title: Clinical management of deliberate self-harm in young people: the need for evidence-based approaches to reduce repetition.
abstract: 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.
authors.affiliation: 'beyondblue; the national depression initiative' Hawthorn West, Victoria, Australia. jane.burns@beyondblue.org.au
authors.forename: Jane
authors.initials: J
authors.lastname: Burns
authors.forename: Michael
authors.initials: M
authors.lastname: Dudley
authors.forename: Philip
authors.initials: P
authors.lastname: Hazell
authors.forename: George
authors.initials: G
authors.lastname: Patton
mesh_terms: 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