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. 2021 Jan 10;1(1):CD013669.
doi: 10.1002/14651858.CD013669.pub2.

Pharmacological interventions for self-harm in adults

Katrina G Witt  1   2 , Sarah E Hetrick  3 , Gowri Rajaram  1   2 , Philip Hazell  4 , Tatiana L Taylor Salisbury  5 , Ellen Townsend  6 , Keith Hawton  7
Affiliations

Pharmacological interventions for self-harm in adults

Katrina G Witt et al. Cochrane Database Syst Rev. .

Abstract

Background: Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of pharmacological agents and/or natural products in the treatment of SH is lacking, especially when compared with the evidence for psychosocial interventions. This review therefore updates a previous Cochrane Review (last published in 2015) on the role of pharmacological interventions for SH in adults.

Objectives: To assess the effects of pharmacological agents or natural products for SH compared to comparison types of treatment (e.g. placebo or alternative pharmacological treatment) for adults (aged 18 years or older) who engage in SH.

Search methods: We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic Reviews [CDSR]), together with MEDLINE. Ovid Embase and PsycINFO (to 4 July 2020).

Selection criteria: We included all randomised controlled trials (RCTs) comparing pharmacological agents or natural products with placebo/alternative pharmacological treatment in individuals with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment acceptability, treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide.

Data collection and analysis: We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence internals (CIs). For continuous outcomes we calculated the mean difference (MD) or standardised mean difference (SMD) and 95% CI. The overall certainty of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach.

Main results: We included data from seven trials with a total of 574 participants. Participants in these trials were predominately female (63.5%) with a mean age of 35.3 years (standard deviation (SD) 3.1 years). It is uncertain if newer generation antidepressants reduce repetition of SH compared to placebo (OR 0.59, 95% CI 0.29 to 1.19; N = 129; k = 2; very low-certainty evidence). There may be a lower rate of SH repetition for antipsychotics (21%) as compared to placebo (75%) (OR 0.09, 95% CI 0.02 to 0.50; N = 30; k = 1; low-certainty evidence). However, there was no evidence of a difference between antipsychotics compared to another comparator drug/dose for repetition of SH (OR 1.51, 95% CI 0.50 to 4.58; N = 53; k = 1; low-certainty evidence). There was also no evidence of a difference for mood stabilisers compared to placebo for repetition of SH (OR 0.99, 95% CI 0.33 to 2.95; N = 167; k = 1; very low-certainty evidence), or for natural products compared to placebo for repetition of SH (OR 1.33, 95% CI 0.38 to 4.62; N = 49; k = 1; lo- certainty) evidence.

Authors' conclusions: Given the low or very low quality of the available evidence, and the small number of trials identified, there is only uncertain evidence regarding pharmacological interventions in patients who engage in SH. More and larger trials of pharmacotherapy are required, preferably using newer agents. These might include evaluation of newer atypical antipsychotics. Further work should also include evaluation of adverse effects of pharmacological agents. Other research could include evaluation of combined pharmacotherapy and psychological treatment.

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Conflict of interest statement

KGW: is an editor for the Cochrane Common Mental Disorders Group, and senior editor for the Self‐Harm and Suicide Satellite of the group. SEH: is the joint co‐ordinating editor of the Cochrane Common Mental Disorders Group. She is funded by an Auckland Medical Research Foundation Douglas Goodfellow Repatriation Fellowship to develop and test a digital intervention for young people who engage in self‐harm. She is the Principal Clinical Advisor of the Suicide Prevention Office of the Ministry of Health for the New Zealand Government. GR: no declarations of interest to report in relation to this review PH: no declarations of interest to report in relation to this review TLTS: no declarations of interest to report in relation to this review ET: no declarations of interest to report in relation to this review KH: no declarations of interest to report in relation to this review

Figures

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Study Flow Diagram
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Results of 'Risk of bias' assessments for each study
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Summary of 'Risk of bias' assessments
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'Risk of bias' assessment for Battaglia 1999
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'Risk of bias' assessment for Hallahan 2007
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'Risk of bias' assessment for Hirsch 1982
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'Risk of bias' assessment for Lauterbach 2008
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'Risk of bias' assessment for Montgomery 1979
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'Risk of bias' assessment for Montgomery 1983
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'Risk of bias' assessment for Verkes 1998
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1.1
1.1. Analysis
Comparison 1: Newer generation antidepressants (NGAs), Outcome 1: Repetition of SH by post‐intervention (NGA class)
1.2
1.2. Analysis
Comparison 1: Newer generation antidepressants (NGAs), Outcome 2: Repetition of SH at final follow‐up (by NGA class)
1.3
1.3. Analysis
Comparison 1: Newer generation antidepressants (NGAs), Outcome 3: Treatment acceptability
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD013669

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