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Systematic Review
The authors state: "To assess the effects of psychosocial interventions or pharmacological agents or natural products for self-harm compared to comparison types of care (e.g. treatment‐as‐usual, routine psychiatric care, enhanced usual care, active comparator, placebo, alternative pharmacological treatment, or a combination of these) for children and adolescents (up to 18 years of age) who engage in self-harm"
The authors state: "We included data from 17 trials with a total of 2280 participants. Participants in these trials were predominately female (87.6%) with a mean age of 14.7 years (standard deviation (SD) 1.5 years). The trials included in this review investigated the effectiveness of various forms of psychosocial interventions. None of the included trials evaluated the effectiveness of pharmacological agents in this clinical population.
There was a lower rate of SH repetition for DBT‐A (30%) as compared to TAU, EUC, or alternative psychotherapy (43%) on repetition of SH at post‐intervention in four trials (OR 0.46, 95% CI 0.26 to 0.82; N = 270; k = 4; high‐certainty evidence).
There may be no evidence of a difference for individual cognitive behavioural therapy (CBT)‐based psychotherapy and TAU for repetition of SH at post‐intervention (OR 0.93, 95% CI 0.12 to 7.24; N = 51; k = 2; low‐certainty evidence). We are uncertain whether mentalisation based therapy for adolescents (MBT‐A) reduces repetition of SH at post‐intervention as compared to TAU (OR 0.70, 95% CI 0.06 to 8.46; N = 85; k = 2; very low‐certainty evidence). Heterogeneity for this outcome was substantial ( I² = 68%).
There is probably no evidence of a difference between family therapy and either TAU or EUC on repetition of SH at post‐intervention (OR 1.00, 95% CI 0.49 to 2.07; N = 191; k = 2; moderate‐certainty evidence). However, there was no evidence of a difference for compliance enhancement approaches on repetition of SH by the six‐month follow‐up assessment, for group‐based psychotherapy at the six‐ or 12‐month follow‐up assessments, for a remote contact intervention (emergency cards) at the 12‐month assessment, or for therapeutic assessment at the 12‐ or 24‐month follow‐up assessments."
The authors state: "Given the moderate or very low quality of the available evidence, and the small number of trials identified, there is only uncertain evidence regarding a number of psychosocial interventions in children and adolescents who engage in SH. Further evaluation of DBT‐A is warranted. Given the evidence for its benefit in adults who engage in SH, individual CBT‐based psychotherapy should also be further developed and evaluated in children and adolescents."