TY - JOUR
T1 - Systematic Review and Individual Participant Data Meta-Analysis
T2 - Reducing Self-Harm in Adolescents: Pooled Treatment Effects, Study, Treatment and Participant Moderators
AU - Wright-Hughes, Alex
AU - Farrin, Amanda J
AU - Fonagy, Peter
AU - Ougrin, Dennis
AU - Stahl, Daniel
AU - Wright, Judy
AU - Irving, Donna
AU - Mughal, Faraz
AU - Truscott, Alex
AU - Diggins, Emma
AU - Chanen, Andrew
AU - Cooney, Emily
AU - Carter, Greg
AU - Clover, Kerrie
AU - Dadds, Mark
AU - Diamond, Guy
AU - Esposito-Smythers, Christianne
AU - Green, Jonathan
AU - Griffiths, Helen
AU - Hassanian-Moghaddam, Hossein
AU - Hatcher, Simon
AU - Hazell, Philip
AU - Husein, Nusrat
AU - Kaess, Michael
AU - King, Cheryl
AU - Morthorst, Britt
AU - O'Connor, Rory C
AU - Santamarina-Perez, Pilar
AU - Tyrer, Peter
AU - Walwyn, Rebecca
AU - Cottrell, David
N1 - Copyright © 2025. Published by Elsevier Inc.
PY - 2025/1/30
Y1 - 2025/1/30
N2 - OBJECTIVE: Self-harm is common in adolescents and a major public health concern. Evidence for effective interventions that stop repetition is lacking. This individual-participant-data (IPD) meta-analysis of randomised controlled trials (RCTs) aimed to provide robust estimates of therapeutic intervention effects and explore which treatments are best suited to different subgroups.METHOD: We searched databases and trial registers, to January-2022. RCTs compared therapeutic intervention to control, targeted adolescents aged 11-18 with a history of self-harm and receiving clinical care and reported on outcomes related to self-harm or suicide attempt. Primary outcome was repetition of self-harm at 12 months post-randomization . Two-stage random-effects IPD meta-analyses were conducted overall and by intervention. Secondary analyses incorporated aggregate data (AD) from RCTs without IPD. PROSPERO registration: CRD42019152119.RESULTS: We identified 39 eligible studies; 26 provided IPD (3,448 participants), 7 provided AD (698 participants). There was no evidence that intervention/s were more or less effective than controls at preventing repeat self-harm by 12 months in IPD (odds ratio (OR)=1.06 [95% CI 0.86, 1.31], studies=20, n=2,949) or IPD+AD (OR=1.02 [95% CI 0.82, 1.27], studies=22, n=3,117) meta-analyses and no evidence of heterogeneity of treatment effects on study and treatment factors. Across all interventions, participants with multiple prior self-harm episodes showed evidence of improved treatment effect on self-harm repetition 6-12 months after randomization (OR=0.33 [95% CI 0.12, 0.94], studies=9, n=1,771).CONCLUSION: This large-scale meta-analysis of RCTs provided no evidence that therapeutic intervention was more, or less, effective than control for reducing repeat self-harm. We observed evidence indicating more effective interventions within youth with two or more self-harm incidents. Funders and researchers need to agree on a core set of outcome measures to include in subsequent studies.
AB - OBJECTIVE: Self-harm is common in adolescents and a major public health concern. Evidence for effective interventions that stop repetition is lacking. This individual-participant-data (IPD) meta-analysis of randomised controlled trials (RCTs) aimed to provide robust estimates of therapeutic intervention effects and explore which treatments are best suited to different subgroups.METHOD: We searched databases and trial registers, to January-2022. RCTs compared therapeutic intervention to control, targeted adolescents aged 11-18 with a history of self-harm and receiving clinical care and reported on outcomes related to self-harm or suicide attempt. Primary outcome was repetition of self-harm at 12 months post-randomization . Two-stage random-effects IPD meta-analyses were conducted overall and by intervention. Secondary analyses incorporated aggregate data (AD) from RCTs without IPD. PROSPERO registration: CRD42019152119.RESULTS: We identified 39 eligible studies; 26 provided IPD (3,448 participants), 7 provided AD (698 participants). There was no evidence that intervention/s were more or less effective than controls at preventing repeat self-harm by 12 months in IPD (odds ratio (OR)=1.06 [95% CI 0.86, 1.31], studies=20, n=2,949) or IPD+AD (OR=1.02 [95% CI 0.82, 1.27], studies=22, n=3,117) meta-analyses and no evidence of heterogeneity of treatment effects on study and treatment factors. Across all interventions, participants with multiple prior self-harm episodes showed evidence of improved treatment effect on self-harm repetition 6-12 months after randomization (OR=0.33 [95% CI 0.12, 0.94], studies=9, n=1,771).CONCLUSION: This large-scale meta-analysis of RCTs provided no evidence that therapeutic intervention was more, or less, effective than control for reducing repeat self-harm. We observed evidence indicating more effective interventions within youth with two or more self-harm incidents. Funders and researchers need to agree on a core set of outcome measures to include in subsequent studies.
KW - self-harm
KW - suicide
KW - adolescents
KW - systematic review
KW - ipd meta-analysis
U2 - 10.1016/j.jaac.2025.01.017
DO - 10.1016/j.jaac.2025.01.017
M3 - Article
C2 - 39892472
SN - 0890-8567
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
ER -
