DELIBERATE SELF-HARM - SYSTEMATIC REVIEW OF EFFICACY OF PSYCHOSOCIAL AND PHARMACOLOGICAL TREATMENTS IN PREVENTING REPETITION

Objective: To identify and synthesise the findings from all randomised controlled trials that have examined the effectiveness of treatments of patients who have deliberately harmed themselves. Design: Systemati c review of randomised controlled trials of psychosocial and physical treatments. Studies categorised according to type of treatment. When t here was more than one investigation in a particular category a summar y odds ratio was estimated with the Mantel-Haenszel method. Setting: R andomised trials available in electronic databases in 1996, in the Coc hrane Controlled Trials Register in 1997, and from hand searching of j ournals to 1997, Subjects: Patients who had deliberately harmed themse lves shortly before entry into the trials with information on repetiti on of behaviour. The included trials comprised 2452 randomised partici pants with outcome data. Main outcome measure: Repetition of self harm . Results: 20 trials reported repetition of self harm as an outcome va riable, classified into 10 categories. Summary odds ratio (all for com parison with standard aftercare) indicated reduced repetition for prob lem solving therapy (0.73; 95% confidence interval 0.45 to 1.18) and f or provision of an emergency contact card in addition to standard care (0.45; 0.19 to 1.07). The summary odds ratios were 0.83 (0.61 to 1.14 ) for trials of intensive aftercare plus outreach and 1.19 (0.53 to 2. 67) for antidepressant treatment compared with placebo. Significantly reduced rates of further self harm were observed for depot flupenthixo l versus placebo in multiple repeaters (0.09; 0.02 to 0.50) and for di alectical behaviour therapy versus standard aftercare (0.24; 0.06 to 0 .93). Conclusion: There remains considerable uncertainty about which f orms of psychosocial and physical treatments of patients who harm them selves are most effective. Further larger trials of treatments are nee ded.