Abstract
BackgroundTo investigate the outcome of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) in terms of reducing suffering and increasing functional adjustment among self-harming and/or suicidal adolescents with high symptom loads and their families.MethodsForty-nine self-harming and/or suicidal adolescents, Mage = 14.6, of predominantly Swedish origin and female gender (85.7%) participated with their parents. The study had a within group design with repeated measures at pre- and post-treatment, as well as six- and twelve-months follow-ups. Self-reports were used for the main outcomes; self-harm rates, suicide attempts, parent-reported days of inpatient/institutional care, internalized and externalized symptoms, perceived stress, emotion regulation, school hours and adjustment. Secondary outcomes were levels of reported expressed emotions within family dyads, as well as parental anxiety, depression and stress.ResultsFrom pre- to post-assessment, the adolescents reported significant reductions of self-harm (p = .001, d = 0.54) and suicide attempts (p < .0001, d = 1.38). Parent-reported days of inpatient/institutional care were reduced, as well as parent- and adolescent-reported internalizing and externalizing symptoms. Furthermore, school attendance and adjustment were improved, and the adolescents reported experiencing less criticism while parents reported less emotional over-involvement. The results were maintained at follow-ups.ConclusionsThe adolescents and the parents reported improvements for the main outcomes. This treatment appears promising in keeping the families in treatment and out of hospital, suggesting that an integrative approach may be beneficial and feasible for this group.Trial registrationThis study has been approved 19/12 2011, by the regional review board in Stockholm (Dnr 2011/1593–31/5).
Highlights
Self-harm is associated with great suffering for the individual while evoking strong reactions among relatives and professionals [1,2,3]
The main aim of the present study is to investigate the outcome of Intensive contextual therapy for self-harm (ICT) on self-harm behaviors and suicide attempts within a pre-post design with long-term follow-ups
Nor did we find any significant differences (t(37) = 0.01, p = .405) between the completers and the drop-out-group on household monthly gross income reported by the fathers
Summary
Self-harm is associated with great suffering for the individual while evoking strong reactions among relatives and professionals [1,2,3]. Researchers have been struggling to agree upon consistent definitions of self-harm behavior with and without suicidal intent and with determining a useful classification system [1, 4]. Wijana et al BMC Psychiatry (2018) 18:371 definition of NSSI is “the deliberate self-inflicted destruction of body tissue without suicidal intent for purposes not socially sanctioned” [9,10,11,12]. A definition of DSH includes any intentional self-harm, irrespective of the apparent purpose of the act. To investigate the outcome of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) in terms of reducing suffering and increasing functional adjustment among self-harming and/or suicidal adolescents with high symptom loads and their families
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