Interventions for self-harm in children and adolescents

BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of interventions in the treatment of SH in children and adolescents is lacking, especially when compared with the evidence for psychosocial interventions in adults. This review therefore updates a previous Cochrane Review (last published in 2015) on the role of interventions for SH in children and adolescents. OBJECTIVES To assess the effects of psychosocial interventions or pharmacological agents or natural products for SH compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator, placebo, alternative pharmacological treatment, or a combination of these) for children and adolescents (up to 18 years of age) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialized Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic Reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing specific psychosocial interventions or pharmacological agents or natural products with treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, placebo, alternative pharmacological treatment, or a combination of these, in children and adolescents with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence internals (CIs). For continuous outcomes, we calculated the mean difference (MD) or standardised mean difference (SMD) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 17 trials with a total of 2280 participants. Participants in these trials were predominately female (87.6%) with a mean age of 14.7 years (standard deviation (SD) 1.5 years). The trials included in this review investigated the effectiveness of various forms of psychosocial interventions. None of the included trials evaluated the effectiveness of pharmacological agents in this clinical population. There was a lower rate of SH repetition for DBT-A (30%) as compared to TAU, EUC, or alternative psychotherapy (43%) on repetition of SH at post-intervention in four trials (OR 0.46, 95% CI 0.26 to 0.82; N = 270; k = 4; high-certainty evidence). There may be no evidence of a difference for individual cognitive behavioural therapy (CBT)-based psychotherapy and TAU for repetition of SH at post-intervention (OR 0.93, 95% CI 0.12 to 7.24; N = 51; k = 2; low-certainty evidence). We are uncertain whether mentalisation based therapy for adolescents (MBT-A) reduces repetition of SH at post-intervention as compared to TAU (OR 0.70, 95% CI 0.06 to 8.46; N = 85; k = 2; very low-certainty evidence). Heterogeneity for this outcome was substantial ( I² = 68%). There is probably no evidence of a difference between family therapy and either TAU or EUC on repetition of SH at post-intervention (OR 1.00, 95% CI 0.49 to 2.07; N = 191; k = 2; moderate-certainty evidence). However, there was no evidence of a difference for compliance enhancement approaches on repetition of SH by the six-month follow-up assessment, for group-based psychotherapy at the six- or 12-month follow-up assessments, for a remote contact intervention (emergency cards) at the 12-month assessment, or for therapeutic assessment at the 12- or 24-month follow-up assessments. AUTHORS' CONCLUSIONS Given the moderate or very low quality of the available evidence, and the small number of trials identified, there is only uncertain evidence regarding a number of psychosocial interventions in children and adolescents who engage in SH. Further evaluation of DBT-A is warranted. Given the evidence for its benefit in adults who engage in SH, individual CBT-based psychotherapy should also be further developed and evaluated in children and adolescents.

[1]  J. Jureidini,et al.  Antidepressant Prescribing and Suicide/Self-Harm by Young Australians: Regulatory Warnings, Contradictory Advice, and Long-Term Trends , 2020, Frontiers in Psychiatry.

[2]  O. Kothgassner,et al.  Does treatment method matter? A meta-analysis of the past 20 years of research on therapeutic interventions for self-harm and suicidal ideation in adolescents , 2020, Borderline Personality Disorder and Emotion Dysregulation.

[3]  C. Kahler,et al.  Skills to enhance positivity in suicidal adolescents: Results from a pilot randomized clinical trial , 2020, The journal of positive psychology.

[4]  G. Diamond,et al.  Emotional processing in attachment-based family therapy for suicidal adolescents , 2020, Psychotherapy research : journal of the Society for Psychotherapy Research.

[5]  M. Kaess,et al.  [Development of an Online Intervention for Adolescents and Young Adults Engaging in Nonsuicidal Self-injury]. , 2020, Praxis der Kinderpsychologie und Kinderpsychiatrie.

[6]  A. Dahlgren,et al.  The effects of interventions preventing self-harm and suicide in children and adolescents: an overview of systematic reviews , 2020, F1000Research.

[7]  D. Dickstein,et al.  The Treatment of Suicide and Self-Injurious Behaviors in Children and Adolescents , 2020, Current Treatment Options in Psychiatry.

[8]  P. Lichtenstein,et al.  Comparison of suicide risk and other outcomes among boys and girls who self-harm , 2020, European Child & Adolescent Psychiatry.

[9]  K. Thomas,et al.  Measuring outcomes in trials of interventions for people who self-harm: qualitative study of service users' views , 2020, BJPsych open.

[10]  M. Kaess,et al.  Life Events Predicting the First Onset of Adolescent Direct Self-Injurious Behavior-A Prospective Multicenter Study. , 2020, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[11]  A. Kiss,et al.  Cognitive behavioral therapy for suicide prevention in youth admitted to hospital following an episode of self-harm: A pilot randomized controlled trial. , 2020, Journal of affective disorders.

[12]  C. King,et al.  Evidence-Based Interventions for Youth Suicide Risk , 2020, Current Psychiatry Reports.

[13]  A. Morer,et al.  Adapted Dialectical Behavior Therapy for Adolescents with a High Risk of Suicide in a Community Clinic: A Pragmatic Randomized Controlled Trial. , 2020, Suicide and Life-Threatening Behaviour.

[14]  C. Clements,et al.  Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: a prospective observational cohort study. , 2020, The Lancet. Child & adolescent health.

