title: Brief psychological intervention after self-harm: randomised controlled trial from Pakistan.
abstract: BACKGROUND
  Self-harm is a major risk factor for completed suicide.
  
  
  OBJECTIVE
  To determine the efficacy of a brief psychological intervention - culturally adapted manual-assisted problem-solving training (C-MAP) - delivered following an episode of self-harm compared with treatment as usual (TAU).
  
  
  METHODS
  The study was a randomised controlled assessor-masked clinical trial (trial registration: ClinicalTrials.gov NCT01308151). All patients admitted after an episode of self-harm during the previous 7 days to the participating medical units of three university hospitals in Karachi, Pakistan, were included in the study. A total of 250 patients were screened and 221 were randomly allocated to C-MAP plus treatment as usual (TAU) or to TAU alone. All patients were assessed at baseline, at 3 months (end of intervention) and at 6 months after baseline. The primary outcome measure was reduction in suicidal ideation at 3 months. The secondary outcome measures included hopelessness, depression, coping resources and healthcare utilisation.
  
  
  RESULTS
  A total of 108 patients were randomised to the C-MAP group and 113 to the TAU group. Patients in the C-MAP group showed statistically significant improvement on the Beck Scale for Suicide Ideation and Beck Hopelessness Inventory, which was sustained at 3 months after the completion of C-MAP. There was also a significant reduction in symptoms of depression compared with patients receiving TAU.
  
  
  CONCLUSIONS
  The positive outcomes of this brief psychological intervention in patients attempting self-harm are promising and suggest that C-MAP may have a role in suicide prevention.
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Nusrat
authors.initials: N
authors.lastname: Husain
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Salahuddin
authors.initials: S
authors.lastname: Afsar
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Jamal
authors.initials: J
authors.lastname: Ara
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Hina
authors.initials: H
authors.lastname: Fayyaz
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Raza Ur
authors.initials: RU
authors.lastname: Rahman
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomenson
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Munir
authors.initials: M
authors.lastname: Hamirani
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Nasim
authors.initials: N
authors.lastname: Chaudhry
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Batool
authors.initials: B
authors.lastname: Fatima
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Meher
authors.initials: M
authors.lastname: Husain
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Farooq
authors.initials: F
authors.lastname: Naeem
authors.affiliation: Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Imran B
authors.initials: IB
authors.lastname: Chaudhry
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D011340:Problem Solving; D016728:Self-Injurious Behavior / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult