Psychosocial interventions for self-harm in adults (Review)
We have reviewed the interventional literature regarding psychosocial intervention treatment trials in the field. A total of 76 trials meeting our inclusion criteria were identified. There may be beneficial eKects for psychological therapy based on cognitive behavioural therapy (CBT) approaches at longer follow-up time points, and for mentalisation-based therapy (MBT), and emotion-regulation psychotherapy at the post-intervention assessment. There may also be some evidence of effectiveness of standard dialectical behaviour therapy (DBT) on frequency of SH repetition. There was no clear evidence of effect for case management, information and support, remote contact interventions (e.g. emergency cards, postcards, telephone-based psychotherapy), provision of information and support, and other multimodal interventions. Why is this review important? Self-harm (SH), which includes intentional self-poisoning/overdose and self-injury, is a major problem in many countries and is strongly linked with suicide. It is therefore important that effective treatments are developed for people who engage in SH. There has been an increase in both the number of trials and the diversity of therapeutic approaches for SH in adults in recent years. It is therefore important to assess the evidence for their eeffctiveness. Who will be interested in this review? Hospital administrators (e.g. service providers), health policy officers and third party payers (e.g. health insurers), clinicians working with people who engage in SH, the people themselves, and their relatives. What questions does this review aim to answer? This review is an update of a previous Cochrane review from 2016 which found that CBT-based psychological therapy can result in fewer individuals repeating SH whilst DBT may lead to a reduction in frequency of repeated SH. This updated review aims to further evaluate the evidence for effectiveness of psychosocial interventions for people engaging in SH with a broader range of outcomes. Which studies were included in the review? To be included in the review, studies had to be randomised controlled trials of psychosocial interventions for adults who had recently engaged in SH. What does the evidence from the review tell us? Overall, there were a number of methodological limitations across the trials included in this review. We found positive effects for psychological therapy based on CBT approaches at longer follow-up assessments, and for mentalisation-based therapy (MBT), and emotion-regulation psychotherapy on repetition of SH at post-intervention. There may also be some evidence of effects for standard dialectical behaviour therapy (DBT) on frequency of SH repetition. However, remote contact interventions, case management, information and support, and other multimodal interventions do not appear to have benefits in terms of reducing repetition of SH. What should happen next? The promising results for CBT-based psychotherapy at longer follow-up time points, and for MBT, group-based emotion regulation, and DBT warrant further investigation to understand which people benefit from these types of interventions. Greater use of head-to-head trials (where treatments are directly compared with each other) may also assist in identifying which component(s) from these often complex interventions may be most effective.