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Jerome L, Ougrin D. Editorial: How Can We Best Support Suicidal Youth? New Evidence for Dialectical Behavior Therapy and Different Forms of Self-Harm. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00251-X. [PMID: 38762071 DOI: 10.1016/j.jaac.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
Establishing effective treatments for youth at risk of suicide is one of the most pressing and important tasks within child and adolescent psychiatry. Self-harm, which includes suicide attempt (SA), nonsuicidal self-injury (NSSI), and nonsuicidal self-poisoning, is one of the strongest predictors of suicide.1 Youth who engage in self-harm or experience mental health crisis are becoming more and more common, at increasingly younger ages, and so confidence in treatments to successfully reduce self-harm and prevent relapse and recurrence is crucial.2 However, the evidence base for such treatments is severely lacking despite some progress in the field.3-5 Dialectical behavior therapy (DBT) is the most established treatment option, but even so, the evidence comes from just a handful of studies and primarily focuses on the ability of DBT to reduce the repetition of self-harm. Whether DBT is successful in supporting young people along their recovery journey and is equally effective at treating different forms of self-harm are yet to be properly explored.
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Affiliation(s)
- Lauren Jerome
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
| | - Dennis Ougrin
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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2
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Haw R, Marsden M, Hartley S, Turpin C, Taylor PJ. A Brief Cognitive Analytic Therapy-Informed Approach for Young People That Have Self-Injured (CATCH-Y): A Case Series. Clin Psychol Psychother 2024; 31:e2976. [PMID: 38757462 DOI: 10.1002/cpp.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) presents an increasingly prevalent problem for young people; however, there remains a scarce evidence base for effective, scalable treatments for adolescents. This study aimed to assess the feasibility and acceptability of a brief, cognitive analytic therapy (CAT)-informed intervention for young people who engage in NSSI (CATCH-Y). METHODS A case series design recruited 13 young people who met the inclusion and exclusion criteria to participate in the five-session intervention. Eligible participants were aged 13-17 years (M = 15.15, SD = 1.28) and had engaged in NSSI at least once in the previous 6 months. Feasibility and acceptability were measured via recruitment, retention, qualitative feedback and missing data. The secondary outcome measures of personal recovery and motivation were administered pre- and post-assessment, with measures of depressive symptoms and urges to self-injure. RESULTS The intervention was found to be largely feasible and acceptable with high rates of recruitment, retention and pre-/post-assessment data completeness. Measures showed preliminary support for positive change in rates of NSSI, urges to self-harm, low mood and personal recovery, although results were mixed. Completion rates for remote assessments were low. CONCLUSIONS The findings of this study support further evaluation of the CATCH-Y intervention on a larger scale. In-person assessments may be preferable to remote to ensure good completion rates.
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Affiliation(s)
- R Haw
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Specialist Perinatal Service, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - M Marsden
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Aquarius Ward, South West London and St. George's Mental Health NHS Trust, London, UK
| | - S Hartley
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Tameside and Glossop CAMHS, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - C Turpin
- Specialist Psychotherapy Service, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - P J Taylor
- Manchester Academic Health Sciences Centre, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Goker Z. Religion would be a missing link in the case formulation of adolescents with conduct problems: an eclectic approach. Front Psychiatry 2024; 15:1348799. [PMID: 38711870 PMCID: PMC11070571 DOI: 10.3389/fpsyt.2024.1348799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/10/2024] [Indexed: 05/08/2024] Open
Abstract
Psychiatry is concerned with mental health. Cognition is one of the key mental functions and manifests itself primarily as behavior. A behavior exhibited in response to a stimulus is influenced by biological (inherited), psychological (individual), and social (environmental) factors. During consolidation of an exhibited behavior, the factors affecting the individual's cognitive structure and personality play crucial roles. Underlying factors for a problematic behavior, and their weakness/strength levels are determined via the Biopsychosocial model. Empirically effective current practices to intervene the problematic behaviors do not always result in success. One of the reasons may be other elements that were omitted during the case formulation process. This article aims to stress the idea that whatever the underlying factor of a problematic behavior is, the most crucial determinant and/or pre-emptive factor in developing or maintaining that behavior might actually be the religion as a governing and directive philosophy on how to conduct oneself. In this instance, the key is in the hands of the parents or caregivers.
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Lu J, Gao W, Wang Z, Yang N, Pang WIP, In Lok GK, Rao W. Psychosocial interventions for suicidal and self-injurious-related behaviors among adolescents: a systematic review and meta-analysis of Chinese practices. Front Public Health 2023; 11:1281696. [PMID: 38164448 PMCID: PMC10757980 DOI: 10.3389/fpubh.2023.1281696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
Background Suicidal and self-injurious-related behaviors (SSIRBs) are a serious public health challenge in China. However, a comprehensive systematic review of psychosocial interventions for SSIRBs among Chinese adolescents has not been performed. To fill this gap, this systematic review and meta-analysis aimed to examine psychosocial interventions for SSIRBs among Chinese adolescents. Methods Eight international (PubMed, EMBASE, Cochrane Library, ScienceDirect, Clinical Trial, CINAHL, PsycINFO, and Web of Science) and four Chinese (Wanfang, SinoMed, CEPS, and CNKI) databases were searched from inception to 31 January 2023. Data extraction and quality assessment were independently conducted by two groups of researchers. Qualitative synthesis and meta-analysis were both used. Results The initial search yielded 16,872 titles. Of the 649 full texts reviewed, 19 intervention articles focusing on SSIRBs met the inclusion criteria. Thirteen out of the 19 included studies involved cognitive-behavioral therapy (CBT). Seven non-suicidal self-injury (NSSI) studies assessing self-injurious behaviors were included (six short-term studies and three long-term studies). Compared with long-term interventions [-1.30 (95% CI: -1.84, -0.76)], short-term psychosocial interventions had a higher standardized mean difference (SMD) value [1.86 (95% CI: -2.72, -0.99)]. Meta-regression showed an inverse relationship between the treatment response and sample size (slope = 0.068, Z = 2.914, p = 0.004) and proportion of females (slope = 1.096, Z = 5.848, p < 0.001). Subgroup analyses showed that compared with the "less than 1 month" group [-0.494 (-0.783, -0.205)], in the "immediate postintervention" group, the pooled estimate was significantly lower [-2.800 (-4.050, -1.550), p < 0.001]. Conclusion Our review systematically summarized the key characteristics and effectiveness of existing psychosocial interventions for SSIRBs among Chinese adolescents. Short-term psychosocial interventions for NSSI were significantly effective in reducing self-injurious behavior scores, especially in the immediate postintervention period. More favorable treatment responses could be observed in both male and small samples.
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Affiliation(s)
- Junjie Lu
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Wanting Gao
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
| | - Zexin Wang
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
| | - Nan Yang
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
| | - Weng Ian Phoenix Pang
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
| | - Grace Ka In Lok
- Macao Polytechnic University, Peking University Health Science Center-Macao Polytechnic University Nursing Academy, Macao, Macao SAR, China
| | - Wenwang Rao
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
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Riccioni A, Siracusano M, Davico C, Klauser P, Morcillo C, Ougrin D, Vitiello B, Plessen KJ, Armando M, Cortese S, Mazzone L. Learning with fun: the 2nd residential course on child and adolescent psychiatry in Catania, Sicily, endorsed by the ESCAP Research Academy. Eur Child Adolesc Psychiatry 2023; 32:725-727. [PMID: 36820997 PMCID: PMC9948784 DOI: 10.1007/s00787-023-02162-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Assia Riccioni
- Child Neurology and Psychiatry Unit, Fondazione PTV-Policlinico Tor Vergata, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy.
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Martina Siracusano
- Child Neurology and Psychiatry Unit, Fondazione PTV-Policlinico Tor Vergata, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy.
