Clinical management of deliberate self-harm in young people: the need for evidence-based approaches to reduce repetition.
OBJECTIVE
To examine the evidence for the effectiveness of clinical interventions designed to reduce the repetition of deliberate self-harm (DSH) in adolescents and young adults.


METHODS
Electronic databases were searched for papers describing randomised and clinical control trials (RCTs) and quasi-experimental studies of interventions targeting adolescents and young adults presenting to clinical services following DSH or suicidal ideation.


RESULTS
Three RCTs, four clinical control trials and three quasi-experimental studies were identified. Group therapy, trialled in a RCT, was the only specific programme which led to a significant reduction in rates of repetition of self-harm. Attendance at follow-up did not improve significantly regardless of the intervention, while one clinically controlled trial of intensive intervention resulted in poorer attendance at follow-up. One quasi-experimental study of family therapy resulted in a significant reduction in suicidal ideation.


CONCLUSIONS
The evidence base for treatments designed to reduce the repetition of self-harm in adolescents and young adults is very limited. Expensive interventions such as intensive aftercare offer no clear benefit over routine aftercare. Given that deliberate self-harm among young people is a common clinical problem further good quality treatment studies are warranted. Careful consideration should be given to process evaluation to determine which individual components of any given intervention are effective.
Burns
Jane
J
'beyondblue; the national depression initiative' Hawthorn West, Victoria, Australia. jane.burns@beyondblue.org.au
Dudley
Michael
M
Hazell
Philip
P
Patton
George
G
D000293:Adolescent; D000328:Adult; D019317:Evidence-Based Medicine; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D016728:Self-Injurious Behavior / Q000517:prevention & control* / Q000523:psychology; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology