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Effectiveness of systemic family therapy versus treatment as usual for young people after self-harm: a pragmatic, phase 3, multicentre, randomised controlled trial

Cottrell, David J., Wright-Hughes, Alexandra, Collinson, Michelle, Boston, Paula, Eisler, Ivan, Fortune, Sarah, Graham, Elizabeth H., Green, Jonathan, House, Allan O., Kerfoot, Michael, and others. (2018) Effectiveness of systemic family therapy versus treatment as usual for young people after self-harm: a pragmatic, phase 3, multicentre, randomised controlled trial. The Lancet Psychiatry, 5 (3). pp. 203-216. ISSN 2215-0366. E-ISSN 2215-0374. (doi:10.1016/S2215-0366(18)30058-0) (KAR id:65837)

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Abstract

Background: Self-harm in adolescents is common and repetition occurs in a high proportion of these cases. Scarce evidence exists for effectiveness of interventions to reduce self-harm.

Methods: This pragmatic, multicentre, randomised, controlled trial of family therapy versus treatment as usual was done at 40 UK Child and Adolescent Mental Health Services (CAMHS) centres. We recruited young people aged 11–17 years who had self-harmed at least twice and presented to CAMHS after self-harm. Participants were randomly assigned (1:1) to receive manualised family therapy delivered by trained and supervised family therapists or treatment as usual by local CAMHS. Participants and therapists were aware of treatment allocation; researchers were masked. The primary

(n=415) or treatment as usual (n=417). Primary outcome data were available for 795 (96%) participants. Numbers of hospital attendances for repeat self-harm events were not significantly different between the groups (118 [28%] in the family therapy group vs 103 [25%] in the treatment as usual group; hazard ratio 1·14 [95% CI 0·87–1·49] p=0·33). Similar numbers of adverse events occurred in both groups (787 in the family therapy group vs 847 in the treatment as usual group).

Interpretation: For adolescents referred to CAMHS after self-harm, having self-harmed at least once before, our family therapy intervention conferred no benefits over treatment as usual in

reducing subsequent hospital attendance for self-harm. Clinicians are therefore still unable to recommend a clear, evidence-based intervention to reduce repeated self-harm in adolescents.

Item Type: Article
DOI/Identification number: 10.1016/S2215-0366(18)30058-0
Uncontrolled keywords: self-harm, family therapy, treatment
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Personal Social Services Research Unit
Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
Depositing User: Eirini Saloniki
Date Deposited: 01 Feb 2018 10:43 UTC
Last Modified: 26 Mar 2021 10:07 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/65837 (The current URI for this page, for reference purposes)
Saloniki, Eirini-Christina: https://orcid.org/0000-0002-5867-2702
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