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Chiara Davico
- Department of Pediatrics, Regina Margherita Pediatric Hospital, 10126, Turin, Italy
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, P.Zza Polonia 94, 10126, Turin, Italy
| | - Paul Klauser
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | | | - Dennis Ougrin
- Youth Resilience Unit, Barts and The London School of Medicine and Dentistry, World Health Organisation Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Benedetto Vitiello
- Department of Pediatrics, Regina Margherita Pediatric Hospital, 10126, Turin, Italy
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, P.Zza Polonia 94, 10126, Turin, Italy
| | - Kerstin J Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
- Child and Adolescent Mental Health Centre, Mental Health Services-Capital Region of Denmark, Copenhagen, Denmark
| | - Marco Armando
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | - Samuele Cortese
- Solent NHS Trust, Southampton, UK
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences and Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Fondazione PTV-Policlinico Tor Vergata, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
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Campisi SC, Ataullahjan A, Baxter JAB, Szatmari P, Bhutta ZA. Mental health interventions in adolescence. Curr Opin Psychol 2022; 48:101492. [PMID: 36347181 DOI: 10.1016/j.copsyc.2022.101492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 01/28/2023]
Abstract
Adolescent mental health (MH) disorders with striking prominence include anxiety, self-harm and depression. The current review aims to highlight high-quality reviews of novel interventions, mainly Cochrane reviews, and/or quality meta-analyses published between 2019 and 2022 on three adolescent mental health challenges. Recent evidence about the effectiveness of psychosocial interventions is encouraging. However, the shift to virtual treatment methods during the pandemic was supported by a relatively thin body of research. Future research and policy in child and youth MH must address the consequences of the pandemic or comparable disruptions on adolescent MH, as well as mitigation strategies. An emphasis on integrated digital, community and school platforms for mental health within child and adolescent health services would benefit from a greater focus on early recognition and prevention.
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Affiliation(s)
- Susan C Campisi
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Burton Wing, Toronto, ON M5G 1X8, Canada
| | - Anushka Ataullahjan
- Centre for Global Child Health, Hospital for Sick Children; 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4. Canada
| | - Jo-Anna B Baxter
- Centre for Global Child Health, Hospital for Sick Children; 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4. Canada
| | - Peter Szatmari
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Burton Wing, Toronto, ON M5G 1X8, Canada; Cundill Centre for Child and Youth Depression, Centre for Addiction, and Mental Health, 80 Workman Way, Toronto, ON - M6J 1H4. Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8. Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children; 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4. Canada; Centre of Excellence in Women, and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, Pakistan. 74800.
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Schmeckenbecher J, Rattner K, Cramer RJ, Plener PL, Baran A, Kapusta ND. Effectiveness of distance-based suicide interventions: multi-level meta-analysis and systematic review. BJPsych Open 2022; 8:e140. [PMID: 35861112 PMCID: PMC9345623 DOI: 10.1192/bjo.2022.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of distance-based interventions (DBIs) to reduce suicidal ideation and behaviours are an increasingly relevant form of intervention. DBIs are more affordable, scalable and available than traditional face-to-face interventions, helping to narrow the gap between needed and provided care. AIMS To evaluate the overall effectiveness of DBIs against suicidal ideation and behaviours. METHOD We systematically searched Web of Science, Scopus and PubMed for all DBIs primarily aimed at reducing suicidal ideation and behaviours. Data were analysed with a robust variance estimation corrected, multi-level meta-analysis. RESULTS We found 38 studies, reporting 110 outcomes. Effectiveness in reducing suicidal ideation was low (standardised mean difference -0.174, 95% CI -0.238 to -0.110). DBIs were significantly less effective against suicidal behaviours than against suicidal ideation, although still effective (standardised mean difference -0.059, 95% CI -0.087 to -0.032). Human involvement had no significant effect on effectiveness. CONCLUSIONS Despite low effectiveness, DBIs might play a role in large-scale prevention efforts against suicidal ideation within a stepped care approach. Further, DBIs may be helpful in expanding mental health services in low- and middle-income countries with otherwise limited access to mental healthcare. Although the evidence for DBIs efficacy is well grounded, the technical and scientific evaluation of DBIs regarding their set up, functionality and components needs to be addressed in future studies.
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Affiliation(s)
- Jim Schmeckenbecher
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Austria
| | - Katrin Rattner
- Clinic for Psychiatry and Psychotherapy, kbo-Inn-Salzach-Klinikum, Freilassing, Germany
| | - Robert J Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, North Carolina, USA
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria; and Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Germany
| | - Anna Baran
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Sweden; and Department of Psychiatry, Blekinge Hospital, Sweden
| | - Nestor D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Austria
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[Psychotherapy after a suicide attempt-current evidence and evaluation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 65:40-46. [PMID: 34878566 PMCID: PMC8732955 DOI: 10.1007/s00103-021-03466-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
Suizidversuche gelten als einer der wichtigsten Risikofaktoren für Suizide. Vor diesem Hintergrund wurden in den letzten Jahren diverse Psychotherapieangebote für Personen nach einem Suizidversuch entwickelt und untersucht. Im Rahmen dieses Artikels wird der aktuelle Stand der Effektivitätsforschung zusammengefasst, es werden Beispiele für erfolgreiche suizidfokussierte Psychotherapieprogramme gegeben und der gegenwärtige Forschungs- und Wissensstand wird kritisch reflektiert. Die Ergebnisse von 2 aktuellen Cochrane-Reviews zur Psychotherapie nach selbstverletzendem Verhalten im Kindes‑, Jugend- und Erwachsenenalter sowie Befunde aus 14 weiteren Metaanalysen zur psychologischen Suizidprävention, die in den vergangenen 5 Jahren publiziert wurden, werden überblicksartig dargestellt. Die kognitive Verhaltenstherapie (KVT) und die dialektisch-behaviorale Therapie (DBT) haben sich als effektiv erwiesen. Insgesamt sind die gemittelten Effektstärken jedoch von geringer Größe und diverse methodische Probleme verunmöglichen weitreichende Schlussfolgerungen. Grundsätzlich kommt der suizidspezifischen Psychotherapie in der individuumszentrierten Suizidprävention besondere Bedeutung zu; die empirische Fundierung und Dissemination entsprechender Programme sind jedoch noch unzureichend.
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9
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Thai TT, Jones MK, Nguyen TP, Pham TV, Bui HHT, Kim LX, Nguyen TV. The Prevalence, Correlates and Functions of Non-Suicidal Self-Injury in Vietnamese Adolescents. Psychol Res Behav Manag 2021; 14:1915-1927. [PMID: 34866944 PMCID: PMC8636691 DOI: 10.2147/prbm.s339168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Research conducted across different countries has consistently identified non-suicidal self-injury (NSSI) to be a common and significant public health problem. This study examined the prevalence, associated factors and functions of NSSI, among a large sample of Vietnamese adolescents. Methods A total of 1316 high school students (15-18 years old, 63.3% female) across urban and suburban areas in Ho Chi Minh City, participated in this cross-sectional study. NSSI was assessed by the Functional Assessment of Self-Mutilation. Results Almost half (43.9%) of the adolescents engaged in at least one type of NSSI within the preceding 12-month period and more than one quarter (26.1%) engaged in multiple types of NSSI. Hitting self on purpose (23.1%), picking at a wound (17.0%), or biting self (16.7%) were the most frequent behaviours. Severe forms of NSSI such as scraping, burning or erasing skin were reported by 17.2%. The most common functions for NSSI were to stop bad feelings (56.0%), to punish self (48.7%), to get control of a situation (44.0%) and to feel relaxed (42.2%). Symptoms of depression, anxiety and stress were significant factors associated with NSSI, particularly for participants who engaged in moderate/severe NSSI and multiple types of NSSI. Conclusion High rates of NSSI were found in Vietnamese adolescents. There is a pressing need for the development and implementation of effective interventions to reduce NSSI. Strategies that promote positive mental health and reduce symptoms of depression, anxiety and stress as well as approaches that help adolescents manage their internal emotions are likely to be beneficial.
