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Meta-Analysis
. 2016 May 12;2016(5):CD012189.
doi: 10.1002/14651858.CD012189.

Psychosocial interventions for self-harm in adults

Keith Hawton  1 , Katrina G Witt, Tatiana L Taylor Salisbury, Ella Arensman, David Gunnell, Philip Hazell, Ellen Townsend, Kees van Heeringen
Affiliations
Meta-Analysis

Psychosocial interventions for self-harm in adults

Keith Hawton et al. Cochrane Database Syst Rev. .

Abstract

Background: Self-harm (SH; intentional self-poisoning or self-injury) is common, often repeated, and associated with suicide. This is an update of a broader Cochrane review first published in 1998, previously updated in 1999, and now split into three separate reviews. This review focuses on psychosocial interventions in adults who engage in self-harm.

Objectives: To assess the effects of specific psychosocial treatments versus treatment as usual, enhanced usual care or other forms of psychological therapy, in adults following SH.

Search methods: The Cochrane Depression, Anxiety and Neurosis Group (CCDAN) trials coordinator searched the CCDAN Clinical Trials Register (to 29 April 2015). This register includes relevant randomised controlled trials (RCTs) from: the Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date).

Selection criteria: We included RCTs comparing psychosocial treatments with treatment as usual (TAU), enhanced usual care (EUC) or alternative treatments in adults with a recent (within six months) episode of SH resulting in presentation to clinical services.

Data collection and analysis: We used Cochrane's standard methodological procedures.

Main results: We included 55 trials, with a total of 17,699 participants. Eighteen trials investigated cognitive-behavioural-based psychotherapy (CBT-based psychotherapy; comprising cognitive-behavioural, problem-solving therapy or both). Nine investigated interventions for multiple repetition of SH/probable personality disorder, comprising emotion-regulation group-based psychotherapy, mentalisation, and dialectical behaviour therapy (DBT). Four investigated case management, and 11 examined remote contact interventions (postcards, emergency cards, telephone contact). Most other interventions were evaluated in only single small trials of moderate to very low quality.There was a significant treatment effect for CBT-based psychotherapy compared to TAU at final follow-up in terms of fewer participants repeating SH (odds ratio (OR) 0.70, 95% confidence interval (CI) 0.55 to 0.88; number of studies k = 17; N = 2665; GRADE: low quality evidence), but with no reduction in frequency of SH (mean difference (MD) -0.21, 95% CI -0.68 to 0.26; k = 6; N = 594; GRADE: low quality).For interventions typically delivered to individuals with a history of multiple episodes of SH/probable personality disorder, group-based emotion-regulation psychotherapy and mentalisation were associated with significantly reduced repetition when compared to TAU: group-based emotion-regulation psychotherapy (OR 0.34, 95% CI 0.13 to 0.88; k = 2; N = 83; GRADE: low quality), mentalisation (OR 0.35, 95% CI 0.17 to 0.73; k = 1; N = 134; GRADE: moderate quality). Compared with TAU, dialectical behaviour therapy (DBT) showed a significant reduction in frequency of SH at final follow-up (MD -18.82, 95% CI -36.68 to -0.95; k = 3; N = 292; GRADE: low quality) but not in the proportion of individuals repeating SH (OR 0.57, 95% CI 0.21 to 1.59, k = 3; N = 247; GRADE: low quality). Compared with an alternative form of psychological therapy, DBT-oriented therapy was also associated with a significant treatment effect for repetition of SH at final follow-up (OR 0.05, 95% CI 0.00 to 0.49; k = 1; N = 24; GRADE: low quality). However, neither DBT vs 'treatment by expert' (OR 1.18, 95% CI 0.35 to 3.95; k = 1; N = 97; GRADE: very low quality) nor prolonged exposure DBT vs standard exposure DBT (OR 0.67, 95% CI 0.08 to 5.68; k = 1; N =18; GRADE: low quality) were associated with a significant reduction in repetition of SH.Case management was not associated with a significant reduction in repetition of SH at post intervention compared to either TAU or enhanced usual care (OR 0.78, 95% CI 0.47 to 1.30; k = 4; N = 1608; GRADE: moderate quality). Continuity of care by the same therapist vs a different therapist was also not associated with a significant treatment effect for repetition (OR 0.28, 95% CI 0.07 to 1.10; k = 1; N = 136; GRADE: very low quality). None of the following remote contact interventions were associated with fewer participants repeating SH compared with TAU: adherence enhancement (OR 0.57, 95% CI 0.32 to 1.02; k = 1; N = 391; GRADE: low quality), mixed multimodal interventions (comprising psychological therapy and remote contact-based interventions) (OR 0.98, 95% CI 0.68 to 1.43; k = 1 study; N = 684; GRADE: low quality), including a culturally adapted form of this intervention (OR 0.83, 95% CI 0.44 to 1.55; k = 1; N = 167; GRADE: low quality), postcards (OR 0.87, 95% CI 0.62 to 1.23; k = 4; N = 3277; GRADE: very low quality), emergency cards (OR 0.82, 95% CI 0.31 to 2.14; k = 2; N = 1039; GRADE: low quality), general practitioner's letter (OR 1.15, 95% CI 0.93 to 1.44; k = 1; N = 1932; GRADE: moderate quality), telephone contact (OR 0.74, 95% CI 0.42 to 1.32; k = 3; N = 840; GRADE: very low quality), and mobile telephone-based psychological therapy (OR not estimable due to zero cell counts; GRADE: low quality).None of the following mixed interventions were associated with reduced repetition of SH compared to either alternative forms of psychological therapy: interpersonal problem-solving skills training, behaviour therapy, home-based problem-solving therapy, long-term psychotherapy; or to TAU: provision of information and support, treatment for alcohol misuse, intensive inpatient and community treatment, general hospital admission, or intensive outpatient treatment.We had only limited evidence on whether the intervention had different effects in men and women. Data on adverse effects, other than planned outcomes relating to suicidal behaviour, were not reported.

Authors' conclusions: CBT-based psychological therapy can result in fewer individuals repeating SH; however, the quality of this evidence, assessed using GRADE criteria, ranged between moderate and low. Dialectical behaviour therapy for people with multiple episodes of SH/probable personality disorder may lead to a reduction in frequency of SH, but this finding is based on low quality evidence. Case management and remote contact interventions did not appear to have any benefits in terms of reducing repetition of SH. Other therapeutic approaches were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to these interventions is inconclusive.

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Conflict of interest statement

KH and DG each authored three of the trials included in the review, EA authored two trials, and KvH is the author of one of the trials.

Figures

1
1
Search flow diagram of included and excluded studies for the 2014 update.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison 1: CBT‐based psychotherapy vs treatment as usual for repetition of SH at six months
5
5
Funnel plot of comparison 1: CBT‐based psychotherapy vs treatment as usual for repetition of SH at 12 months
6
6
Funnel plot of comparison 1: CBT‐based psychotherapy vs treatment as usual for repetition of SH at final follow‐up
7
7
Funnel plot of comparison 1: CBT‐based psychotherapy vs Treatment as usual for depression scores at final follow‐up.
1.1
1.1. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 1: Repetition of SH at 6 months
1.2
1.2. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 2: Repetition of SH at 12 months
1.3
1.3. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 3: Repetition of SH at 24 months
1.4
1.4. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 4: Repetition of SH at final follow‐up
1.5
1.5. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 5: Frequency of SH at final follow‐up
1.6
1.6. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 6: Depression scores at 6 months
1.7
1.7. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 7: Depression scores at 12 months
1.8
1.8. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 8: Depression scores at 24 months
1.9
1.9. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 9: Depression scores at final follow‐up
1.10
1.10. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 10: Hopelessness scores at post‐intervention
1.11
1.11. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 11: Hopelessness scores at 6 months
1.12
1.12. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 12: Hopelessness scores at 12 months
1.13
1.13. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 13: Hopelessness scores at final follow‐up
1.14
1.14. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 14: Suicidal ideation scores at post‐intervention
1.15
1.15. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 15: Suicidal ideation scores at 6 months
1.16
1.16. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 16: Suicidal ideation scores at final follow‐up
1.17
1.17. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 17: Proportion with improved problems at 6 months
1.18
1.18. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 18: Proportion with improved problems at final follow‐up
1.19
1.19. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 19: Problem‐solving scores at post‐intervention
1.20
1.20. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 20: Problem‐solving scores at 6 months
1.21
1.21. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 21: Problem‐solving scores at final follow‐up
1.22
1.22. Analysis
Comparison 1: Cognitive behavioural therapy (CBT)‐based psychotherapy vs. treatment as usual (TAU), Outcome 22: Suicide at final follow‐up
2.1
2.1. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 1: Repetition of SH at post‐intervention
2.2
2.2. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 2: Repetition of SH at 6 months
2.3
2.3. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 3: Repetition of SH at 12 months
2.4
2.4. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 4: Repetition of SH at final follow‐up
2.5
2.5. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 5: Frequency of repetition of SH at post‐intervention
2.6
2.6. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 6: Frequency of repetition of SH at 6 months
2.7
2.7. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 7: Number completing full course of treatment
2.8
2.8. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 8: Depression scores at post‐intervention
2.9
2.9. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 9: Depression scores at 6 months
2.10
2.10. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 10: Depression scores at 12 months
2.11
2.11. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 11: Suicide ideation scores at post‐intervention
2.12
2.12. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 12: Suicide ideation scores at 12 months
2.13
2.13. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 13: Suicide at post‐intervention
2.14
2.14. Analysis
Comparison 2: Interventions for multiple repetition of self‐harm (SH)/probable personality disorder vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 14: Suicide at 6 months
3.1
3.1. Analysis
Comparison 3: Case management vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 1: Repetition of SH at post‐intervention
3.2
3.2. Analysis
Comparison 3: Case management vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 2: Suicide at post‐intervention
4.1
4.1. Analysis
Comparison 4: Treatment adherence enhancement approaches vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 1: Repetition of SH at 12 months
4.2
4.2. Analysis
Comparison 4: Treatment adherence enhancement approaches vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 2: Depression scores at 12 months
4.3
4.3. Analysis
Comparison 4: Treatment adherence enhancement approaches vs treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 3: Suicide at 12 months
5.1
5.1. Analysis
Comparison 5: Remote contact interventions vs treatment as usual (TAU), Outcome 1: Repetition of SH at post‐intervention
5.2
5.2. Analysis
Comparison 5: Remote contact interventions vs treatment as usual (TAU), Outcome 2: Repetition of SH at 12 months
5.3
5.3. Analysis
Comparison 5: Remote contact interventions vs treatment as usual (TAU), Outcome 3: Repetition of SH at final follow‐up
5.4
5.4. Analysis
Comparison 5: Remote contact interventions vs treatment as usual (TAU), Outcome 4: Frequency of SH at post‐intervention
5.5
5.5. Analysis
Comparison 5: Remote contact interventions vs treatment as usual (TAU), Outcome 5: Frequency of SH at 12 months
5.6
5.6. Analysis
Comparison 5: Remote contact interventions vs treatment as usual (TAU), Outcome 6: Suicide at post‐intervention
5.7
5.7. Analysis
Comparison 5: Remote contact interventions vs treatment as usual (TAU), Outcome 7: Suicide at 12 months
5.8
5.8. Analysis
Comparison 5: Remote contact interventions vs treatment as usual (TAU), Outcome 8: Suicide at final follow‐up
6.1
6.1. Analysis
Comparison 6: Other mixed interventions versus treatment as usual (TAU) or other alternative forms of psychotherapy, Outcome 1: Repetition of SH at final follow‐up
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Comment in

  • [The soothing pain].
    Møhl B. Møhl B. Ugeskr Laeger. 2016 Nov 28;178(48):V68569. Ugeskr Laeger. 2016. PMID: 27908319 Danish. No abstract available.

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Linehan 2006 {published and unpublished data}
    1. Bedics JD, Atkins DC, Comtois JA, Linehan MM. Treatment differences in the therapeutic relationship and introject during a 2-year randomized controlled trial of dialectical behavior therapy versus non-behavioral psychotherapy experts for borderline personality disorder. Journal of Consulting and Clinical Psychology 2012;80(1):66-77. - PMC - PubMed
    1. Bedics JD, Atkins DC, Harned MS, Linehan MM. The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder. Psychotherapy: Theory, Research and Practice 2015;52(1):67-77. - PubMed
    1. Harned MS, Chapman AL, Dexter-Mazza ET, Murray A, Comtois KA, Linehan MM. Treating co-occurring axis I disorders in recurrently suicidal women with borderline personality disorder: A 2-year randomized trial of dialectical behavior therapy versus community treatment by experts. Journal of Consulting and Clinical Psychology 2008;76(6):1068-75. - PubMed
    1. Harned MS, Chapman AL, Dexter-Mazza ET, Murray A, Comtois KA, Linehan MM. Treating co-occurring axis I disorders in recurrently suicidal women with borderline personality disorder: A 2-year randomized trial of dialectical behavior therapy versus community treatment by experts. Personality Disorders: Theory, Research and Treatment 2009;5:35-45. - PubMed
    1. Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry 2006;63(7):757-66. - PubMed
Marasinghe 2012 {published and unpublished data}
    1. Marasinghe RB, Edirippulige S, Kavanagh D, Smith A, Jiffry MTM. Effect of mobile phone-based psychotherapy in suicide prevention: A randomized controlled trial in Sri Lanka. Journal of Telemedicine and Telecare 2012;18(3):151-5. - PubMed
    1. Marasinghe RB. Evaluation of a Brief Inpatient and Community Intervention to Address Suicide Risk in Sri Lanka Using Mobile Phones [PhD thesis]. Brisbane, Australia: The Univerity of Queensland, School of Medicine, 2012.
McAuliffe 2014 {published and unpublished data}
    1. McAuliffe C, McLeavey BC, Fitzgerald T, Corcoran P, Carroll B, Ryan L, O'Keeffe B, Fitzgerald E, Hickey P, O'Regan M, Mulqueen J, Arensman E. Group problem-solving skills training for self-harm: Randomised controlled trial. British Journal of Psychiatry 2014;204:383-90. - PubMed
McLeavey 1994 {published data only}
    1. McLeavey B, Daly R, Ludgate J, Murray C. Interpersonal problem-solving skills training in the treatment of self-poisoning patients. Suicide and Life-Threatening Behavior 1994;24(4):382-94. - PubMed
McMain 2009 {published and unpublished data}
    1. Case BG. Dialectical behavior therapy versus general psychiatric management in the treatment of borderline personality disorder. American Journal of Psychiatry 2010;167(4):475. - PubMed
    1. McMain SF, Guimond T, Streiner DL, Cardish RJ, Links PS. Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: Clinical outcomes and functioning over a 2-year follow-up. American Journal of Psychiatry 2012;169(6):650-61. - PubMed
    1. McMain SF, Links PS, Gnam WH, Guimond T, Cardish RJ, Korman L, Streiner DL. A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry 2009;166(12):1365-74. - PubMed
Morgan 1993 {published data only}
    1. Morgan HG, Jones EM, Owen JH. Secondary prevention of non-fatal deliberate self-harm. The green card study. British Journal of Psychiatry 1993;163:111-2. - PubMed
Morthorst 2012 {published data only}
    1. Morthorst B, Krogh J, Erlangsen A, Alberdi F, Nordentoft M. Effect of assertive outreach after suicide attempt in the AID (Assertive Intervention for Deliberate self-harm) trial: randomised controlled trial. British Medical Journal 2012;345:e4972. - PMC - PubMed
Patsiokas 1985 {published data only}
    1. Patsiokas AT, Clum GA. Effects of psychotherapeutic strategies in the treatment of suicide attempters. Psychotherapy: Theory, Research and Practice 1985;22(2):281-90.
Priebe 2012 {published and unpublished data}
    1. Priebe S, Bhatti N, Barnicot K, Bremner S, Gaglia A, Katsakou C, Molosankwe I, McCrone P, Zinkler M. Effectiveness and cost-effectiveness of dialectical behaviour therapy for self-harming patients with personality disorder: A pragmatic randomised controlled trial. Psychotherapy and Psychosomatics 2012;81(6):356-65. - PubMed
Salkovskis 1990 {published data only}
