Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition.
OBJECTIVE
To identify and synthesise the findings from all randomised controlled trials that have examined the effectiveness of treatments of patients who have deliberately harmed themselves.


METHODS
Systematic review of randomised controlled trials of psychosocial and physical treatments. Studies categorised according to type of treatment. When there was more than one investigation in a particular category a summary odds ratio was estimated with the Mantel-Haenszel method.


METHODS
Randomised trials available in electronic databases in 1996, in the Cochrane Controlled Trials Register in 1997, and from hand searching of journals to 1997.


METHODS
Patients who had deliberately harmed themselves shortly before entry into the trials with information on repetition of behaviour. The included trials comprised 2452 randomised participants with outcome data.


METHODS
Repetition of self harm.


RESULTS
20 trials reported repetition of self harm as an outcome variable, classified into 10 categories. Summary odds ratio (all for comparison with standard aftercare) indicated reduced repetition for problem solving therapy (0.73; 95% confidence interval 0.45 to 1.18) and for provision of an emergency contact card in addition to standard care (0.45; 0.19 to 1.07). The summary odds ratios were 0.83 (0.61 to 1.14) for trials of intensive aftercare plus outreach and 1.19 (0.53 to 2.67) for antidepressant treatment compared with placebo. Significantly reduced rates of further self harm were observed for depot flupenthixol versus placebo in multiple repeaters (0.09; 0.02 to 0.50) and for dialectical behaviour therapy versus standard aftercare (0.24; 0.06 to 0.93).


CONCLUSIONS
There remains considerable uncertainty about which forms of psychosocial and physical treatments of patients who harm themselves are most effective. Further larger trials of treatments are needed.
Department of Psychiatry, Oxford University, Warneford Hospital, Oxford OX3 7JX.
K
K
Hawton
E
E
Arensman
E
E
Townsend
S
S
Bremner
E
E
Feldman
R
R
Goldney
D
D
Gunnell
P
P
Hazell
K
K
van Heeringen
A
A
House
D
D
Owens
I
I
Sakinofsky
L
L
Träskman-Bendz
D000359:Aftercare; D003266:Continuity of Patient Care; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D016728:Self-Injurious Behavior / Q000188:drug therapy / Q000517:prevention & control*; D013406:Suicide, Attempted / Q000517:prevention & control; D016896:Treatment Outcome