[15]  Jonathan Green,et al.  Longer-term effectiveness of systemic family therapy compared with treatment as usual for young people after self-harm: An extended follow up of pragmatic randomised controlled trial , 2020, EClinicalMedicine.

[16]  S. Khalid-Khan,et al.  Psychotherapies for Adolescents with Subclinical and Borderline Personality Disorder: A Systematic Review and Meta-Analysis , 2020, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[17]  Dennis Ougrin,et al.  Specialized Therapeutic Assessment-Based Recovery-Focused Treatment for Young People With Self-Harm: Pilot Study , 2019, Front. Psychiatry.

[18]  C. Loo,et al.  Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials , 2019, The Australian and New Zealand journal of psychiatry.

[19]  S. Hetrick,et al.  Are young female suicides increasing? A comparison of sex-specific rates and characteristics of youth suicides in Australia over 2004–2014 , 2019, BMC Public Health.

[20]  A. John,et al.  Clustering of suicides in children and adolescents. , 2019, The Lancet. Child & adolescent health.

[21]  L. Mehlum,et al.  Practitioner Review: Treatment for suicidal and self-harming adolescents - advances in suicide prevention care. , 2019, Journal of child psychology and psychiatry, and allied disciplines.

[22]  M. Kaess,et al.  Effectiveness of a brief psychotherapeutic intervention compared with treatment as usual for adolescent nonsuicidal self-injury: a single-centre, randomised controlled trial , 2019, European Child & Adolescent Psychiatry.

[23]  P. Corcoran,et al.  Dialectical behaviour therapy for adolescents: a comparison of 16-week and 24-week programmes delivered in a public community setting. , 2019, Child and adolescent mental health.

[24]  Natalie S Blencowe,et al.  RoB 2: a revised tool for assessing risk of bias in randomised trials , 2019, BMJ.

[25]  R. Gallop,et al.  Predictors and moderators of recurring self-harm in adolescents participating in a comparative treatment trial of psychological interventions. , 2019, Journal of child psychology and psychiatry, and allied disciplines.

[26]  B. Mars,et al.  Rising suicide rates among adolescents in England and Wales , 2019, The Lancet.

[27]  M. Kaess,et al.  Self-injury: Treatment, Assessment, Recovery (STAR): online intervention for adolescent non-suicidal self-injury - study protocol for a randomized controlled trial , 2019, Trials.

[28]  D. Gunnell,et al.  Psychosocial Interventions for People Who Self-Harm: Methodological Issues Involved in Trials to Evaluate Effectiveness , 2019, Archives of suicide research : official journal of the International Academy for Suicide Research.

[29]  R. Gallop,et al.  A Randomized Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Youth Who Are Suicidal. , 2019, Journal of the American Academy of Child and Adolescent Psychiatry.

[30]  F. Vázquez,et al.  Efficacy of a problem-solving intervention for the indicated prevention of suicidal risk in young Brazilians: Randomized controlled trial. , 2019, Suicide & life-threatening behavior.

[31]  W. Gardner,et al.  Changing Rates of Self-Harm and Mental Disorders by Sex in Youths Presenting to Ontario Emergency Departments: Repeated Cross-Sectional Study , 2019, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[32]  M. Schwannauer,et al.  Efficacy of Mentalization-based group therapy for adolescents: the results of a pilot randomised controlled trial , 2019, BMC Psychiatry.

[33]  P. Szatmari,et al.  Systematic Review and Quality Appraisal of Practice Guidelines for Self-Harm in Children and Adolescents. , 2019, Suicide & life-threatening behavior.

[34]  I. Miller,et al.  Coping long term with active suicide in adolescents: Results from a pilot randomized controlled trial , 2019, Clinical child psychology and psychiatry.

[35]  Andrew C. Porter,et al.  Evidence Base Update of Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth , 2019, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[36]  B. Gillespie,et al.  Association of the Youth-Nominated Support Team Intervention for Suicidal Adolescents With 11- to 14-Year Mortality Outcomes: Secondary Analysis of a Randomized Clinical Trial , 2019, JAMA psychiatry.

[37]  Manivel Rengasamy,et al.  Reduction of Postdischarge Suicidal Behavior Among Adolescents Through a Telephone-Based Intervention. , 2019, Psychiatric services.

[38]  Dennis Ougrin,et al.  Treatment Engagement in Specific Psychological Treatment vs. Treatment as Usual for Adolescents With Self-Harm: Systematic Review and Meta-Analysis , 2019, Front. Psychol..

[39]  J. Pirkis,et al.  Patterns of self-harm methods over time and the association with methods used at repeat episodes of non-fatal self-harm and suicide: A systematic review. , 2019, Journal of affective disorders.

[40]  S. Pearson,et al.  Trends in self-poisoning and psychotropic drug use in people aged 5–19 years: a population-based retrospective cohort study in Australia , 2019, BMJ Open.

[41]  D. Brent Master Clinician Review: Saving Holden Caulfield: Suicide Prevention in Children and Adolescents. , 2019, Journal of the American Academy of Child and Adolescent Psychiatry.

[42]  S. Hiles,et al.  Is the reported increase in young female hospital-treated intentional self-harm real or artefactual? , 2018, The Australian and New Zealand journal of psychiatry.

[43]  P. Moran,et al.  A Further Look at Therapeutic Interventions for Suicide Attempts and Self-Harm in Adolescents: An Updated Systematic Review of Randomized Controlled Trials , 2018, Front. Psychiatry.

