Summary of findings 1. Newer generation antidepressants (NGAs) compared to placebo for self‐harm in adults.
| Newer generation antidepressants (NGAs) compared to placebo for self‐harm in adults | ||||||
| Patient or population: Self‐harm in adults Intervention: Newer generation antidepressants (NGAs) Comparison: Placebo | ||||||
| Outcomes | Relative effect (95% CI) | Anticipated absolute effects* (95% CI) | Certainty of the evidence (GRADE) | What happens | ||
| Without Newer generation antidepressants (NGAs) | With Newer generation antidepressants (NGAs) | Difference | ||||
| Repetition of SH by post‐intervention (NGA class) № of participants: 129 (2 RCTs) | OR 0.59 (0.29 to 1.19) | Study population | ⊕⊝⊝⊝ VERY LOW 1 2 3 | The evidence is very uncertain about the effect of newer generation antidepressants (NGAs) on repetition of self‐harm by post‐intervention. | ||
| 50.0% | 37.1% (22.5 to 54.3) | 12.9% fewer (27.5 fewer to 4.3 more) | ||||
| Repetition of SH by post‐intervention (NGA class) ‐ Mianserin vs. Placebo № of participants: 38 (1 RCT) | OR 0.67 (0.18 to 2.41) | Study population | ⊕⊝⊝⊝ VERY LOW 1 2 3 | The evidence is very uncertain about the effect of newer generation antidepressants (NGAs) on repetition of self‐harm by post‐intervention by NGA class (i.e., mianserin vs. placebo). | ||
| 57.1% | 47.2% (19.4 to 76.3) | 10.0% fewer (37.8 fewer to 19.1 more) | ||||
| Repetition of SH by post‐intervention (NGA class) ‐ Paroxetine vs. Placebo № of participants: 91 (1 RCT) | OR 0.55 (0.24 to 1.29) | Study population | ⊕⊕⊝⊝ LOW 2 3 | Further research is very likely to have an important impact on our confidence in the estimate of the effect of newer generation antidepressants (NGAs) on repetition of self‐harm by post‐intervention by NGA class (paroxetine vs. placebo), and may change the estimate. | ||
| 46.7% | 32.5% (17.4 to 53) | 14.2% fewer (29.3 fewer to 6.4 more) | ||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
1 We downgraded this domain by one level as we rated any of the sources of risk of bias (as described in Assessment of risk of bias in included studies) at high risk for one of the trials included in the pooled estimate.
2 We downgraded this domain as these were relatively older agents and, in one trial, no information on how SH was ascertained was reported.
3 We downgraded this domain by one level as the 95% CI for the pooled effect included the null value.