title: Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis.
abstract: OBJECTIVE
  Suicidal behavior and self-harm are common in adolescents and are associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm and links between self-harm and suicide and risk of suicide attempt, progress in reducing suicide death rates has been elusive, with no substantive reduction in suicide death rates over the past 60 years. Extending prior reviews of the literature on treatments for suicidal behavior and repetitive self-harm in youth, this article provides a meta-analysis of randomized controlled trials (RCTs) reporting efficacy of specific pharmacological, social, or psychological therapeutic interventions (TIs) in reducing both suicidal and nonsuicidal self-harm in adolescents.
  
  
  METHODS
  Data sources were identified by searching the Cochrane, Medline, PsychINFO, EMBASE, and PubMed databases as of May 2014. RCTs comparing specific therapeutic interventions versus treatment as usual (TAU) or placebo in adolescents (through age 18 years) with self-harm were included.
  
  
  RESULTS
  Nineteen RCTs including 2,176 youth were analyzed. TIs included psychological and social interventions and no pharmacological interventions. The proportion of the adolescents who self-harmed over the follow-up period was lower in the intervention groups (28%) than in controls (33%) (test for overall effect z = 2.31; p = .02). TIs with the largest effect sizes were dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), and mentalization-based therapy (MBT). There were no independent replications of efficacy of any TI. The pooled risk difference between TIs and TAU for suicide attempts and nonsuicidal self-harm considered separately was not statistically significant.
  
  
  CONCLUSIONS
  TIs to prevent self-harm appear to be effective. Independent replication of the results achieved by DBT, MBT, and CBT is a research priority.
authors.affiliation: Institute of Psychiatry, King's College London and South London and Maudsley National Health Service (NHS) Foundation Trust. Electronic address: dennis.ougrin@kcl.ac.uk.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ougrin
authors.affiliation: South London and Maudsley NHS Foundation Trust.
authors.forename: Troy
authors.initials: T
authors.lastname: Tranah
authors.affiliation: King's College London.
authors.forename: Daniel
authors.initials: D
authors.lastname: Stahl
authors.affiliation: King's College London.
authors.forename: Paul
authors.initials: P
authors.lastname: Moran
authors.affiliation: University of California, Los Angeles.
authors.forename: Joan Rosenbaum
authors.initials: JR
authors.lastname: Asarnow
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy / Q000379:methods; D006801:Humans; D001523:Mental Disorders / Q000517:prevention & control* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016728:Self-Injurious Behavior / Q000517:prevention & control*; D013406:Suicide, Attempted / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: meta-analysis; randomized controlled trials; self-harm