[44]  D. Cottrell,et al.  Understanding Adolescents’ Experiences of Self-Harm: Secondary Analysis of Family Therapy Sessions from the SHIFT Trial , 2018, Archives of suicide research : official journal of the International Academy for Suicide Research.

[45]  S. Hemphill,et al.  Are Bullying Perpetration and Victimization Associated with Adolescent Deliberate Self-Harm? A Meta-Analysis , 2018, Archives of suicide research : official journal of the International Academy for Suicide Research.

[46]  Claudia D van Borkulo,et al.  The association between motives, perceived problems and current thoughts of self-harm following an episode of self-harm. A network analysis. , 2018, Journal of affective disorders.

[47]  S. Tubeuf,et al.  Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England , 2018, PharmacoEconomics.

[48]  B. Gillespie,et al.  6.35 Effect of a Youth-Nominated Support Team on 10- to 12-Year Mortality Outcomes of Suicidal Adolescents: An RTC , 2018, Journal of the American Academy of Child and Adolescent Psychiatry.

[49]  Manivel Rengasamy,et al.  6.50 Reduction of Adolescent Suicide Attempts After Telephone-Based Intervention , 2018, Journal of the American Academy of Child and Adolescent Psychiatry.

[50]  D. Brent,et al.  22.4 Impact of a Brief Inpatient Intervention and Suicide Safety Planning App to Decrease Suicidal Behavior After Hospital Discharge , 2018, Journal of the American Academy of Child and Adolescent Psychiatry.

[51]  E. McCauley,et al.  5.5 Youth Suicide: How Gender, Sexual Orientation, and Gender-Nonconforming Status Shape Risk and Inform Intervention Strategies , 2018, Journal of the American Academy of Child and Adolescent Psychiatry.

[52]  J. Pirkis,et al.  What Works in Youth Suicide Prevention? A Systematic Review and Meta-Analysis , 2018, EClinicalMedicine.

[53]  A. Dawson,et al.  Study protocol: a pilot randomized controlled trial to evaluate the acceptability and feasibility of a counseling intervention, delivered by nurses, for those who have attempted self-poisoning in Sri Lanka , 2018, Pilot and Feasibility Studies.

[54]  E. Czyz,et al.  Motivational Interviewing-Enhanced Safety Planning for Adolescents at High Suicide Risk: A Pilot Randomized Controlled Trial , 2018, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[55]  R. Gallop,et al.  Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial , 2018, JAMA psychiatry.

[56]  D. Gunnell,et al.  Treatment as usual (TAU) as a control condition in trials of cognitive behavioural-based psychotherapy for self-harm: Impact of content and quality on outcomes in a systematic review. , 2018, Journal of affective disorders.

[57]  A. Douaihy,et al.  As Safe as Possible (ASAP): A Brief App-Supported Inpatient Intervention to Prevent Postdischarge Suicidal Behavior in Hospitalized, Suicidal Adolescents. , 2018, The American journal of psychiatry.

[58]  Amy M. Brausch,et al.  Emotion Regulation Deficits and Nonsuicidal Self-Injury Prospectively Predict Suicide Ideation in Adolescents. , 2018, Suicide & life-threatening behavior.

[59]  S. Hwang,et al.  Deliberate Self-harm among Young People Begins to Increase at the Very Early Age: a Nationwide Study , 2018, Journal of Korean medical science.

[60]  A. Pignatiello,et al.  FEASIBILITY OF A MANUALIZED FAMILY-BASED SUICIDE PREVENTION STRATEGY TO REDUCE ADOLESCENT SUICIDE RISK AMONG EMERGENCY DEPARTMENT REFERRED YOUTH: A QUALITY IMPROVEMENT PROJECT , 2018 .

[61]  L. Negi,et al.  The Efficacy of Cognitively-Based Compassion Training for African American Suicide Attempters , 2018, Mindfulness.

[62]  P. Corcoran,et al.  Increasing rates of self-harm among children, adolescents and young adults: a 10-year national registry study 2007–2016 , 2018, Social Psychiatry and Psychiatric Epidemiology.

[63]  B. Goldstein,et al.  T68. Hope and Borderline-Personality Disorder as Predictors of Study Drop-Out Among Inpatient Youth Receiving Psychotherapy Treatment for an Episode of Deliberate Self-Harm , 2018, Biological Psychiatry.

[64]  L. Mehlum,et al.  Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm , 2018, Child and Adolescent Psychiatry and Mental Health.

[65]  R. Ivers,et al.  Presentations to NSW emergency departments with self‐harm, suicidal ideation, or intentional poisoning, 2010–2014 , 2018, The Medical journal of Australia.

[66]  M. Hengartner,et al.  Antidepressant prescription rates and suicide attempt rates from 2004 to 2016 in a nationally representative sample of adolescents in the USA , 2018, Epidemiology and Psychiatric Sciences.

[67]  Sophie Wood,et al.  Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review , 2018, Journal of medical Internet research.

[68]  M. Hsieh,et al.  Comparative effect of antipsychotics on risk of self‐harm among patients with schizophrenia , 2018, Acta psychiatrica Scandinavica.

[69]  Jonathan Green,et al.  A pragmatic randomised controlled trial and economic evaluation of family therapy versus treatment as usual for young people seen after second or subsequent episodes of self-harm: the Self-Harm Intervention - Family Therapy (SHIFT) trial. , 2018, Health technology assessment.

