title: Problem-solving therapy for people who present to hospital with self-harm: Zelen randomised controlled trial.
abstract: BACKGROUND
  Presentations to hospital with self-harm are common, associated with suicide and have an increased mortality, yet there is no accepted effective intervention.
  
  
  OBJECTIVE
  To investigate whether problem-solving therapy would improve outcomes in adults presenting to hospital with self-harm, compared with usual care.
  
  
  METHODS
  A Zelen randomised controlled trial was conducted in four district health boards in New Zealand. A second hospital presentation with self-harm at 1 year for all episodes, plus separate comparisons of first-time and repeat presentations at the index episode, were the a priori primary outcomes. The trial registration number was ACTRN12605000337673.
  
  
  RESULTS
  In an intention-to-treat analysis of all randomised patients (n = 1094) there was no significant difference at 12 months in the proportion of people who had presented again with self-harm when comparing all episodes (intervention 13.4%, usual care 14.1%; relative risk reduction RR = 0.05, 95% CI -0.28 to 0.30, P = 0.79) or where the index episode was the first episode (intervention 13.4%, usual care 9.4%, RR = -0.42, 95% CI -1.17 to 0.08, P = 0.37). Where the index episode was repeated self-harm, those who received therapy were less likely to present again with self-harm (intervention 13.5%, usual care 22.1%, RR = 0.39, 95% CI 0.07 to 0.60, number needed to treat 12, P = 0.03).
  
  
  CONCLUSIONS
  Problem-solving therapy is not recommended for everyone who presents to hospital with self-harm. Among adults with a history of self-harm it may be an effective intervention.
authors.affiliation: Department of Psychological Medicine, University of Auckland, New Zealand. s.hatcher@auckland.ac.nz
authors.forename: Simon
authors.initials: S
authors.lastname: Hatcher
authors.forename: Cynthia
authors.initials: C
authors.lastname: Sharon
authors.forename: Varsha
authors.initials: V
authors.lastname: Parag
authors.forename: Nicola
authors.initials: N
authors.lastname: Collins
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D009520:New Zealand; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D016728:Self-Injurious Behavior / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome