Psychosocial interventions for self-harm in adults

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

Clinical curse, predictive factors and effects of intervention after attempted suicide. A randomised controlled study

Abstract One important task for the mental health services is to prevent suicidal behaviour, especially among persons at high risk, e.g. those who have attempted suicide. In two follow-up samples, one and three months after a suicide attempts, both n=97, we found that 32% and 38% of the patients respectively had no treatment and 30% in each sample had suicidal thoughts. In a randomised controlled study (n=216) we investigated the effects of two telephone interventions in addition to ordinary treatment on attendance to treatment, suicidal behaviour and psychosocial functioning 1-12 months after a suicide attempt. There were no general main effects. Among patients who initially had other treatment than psychiatric attendance to such treatment was higher in the intervention group as compared to controls at 12 months. Further, subjects in the intervention group who had no initial treatment contact reduced certain psychological symptoms more than controls. In all patients an improvement in global functioning, psychological symptoms, suicide ideation and a reduction in number of needs were found, with no differences between the intervention and the control group. Initially needs were very common in health, basic and social needs. At follow-up, a significant reduction was found in health aspects, but not in social and basic needs. An analysis of predictive factors for repetition of suicide attempts during follow-up showed that reattempts within one month and three or more suicide attempts before the index attempt were highly predictive for repetition 1-12 months thereafter. It is concluded that telephone follow-up could be useful in patients without psychiatric contact. A special attention should be put to patients who make several suicide attempts

Patients' needs during the year after a suicide attempt A secondary analysis of a randomised controlled intervention study.

OBJECTIVE: We first studied whether changes of needs were influenced by randomly allocated telephone interventions between 1 and 12 months after a suicide attempt in addition to treatment as usual. These were aimed at improving motivation for professional treatment. As a secondary analysis we investigated the frequency and changes of needs during this period and if changes were related to other outcome measures. Method One month after a suicide attempt 216 patients were randomised to two telephone interventions or to no such interventions within 1 year. The Camberwell Assessment of Need (CAN) was used to evaluate 22 different need areas at 1 and 12 months. Other outcome measurements used were Global functioning axis V (GAF), psychological symptoms (SCL-90, GSI) and scale of suicide ideation (SSI). Results Of 178 patients who were followed up, 140 had been rated by CAN at both 1 and 12 months. Changes of needs did not differ between the randomised groups. At 1 month the patients had a mean number of 5.1 +/- 2.4 needs and 2.4 +/- 1.5 of these were considered as unmet. The most frequently reported needs concerned health aspects, basic needs and social needs. At 12 months needs concerning health aspects were significantly reduced, while basic needs and social needs were not. Changes of GAF explained 21 % and changes of GSI 4 % of the variance of the reduction of needs. Conclusions After 12 months, needs in health aspects, basic needs and social needs were still common. A structured evaluation of the patient's needs seems to be helpful when planning treatment after a suicide attempt

Formal and informal help during the year after a suicide attempt: A one-year follow-up

Aims: The aims of this study are threefold: to investigate formal and informal help with clinical and social needs that patients who attempted suicide received during the year after their attempt; to examine whether help from services was estimated to be adequate; and to look at whether patients who repeated suicide attempt(s) during follow-up differed from those who did not. Methods: The Camberwell Assessment of Need instrument measuring 22 need areas was used in semi-structured interviews with 140 patients at 1 and 12 months after a suicide attempt. Results: Help given from services was rated as high at both 1 and 12 months in health-related areas, but lower in areas related to social needs. Informal help was initially frequent, with some exceptions. The amount of help from services did not decrease in any need area during follow-up, neither in repeaters nor in non-repeaters. There were no changes in informal help in repeaters, while in non-repeaters informal help decreased in some areas. At both 1 and 12 months, repeaters and non-repeaters mostly found help from services to be adequate. However, in the areas of information, intimate relationships, psychotic symptoms and sexual expression about half of the patients in both groups did not consider that they had received the right type of help. Conclusions: The generally high level of formal help in health-related areas during the first year after a suicide attempt and the high rated adequacy of help given is satisfactory. However, in certain areas lack of formal help was evident. Informal caregivers contributed significantly to the help that patients received. The use of the Camberwell Assessment of Need instrument could improve observation on needs areas and whether help is available. Perhaps this kind of evaluation could be used earlier than after 1 year in such a vulnerable group as suicide attempters