[70]  A. Farrin,et al.  Routine hospital data – is it good enough for trials? An example using England’s Hospital Episode Statistics in the SHIFT trial of Family Therapy vs. Treatment as Usual in adolescents following self-harm , 2018, Clinical trials.

[71]  F. Konradsen,et al.  Quality Assessment of Economic Evaluations of Suicide and Self-Harm Interventions: A Systematic Review , 2018, Crisis.

[72]  S. Joe,et al.  What Works for Adolescent Black Males at Risk of Suicide , 2018, Research on social work practice.

[73]  A. House,et al.  Effectiveness of systemic family therapy versus treatment as usual for young people after self-harm: a pragmatic, phase 3, multicentre, randomised controlled trial , 2018, The lancet. Psychiatry.

[74]  Eun-hee Jung,et al.  A Comparative Study of Suicide Rates among 10–19-Year-Olds in 29 OECD Countries , 2018, Psychiatry investigation.

[75]  P. Stallard,et al.  Acceptability, Use, and Safety of a Mobile Phone App (BlueIce) for Young People Who Self-Harm: Qualitative Study of Service Users’ Experience , 2018, JMIR mental health.

[76]  Hanni B. Flaherty Treating Adolescent Nonsuicidal Self-Injury: A Review of Psychosocial Interventions to Guide Clinical Practice , 2018 .

[77]  P. Moran,et al.  Web-Based Decision Aid to Assist Help-Seeking Choices for Young People Who Self-Harm: Outcomes From a Randomized Controlled Feasibility Trial , 2018, JMIR mental health.

[78]  C. Clements,et al.  Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study. , 2017, The lancet. Psychiatry.

[79]  W. Hall,et al.  Understanding the true economic impact of self-harming behaviour. , 2017, Lancet psychiatry.

[80]  Sarah K. Pittman,et al.  Childhood maltreatment and non-suicidal self-injury: A systematic review and meta-analysis , 2017, The lancet. Psychiatry.

[81]  P. Slee,et al.  Effectiveness Of An Intervention Programme For Teenage Girls With Self-Harm In Adelaide, South Australia , 2017 .

[82]  L. Diep,et al.  The impact of borderline personality disorder and sub-threshold borderline personality disorder on the course of self-reported and clinician-rated depression in self-harming adolescents , 2017, Borderline Personality Disorder and Emotion Dysregulation.

[83]  Jonathan Green,et al.  Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care , 2017, British Medical Journal.

[84]  E. Ballard,et al.  The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis. , 2017, The American journal of psychiatry.

[85]  E. Perez,et al.  P.2.f.013 Efficacy of dialectical behavior therapy compared to supportive therapy in adolescents with suicidal behavior , 2017, European Neuropsychopharmacology.

[86]  M. Picado,et al.  3.65 Dialectical Behavior Therapy Versus Supportive Therapy for Adolescents With Suicidal Behavior: A Randomized-Controlled Trial , 2017 .

[87]  A. Hassett,et al.  Young Men’s Experiences of Accessing and Receiving Help From Child and Adolescent Mental Health Services Following Self-Harm , 2017 .

[88]  Catherine A. Sugar,et al.  Cognitive-Behavioral Family Treatment for Suicide Attempt Prevention: A Randomized Controlled Trial. , 2017, Journal of the American Academy of Child and Adolescent Psychiatry.

[89]  R. Gable,et al.  Current Perspectives on Interventions for Self-Injurious Behavior of Children with Autism Spectrum Disorder: A Systematic Review of the Literature , 2017 .

[90]  P. Bech,et al.  MYPLAN –mobile phone application to manage crisis of persons at risk of suicide: study protocol for a randomized controlled trial , 2017, Trials.

[91]  Robert D. Gibbons,et al.  Children's Depression Rating Scale--Revised , 2017 .

[92]  S. Hetrick,et al.  Psychosocial interventions for self-harm, suicidal ideation and suicide attempt in children and young people: What? How? Who? and Where? , 2017, Evidence-Based Mental Health.

[93]  M. Frye,et al.  A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders , 2017, JAMA psychiatry.

[94]  Matthew T. White,et al.  Family-Based Crisis Intervention With Suicidal Adolescents: A Randomized Clinical Trial , 2017, Pediatric emergency care.

[95]  Timothy W. Curby,et al.  Randomized pilot trial of a cognitive-behavioral alcohol, self-harm, and HIV prevention program for teens in mental health treatment. , 2017, Behaviour research and therapy.

[96]  A. House,et al.  Age-related differences in self-harm presentations and subsequent management of adolescents and young adults at the emergency department. , 2017, Journal of affective disorders.

[97]  M. Kaess,et al.  Treating nonsuicidal self-injury (NSSI) in adolescents: consensus based German guidelines , 2016, Child and Adolescent Psychiatry and Mental Health.

[98]  P. Corcoran,et al.  Risk of repeated self-harm and associated factors in children, adolescents and young adults , 2016, BMC Psychiatry.

[99]  P. Stallard,et al.  Safety, Acceptability, and Use of a Smartphone App, BlueIce, for Young People Who Self-Harm: Protocol for an Open Phase I Trial , 2016, JMIR research protocols.

[100]  M. Large,et al.  Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm , 2016, The Australian and New Zealand journal of psychiatry.

[101]  P. Moran,et al.  Decisional support for young people who self-harm: protocol for a feasibility trial , 2016, BMJ Open.

[102]  S. Hetrick,et al.  Effective psychological and psychosocial approaches to reduce repetition of self-harm: a systematic review, meta-analysis and meta-regression , 2016, BMJ Open.