    1. Salkovskis PM, Atha C, Storer D. Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide. A controlled trial. British Journal of Psychiatry 1990;157:871-876. - PubMed
Slee 2008 {published and unpublished data}
    1. Slee N, Garnefski N, Van der Leeden R, Arensman E, Spinhoven P. Cognitive-behavioural intervention for self-harm: Randomised controlled trial. British Journal of Psychiatry 2008;192:202-11. - PubMed
Stewart 2009 {published and unpublished data}
    1. Stewart CD, Quinn A, Plever S, Emmerson B. Comparing cognitive behavior therapy, problem solving therapy, and treatment as usual in a high risk population. Suicide and Life-Threatening Behavior 2009;39(5):538-47. - PubMed
Tapolaa 2010 {published and unpublished data}
    1. Tapolaa V, Lappalainen R, Wahlström J. Brief intervention for deliberate self-harm: An exploratory study. Suicidology Online 2010;1:95-108.
Torhorst 1987 {published data only}
    1. Möller HJ. Efficacy of different strategies of aftercare for patients who have attempted suicide. Journal of the Royal Society of Medicine 1989;82(11):643-7. - PMC - PubMed
    1. Torhorst A, Möller HJ, Bürk F, Kurz A, Wächtler C, Lauter H. The psychiatric management of parasuicide patients: A controlled clinical study comparing different strategies of outpatient treatment. Crisis 1987;8(1):53-61. - PubMed
Torhorst 1988 {published data only}
    1. Torhorst A, Möller HJ, Kurz A, Schmid-Bode W, Lauter H. Comparing a 3-month and a 12-month-outpatient aftercare program for parasuicide repeaters. In: Möller HJ, Schmidtke A, Welz R, editors(s). Current Issues of Suicidology. Berlin, Germany: Springer-Verlag, 1988:419-24.
Turner 2000 {published data only}
    1. Turner RM. Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cognitive and Behavioral Practice 2000;7(4):413-9.
Tyrer 2003 {published data only}
    1. Tyrer P, Thompson S, Schmidt U, Jones V, Knapp M, Davidson K, Catalan J, Airlie J, Baxter S, Byford S, Byrne G, Cameron S, Caplan R, Cooper S, Ferguson B, Freeman C, Frost S, Godley J, Greenshields J, Henderson J, Holden N, Keech P, Kim L, Logan K, Manley C, MacLeod A, Murphy R, Patience L, Ramsay L, De Munroz S, Scott J, Seivewright H, Sivakumar K, Tata P, Thornton S, Ukoumunne OC, Wessely S. Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: The POPMACT study. Psychological Medicine 2003;33(6):969-76. - PubMed
Vaiva 2006 {published data only}
    1. Vaiva G, Ducrocq F, Meyer P, Mathieu D, Philippe A, Libersa C, Goudemand M. Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: Randomised controlled study. British Medical Journal 2006;332(7552):1241-5. - PMC - PubMed
Van der Sande 1997a {published data only}
    1. Van der Sande R, Buskens E, Van der Graaf Y, Van Rooijen E, Allart E, Van Engeland H. No measurable effect from general socio-psychiatric care for those attempting suicide: A randomized experiment [Geen meetbaar effect van algemene sociaal-psychiatrische nazorg voor suicidepogers; een gerandomiseerd experiment]. Nederlands Tijdschrift voor de Geneeskunde 1998;142:2356.
    1. Van der Sande R, Van Rooijen L, Buskens E, Allart E, Hawton K, Van der Graaf Y, Van Engeland H. Intensive in-patient and community intervention versus routine care after attempted suicide. A randomised controlled intervention study. British Journal of Psychiatry 1997;171:35-41. - PubMed
Van Heeringen 1995 {published data only}
    1. Van Heeringen C, Jannes S, Buylaert W, Hendrick H, De Bacquer D, Van Remoortel J. The management of non-compliance with referral to out-patient after-care among attempted suicide patients: A controlled intervention study. Psychological Medicine 1995;25(5):963-70. - PubMed
Waterhouse 1990 {published data only}
    1. Waterhouse J, Platt S. General hospital admission in the management of parasuicide. A randomised controlled trial. British Journal of Psychiatry 1990;156:236-242. - PubMed
Wei 2013 {published data only}
    1. Wei S, Liu L, Bi B, Li H, Hou J, Tan S, Chen X, Chen W, Jia X, Dong G, Qin X, Liu Y. An intervention and follow-up study following a suicide attempt in the emergency departments of four general hospitals in Shenyang, China. Crisis 2013;34(2):107-15. - PubMed
Weinberg 2006 {published data only}
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Welu 1977 {published data only}
    1. Welu T. A follow-up program for suicide attempters: Evaluation of effectiveness. Suicide and Life-Threatening Behavior 1977;7(1):17-30. - PubMed

