The efficacy of problem-solving treatments after deliberate self-harm: meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems

Background. Brief problem-solving therapy is regarded as a pragmatic treatm ent for deliberate self-harm (DSH) patients. A recent meta-analysis of rand omized controlled trials (RCTs) evaluating this approach indicated a trend towards reduced repetition of DSH but the pooled odds ratio was not statist ically significant. We have now examined other important outcomes using thi s procedure, namely depression, hopelessness and improvement in problems. Method. Six trials in which problem-solving therapy was compared with contr ol treatment were identified from an extensive literature review of RCTs of treatments for DSH patients. Data concerning depression, hopelessness and improvement in problems were extracted. Where relevant statistical data (e. g. standard deviations) were missing these were imputed using various stati stical methods. Results were pooled using, meta-analytical procedures. Results. At follow-up, patients who were offered problem-solving therapy ha d significantly greater improvement in scores for depression (standardized mean difference = -0.36; 95 % CI -0.61 to -0.11) and hopelessness (weighted mean difference = -3.2; 95% CI -4.0 to -2.41), and significantly more repo rted improvement in their problems (odds ratio = 2.31 95 % CI 1.29 to 4.13) , than patients who were in the control treatment groups. Conclusions. Problem-solving therapy for DSH patients appears to produce be tter results than control treatment with regard to improvement in depressio n, hopelessness and problems. It is desirable that this finding is confirme d in a large trial, which will also allow adequate testing of the impact of this treatment on repetition of DSH.