A Further Look at Therapeutic Interventions for Suicide Attempts and Self-Harm in Adolescents: An Updated Systematic Review of Randomized Controlled Trials.

Udita Iyengar,Troy Tranah,Joan R Asarnow,Dennis Ougrin,Paul Moran,Natasha Snowden

doi:10.3389/fpsyt.2018.00583

Abstract

Background: Suicide attempts (SA) and other types of self-harm (SH) are strong predictors of death by suicide in adolescents, emphasizing the need to investigate therapeutic interventions in reduction of these and other symptoms. We conducted an updated systematic review of randomized controlled trials (RCTs) from our previous study reporting therapeutic interventions that were effective in reducing SH including SA, while additionally exploring reduction of suicidal ideation (SI) and depressive symptoms (DS).Method: A systematic literature search was conducted across OVID Medline, psycINFO, PubMed, EMBASE, and Cochrane Library from the first available article to October 22nd, 2017, with a primary focus on RCTs evaluating therapeutic interventions in the reduction of self-harm. Search terms included self-injurious behavior; self-mutilation; suicide, attempted; suicide; drug overdose.Results: Our search identified 1,348 articles, of which 743 eligible for review, yielding a total of 21 studies which met predetermined inclusion criteria. Eighteen unique therapeutic interventions were identified among all studies, stratified by individual-driven, socially driven, and mixed interventions, of which 5 studies found a significant effect for primary outcomes of self-harm and suicide attempts (31.3%), and 5 studies found a significant effect for secondary outcomes of suicidal ideation and depressive symptoms (29.4%) for therapeutic intervention vs. treatment as usual. Collapsing across different variations of Cognitive Behavior Therapy (CBT), and classifying Dialectical Behavior Therapy for Adolescents (DBT-A) as a type of CBT, CBT is the only intervention with replicated positive impact on reducing self-harm in adolescents.Conclusion: While the majority of studies were not able to determine efficacy of therapeutic interventions for both primary and secondary outcomes, our systematic review suggests that individual self-driven and socially-driven processes appeared to show the greatest promise for reducing suicide attempts, with benefits of combined self-driven and systems-driven approaches for reducing overall self-harm. Further RCTs of all intervention categories are needed to address the clinical and etiological heterogeneity of suicidal behavior in adolescents, specifically suicidal ideation and depressive symptoms.

Highlights

Suicide is a major global and public health concern [1]
The screening procedure consisted of three phases: title, abstract and full text screening, with the latter two conducted independently by the two authors (UI and NS)
Title screening was conducted by NS as a preliminary measure to ensure the exclusion of any notpertinent studies and duplicates, reducing the number of eligible studies from 743 to 102

Summary

Introduction

Suicide is a major global and public health concern [1]. It is the second leading cause of death in people age 15–24 years [2] and there is a pressing need to identify effective interventions to reduce the risk of suicide. Non-fatal suicide attempts (SA) can be defined as self-directed injuries with implicit or explicit intent to kill oneself, while non-suicidal self-injury (NSSI) is direct destruction of one’s body without intention to die [3] For the latter, it is useful to consider the definition of nonsuicidal self-injury found in the DMS-5, which states that the preoccupied individual partakes in premeditated, self-directed damage to themselves in order to relieve negative experiences and does not exhibit suicidal intent through this behavior [4]. There was little to no evidence of benefits of tested interventions in reducing suicide attempts Our findings highlighted both the beneficial effects of therapeutic interventions for self-harm as a global category, the challenges of reducing the risk of future suicide attempts and the need for rigorous and replicable studies. We conducted an updated systematic review of randomized controlled trials (RCTs) from our previous study reporting therapeutic interventions that were effective in reducing SH including SA, while exploring reduction of suicidal ideation (SI) and depressive symptoms (DS)

Methods

Results

Discussion

Conclusion