Decisional support for young people who self-harm: protocol for a feasibility trial

Introduction: Self-harm is common in adolescents and it is the strongest predictor of suicide. Young people who self-harm are often unsure of how and where to get help. Decision aids (DA) have been shown to help with decisional conflict where there is uncertainty around different options. We have developed an online DA to support young people in help-seeking for self-harm. A feasibility trial will examine the acceptability of the online intervention, and the ability to recruit and follow-up participants within a school setting. Methods and Analysis: In this parallel arm, single blind feasibility trial, 60 participants aged 12-18 years who have self-harmed in the past 12 months, will be randomised to either: 1) a group receiving the online DA or 2) a control group receiving general information about feelings and emotions. Both groups will complete measures assessing decision-making and help-seeking behaviour. The school counsellor will be notified of any participants who have been randomised to ensure safeguarding for the young person. Participants in both groups will be followed up at 4-weeks and the measures will be repeated. Qualitative interviews will be conducted with a subset of participants to explore their views and experiences of the DA and of participation in the study. Ethics and Dissemination: Ethical approval was granted by King’s College London (KCL) College Research Ethics Committee. Results of this study will help to clarify if we can recruit and administer an online decisional support intervention within a school setting for young people who self-harm. The study will inform the design and implementation of a larger randomised controlled trial to test the effectiveness of the DA. Dissemination of the study findings will target publication in peer-reviewed journals of general and special interest. The funder will be sent a report outlining the major findings of the study

Editorial: early intervention and prevention of severe mental illness: a child and adolescent psychiatry perspective

No abstract available

Web-based decision-aid to assist help-seeking choices for young people who self-harm: outcomes from a randomised controlled feasibility trial

Background: Adolescents who self-harm are often unsure how or where to get help. We developed a web-based personalised decision aid (DA), designed to support young people in decision-making about seeking help for their self-harm. Objective: Our aim was to evaluate the feasibility and acceptability of the DA intervention and the randomised controlled trial (RCT) in a school setting. Methods: We conducted a 2-group, single blind, randomised controlled feasibility trial in a school setting. Participants aged 12-18 years who reported self-harm in the past 12 months were randomised to either a web-based DA or to general information about mood and feelings. Feasibility of recruitment, randomisation and follow-up rates were assessed, as was acceptability of the intervention and study procedures. Descriptive data were collected on outcome measures examining decision-making and help-seeking behaviour. Qualitative interviews were conducted with young people, parents/carers and staff, and subjected to thematic analysis to explore their views of the DA and study processes. Results: Parental consent was a significant barrier to young people participating in the trial, with only 208 (18%) of the 1,164 parent/guardians contacted for consent responding to study invitations. Where parental consent was obtained, we were able to recruit 82% (n=170) of young people into the study. Of those young people screened, 14% (n=23) had self-harmed in the past year. Ten participants were randomised to receiving the DA and 13 were randomised to the control group. Four-week follow-up assessments were completed with all participants. The DA had good acceptability but qualitative interviews suggested that a DA that addressed broader mental health problems such as depression, anxiety and self-harm may be more beneficial. Conclusions: A broad-based mental health DA addressing a wide range of psychosocial problems may be useful for young people. The requirement for parental consent is a key barrier to intervention research on self-harm in the school setting. Adaptations to the research design and/or the intervention are needed before generalisable research about DAs can be successfully conducted in a school setting

Evaluation of pilot community art-based workshops designed for Ukrainian refugee children

ObjectivesApproximately 8 million Ukrainians have been displaced by the war in Ukraine and five million children had their education disrupted. Here, we report an evaluation of (1) the feasibility (i.e., recruitment), (2) the acceptability (i.e., attendance, participants' views) and (3) the influence of a pilot community art-based project on the well-being, health behaviour and socialisation of Ukrainian refugee children in London, UK.MethodsTwenty-two refugee children aged 4–14 years from St Mary's Ukrainian school in London took part in five weekly art workshop group sessions led by a team of volunteer independent artists based in a community art studio in West London in collaboration with Children and War UK. Analyses were conducted on measures of the children's psychological well-being, health behaviour, and socialisation; collected from participating children and their parents through the workshops.ResultsThe community art workshops received sufficient interest from parents during recruitment. Child participants and their parents expressed overwhelmingly positive views and high satisfaction towards the workshops and their activities. While the workshops were conducted without a control group, changes in psychological well-being and health behaviour and socialisation were in the expected direction. The workshops were associated with reduced impact of intrusive re-experiencing of traumatic events (p = .021), negative emotion (ps = .006–.043; rated by children and by their parents, respectively), and sleep disturbance (p = .015). Mood and motivational states increase relative to before activities within sessions (ps = .001–.023).ConclusionsThe artist-led workshops are a valuable community project associated with high satisfaction and potentially increased well-being in Ukrainian refugee children. A provision for a larger number of participants should be considered

Age-related differences in self-harm presentations and subsequent management of adolescents and young adults at the emergency department

Background Characteristics of self-harm differ across ages, but there is little work identifying age-related differences in younger people. Young people entering adolescence face emotionally and developmentally different challenges to those entering adulthood. This study investigates how Emergency Department (ED) presentations and management of self-harm differ through adolescence and early adulthood. Methods 3782 consecutive self-harm episodes involving 2559 people aged 12–25 years were identified from an existing database of Leeds ED attendances from 2004–2007. Odds ratios for each of four age bands were compared to the remaining young people. Results The female to male ratio was 6.3:1 at 12–14 years old, decreasing with successive age groups to 1.2:1 at 22–25 years old. Self-poisoning was commoner in those under 18 years old. 18–25 year olds were more likely to self-poison with prescribed medications, mixed overdoses, alcohol or recreational drugs. 18–25 year olds more often required medical treatment for the effects of the self-harm. 12–14 year olds were more often seen urgently by ED medical staff and offered high intensity mental health aftercare. Repetition of self-harm was commonest in 12–14 year olds, although multiple repetition of self-harm was commonest in 22–25 year olds. Limitations Data were not collected on whether the aftercare offered was received. The study sample included hospital attenders only. Conclusions The large excess of females over males in young people’s self-harm is only true at the younger age range. Older adolescents present with more severe acts of self-harm, yet receive the lowest intensity of assessment and after care

Does clinical management improve outcomes following self-Harm? Results from the multicentre study of self-harm in England

Background Evidence to guide clinical management of self-harm is sparse, trials have recruited selected samples, and psychological treatments that are suggested in guidelines may not be available in routine practice. Aims To examine how the management that patients receive in hospital relates to subsequent outcome. Methods We identified episodes of self-harm presenting to three UK centres (Derby, Manchester, Oxford) over a 10 year period (2000 to 2009). We used established data collection systems to investigate the relationship between four aspects of management (psychosocial assessment, medical admission, psychiatric admission, referral for specialist mental health follow up) and repetition of self-harm within 12 months, adjusted for differences in baseline demographic and clinical characteristics. Results 35,938 individuals presented with self-harm during the study period. In two of the three centres, receiving a psychosocial assessment was associated with a 40% lower risk of repetition, Hazard Ratios (95% CIs): Centre A 0.99 (0.90–1.09); Centre B 0.59 (0.48–0.74); Centre C 0.59 (0.52–0.68). There was little indication that the apparent protective effects were mediated through referral and follow up arrangements. The association between psychosocial assessment and a reduced risk of repetition appeared to be least evident in those from the most deprived areas. Conclusion These findings add to the growing body of evidence that thorough assessment is central to the management of self-harm, but further work is needed to elucidate the possible mechanisms and explore the effects in different clinical subgroups