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. 2020 Jan 10:18:100246.
doi: 10.1016/j.eclinm.2019.100246. eCollection 2020 Jan.

Longer-term effectiveness of systemic family therapy compared with treatment as usual for young people after self-harm: An extended follow up of pragmatic randomised controlled trial

D J Cottrell  1 , A Wright-Hughes  2 , I Eisler  3 , S Fortune  4 , J Green  5   6 , A O House  1 , M Kerfoot  7 , D W Owens  1 , M Simic  8 , V McLellan  2 , S Tubeuf  9 , A J Farrin  2
Affiliations

Longer-term effectiveness of systemic family therapy compared with treatment as usual for young people after self-harm: An extended follow up of pragmatic randomised controlled trial

D J Cottrell et al. EClinicalMedicine. .

Abstract

Background: Self-harm in adolescents is common and repetition frequent. Evidence for effective interventions to reduce self-harm is limited. Long term follow-up of existing studies is rare.

Methods: Extended follow up, from 18 to at least 36-months, of the SHIFT trial: a pragmatic, multi-centre, individually-randomised, controlled trial involving young people (11-17) who had self-harmed at least twice and presented to Child & Adolescent Mental Health Services (CAMHS). SHIFT evaluated manualised family therapy (FT) versus treatment as usual (TAU) in reducing repetition of self-harm leading to hospital attendance 18 months post-randomisation.We obtained ONS mortality data, adult mental health data, and further details of hospital attendance from routine Hospital Episode Statistics (HES) data plus researcher follow-up. We assessed longer-term differences in outcome using multivariable Cox Proportional Hazards regression analysis, and assessed all-cause mortality and morbidity relating to hospital attendances for reasons other than self-harm.

Study registration: ISRCTN 59793150.

Outcomes: The original sample of 832 were randomised between April 2010 and December 2013. Extended follow-up continued until February 2017 for a median 55·4 months (range 0-82·5 months), providing post 18-month data for 804 (96·6%) participants, of whom 785 (94·4%) had a minimum of 36-months follow-up.There was no evidence of a between-group difference in the primary outcome during the extended follow-up period (Hazard Ratio (HR) 1·03; 95% CI: 0·83, 1·28; p-value=0·78), consistent with our findings in the original trial with 18 months follow-up (HR 1·14, 95% CI 0·87, 1·49; p-value 0·33). There was a reduced rate of self-harm in older participants aged 15-17 (HR 0·7, 95% CI 0·56, 0·88), as compared with those aged 11-14; and significantly increased rates of self-harm in participants whose index episode combined self-injury and poisoning (HR 1·8, 95% CI 1·2, 2·7). Two deaths were reported during the extended follow up period.

Interpretation: For adolescents referred to CAMHS after self-harm, having self-harmed at least once before, trial FT confers no benefits over TAU in reducing subsequent hospitalisation for self-harm over 18 months or 36 months.

Funding: NIHR HTA Reference: 07/33/01.

Keywords: Family therapy; Long term follow up; RCT; Self-harm.

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Conflict of interest statement

All authors received funding from NIHR HTA to conduct this study DC is Co-chair of the NIHR Advanced Fellowship Panel and a co-author of the SHIFT Manual AF was a member of the NIHR HTA Clinical Evaluation & Trials Board and the HTA Commissioning Strategy Group until December 2018 JG is an NIHR Senior Investigator AH is a member of the NIHR Advanced Fellowships Panel and a sub-panel member for NIHR Programmes for Applied Health Research IE was a co-author of the SHIFT Manual ST is a member of the NIHR Programmes for Applied Health Research MS has received personal fees as co-author of the book Cutting Down: a CBT Workbook for Treating Young People Who Self-harm

Figures

Fig 1
Fig. 1
Flow diagram and timing of participants’ original and extended follow-up. *Note post 18 m HES data was included for these participants based on post 18 m HES data obtained during the original trial follow-up period. This data was not included in the original 18-month analysis.
Fig 2:
Fig. 2
Kaplan-Meier plot of time to self-harm by Randomised Treatment group with 95% CIs.
Fig 3:
Fig. 3
Kaplan–Meier plot of time to recurrent self-harm events (up to 4 events) (a) from randomisation, and (b) between self-harm events.
See this image and copyright information in PMC

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