References to studies excluded from this review

Almeida 2012 {published data only}
    1. Almeida OP, Pirkis J, Kerse N, Sim M, Flicker L, Snowdon J, Draper B, Byrne G, Goldney R, Lautenschlager NT, Stocks N, Alfonso H, Pfaff JJ. A randomized trial to reduce the prevalence of depression and self-harm behavior in older primary care patients. Annals of Family Medicine 2012;10(4):347-56. - PMC - PubMed
Aoun 1999 {published data only}
    1. Aoun S. Deliberate self-harm in rural Western Australia: Results of an intervention study. Australian and New Zealand Journal of Mental Health Nursing 1999;8(2):65-73. - PubMed
Bannan 2010 {published and unpublished data}
    1. Bannan, N. Group-based problem-solving therapy in self-poisoning females: A pilot study. Counselling and Psychotherapy Research 2010;10(3):201-13.
Bartman 1979 {published data only}
    1. Bartman ER. Assertive training with hospitalized suicide attempters [PhD thesis]. Washington DC: Catholic University of America, 1979.
Bateson 1989 {published data only}
    1. Bateson M, Oliver JPJ, Goldberg DP. A comparative study of the management of cases of deliberate self-harm in a district general hospital. British Journal of Social Work 1989;19(1):461-78.
Berrino 2011 {published data only}
    1. Berrino A, Ohlendorf P, Duriaux S, Burnand Y, Lorillard S, Andreoli A. Crisis intervention at the general hospital: An appropriate treatment choice for acutely suicidal borderline patients. Psychiatry Research 2011;186(2-3):287-92. - PubMed
Carter 2013 {published data only}
    1. Carter GL, Clover K, Whyte IM, Dawson AH, D'este C. Postcards from the EDge: 5-year outcomes of a randomised controlled trial for hospital-treated self-poisoning. British Journal of Psychiatry 2013;202:372-80. - PubMed
Cebrià 2013 {published data only}
    1. Cebrià AI, Parra I, Pàmias M, Escayola A, García-Parés G, Puntí J, Laredo A, Vallès V, Cavero M, Oliva JC, Hegerl U, Pérez-Solà V, Palao DJ. Effectiveness of a telephone management programme for patients discharged from an emergency department after a suicide attempt: Controlled study in a Spanish population. Journal of Affective Disorders 2013;147(1-3):269-76. - PubMed
Chen 2013 {published and unpublished data}
    1. Chen W-J, Ho C-K, Shyu S-S, Chen C-C, Lin G-G, Chou L-S, Fang YJ, Yeh PY, Chung TC, Chou FH. Employing crisis postcards with case management in Kaohsiung, Taiwan: 6-month outcomes of a randomised controlled trial for suicide attempters. BMC Psychiatry 2013;13(191):191-97. - PMC - PubMed
Chowdhury 1973 {published data only}
    1. Chowdhury N, Hicks R, Kreitman N. Evaluation of an after-care service for parasuicide (attempted suicide) patients. Social Psychiatry 1973;8:67-81.
Christensen 2014 {published data only}
    1. Christensen H, Calear AL, Van Spijker B, Gosling J, Petrie K, Donker T, Fenton K. Psychosocial interventions for suicidal ideation, plans, and attempts: A database of randomised controlled trials. BMC Psychiatry 2014;14:86. - PMC - PubMed
Comtois 2011 {published and unpublished data}
    1. Comtois KA, Jobes DA, O'Connor SS, Atkins DC, Janis K, Chessen CE, Landes SJ, Holen A, Yuodelis-Flores C. Colloborative assessment and management of suicidality (CAMS): Feasibility trial for next-day appointment services. Depression and Anxiety 2011;28(11):963-72. - PubMed
    1. Ellis TE, Green KL, Allen JG, Jobes DA, Nadorff MR. Collaborative assessment and management of suicidality in an inpatient setting: Results of a pilot study. Psychotherapy 2012;49(1):72-80. - PMC - PubMed
    1. Jobes DA. The Collaborative Assessment and Management of Suicidality (CAMS): An evolving evidence-based clinical approach to suicidal risk. Suicide and Life-Threatening Behavior 2012;42(6):640-53. - PubMed
Crawford 1998 {published data only}
    1. Crawford MJ, Turnbull G, Wessely S. Deliberate self-harm assessment by accident and emergency staff--an intervention study. Journal of Accident and Emergency Medicine 1998;15(1):18-22. - PMC - PubMed
Currier 2010 {published data only}
    1. Currier GW, Fisher SG, Caine ED. Mobile crisis team intervention to enhance linkage of discharged suicidal emergency department patients to outpatient psychiatric services: A randomized controlled trial. Academic Emergency Medicine 2010;17(1):35-43. - PMC - PubMed
Davidson 2006 {published data only}
    1. Davidson K, Norrie J, Tyrer P, Gumley A, Tata P, Murray H, Palmer S. The effectiveness of cognitive behavior therapy for borderline personality disorder: Results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. Journal of Personality Disorders 2006;20(5):450-65. - PMC - PubMed
    1. Norrie J, Davidson K, Tata P, Gumley A. Influence of therapist competence and quantity of cognitive behavioural therapy on suicidal behaviour and inpatient hospitalisation in a randomised controlled trial in borderline personality disorder: Further analyses of treatment effects in the BOSCOT study. Psychology and Psychotherapy: Theory, Research and Practice 2013;86:280-293. - PMC - PubMed
De Leo 2007 {published data only}
    1. De Leo D, Heller T. Intensive case management in suicide attempters following discharge from psychiatric care. Australian Journal of Primary Health 2007;13(3):49-58.
Evans 1998 {published and unpublished data}
    1. Evans J, Sheard T. A pilot study of a three session treatment package beginning during admission for deliberate self-harm. In: South West Research and Development Directorate Conference. 1998.
George 2014 {published data only}
    1. George MS, Raman R, Benedek DM, Pelic CG, Crammer GG, Stokes KT, Schmidt M, Spiegel C, Dealmeida N, Beaver KL, Borckardt JJ, Sun X, Jain S, Stein MB. A two-site pilot randomized 3 day trial of high dose left prefrontal repetitiveTranscranial Magnetic Stimulation (rTMS) for suicidal inpatients. Brain Stimulation 2014;7(3):421-31. - PubMed
Ghahramanlou‐Holloway 2012 {published data only}
    1. Ghahramanlou-Holloway M, Crox DW, Greene FN. Post-admission cognitive therapy: A brief intervention for psychiatric inpatients admitted after a suicide attempt. Cognitive and Behavioral Practice 2012;19(2):233-44.
Gunnarsdottir 2010 {published data only}
    1. Gunnarsdottir OS, Rafnsson V. Risk of suicide and fatal drug poisoning after discharge from the emergency department: A nested case-control study. Emergency Medicine Journal 2010;27(2):93-6. - PubMed
Harned 2010 {published data only}
    1. Harned MS, Jackson SC, Comtois KA, Linehan MM. Dialectical behavior therapy as a precursor to PTSD treatment for suicidal and/or self-injuring women with borderline personality disorder. Journal of Traumatic Stress 2010;23(4):421-9. - PubMed
Hatcher 2005 {published data only}
    1. Hatcher S, Sharon C, Fontanella I, Healey C. A patient preference trial of problem solving therapy after attempted suicide: Work in progress. Australian and New Zealand Journal of Psychiatry 2005;39:A121-A122.
Hellerstein 2003 {published data only}
    1. Hellerstein DJ, Aviram R, Gerson, Stanley B. Supportive therapy for BPD patients with self-injurious behavior. In: Proceedings of the 156th Annual Meeting of the American Psychiatric Association. San Francisco, CA. 2003:10.
Horrocks 2002 {published data only}
    1. Horrocks J, Owens D, House A. General practice based interventions to prevent repeat episodes of deliberate self-harm. Pictures of self-injury misrepresent published trial. British Journal of Medicine 2002;325(7358):281. - PubMed
Kapur 2013b {published data only}
    1. Kapur N, Steeg S, Webb R, Haigh M, Bergen H, Hawton K, Ness J, Waters K, Cooper J. Does clinical management improve outcomes following self-harm? Results from the multicentre study of self-harm in England. PLoS One 2013;8(8):e70434. - PMC - PubMed
Lamprecht 2007 {published data only}
    1. Lamprecht H, Laydon C, McQuillan C, Wiseman S, Williams L, Gash A, Reilly J. Single-session solution-focused brief therapy and self-harm: a pilot study. Journal of Psychiatric and Mental Health Nursing 2007;14(6):601-2. - PubMed
Liberman 2001 {published data only}
    1. Liberman RP. Follow-up for parasuicidal patients. Psychiatric Services 2001;52(9):1254. - PubMed
Links 1999 {published data only}
    1. Links PS, Balchand K, Dawe I, Watson WJ. Preventing recurrent suicidal behaviour. Canadian Family Physician 1999;45:2656-60. - PMC - PubMed
Links 2003a {published data only}
    1. Links PS, Bergmans Y, Cook M. Psychotherapeutic interventions to prevent repeated suicidal behavior. Brief Treatment and Crisis Intervention 2003;3:445-64.
Low 2001 {published data only}
    1. Low G, Jones D, Duggan C, Power M, MacLeod A. The treatment of deliberate self-harm in borderline personality disorder using dialectical behaviour therapy: A pilot study in a high security hospital. Behavioural and Cognitive Psychotherapy 2001;29(1):85-92.
Martin 2013 {published and unpublished data}
    1. Martin S, Martin G, Lequertier B, Swannell S, Follent A, Choe F. Voice movement therapy: Evaluation of a group-based expressive arts therapy for nonsuicidal self-injury in young adults. Music and Medicine 2013;5(1):31-8.
McMain 2007a {published data only}
    1. McMain S. Effectiveness of psychosocial treatments on suicidality in personality disorders. Canadian Journal of Psychiatry/Revue Canadienne de Psychiatrie 2007;52(6 Suppl 1):s103-s114. - PubMed
McQuillan 2005 {published data only}
    1. McQuillan A, Nicastro R, Guenot F, Girard M, Lissner C, Ferrero F. Intensive dialectical behavior therapy for outpatients with borderline personality disorder who are in crisis. Psychiatric Services 2005;56(2):193-7. - PubMed
Montgomery 1983 {published data only}
    1. Montgomery S, Roy D, Montgomery D. The prevention of recurrent suicidal acts. British Journal of Clinical Pharmacology 1983;15(Suppl 2):s183s-s188. - PMC - PubMed
Morley 2014 {published data only}
    1. Morley KC, Sitharthan G, Haber PS, Tucker P, Sitharthan T. The efficacy of an Opportunistic Cognitive Behavioral Intervention Package (OCB) on substance use and comorbid suicide risk: A multisite randomized controlled trial. Journal of Consulting and Clinical Psychology 2014;82(1):130-40. - PubMed
Ono 2008 {published data only}
    1. Inagaki M, Yamada M, Tonemoto N, Takahashi K on behalf of the J-MISP group. NOCOMIT-J: A community intervention trial of multi-modal suicide prevention program in Japan. European Psychiatry 2012;27:s1.
    1. Ono Y, Awata S, Iida H, Ishida Y, Ishizuka N, Iwasa H, Kamei Y, Motohashi Y, Nakagawa A, Nakamura J, Nishi N, Otsuka K, Oyama H, Sakai A, Sakai H, Suzuki Y, Tajima M, Tanaka E, Uda H, Yonemoto N, Yotsumoto T, Watanabe N. A community intervention trial of multimodal suicide prevention program in Japan: A novel multimodal community intervention program to prevent suicide and suicide attempt in Japan, NOCOMIT-J. BMC Public Health 2008;8:315. - PMC - PubMed
