Editorial: Where Are the Trials on Adolescent Self-Harm and Suicide?

Self-harm and suicide are a major public health problem, particularly among adolescents. Suicide is the third leading cause of death in adolescents in the United Kingdom and the United States, and nonsuicidal self-injury (NSSI) remains a significant source of morbidity and mortality in this population.^1,2 Despite relative consensus about the acuity of this public health problem, we lack evidence-based treatments for patients struggling with self-harm. This scarcity of effective treatments for self-harm in adolescents is highlighted by an important meta-analysis in this issue of the Journal.³ Wright-Hughes and colleagues identified 39 randomized control trials (RCTs) comparing a therapeutic intervention for self-harm to control with 26 studies providing individual patient data (IPD; 3,448 participants) and 7 providing only aggregate data (698 participants). Their 2-stage random-effects meta-analysis of studies with IPD found no significant difference in efficacy between therapeutic interventions and control treatment for preventing self-harm at 12 months. Secondary analyses incorporating aggregate data similarly showed no difference in efficacy and no strong evidence regarding moderators of treatment effect.