title: Te Ira Tangata: a Zelen randomised controlled trial of a culturally informed treatment compared to treatment as usual in Māori who present to hospital after self-harm.
abstract: Indigenous people have high rates of suicide and self-harm compared to other population groups.
  
  
  
  The aim of this trial was to see if a package of interventions delivered in a culturally appropriate way improved outcomes at one year in Maori who presented with intentional self-harm to emergency departments.
  
  
  
  Participants were Maori who presented with intentional self-harm to emergency departments in New Zealand. The study design was a double consent Zelen randomised controlled trial. The intervention included regular postcards, problem solving therapy, patient support, risk management, improved access to primary care and cultural assessment in addition to usual care. The control group received usual care. The main outcome measure was the self-rated change in scores on the Beck Hopelessness Scale at one year.
  
  
  
  182 people were randomized to the intervention group 95 of whom consented to take part in the study. 183 people were randomized to the control group 72 of whom consented to take part in the study. For those who consented comparing the intervention group with the control group there was a statistically significant greater change in hopelessness scores at 3 months (difference -1.7 95 % CI -3.4 to -0.01, p = 0.05) but not at one year (difference -1.6 95 % CI -3.4 to 0.3, p = 0.11). Maori who consented and received the intervention were also significantly less likely to present to hospital for non-self-harm reasons in the year after the index episode (44.2 vs. 61.1 %, p = 0.03). Those participants randomised to the intervention were less likely to re-present with self-harm at 3 months (10.4 vs. 18 %, p = 0.04) but not at 12 months compared to the control group.
  
  
  
  In Maori who presented to hospital with intentional self-harm a culturally informed intervention had an effect on hopelessness and re-presentation with self-harm in the short term but not at 12 months. There was a significant decrease in hospital presentations for non-self harm over the next year.
  
  
  
  Australian and New Zealand Clinical Trials Registry ACTRN12609000952246.
authors.affiliation: Department of Psychiatry, University of Ottawa, Room 5457, The Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada. shatcher@uottawa.ca.|Department of Psychological Medicine, University of Auckland, Auckland, New Zealand. shatcher@uottawa.ca.
authors.forename: Simon
authors.initials: S
authors.lastname: Hatcher
authors.affiliation: Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Nicole
authors.initials: N
authors.lastname: Coupe
authors.affiliation: Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Karen
authors.initials: K
authors.lastname: Wikiriwhi
authors.affiliation: Massey University, Palmerston North, New Zealand.
authors.forename: Sir Mason
authors.initials: SM
authors.lastname: Durie
authors.affiliation: Department of Statistics, University of Auckland, Auckland, New Zealand.
authors.forename: Avinesh
authors.initials: A
authors.lastname: Pillai
mesh_terms: D000328:Adult; D065246:Culturally Competent Care / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D009520:New Zealand / Q000208:ethnology; D010043:Outcome and Process Assessment, Health Care; D016728:Self-Injurious Behavior / Q000208:ethnology* / Q000517:prevention & control*
keywords: Attempted; Culture; Hopelessness; Indigenous; Maori; Randomised controlled trial; Suicide