Pham‐Scottez 2010 {published data only}
    1. Pham-Scottez A. Impact of a 24/24 phone permanency on suicide attempts of borderline patients [Évaluation de l'efficacité d'une permanence téléphonique sur l'incidencedes tentatives de suicide des patients borderline]. Annales Medico-Psychologiques 2010;168(2):141-4.
Raj 2001 {published data only}
    1. Raj MAJ, Kumaraiah V, Bhide AV. Cognitive-behavioural intervention in deliberate self-harm. Acta Psychiatrica Scandinavica 2001;104(5):340-5. - PubMed
Razzaque 2013 {published data only}
    1. Razzaque R. An acceptance and commitment therapy based protocol for the management of acute self-harm and violence in severe mental illness. Journal of Psychiatric Intensive Care 2013;9:72-6.
Ruchlewska 2013 {published data only}
    1. Ruchlewska A, Wierdsma AI, Kamperman AM, Gaag M, Smulders R, Roosenschoon B-J, Mulder CL. Effect of crisis plans on admissions and emergency visits: A randomized controlled trial. PLoS One 2014;9(3):e91882. - PMC - PubMed
Sáiz 2014 {published and unpublished data}
    1. Sáiz PA, Rodríguez-Revuelta J, González-Blanco L, Burón P, Al-Halabí S, Garrido M, García-Alvarez L, García-Portilla P, Bobes J. Study protocol of a prevention of recurrent suicidal behaviour program based on case management (PSyMAC) [Protocolo de estudio de un programa para la prevención de la recurrencia del comportamiento suicida basado en el manejo de casos (PSyMAC)]. Revista de Psiquiatría y Salud Mental 2014;7(3):131-8. - PubMed
Sambrook 2007 {published data only}
    1. Sambrook S, Abba N, Chadwick P. Evaluation of DBT emotional coping skills groups for people with parasuicidal behaviours. Behavioural and Cognitive Psychotherapy 2007;35(2):241-4.
Strum 2012 {published and unpublished data}
    1. Sturm J, Plöderl M, Fartacek C, Kralovec K, Neunhäuserer D, Niederseer D, Hitzl W, Niebauer J, Schiepek G, Fartacek R. Physical exercise through mountain hiking in high-risk suicide patients. A randomized crossover trial. Acta Psychiatrica Scandinavica 2012;126(6):467-75. - PubMed
Tarrier 2008a {published data only}
    1. Tarrier N, Taylor K, Gooding P. Cognitive-behavioral interventions to reduce suicide behavior: A systematic review and meta-analysis. Behavior Modification 2008;32(1):77-108. - PubMed
Termansen 1975 {published data only}
    1. Termansen PE, Bywater C. S.A.F.E.R.: A follow-up service for attempted suicide in Vancouver. Canadian Psychiatric Association Journal 1975;20(1):29-34. - PubMed
Trembley 2013 {published data only}
    1. Trembley AL, Page D. Staying off the ledge: Effectiveness of follow-up postcards to suicidal patients. Journal of Emergency Medical Services 2010;38:26-7.
Van Spijker 2010 {published data only}
    1. Van Spijker BAJ, Van Straten A, Kerkhof AJFM. The effectiveness of a web-based self-help intervention to reduce suicidal thoughts: A randomized controlled trial. Trials 2010;11:25. - PMC - PubMed
Vitiello 2009 {published data only}
    1. Stanley B, Brown G, Brent DA, Wells K, Poling K, Curry J, Kennard BD, Wagner A, Cwik MF, Klomek AB, Goldstein T, Vitiello B, Barnett S, Daniel S, Hughes J. Cognitive-behavioral therapy for suicide prevention (CBT-SP): Treatment model, feasibility, and acceptability. Journal of the American Academy of Child and Adolescent Psychiatry 2009;48(10):1005-30. - PMC - PubMed
    1. Vitiello B, Brent DA, Greenhill LL, Emslie G, Wells K, Walkup JT, Stanley B, Bukstein O, Kennard BD, Compton S, Coffey B, Cwik MF, Posner K, Wagner A, March JS, Riddle M, Goldstein T, Curry J, Capasso L, Mayes T, Shen S, Gugga SS, Turner JB, Barnett S, Zelazny J. Depressive symptoms and clinical status during the Treatment of Adolescent Suicide Attempters (TASA) study. Journal of the American Academy of Child and Adolescent Psychiatry 2009;48(10):997-1004. - PMC - PubMed
Warren 2004 {published data only}
    1. Warren F, Evans C, Dolan B, Norton K. Impulsivity and self-damaging behaviour in severe personality disorder: The impact of democratic therapeutic community treatment. Therapeutic Communities 2004;25(1):55-71.
Winter 2007 {published data only}
    1. Winter D, Sireling L, Riley T, Metcalfe C, Quaite A, Bhandari S. A controlled trial of personal construct psychotherapy for deliberate self-harm. Psychology and Psychotherapy 2007;80(Pt 1):23-37. - PubMed
Wullimier 1979 {published data only}
    1. Wullimier F, Bovet J, Meylan D. Comparative study of two intervention modes on suicide attempters hospitalized in the general hospital. In: Proceedings of the 9th International Conference on Suicide Prevention. Helsinki, Finland, 1977.
    1. Wullimier F, Bovet J, Meylan D. The future of suicidal patients admitted to a general hospital. Comparative study of two methods of preventing recurrence and suicides. Sozial-und Praventivmedizin 1979;24(1):73-88. - PubMed
Zhang 2013 {published data only}
    1. Zhang H, Neelarambam K, Schwenke TJ, Rhodes MN, Pittman DM, Kaslow NJ. Mediators of a culturally-sensitive intervention for suicidal African American women. Journal of Clinical Psychology in Medical Settings 2013;20(4):401-14. - PMC - PubMed

