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Brief psychological intervention after self-harm: randomised controlled trial from Pakistan
Nusrat Husain1, Salahuddin Afsar1, Jamal Ara1
1Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
Background:
Self-harm is a major risk factor for completed suicide.
Aims:
To determine the efficacy of a brief psychological intervention - culturally adapted manual-assisted problem-solving training (C-MAP) - delivered following an episode of self-harm compared with treatment as usual (TAU).
Method:
The study was a randomised controlled assessor-masked clinical trial (trial registration: ClinicalTrials.gov NCT01308151). All patients admitted after an episode of self-harm during the previous 7 days to the participating medical units of three university hospitals in Karachi, Pakistan, were included in the study. A total of 250 patients were screened and 221 were randomly allocated to C-MAP plus treatment as usual (TAU) or to TAU alone. All patients were assessed at baseline, at 3 months (end of intervention) and at 6 months after baseline. The primary outcome measure was reduction in suicidal ideation at 3 months. The secondary outcome measures included hopelessness, depression, coping resources and healthcare utilisation.
Results:
A total of 108 patients were randomised to the C-MAP group and 113 to the TAU group. Patients in the C-MAP group showed statistically significant improvement on the Beck Scale for Suicide Ideation and Beck Hopelessness Inventory, which was sustained at 3 months after the completion of C-MAP. There was also a significant reduction in symptoms of depression compared with patients receiving TAU.
Conclusions:
The positive outcomes of this brief psychological intervention in patients attempting self-harm are promising and suggest that C-MAP may have a role in suicide prevention.