Interventions for self-harm in children and adolescents

Area of Science:

• Psychiatry
• Adolescent Health
• Mental Health Interventions

Background:

• Self-harm (SH) is a growing global concern in children and adolescents, often repeated and linked to suicide.
• Evidence for effective interventions in this population is scarce compared to adults.
• This review updates previous findings on interventions for adolescent self-harm.

Purpose of the Study:

• To assess the effectiveness of psychosocial interventions and pharmacological agents for self-harm in children and adolescents.
• To compare these interventions against various control groups, including treatment-as-usual.

Main Methods:

• Included randomized controlled trials (RCTs) of psychosocial interventions or pharmacological agents for recent self-harm in individuals up to 18 years old.
• Primary outcome was repetition of self-harm within two years.
• Searched major databases including Cochrane, MEDLINE, Embase, and PsycINFO up to July 2020.

Main Results:

• 17 trials with 2280 participants were included; predominantly female (87.6%), mean age 14.7 years.
• Dialectical Behavior Therapy for Adolescents (DBT-A) showed a lower rate of self-harm repetition (30%) compared to control groups (43%) (high-certainty evidence).
• Evidence for other interventions like CBT-based psychotherapy, mentalization-based therapy, and family therapy showed limited or uncertain effects on reducing self-harm repetition.

Conclusions:

• Evidence for many psychosocial interventions for adolescent self-harm is uncertain due to moderate to very low quality and small trial numbers.
• Further evaluation of DBT-A is recommended.
• Individual CBT-based psychotherapy warrants further development and evaluation in this population, given its established benefit in adults.