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Affiliation(s)
- Truc Thanh Thai
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City Vietnam
| | - Mairwen K Jones
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Thao Phuong Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City Vietnam
| | - Thao Van Pham
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City Vietnam
| | - Han Hy Thi Bui
- Woolcock Institute of Medical Research Vietnam, Ho Chi Minh City, Vietnam
| | - Loan Xuan Kim
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City Vietnam
| | - Tap Van Nguyen
- Department of Medicine and Pharmacy, Tra Vinh University, Tra Vinh, Vietnam
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Walsh L, Luthy E, Feng X, Yilmazer T, Ford J, Kelleher K, Chavez L, Slesnick N. Predictors of Treatment Engagement Among Suicidal Youth Experiencing Homelessness. Community Ment Health J 2021; 57:1310-1317. [PMID: 34050857 PMCID: PMC8416804 DOI: 10.1007/s10597-021-00850-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Homeless youth experience high rates of suicidal ideation and attempts, yet limited research has examined predictors of treatment engagement among this population. Suicidal homeless youth (N = 150) between the ages of 18 and 24 years were recruited from a drop-in center in Columbus, Ohio. Participants were randomly assigned to Cognitive Therapy for Suicide Prevention + treatment as usual through a local drop-in center (CTSP + TAU) (N = 75) or TAU alone (N = 75), and treatment attendance among those assigned to CTSP + TAU was examined in this study. As expected, among youth engaged in CTSP + TAU, those with a history of intimate partner violence (IPV) showed decreased odds of treatment attendance. Additionally, youth randomized into CTSP + TAU with higher acquired capability for suicide (ACS) scores and those identifying as Black were more likely to attend treatment sessions. Findings suggest that effective treatment implementation must consider youth's trauma history, demographics and severity of suicidal ideation and behaviors.
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Affiliation(s)
- Laura Walsh
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA.
| | - Ellison Luthy
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
| | - Xin Feng
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
| | - Tansel Yilmazer
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
| | - Jodi Ford
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | | | - Laura Chavez
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
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Wang L, Zheng D, Liu L, Zhong G, Bi X, Hu S, Wang M, Qiao D. Relationship between SIRT1 gene and adolescent depressive disorder with nonsuicidal self-injury behavior: Based on gene methylation and mRNA expression. Medicine (Baltimore) 2021; 100:e26747. [PMID: 34397817 PMCID: PMC8341318 DOI: 10.1097/md.0000000000026747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/23/2021] [Accepted: 07/09/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The incidence of non-suicidal self-injury (NSSI) behavior in adolescents is increasing year by year. Patients with a history of both depression and NSSI behavior tend to be at greater risk for suicide. At present, the mechanism of adolescent depressive disorder with NSSI behavior is not clear and still in research and exploration. The expression of the Silent Information Regulator 2 Related Enzyme 1 (SIRT1) gene is closely related to the level of serotonin in molecular mechanisms, and may be closely related to the occurrence and development of depressive disorder. This study aimed to explore the relationship between the SIRT1 gene and NSSI behaviors in adolescents with depressive disorder. METHODS A total of 15 adolescent depressed patients with NSSI behavior and 15 healthy controls were enrolled in the study. Bisulfite Sequencing PCR (BSP) was used to test the methylation level of SIRT1 gene promoter region of the participants. The real-time fluorescent quantitative PCR was conducted to measure the mRNA expression level of SIRT1 gene. RESULTS Our study found that the methylation level of SIRT1 gene promoter region at cytosine-guanine dinucleotide 5 (CpG5) site in depression group was higher than that of control group. Compared with that of control group, the plasma concentration of Sirt1 protein significantly decreased in depression group. CONCLUSION Our study investigated the methylation level and the mRNA expression of SIRT1 gene in adolescent depressive patients with NSSI behavior. The study points towards finding an in vivo molecular marker for those adolescent patients.