[103]  F. Guillemin,et al.  MEDIACONNEX: a multicenter randomised trial based on short message service to reduce suicide attempt recurrence in adolescents , 2016, BMC Psychiatry.

[104]  M. de Zwaan,et al.  Prevalence and Correlates of Self-Harm in the German General Population , 2016, PloS one.

[105]  J. Pirkis,et al.  Mechanisms of brief contact interventions in clinical populations: a systematic review , 2016, BMC Psychiatry.

[106]  D. Gunnell,et al.  Psychosocial interventions for self-harm in adults. , 2016, The Cochrane database of systematic reviews.

[107]  H. Christensen,et al.  A systematic review of psychosocial suicide prevention interventions for youth , 2016, European Child & Adolescent Psychiatry.

[108]  L. Diep,et al.  Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up. , 2016, Journal of the American Academy of Child and Adolescent Psychiatry.

[109]  D. Cottrell,et al.  Family factors associated with adolescent self-harm: a narrative review , 2016 .

[110]  M. Berk,et al.  Cognitive behavioral approaches for treating suicidal behavior in adolescents , 2016 .

[111]  L. Berk,et al.  The treatment of suicidality in adolescents by psychosocial interventions for depression: A systematic literature review , 2016, The Australian and New Zealand journal of psychiatry.

[112]  Rosie P Cornish,et al.  Using Data Linkage to Investigate Inconsistent Reporting of Self-Harm and Questionnaire Non-Response , 2016, Archives of Suicide Research.

[113]  D. Gunnell,et al.  Interventions for self-harm in children and adolescents , 2015, BJPsych Advances.

[114]  Jonathan Green,et al.  Self-Harm Intervention: Family Therapy (SHIFT), a study protocol for a randomised controlled trial of family therapy versus treatment as usual for young people seen after a second or subsequent episode of self-harm , 2015, Trials.

[115]  L. Pouliot,et al.  A systematic review and meta-analysis of cognitive behavioural treatments for suicidal and self-harm behaviours in adolescents , 2015 .

[116]  Antoine Douaihy,et al.  Developing a Brief Suicide Prevention Intervention and Mobile Phone Application: A Qualitative Report , 2015, Journal of technology in human services.

[117]  C. Roberts,et al.  The influence of personality disorder on outcome in adolescent self-harm , 2015, British Journal of Psychiatry.

[118]  Lauren J. Breen,et al.  Group mindfulness based cognitive therapy vs group support for self-injury among young people: study protocol for a randomised controlled trial , 2015, BMC Psychiatry.

[119]  Joseph L. Annest,et al.  Suicide Trends Among Persons Aged 10–24 Years — United States, 1994–2012 , 2015, MMWR. Morbidity and mortality weekly report.

[120]  J. Asarnow,et al.  The SAFETY Program: A Treatment-Development Trial of a Cognitive-Behavioral Family Treatment for Adolescent Suicide Attempters , 2015, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[121]  P. Szatmari,et al.  Antecedents and sex/gender differences in youth suicidal behavior. , 2014, World journal of psychiatry.

[122]  Rachel Churchill,et al.  Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. , 2014, The Cochrane database of systematic reviews.

[123]  B. Larsson,et al.  Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. , 2014, Journal of the American Academy of Child and Adolescent Psychiatry.

[124]  B. Soenens,et al.  The psychometric qualities of a short version of the Experiences in Close Relationships Scale – Revised Child version , 2014 .

[125]  S. Selph,et al.  Impact of contacting study authors to obtain additional data for systematic reviews: diagnostic accuracy studies for hepatic fibrosis , 2014, Systematic Reviews.

[126]  D. Best,et al.  Benzodiazepine use and aggressive behaviour: A systematic review , 2014, The Australian and New Zealand journal of psychiatry.

[127]  Fang Zhang,et al.  Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study , 2014, BMJ : British Medical Journal.

[128]  P. Corcoran,et al.  The iceberg of suicide and self-harm in Irish adolescents: a population-based study , 2014, Social Psychiatry and Psychiatric Epidemiology.

[129]  E. Latimer,et al.  Cost-Effectiveness of a Rapid Response Team Intervention for Suicidal Youth Presenting at an Emergency Department , 2014, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[130]  T. Stürmer,et al.  Antidepressant dose, age, and the risk of deliberate self-harm. , 2014, JAMA internal medicine.

[131]  J. Mann,et al.  The neurobiology of suicide. , 2014, The lancet. Psychiatry.

[132]  K. Hawton,et al.  Change in Access to Prescribed Medication following an Episode of Deliberate Self-Poisoning: A Multilevel Approach , 2014, PloS one.

[133]  Farooq Naeem,et al.  Brief psychological intervention after self-harm: randomised controlled trial from Pakistan , 2014, British Journal of Psychiatry.

[134]  P. Fonagy,et al.  The measurement of reflective function in adolescents with and without borderline traits. , 2013, Journal of adolescence.

[135]  K. Saunders,et al.  Psychiatric disorders in patients presenting to hospital following self-harm: a systematic review. , 2013, Journal of affective disorders.

[136]  P. Corcoran,et al.  Adolescents exposed to suicidal behavior of others: prevalence of self-harm and associated psychological, lifestyle, and life event factors. , 2013, Suicide & life-threatening behavior.

[137]  A. Young,et al.  Valproic acid, valproate and divalproex in the maintenance treatment of bipolar disorder. , 2013, The Cochrane database of systematic reviews.

