Table 3.
Selection of Randomized Control Trials and Results Investigating the Efficacy of Therapeutic Interventions (TI's) Versus Control Treatments on Self-Harming Adolescents.
| Study | Sample Criteria (after attrition) | Inclusion Criteria (Self-harm definition) | Relevant Diagnostic Tools | Outcomes Investigated | Treatment Type | Periods of Assessment | Outcomes and Findings | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Treatment/Control (n) | Demographics (mean age) | Self-Harm | Suicidal Ideation | Depressive Symptoms | Intervention | Control | |||||
| Alavi et al. (27) Iran | 15/15 | 12–18 (16.1) 90% female | Hospital presentation following suicide attempt within 3 months of study | Scale for Suicidal Ideation (SSI) Hopelessness Inventory (BHI) Depression Inventory (BDI) | ✓ | ✓ | CBT for suicidal ideation | WL | 12 weeks | Significant reduction in suicidal ideation, hopelessness, and depressive symptoms in treatment group | |
| Asaranow et al. (6) USA | 89/92 | 10–17 (14.7) 69% female | Hospital presentation following suicide attempt or suicidal ideation (intentional self-injury with/without intent to die) | Suicide attempts on the NIMH-DISC-IV Center for Epidemiological Studies Depression Scale (CES-D) | ✓ | ✓ | Family Intervention for Suicide Prevention (FISP) | TAU | ~2 months | No significant reduction in self-harm or depressive symptoms, but improved linkage to outpatient care | |
| Asarnow et al. (31) USA | 20/22 | 11–18 (14.62) 88% female | Suicide attempt within 3 months of study or ≥3 episodes of self-harm within lifetime | Columbia-Suicide Severity Rating Scale (C-SSRC) NIMH-DISC-IV Suicide History Interview (SHI) Service assessment for children and Adolescents (SACA) | ✓ | SAFETY (DBT informed CBT) | E-TAU | 3 months | Significant differences between groups for SA at 30month timepoint, no difference between groups on NSSI. | ||
| Chanen et al. (33) Australia | 44/42 | 15–18 (16.4) 76% female | Fulfillment of 2/9 DSM-IV Criteria for Borderline Personality Disorder | Semi-structured interview for paras-suicidal behavior developed by research group | ✓ | Cognitive Analytic Therapy | GCC | 6, 12, 24 months | Reduction of parasuicidal behaviors seen within whole cohort, with no significant group differences | ||
| Cotgrove et al. (35) UK | 47/58 | ≤ 16 (14.9) 85% female | Hospital presentation following suicide attempt (attempted suicide, deliberate acts of self-injury or self-poisoning) | Clinical records Questionnaire, unspecified | ✓ | Token for readmission to hospital + AAU | AAU | 12 months | Fewer people (50%) with hospital readmission tokens re-attempt suicide than those without, but no significant effect found within treatment group | ||
| Diamond et al. (38) USA | 35/31 | 12–17 (15.1) 83% female | >31 SIQ score >20 BDI-II | Suicide Ideation Questionnaire (SIQ-JR) Beck Depression Inventory (BDI-II) Scale for Suicidal Ideation (SSI) | ✓ | ✓ | Attachment-based Family Therapy | E-TAU | 6, 12, 24 weeks | Significant reduction in SI within treatment group at all-time points; Significant reduction in DS within treatment group my mid-treatment, but loss of effect at post-treatment and follow-up | |
| Donaldson et al. (38) USA | 21/18 | 12–17 (15) 82%female | Hospital presentation following suicide attempt (intentional non-fatal self-injury with intent to die) | Structured Follow-up Interviews SIQ CES-D | ✓ | ✓ | ✓ | Skills-Based Treatment (SBT) | SRT | 3, 6 months | Overall reduction in likelihood of re-attempting suicide and an improvement in ideation and depressive symptoms, but no significant differences between groups at any point |
| Esposito-Smythers et al. (28) USA | 20/20 | 13–17(15) 68% female | Suicide attempt within 3 months of study or ≥41 on SIQ in the past month | SIQ Columbia Impairment Scale (CIS) Reynolds Adolescent Depression Scale (RADS-2) | ✓ | ✓ | ✓ | I-CBT | E-TAU | 18 months | Significant reduction in suicide attempts in treatment condition; overall improvement in cohort on ideation and depressive symptoms with no significant differences between groups |
| Green et al. (23) UK | 179/180 | 12–17 89% female | Hospital presentation following ≥2 episodes of self-harm within 12 months (intentional self-inflicted injuries or overdose of toxic substances) | SIQ Mood and Feeling Questionnaire (MFQ) Health of Nation Outcomes Scales for Children and Adolescents (HoNOSCA) | ✓ | ✓ | ✓ | Developmental Group Psychotherapy | TAU | 6,12 months | Overall improvement within cohort on self-harm, ideation and depressive symptoms, but no significant differences between groups at any point |
| Harrington et al. (36) UK | 85/77 | ≤ 16 (14.5) 90% female | Hospital presentation following deliberate self-poisoning (ingestion of substances not for human consumption, or overdose) | SIQ Hopelessness Questionnaire McMaster Family Assessment Device | ✓ | Home-based Family Intervention + TAU | TAU | 2, 6 months | No significant differences between groups at any point on rates of suicidal ideation | ||
