title: Effective psychological and psychosocial approaches to reduce repetition of self-harm: a systematic review, meta-analysis and meta-regression.
abstract: OBJECTIVE
  To examine the efficacy of psychological and psychosocial interventions for reductions in repeated self-harm.
  
  
  METHODS
  We conducted a systematic review, meta-analysis and meta-regression to examine the efficacy of psychological and psychosocial interventions to reduce repeat self-harm in adults. We included a sensitivity analysis of studies with a low risk of bias for the meta-analysis. For the meta-regression, we examined whether the type, intensity (primary analyses) and other components of intervention or methodology (secondary analyses) modified the overall intervention effect.
  
  
  METHODS
  A comprehensive search of MEDLINE, PsycInfo and EMBASE (from 1999 to June 2016) was performed.
  
  
  METHODS
  Randomised controlled trials of psychological and psychosocial interventions for adult self-harm patients.
  
  
  RESULTS
  Forty-five trials were included with data available from 36 (7354 participants) for the primary analysis. Meta-analysis showed a significant benefit of all psychological and psychosocial interventions combined (risk ratio 0.84; 95% CI 0.74 to 0.96; number needed to treat=33); however, sensitivity analyses showed that this benefit was non-significant when restricted to a limited number of high-quality studies. Meta-regression showed that the type of intervention did not modify the treatment effects.
  
  
  CONCLUSIONS
  Consideration of a psychological or psychosocial intervention over and above treatment as usual is worthwhile; with the public health benefits of ensuring that this practice is widely adopted potentially worth the investment. However, the specific type and nature of the intervention that should be delivered is not yet clear. Cognitive-behavioural therapy or interventions with an interpersonal focus and targeted on the precipitants to self-harm may be the best candidates on the current evidence. Further research is required.
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Sarah E
authors.identifier: http://orcid.org/0000-0003-2532-0142
authors.initials: SE
authors.lastname: Hetrick
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Jo
authors.initials: J
authors.lastname: Robinson
authors.affiliation: Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Spittal
authors.affiliation: Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Carter
keywords: MENTAL HEALTH