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Affiliation(s)
- Lina Wang
- Department of Psychiatry, Shandong Mental Health Center, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Doudou Zheng
- Department of Psychiatry, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lanfen Liu
- Department of Psychiatry, Shandong Mental Health Center, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Gengkun Zhong
- Department of Psychiatry, Shandong Mental Health Center, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaojiao Bi
- Department of Psychiatry, Shandong Mental Health Center, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shiqi Hu
- Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, China
| | - Miao Wang
- Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, China
| | - Dongdong Qiao
- Department of Psychiatry, Shandong Mental Health Center, Cheeloo College of Medicine, Shandong University, Jinan, China
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Interventions for self-harm in children and adolescents. Cochrane Database Syst Rev 2021; 3:CD013667. [PMID: 33677832 PMCID: PMC8094399 DOI: 10.1002/14651858.cd013667.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Ougrin D, Corrigall R, Stahl D, Poole J, Zundel T, Wait M, Slater V, Reavey P, Byford S, Ivens J, Crommelin M, Hayes D, Middleton K, Young P, Taylor E. Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm, functional impairment, and educational and clinical outcomes. Eur Child Adolesc Psychiatry 2021; 30:1427-1436. [PMID: 32885344 PMCID: PMC8440265 DOI: 10.1007/s00787-020-01617-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/04/2020] [Indexed: 10/24/2022]
Abstract
Clinical guidelines recommend intensive community care service treatment (ICCS) to reduce adolescent psychiatric inpatient care. We have previously reported that the addition of ICCS led to a substantial decrease in hospital use and improved school re-integration. The aim of this study is to undertake a randomised controlled trial (RCT) comparing an inpatient admission followed by an early discharge supported by ICCS with usual inpatient admission (treatment as usual; TAU). In this paper, we report the impact of ICCS on self-harm and other clinical and educational outcomes. 106 patients aged 12-18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomisation, we compared the two treatment arms on the number and severity of self-harm episodes, the functional impairment, severity of psychiatric symptoms, clinical improvement, reading and mathematical ability, weight, height and the use of psychological therapy and medication. At six-month follow-up, there were no differences between the two groups on most measures. Patients receiving ICCS were significantly less likely to report multiple episodes (five or more) of self-harm (OR = 0.18, 95% CI: 0.05-0.64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28.2-208.6) fewer days in hospitals if they were in the ICCS group compared to TAU. The addition of ICCS to TAU may lower the risk of multiple self-harm and may reduce the duration of inpatient stay, especially in those patients admitted for private care. Early discharge with ICCS appears to be a viable alternative to standard inpatient treatment.
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Affiliation(s)
- Dennis Ougrin
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | | | - Daniel Stahl
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Jason Poole
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Toby Zundel
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Mandy Wait
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Victoria Slater
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Paula Reavey
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Sarah Byford
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - John Ivens
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | | | - Daniel Hayes
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Kerry Middleton
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | | | - Eric Taylor
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
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14
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Zheng D, Bi X, Zhang T, Han C, Ma T, Wang L, Sun M, Cui K, Yang L, Liu L. Epigenetic Alterations of the Promoter Region of the POMC Gene in Adolescent Depressive Disorder Patients with Nonsuicidal Self-injury Behaviors. Psychol Res Behav Manag 2020; 13:997-1008. [PMID: 33235529 PMCID: PMC7678717 DOI: 10.2147/prbm.s272445] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/09/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The incidence of nonsuicidal self-injury (NSSI) behavior among adolescents increases year by year. Patients with a history of both depression and NSSI behaviors tend to have greater risk of suicide. At present, the mechanism of adolescent depressive disorder patients with NSSI behaviors is not clear, epigenetic mechanism may be involved. Proopiomelanocortin (POMC) gene may be associated with depressive disorder. The purpose of this study was to investigate DNA methylation of POMC gene promoter region of adolescent depressive disorder patients with NSSI behaviors. METHODS Bisulfite Sequencing PCR (BSP) was used to test the methylation level of POMC promoter of 15 adolescent depressive disorder patients with NSSI behaviors and 15 healthy controls (HC). Self-made questionnaires were used to collect clinical data of the case group and control group. Hamilton depression scale-24 (HAMD-24), Hamilton anxiety scale (HAMA), Symptom Checklist-90 (SCL-90) were used to evaluate the characteristics and severity of depressive, anxiety and psychotic symptoms. Adolescent self-injury questionnaire was used to assess NSSI behaviors and its severity. RESULTS BSP analysis found that the POMC methylation level of cytosine-guanine dinucleotide 1 (CpG1) site was higher in the case group than that of HC (P<0.05). The significance in POMC methylation at CpG1 between case group and HC was gender-independent, and CpG1 methylation level was higher in both male (P<0.05) and female (P<0.05) patients than that in HC. The CpG1 methylation level had a little correlation trends with family history of psychosis (P=0.05). We also found that POMC methylation level at CpG17 in female patients was significantly higher than that of the female HC (P<0.05). CONCLUSION There was abnormal methylation in the POMC promoter region of adolescent depressive disorder patients with NSSI behaviors, the methylation of CpG1 may act as epigenetic markers for those adolescents.
