Self-harm (intentional acts of nonfatal self-poisoning or self-injury), which is strongly associated with suicide, is a growing problem in many countries, according to the study authors. By some estimates, up to 25% of individuals who present at hospitals with injuries caused by self-harm return because of a repeat episode within a year.
To determine the effectiveness of psychosocial interventions at preventing patients from repeating self-harm, a team of international researchers conducted a systematic review of randomized, controlled trials of psychosocial interventions that included adults 18 years and older after a recent (within six months) episode of self-harm.
The researchers included 29 trials in their analysis, comprising 18 trials of cognitive-behavioral therapy, problem-solving therapy, or both; three trials of dialectical behavioral therapy; and four trials each of case management and postcards sent periodically to participants over the course of the 12-month intervention period. The primary outcome analyzed was repetition of self-harm at the conclusion of treatment and at follow-up six, 12, and 24 months later; secondary outcomes included improvements in suicidal ideation and various aspects of mood and cognitive function.
The analysis revealed that cognitive-behavioral and problem-solving therapy was associated with fewer participants repeating self-harm at six- and 12-month follow-up compared with patients who received usual care. Patients who received cognitive-behavioral and problem-solving therapy also experienced significant improvements in depression, hopelessness, suicidal ideation, and problem solving.
“In view of the apparent positive benefits of CBT, studies should be conducted to identify which types of patients are most likely to benefit from this approach,” the authors wrote. “Researchers evaluating psychosocial treatments should investigate whether the intervention results in changes in the psychological or social mechanisms that are the targets of treatment (e.g., improved problem solving, regulating emotions, and changes in interpersonal skills) and the extent to which such changes relate to positive outcomes.”
For related information, see the Psychiatric News article “CBT for Child Anxiety May Confer Long-Term Protection From Suicidality.”