[138]  G. Diamond,et al.  Attachment-Based Family Therapy for Depressed Adolescents , 2013 .

[139]  Michelle Cleary,et al.  Psychosocial interventions for people with both severe mental illness and substance misuse. , 2013, The Cochrane database of systematic reviews.

[140]  M. Kaess,et al.  Short-term psychotherapeutic treatment in adolescents engaging in non-suicidal self-injury: a randomized controlled trial , 2013, Trials.

[141]  M. Dadds,et al.  Family intervention for adolescents with suicidal behavior: a randomized controlled trial and mediation analysis. , 2013, Journal of the American Academy of Child and Adolescent Psychiatry.

[142]  A. Ghanizadeh,et al.  Effectiveness of Cognitive-Behavioral Therapy in Decreasing Suicidal Ideation and Hopelessness of the Adolescents with Previous Suicidal Attempts , 2013, Iranian journal of pediatrics.

[143]  Andrea Cipriani,et al.  Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis , 2013, BMJ.

[144]  D. Ståhl,et al.  Randomised controlled trial of therapeutic assessment versus usual assessment in adolescents with self-harm: 2-year follow-up , 2013, Archives of Disease in Childhood.

[145]  J. Mann,et al.  The serotonergic system in mood disorders and suicidal behaviour , 2013, Philosophical Transactions of the Royal Society B: Biological Sciences.

[146]  K. Hawton,et al.  Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the Multicentre Study of Self-harm in England. , 2012, Journal of child psychology and psychiatry, and allied disciplines.

[147]  P. Fonagy,et al.  Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial. , 2012, Journal of the American Academy of Child and Adolescent Psychiatry.

[148]  J. McKenzie,et al.  Newer generation antidepressants for depressive disorders in children and adolescents. , 2012, The Cochrane database of systematic reviews.

[149]  P. Tyrer Why benzodiazepines are not going away: Commentary on… Benzodiazepines for Anxiety Disorders , 2012 .

[150]  A. Ghanizadeh,et al.  Cognitive-behavioral therapy in decreasing suicidal ideation and hopelessness in depressed adolescents with previous suicidal attempt , 2012 .

[151]  Kate E A Saunders,et al.  Self-harm and suicide in adolescents , 2012, The Lancet.

[152]  S. Mcfaull,et al.  Suicide among children and adolescents in Canada: trends and sex differences, 1980–2008 , 2012, Canadian Medical Association Journal.

[153]  S. Lévy,et al.  Bindungsorientierte Familientherapie als ambulante Nachsorge für Jugendliche nach Suizidversuch , 2012 .

[154]  I. Cormac,et al.  Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia. , 2012, The Cochrane database of systematic reviews.

[155]  M. Andover,et al.  The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: distinguishing risk factors and psychosocial correlates , 2012, Child and Adolescent Psychiatry and Mental Health.

[156]  Jason J. Washburn,et al.  Psychotherapeutic approaches to non-suicidal self-injury in adolescents , 2012, Child and Adolescent Psychiatry and Mental Health.

[157]  K. Hawton,et al.  Epidemiology and nature of self-harm in children and adolescents: findings from the multicentre study of self-harm in England , 2012, European Child & Adolescent Psychiatry.

[158]  D. Ståhl,et al.  Adolescents with suicidal and nonsuicidal self-harm: clinical characteristics and response to therapeutic assessment. , 2012, Psychological assessment.

[159]  K. Hawton,et al.  Distinguishing adolescents who think about self-harm from those who engage in self-harm. , 2012, The British journal of psychiatry : the journal of mental science.

[160]  U. Schmidt,et al.  Development and pilot evaluation of a manualized cognitive-behavioural treatment package for adolescent self-harm. , 2011, Behavioural and cognitive psychotherapy.

[161]  P. Räsänen,et al.  Youth suicide trends in Finland, 1969-2008. , 2011, Journal of child psychology and psychiatry, and allied disciplines.

[162]  S. Fekete,et al.  Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study , 2011, European Child & Adolescent Psychiatry.

[163]  J Rothwell,et al.  Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation , 2011, BMJ : British Medical Journal.

[164]  A. Gray,et al.  Healthcare and social services resource use and costs of self-harm patients , 2011, Social Psychiatry and Psychiatric Epidemiology.

[165]  E. D. Klonsky Non-suicidal self-injury in United States adults: prevalence, sociodemographics, topography and functions , 2011, Psychological Medicine.

[166]  P. Fonagy,et al.  The risk-taking and self-harm inventory for adolescents: development and psychometric evaluation. , 2010, Psychological assessment.

[167]  A. Bottle,et al.  Trial of Therapeutic Assessment in London: randomised controlled trial of Therapeutic Assessment versus standard psychosocial assessment in adolescents presenting with self-harm , 2010, Archives of Disease in Childhood.

[168]  D. Gunnell,et al.  Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose , 2010, British Journal of Psychiatry.

[169]  Wolfgang Viechtbauer,et al.  Outlier and influence diagnostics for meta‐analysis , 2010, Research synthesis methods.

[170]  J. Ioannidis,et al.  The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration , 2009, Annals of Internal Medicine [serial online].

[171]  P. Hazell,et al.  Group therapy for repeated deliberate self-harm in adolescents: failure of replication of a randomized trial. , 2009, Journal of the American Academy of Child and Adolescent Psychiatry.

