Culturally adapted manual assisted problem solving training (C-MAPS) for prevention of self harm: An RCT from a low income country

Background: Suicide is a global public health problem. Self harm is a major risk factor for completed suicide. Since most episodes of self harm in Pakistanis are precipitated by an interpersonal problem with family members, there is a strong rationale for investigating the efficacy of a psychological intervention which addresses such issues. Aims: To determine the effect of a brief psychological intervention, which had been culturally adapted, on suicidal ideation and depression among those who had harmed themselves? Methods: Randomized controlled trial of 46 adults admitted to a medical ward of a teaching hospital, after an episode of self harm in Karachi. The Control group received "treatment as usual" which in most cases was referral back to the family physician. Six sessions of culturally adapted problem solving training, lasting approximately 50 minutes and delivered over 3 months. Primary outcome measure was suicidal ideation as measured by the Beck scale for suicidal ideation. Secondary outcome measures included depressive symptoms measured by the Beck depression inventory and hopelessness measured by the Beck hopelessness scale at baseline and at 3 months. Results: A linear regression taking into consideration baseline differences showed that there were statistically significant differences in favour of therapy at the end of intervention after 3 months, for Suicidal ideation (Pb0.000, Mean difference=21.5, CI=18.7-24.3), depressive symptoms (Pb0.000, Mean difference=31.7, CI=26.0-37.3) and hopelessness (Pb0.000, Mean difference=16.8, CI=15.1- 18.6). Conclusions: Our preliminary results show that brief psychological intervention (C-MAPS) was effective in reducing suicidal ideation, depressive symptoms and hopelessness in self harm patients.