Psychosocial Interventions for Self-Harm in Adults

Summary

A Cochrane review [Abstract] 1 included 55 studies with a total of 17 699 subjects. All had engaged in at least one episode of SH in the six months prior to randomisation. The trials investigated cognitive-behavioural-based psychotherapy (CBT-based psychotherapy; comprising cognitive-behavioural, problem-solving therapy or both, 18 trials), interventions for multiple repetition of SH/probable personality disorder, comprising emotion-regulation group-based psychotherapy, mentalisation, dialectical behaviour therapy (DBT, 9 trials), case management (4 trials), and remote contact interventions (postcards, emergency cards, telephone contact, 11 trials).

• CBT-based psychotherapy vs. treatment as usual (TAU):There was a significant reduction at final follow-up in patients repeating SH (OR 0.70, 95% CI 0.55 to 0.88; 17 studies, n = 2665), but with no reduction in frequency of SH (MD -0.21, 95% CI -0.68 to 0.26; 6 studies, n = 594).Group-based emotion-regulation psychotherapy (OR 0.34, 95% CI 0.13 to 0.88; 2 studies, n = 83) and mentalisation (OR 0.35, 95% CI 0.17 to 0.73; 1 study, n = 134) were associated with significantly reduced repetition when compared to TAU.
• DBT vs. TAU: There was a significant reduction in frequency of SH at final follow-up (MD -18.82, 95% CI -36.68 to -0.95; 3 studies, n = 292) but not in the proportion of individuals repeating SH (OR 0.57, 95% CI 0.21 to 1.59, 3 studies, n = 247). Compared with an alternative form of psychological therapy, DBT-oriented therapy had a significant treatment effect for repetition of SH at final follow-up (OR 0.05, 95% CI 0.00 to 0.49; 1 study, n = 24). However, neither DBT vs. 'treatment by expert' (OR 1.18, 95% CI 0.35 to 3.95; 1 study, n = 97) nor prolonged exposure DBT vs. standard exposure DBT (OR 0.67, 95% CI 0.08 to 5.68; 1 study, n =18) reduced significantly the repetition of SH.
• Case management vs. TAU or enhanced usual care: There was no significant reduction in repetition of SH (OR 0.78, 95% CI 0.47 to 1.30; 4 studies, n = 1608). Continuity of care by the same vs a different therapist did not reduce significantly the repetition of SH (OR 0.28, 95% CI 0.07 to 1.10; 1 study, n = 136).
• Remote contact interventions vs. TAU: None of the following were associated with fewer participants repeating SH: adherence enhancement (OR 0.57, 95% CI 0.32 to 1.02; 1 study, n = 391), mixed multimodal interventions (comprising psychological therapy and remote contact-based interventions) (OR 0.98, 95% CI 0.68 to 1.43; 1 study, n = 684), including a culturally adapted form of this intervention (OR 0.83, 95% CI 0.44 to 1.55; 1 study, n = 167), postcards (OR 0.87, 95% CI 0.62 to 1.23; 4 studies, n = 3277), emergency cards (OR 0.82, 95% CI 0.31 to 2.14; 2 studies, n= 1039), general practitioner's letter (OR 1.15, 95% CI 0.93 to 1.44; 1 study, n = 1932) and telephone contact (OR 0.74, 95% CI 0.42 to 1.32; 3 studies, n= 840).
• Mixed interventions vs. alternative forms of psychological therapy or TAU: None of the following were associated with reduced repetition of SH: interpersonal problem-solving skills training, behaviour therapy, home-based problem-solving therapy, long-term psychotherapy, provision of information and support, treatment for alcohol misuse, intensive inpatient and community treatment, general hospital admission or intensive outpatient treatment.

The evidence was only limited concerning the different effects in men and women. Data on adverse effects were not reported.