[172]  J. Hurry,et al.  Adolescents choosing self-harm as an emotion regulation strategy: the protective role of trait emotional intelligence. , 2009, The British journal of clinical psychology.

[173]  Sally Hopewell,et al.  Publication bias in clinical trials due to statistical significance or direction of trial results. , 2009, The Cochrane database of systematic reviews.

[174]  A. James,et al.  A Preliminary Community Study of Dialectical Behaviour Therapy (DBT) with Adolescent Females Demonstrating Persistent, Deliberate Self-Harm (DSH). , 2008, Child and adolescent mental health.

[175]  H. Kandemir,et al.  Behavioral disinhibition, suicidal ideation, and self-mutilation related to clonazepam. , 2008, Journal of child and adolescent psychopharmacology.

[176]  S. Fekete,et al.  Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. , 2008, Journal of child psychology and psychiatry, and allied disciplines.

[177]  A. Pickles,et al.  Pathways from adolescent deliberate self-poisoning to early adult outcomes: a six-year follow-up. , 2008, Journal of child psychology and psychiatry, and allied disciplines.

[178]  J. Mann,et al.  Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents. , 2007, The American journal of psychiatry.

[179]  A. House,et al.  Self-harm in England: a tale of three cities , 2007, Social Psychiatry and Psychiatric Epidemiology.

[180]  L. Claes,et al.  Self-injury in female versus male psychiatric patients: A comparison of characteristics, psychopathology and aggression regulation , 2007 .

[181]  Alexander L. Chapman,et al.  Psychometric Properties of the Borderline Symptom List (BSL) , 2007, Psychopathology.

[182]  Katherine Anne Comtois,et al.  Suicide Attempt Self-Injury Interview (SASII): development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. , 2006, Psychological assessment.

[183]  J. Mann,et al.  Omega-3 Polyunsaturated Essential Fatty Acid Status as a Predictor of Future Suicide Risk , 2006 .

[184]  A. Horvath,et al.  System for Observing Family Therapy Alliances: A Tool for Research and Practice. , 2006 .

[185]  Janice R. Kuo,et al.  Mechanisms of change in dialectical behavior therapy: theoretical and empirical observations. , 2006, Journal of clinical psychology.

[186]  J. Endicott,et al.  Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q): reliability and validity. , 2006, Journal of the American Academy of Child and Adolescent Psychiatry.

[187]  C. Good Adjunctive quetiapine targets self-harm behaviors in adolescent females with major depressive disorder. , 2006, Journal of child and adolescent psychopharmacology.

[188]  A. Pickles,et al.  Early adult outcomes of adolescents who deliberately poisoned themselves. , 2006, Journal of the American Academy of Child and Adolescent Psychiatry.

[189]  A. Spirito,et al.  Treatment for adolescents following a suicide attempt: results of a pilot trial. , 2005, Journal of the American Academy of Child and Adolescent Psychiatry.

[190]  K. Hawton,et al.  Self-cutting: patient characteristics compared with self-poisoners. , 2004, Suicide & life-threatening behavior.

[191]  K. Hawton,et al.  Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients , 2004, British Journal of Psychiatry.

[192]  K. L. Gratz,et al.  Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale , 2004 .

[193]  D. Torgerson The use of Zelen's design in randomised trials , 2004, BJOG : an international journal of obstetrics and gynaecology.

[194]  Paula Diehr,et al.  Imputation of missing longitudinal data: a comparison of methods. , 2003, Journal of clinical epidemiology.

[195]  K. Hawton,et al.  Deliberate self-harm in Oxford, 1990–2000: a time of change in patient characteristics , 2003, Psychological Medicine.

[196]  D. Healy Lines of Evidence on the Risks of Suicide with Selective Serotonin Reuptake Inhibitors , 2003, Psychotherapy and Psychosomatics.

[197]  L. Hechtman,et al.  A rapid-response outpatient model for reducing hospitalization rates among suicidal adolescents. , 2002, Psychiatric services.

[198]  Allan Donner,et al.  Issues in the meta‐analysis of cluster randomized trials , 2002, Statistics in medicine.

[199]  T. MacDonald,et al.  Paracetamol toxicity: epidemiology, prevention and costs to the health-care system. , 2002, QJM : monthly journal of the Association of Physicians.

[200]  Douglas G Altman,et al.  Meta‐analysis combining parallel and cross‐over clinical trials. III: The issue of carry‐over , 2002, Statistics in medicine.

[201]  Douglas G Altman,et al.  Meta‐analysis combining parallel and cross‐over clinical trials. I: Continuous outcomes , 2002, Statistics in medicine.

[202]  D. Bishop,et al.  An intervention trial to improve adherence to community treatment by adolescents after a suicide attempt. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[203]  C. Stanton,et al.  Treatment-as-Usual for Adolescent Suicide Attempters: Implications for the Choice of Comparison Groups in Psychotherapy Research , 2002, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[204]  Douglas G Altman,et al.  Meta-analyses involving cross-over trials: methodological issues. , 2002, International journal of epidemiology.

[205]  R. Harrington,et al.  Randomized trial of group therapy for repeated deliberate self-harm in adolescents. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[206]  F. Roudot-thoraval,et al.  Predictive factors of post‐discharge follow‐up care among adolescent suicide attempters , 2001, Acta psychiatrica Scandinavica.

[207]  K. Honkalampi,et al.  Fish consumption, depression, and suicidality in a general population. , 2001, Archives of general psychiatry.

[208]  D. Feeny,et al.  The Health Utilities Index (HUI®) system for assessing health-related quality of life in clinical studies , 2001, Annals of medicine.

