Summary of findings 1. Comparison 1: individual CBT‐based psychotherapy versus treatment as usual.
| CBT‐based psychotherapy compared to treatment as usual | ||||||
| Patient or population: children and adolescents who engage in SH. Settings: outpatient. Intervention: individual CBT‐based psychotherapy. Comparison: treatment as usual. | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Treatment as usual | CBT‐based psychotherapy | |||||
| Repetition of SH at six months | Study population | OR 1.88 (0.3 to 11.73) | 39 (1 RCT) | ⊕⊝⊝⊝ VERY LOW1,2 | Quality was downgraded as information on allocation concealment, participant blinding, outcome assessor blinding, and selective outcome reporting was not adequately described. The trial was further downgraded as the same therapists delivered both the intervention and control treatments leading to possible confounding which could have led to a reduction in the demonstrated effect. | |
| 111 per 1000 | 190 per 1000 (36 to 595) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CBT: cognitive behavioural therapy; CI: confidence interval; OR: odds ratio; RCT: randomised controlled trial; SH: self‐harm. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Risk of bias was rated as VERY SERIOUS as information on allocation concealment, participant blinding, outcome assessor blinding, and selective outcome reporting was not adequately described raising the possibility of selection bias, performance bias, detection bias, and reporting bias. Given that the same therapists delivered both the intervention and control treatments in this trial, there is also the possibility of confounding which could have led to a reduction in the demonstrated effect.
2 Imprecision was rated as SERIOUS owing to the wide confidence interval associated with the estimate of treatment effect.