information on interventions for males, information on the control condition was often limited, data on suicides were often not reported, and, while trials have increased in size in recent years, most have included too few participants to detect clinically significant results. There are major limitations in many trials of interventions for individuals who self-harm. Improved methodology, especially with regard to study size, provision of details of control therapy, and evaluation of key outcomes, would enhance the evidence base for clinicians and service users.

Keywords:

• self-harm
• attempted suicide
• suicide
• methodology
• outcome

ETHICAL APPROVAL AND CONSENT TO PARTICIPATE

Ethical approval and participant consent were not required for this review, since the study involved review and analysis of previously published data.

Acknowledgements

The authors wish to acknowledge the help of all authors who provided additional clarification and/or extra data for their trials.

CONSENT TO PUBLISH

All authors read and approved the final version of the manuscript for publication.

AVAILABILITY OF DATA AND MATERIALS

This review involves analysis of previously published data available in the studies included in this review. The final dataset is available from the corresponding author upon reasonable request.

DISCLOSURE STATEMENT

K.H. authored two of the trials included in this article, and E.A., D.G., P.H., and K.V.H. authored one trial each. We declare no other competing interests.

AUTHOR CONTRIBUTIONS

K.H. had the idea for this article. All authors extracted data and assessed risk of bias for included trials. K.W. and T.T.S. conducted the statistical analyses. K.W. and K.H. wrote the initial version of the article. All authors contributed to the interpretation of results and revisions of the article and approved the final version.

SUPPLEMENTAL DATA

Supplemental data for this article can be accessed at publisher’s weblink.

Additional information

Funding

This review received no specific source of external funding. K.H. used personal funding received from the National Institute for Health Research (NIHR) to support the project. The NIHR had no role in the research or the decision to publish. The views expressed are those of the authors and not necessarily those of the NIHR.

Notes on contributors

Katrina Witt

Katrina Witt Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK.

Ellen Townsend

Ellen Townsend Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK.

Ella Arensman

Ella Arensman National Suicide Research Foundation and Department of Epidemiology and Public Health, University College Cork, Cork, Republic of Ireland.

David Gunnell

David Gunnell School of Social and Community Medicine, University of Bristol, Bristol, UK.

Philip Hazell

Philip Hazell Discipline of Psychiatry, Sydney Medical School, Sydney, Australia.

Tatiana Taylor Salisbury

Tatiana Taylor Sailsbury Institute of Psychiatry, King’s College London, London, UK.

Tatiana Taylor Sailsbury Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK.

Kees Van Heeringen

Kees Van Heeringen Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.

Keith Hawton

Keith Hawton Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK.