Summary of findings 2. Comparison 2: interventions for patients with multiple episodes of SH or emerging personality problems versus treatment as usual or routine management.
| Dialectical behaviour therapy or mentalisation for adolescents compared to treatment as usual or other routine management | ||||||
| Patient or population: children and adolescents who engage in SH. Settings: outpatients. Intervention: dialectical behaviour therapy or mentalisation for adolescents. Comparison: treatment as usual or other routine management (i.e., enhanced usual care) | ||||||
| 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 | Interventions for patients with multiple episodes of SH or emerging personality problems | |||||
| Dialectical behaviour therapy for adolescents (DBT‐A) | ||||||
| Repetition of SH at post‐intervention | 151 per 1000 |
113 per 1000 (21 per 439) |
OR 0.72 (0.12 to 4.40) |
105 (2 RCTs) |
⊕⊕⊝⊝ LOW1,2 | Quality was downgraded as neither participants nor clinical personnel were blind as to treatment allocation. Quality was further downgraded due to imprecision in the effect size estimate. |
| Frequency of SH at post‐intervention | The mean frequency of SH episodes at post‐intervention in the intervention group was 0.79 lower (2.78 lower to 1.20 higher) | ‐ | 104 (2 RCTs) |
⊕⊕⊝⊝ LOW1,2 | Quality was downgraded as neither participants nor clinical personnel were blind as to treatment allocation. Quality was further downgraded due to imprecision in the effect size estimate. | |
| Mentalisation | ||||||
| Repetition of SH at post‐intervention | 829 per 1000 |
557 per 1000 (303 to 790) |
OR 0.26 (0.09 to 0.78) |
71 (1 RCT) |
⊕⊕⊕⊝ MODERATE1 | Quality was downgraded as the nature of this intervention means it is unlikely participants and clinical personnel would have been blind to treatment allocation. |
| *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). 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 SERIOUS as the nature of the intervention means that clinical personnel could not have remained blind to treatment allocation suggesting that performance and detection bias may have been present.
2 Imprecision was rated as SERIOUS owing to the wide confidence interval associated with the estimate of treatment effect.