[209]  B. Chorpita,et al.  Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. , 2000, Behaviour research and therapy.

[210]  W. Compton,et al.  The Service Assessment for Children and Adolescents (SACA): adult and child reports. , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[211]  C. Adams,et al.  Unpublished rating scales: A major source of bias in randomised controlled trials of treatments for schizophrenia , 2000, British Journal of Psychiatry.

[212]  R. Harrington,et al.  Deliberate self-poisoning in adolescence: why does a brief family intervention work in some cases and not others? , 2000, Journal of adolescence.

[213]  P. Lelliott,et al.  Brief scale for measuring the outcomes of emotional and behavioural disorders in children , 1999, British Journal of Psychiatry.

[214]  D. Torgerson,et al.  Cost-effectiveness analysis of a home-based social work intervention for children and adolescents who have deliberately poisoned themselves , 1999, British Journal of Psychiatry.

[215]  M. Linehan,et al.  The Reasons for Living Inventory for Adolescents (RFL-A): development and psychometric properties. , 1998, Journal of clinical psychology.

[216]  H. Meltzer,et al.  The strengths and difficulties questionnaire: A pilot study on the validity of the self-report version , 1998, European Child & Adolescent Psychiatry.

[217]  D. Cook,et al.  Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? , 1998, The Lancet.

[218]  R. Harrington,et al.  Randomized trial of a home-based family intervention for children who have deliberately poisoned themselves. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[219]  J M Bland,et al.  Analysis of a trial randomised in clusters , 1998, BMJ.

[220]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[221]  Martin T. Wells,et al.  USING RANDOM RATHER THAN FIXED EFFECTS MODELS IN META‐ANALYSIS: IMPLICATIONS FOR SITUATIONAL SPECIFICITY AND VALIDITY GENERALIZATION , 1996 .

[222]  Albert Maydeu-Olivares,et al.  A factor-analytic study of the Social Problem-Solving Inventory: An integration of theory and data , 1996, Cognitive Therapy and Research.

[223]  D. Black,et al.  Secondary Prevention of Attempted Suicide in Adolescence. , 1995 .

[224]  D. Shaffer,et al.  The Columbia Impairment Scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. , 1993 .

[225]  M. Kelley,et al.  Social problem solving in suicidal adolescents. , 1993, Journal of consulting and clinical psychology.

[226]  P. Easterbrook,et al.  Publication bias in clinical research , 1991, The Lancet.

[227]  L. Radloff The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults , 1991, Journal of youth and adolescence.

[228]  G. Parker,et al.  Development of a scale to measure interpersonal sensitivity. , 1989, The Australian and New Zealand journal of psychiatry.

[229]  R A Steer,et al.  Scale for Suicide Ideation: psychometric properties of a self-report version. , 1988, Journal of clinical psychology.

[230]  E. A. Taylor,et al.  Children who Poison Themselves II. Prediction of Attendance for Treatment , 1984, British Journal of Psychiatry.

[231]  James Robert Brašić,et al.  A children's global assessment scale (CGAS). , 1983, Archives of general psychiatry.

[232]  A. Kazdin,et al.  Hopelessness, depression, and suicidal intent among psychiatrically disturbed inpatient children. , 1983, Journal of consulting and clinical psychology.

[233]  R. Snaith,et al.  The Hospital Anxiety And Depression Scale , 2003, Health and quality of life outcomes.

[234]  Lawrence M. Baldwin,et al.  THE McMASTER FAMILY ASSESSMENT DEVICE , 1983 .

[235]  M. Zelen A new design for randomized clinical trials. , 1979, The New England journal of medicine.

[236]  M. Åsberg,et al.  A New Depression Scale Designed to be Sensitive to Change , 1979, British Journal of Psychiatry.

[237]  D Lester,et al.  The measurement of pessimism: the hopelessness scale. , 1974, Journal of consulting and clinical psychology.

[238]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[239]  M. Varacallo,et al.  2019 , 2019, Journal of Surgical Orthopaedic Advances.

[240]  J. Pirkis,et al.  Population attributable risk of factors associated with the repetition of self-harm behaviour in young people presenting to clinical services: a systematic review and meta-analysis , 2018, European Child & Adolescent Psychiatry.

[241]  C. Sharp,et al.  An 11-item measure to assess borderline traits in adolescents: refinement of the BPFSC using IRT. , 2014, Personality disorders.

[242]  M. Linehan,et al.  Differentiating Adolescent Self-Injury from Adolescent Depression: Possible Implications for Borderline Personality Development , 2012, Journal of abnormal child psychology.

[243]  S. Kathriarachchi,et al.  Problem—solving counseling as a therapeutic tool on youth suicidal behavior in the suburban population in Sri Lanka , 2011, Indian journal of psychiatry.

[244]  K. Hawton,et al.  The changing gender ratio in occurrence of deliberate self-harm across the lifecycle. , 2008, Crisis.

[245]  J. Overholser,et al.  Treatment of Adolescent Suicide Attempters , 2003 .

[246]  Prathiba Chitsabesan,et al.  Predicting repeat self-harm in children , 2003, European Child & Adolescent Psychiatry.

[247]  J. Brunner,et al.  Cholesterol, essential fatty acids, and suicide. , 2002, Pharmacopsychiatry.

[248]  A. Kasuya EuroQol--a new facility for the measurement of health-related quality of life. , 1990, Health policy.