| Hazell et al. (22) Australia | 35/37 | 12–16 (14.5) 91% female | ≥3 episodes of self-harm, one happening within 1 month of study (intentional self-inflicted injury irrespective of intent) | SIQ MFQ Schedule for Affective Disorders and Schizophrenia (K-SADS) HoNOSCA | ✓ | ✓ | ✓ | Developmental Group Psychotherapy | TAU | 2, 6, 12 months | Overall improvement within cohort on self-harm, ideation, and depressive symptoms but no significant differences between by follow-up; Significantly higher proportion of treatment group engaged in self-harm until 6 months |
| King et al. (39) USA | 113/123 | 12–17 (15.3) 68% female | Significant suicidal ideation or suicide attempt with 1 month of study / score of 20 or 30 on Self-harm subscale of the Child and Adolescent Functional Assessment Scale (CAFAS) | SIQ-JR Spectrum of Suicide Behavior Scale Youth Self-Report (YSR) RADS CAFAS | ✓ | ✓ | YST-I + TAU | TAU | 6 months | No significant difference in suicide attempts between groups. Small to medium effect on the reduction of suicidal ideation only after altering analyses from intent-to-treat to only in female participants | |
| King et al. (40) USA | 223/225 | 13–17 (15.6) 71% female | Significant suicidal ideation or suicide attempt within 4 weeks of study | SIQ-JR BHS Children's Depression Rating Scale Revised (CDRS-R) | ✓ | ✓ | YST-II + TAU | TAU | 6 weeks, 3, 6, 12 months | No significant reduction in suicide attempts. Overall improvement on depressive symptoms (moderated by multiple attempts) lasting 6 weeks. | |
| Mehlum et al. (42) Norway | 39/38 | (15.6) 83% female | ≥1 episode of self-harm within 16 weeks of study / Fulfillment of 2 criteria of BPD / fulfillment of 1 + 2 subthreshold criteria of BPD (intention self-inflicted injury irrespective of intent) | Lifetime Parasuicide Count (LPC) Interview Suicide Intent Scale (SIS) SIQ-JR Short MFQ | ✓ | ✓ | ✓ | DBT-A | E-TAU | 9, 15, 19, 71 weeks | Significant reduction in self-harm, ideation, and depressive symptoms at 19 weeks, but loss of significance at 1 year follow-up; |
| Ougrin et al. (34) UK | 35/34 | 12–18 (15.5) 80% female | Engaging in self-harm without prior involvement with psychiatric services (intentional self-inflicted injury or self-poisoning irrespective of intent) | Health department records including: CAMHS, A&E, and Primary Care | ✓ | Therapeutic Assessment (TA) | AAU | 24 months | No significant reduction in hospital presentations for self-harm, though treatment engagement increased significantly | ||
| Pineda and Dadds (41) Australia | 22/18 | 12–17 (15.14) 75% female | ≥ 1 episode of suicidal behavior (suicidal ideation, intent, suicide attempt, self-injury) within the last 2 months before referral to hospital; residing with at least 1 parent | Adolescent Suicide Questionnaire- Revised (ASQ-R) | ✓ | RAP-P | Routine Care | 3, 6 months | Significant improvement in suicidal behavior at 3 and 6 months in RAP-P group, compared to control group. | ||
| Rossouw et al. (32) UK | 20/20 | 12–17 (14.7) 80% female | ≥1 episode of self-harm within past month (intentional self-inflicted injury irrespective of intent) | Risk-Taking and Self-Harm Inventory (RTSHI) MFQ | ✓ | ✓ | MBT-A | TAU | 3, 6, 9, 12 months | Significant reduction in self-harm and depressive symptoms for treatment group during treatment and at follow-up | |
| Schuppert et al. (26) Holland | 23/20 | 14–19(16.14) 88% female | Fulfillment of 2/9 DSM-IV Criteria for Borderline Personality Disorder including: Recurrent suicidal behavior, gestures, threats, or self-mutilation | Clinical interview Youth Self-Report (YSR) Internalizing & Externalizing | ✓ | ✓ | Emotion Regulation Training + TAU | TAU | 3, 6 months | Reduction in self-harm and depressive symptoms seen within whole cohort with no significant group differences | |
| Schuppert et al. (25) Holland | 54/55 | 14–19 (15.98) 96% female | Fulfillment of 2/9 DSM-IV Criteria for Borderline Personality Disorder including: Recurrent suicidal behavior, gestures, threats, or self-mutilation | Clinical interview Youth Self-Report (YSR) Internalizing & Externalizing | ✓ | ✓ | Emotion Regulation Training + TAU | TAU | 6, 12 months | Reduction in self-harm and depressive symptoms seen within whole cohort with no significant group differences (information obtained via e-mail) | |
| Wharff et al. (37)USA | 68/71 | 13–18 (15.5) 72% female | Hospital presentation for suicidality (suicidal self-identification, adult-noted suicidality, suicide attempt) | Reasons for Living Inventory for Adolescents (RFL-A) | ✓ | Family-Based Crisis Intervention | TAU | Post-test, 3 day, 1 week, 1 month | Overall reduction of ideation and depressive symptoms within whole cohort with no significant group differences; Intervention group significantly less likely to be re-hospitalized post treatment | ||
| Wood et al. (24) UK | 32/31 | 12–16 (14.25) 78% female | Hospital presentation following incident of self-harm (intentional self-inflicted injury irrespective of intent) | MFQ SIQ HoNOSCA | ✓ | ✓ | ✓ | Developmental Group Psychotherapy | TAU | 7 months | Significant reduction in likelihood of re-attempting suicide within treatment group; overall improvement within cohort but no treatment effect on ideation and depressive symptoms |
TAU, Treatment As Usual; E-TAU, Enhanced Treatment As Usual; GCC, Good Clinical Care; AAU, Assessment As Usual; SDP, Standard Disposition Planning; SRT, Supportive Relationship Treatment; I-CBT, Integrated CBT.