References to studies awaiting assessment

Andreasson 2016 {published and unpublished data}
    1. Andreasson K, Krogh J, Rosenbaum B, Gluud C, Jobes DA, Nordentoft M. The DiaS trial: dialectical behavior therapy versus collaborative assessment and management of suicidality on self-harm in patients with a recent suicide attempt and borderline personality disorder traits - study protocol for a randomized controlled trial. Trials 2014;15:194. - PMC - PubMed
    1. Andreasson K, Krogh J, Wenneberg C, Jessen HK, Krakauer K, Gluud C, Thomsen RR, Randers L, Nordentoft M. Effectiveness of dialectical behavior therapy versus collaborative assessment and management of suicidality treatment for reduction of self-harm in adults with borderline personality traits and disorder - a randomized observer-blinded clinical trial. Depression and Anxiety 2016:DOI: 10.1002/da.22472. - PubMed
Armitage 2016 {published and unpublished data}
    1. Armitage CJ, Rahim WA, Rowe R, O'Connor RC. An exploratory randomised trial of a simple, brief psychological intervention to reduce subsequentsuicidal ideation and behaviour in patients admitted to hospital for self-harm. British Journal of Psychiatry 2016;208(5):470-6. - PubMed
Gysin‐Maillart 2016 {published data only}
    1. Gysin-Maillart A, Schwab S, Soravia L, Megert M, Michel K. A novel brief therapy for patients who attempt suicide: A 24-months follow-up randomized controlled study of the Attempted Suicide Short Intervention Program (ASSIP). PLoS Medicine 2016;13:e1001968. - PMC - PubMed
Linehan 2015 {published data only (unpublished sought but not used)}
    1. Linehan MM, Korslund KE, Harned MS, Gallop RJ, Lungu A, Neacsiu AD, McDavid J, Comtois KA, Murray-Gregory AM. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. Journal of the American Medical Association 2015;72(5):475-82. - PubMed

References to ongoing studies

Agyapong 2013 {published data only (unpublished sought but not used)}
    1. Agyapong VIO, Buckmaster R, McKeever P, O'Raghallaigh JW, Houlihan P, MacHale S. Text message intervention to reduce repeat self-harm in patients presenting to the emergency department - a study protocol. British Journal of Medicine and Medical Research 2013;3(4):2222-3.
    1. NCT01823120. Text message intervention to reduce repeat self-harm in patients presenting to the emergency department. https://clinicaltrials.gov/ct2/show/NCT01823120 (accessed 4 December 2015).
Andover 2008 {published data only (unpublished sought but not used)}
    1. NCT01018433. Development of an intervention for non-suicidal self-injury in young adults. https://clinicaltrials.gov/ct2/show/NCT01018433 (accessed 4 December 2015).
Berrouiquet 2015 {published data only}
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