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Affiliation(s)
- Doudou Zheng
- Department of Psychiatry, School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Xiaojiao Bi
- Department of Psychology, Shandong Mental Health Center Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China
| | - Tianliang Zhang
- Department of Psychiatry, Shandong Mental Health Center Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China
| | - Chao Han
- Department of Psychiatry, Shandong Mental Health Center Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China
| | - Tantan Ma
- Department of Psychiatry, Shandong Mental Health Center Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China
| | - Lina Wang
- Department of Psychology, Shandong Mental Health Center Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China
| | - Mengmeng Sun
- Department of Psychiatry, Shandong Mental Health Center Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China
| | - Kaiyan Cui
- Department of Psychiatry, Shandong Mental Health Center Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China
| | - Limin Yang
- Department of Psychiatry, Shandong Mental Health Center Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China
| | - Lanfen Liu
- Department of Psychiatry, Shandong Mental Health Center Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China
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Robertson L, Aboaja A, Walker DM, Vostanis P, Witt KG, Chakrabarti I, Perry AE, Townsend E. Interventions for mood, anxiety disorders or self-harm in young offenders. Hippokratia 2020. [DOI: 10.1002/14651858.cd013768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Lindsay Robertson
- Cochrane Common Mental Disorders; University of York; York UK
- Centre for Reviews and Dissemination; University of York; York UK
| | - Anne Aboaja
- Tees, Esk and Wear Valleys NHS Foundation Trust; Middlesbrough UK
| | | | - Panos Vostanis
- Department of Neurosciences, Psychology and Behaviour; University of Leicester; Leicester UK
| | - Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | | | - Amanda E Perry
- Department of Health Sciences; University of York; York UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
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16
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Bettis AH, Liu RT, Walsh BW, Klonsky ED. Treatments for Self-Injurious Thoughts and Behaviors in Youth: Progress and Challenges. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2020; 5:354-364. [PMID: 32923664 DOI: 10.1080/23794925.2020.1806759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Self-injurious thoughts and behaviors (SITBs) remain a common clinical problem in youth. This article reviews the state of knowledge regarding psychosocial treatments for SITBs in youth. Broadly speaking, psychosocial treatments that incorporate parents/family and that emphasize skills development (including emotion regulation and interpersonal skills) appear to produce the best outcomes. We also describe several challenges to the implementation of evidence-based psychotherapy, as well as potential solutions to these challenges, and provide an illustrative case example. Finally, because even evidence-based psychosocial treatments can take weeks to produce effects, increased attention has been given to biological approaches such as esketamine administration and transcranial direct current stimulation that have potential to yield rapid improvement for acute suicidal ideation, though evidence for the safety and efficacy of these approaches is in the early stages.
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Affiliation(s)
- Alexandra H Bettis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital; Department of Psychiatry, Harvard Medical School
| | - Barent W Walsh
- Executive Director Emeritus and Senior Clinical Consultant, Open Sky Community Services
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Witt KG, Hawton K, Hetrick SE, Taylor Salisbury TL, Townsend E, Hazell P. Interventions for self-harm in children and adolescents. Hippokratia 2020. [DOI: 10.1002/14651858.cd013667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Sarah E Hetrick
- Department of Psychological Medicine; University of Auckland; Auckland New Zealand
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
| | - Philip Hazell
- Discipline of Psychiatry; The University of Sydney School of Medicine; Sydney Australia
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English O, Wellings C, Banerjea P, Ougrin D. Specialized Therapeutic Assessment-Based Recovery-Focused Treatment for Young People With Self-Harm: Pilot Study. Front Psychiatry 2019; 10:895. [PMID: 31920749 PMCID: PMC6915197 DOI: 10.3389/fpsyt.2019.00895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 11/13/2019] [Indexed: 02/02/2023] Open
Abstract
Background: Suicide is the second leading cause of death in young people worldwide. Self-harm is the strongest predictor of death by suicide. There is increasing evidence that psychological therapies are efficacious in treating self-harm in adolescents. However, studies so far have predominantly focused on highly selective groups of adolescents and have investigated interventions that require intensive training and considerable expense. Methods: We conducted a pilot study of a novel psychological therapy package, Specialized Therapeutic Assessment-Based Recovery-Focused Treatment (START) that consists of Therapeutic Assessment followed by treatment in one of three modules, depending on adolescents' needs and preferences: Solution Focused Brief Therapy, Cognitive Behavior Therapy (CBT), or Mentalization Based Treatment. Adolescents (12-17) with at least one self-harm episode in the previous 6 months referred for community treatment, who had no intellectual disability, psychosis or autism were eligible for START. The primary outcome measure was the number of self-harm (regardless of suicidal intent) episodes 6 months before and 6 months after commencing START. Secondary outcomes included measures of psychopathology, functional impairment and family satisfaction. Results: Twenty-one consecutively referred adolescents were recruited and 15 received a therapeutic module of START: three received Solution Focused Brief Therapy, nine CBT, and three Mentalization Based Treatment. There was a statistically significant reduction in the number of self-harm episodes from a mean of 7.93 (SD = 12.26) to 1.00 (SD = 1.47), p < 0.02 following START. There was also a significant reduction in self-harm episodes, Revised Children's Anxiety and Depression Scale scores and a statistically significant improvement in Children Global Assessment Scale scores for the CBT group alone. There were no significant differences in any other outcomes. Most families were somewhat or very much satisfied with the intervention. Conclusion: The results show that START was associated with a reduction in self-harm and depression and anxiety symptoms, which could indicate that START should be rigorously studied in a randomized control trial (RCT). However, the model had difficulties in its implementation, with CBT being only module that was offered to enough young people to allow before and after analysis. CBT appears to be the most promising module in treating adolescents with self-harm referred to community mental health services.
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Affiliation(s)
- Oliver English
- The Institute of Psychiatry, Psychology, Child & Adolescent Psychiatry Department, King’s College London, London, United Kingdom
| | - Christy Wellings
- Southwark Child & Adolescent Mental Health Service, South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom
| | - Partha Banerjea
- Southwark Child & Adolescent Mental Health Service, South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom
| | - Dennis Ougrin
- The Institute of Psychiatry, Psychology, Child & Adolescent Psychiatry Department, King’s College London, London, United Kingdom
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19
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Robinson J, Clarke A. Commentary: Adolescent self-harm prevention and intervention in secondary schools: a survey of staff in England and Wales - a reflection on Evans et al. (2019). Child Adolesc Ment Health 2019; 24:239-241. [PMID: 32677212 DOI: 10.1111/camh.12335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2019] [Indexed: 11/27/2022]
Abstract
Self-harm (SH) continues to be a worldwide concern among adolescents and there is a great need for programming aimed at reducing SH in adolescents. Evans and colleagues discuss the opinions of school staff from a representative sample of secondary schools across England and Wales regarding their school's current prevention and intervention practices in responding to self-harm and how this should be addressed in future practice. The most salient points include the high prevalence of SH internationally, the existing barriers to SH prevention and intervention and possible solutions to these barriers. There is clearly an urgent need for high quality, evidence-based interventions that can be embedded in school settings, and have the capacity to overcome both the individual and structural barriers to supporting these vulnerable young people.
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Affiliation(s)
- Jo Robinson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Alison Clarke
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic., Australia
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