Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
Skip Navigation U.S. Department of Health and Human Services www.hhs.gov
Agency for Healthcare Research Quality www.ahrq.gov
AHRQ Home | Questions? | Contact Us | Site Map | What's New | Browse | Información en español | E-mail UpdatesE-mail Updates
www.ahrq.gov

Table 2. Additional Randomized Controlled Trials of Interventions to Reduce Deliberate Self-Harm in Adults and Older Adolescentsa

Treatment Compared Study, Year Population Age Range (Yrs) Intervention and Control Groups Followup Period (After Enrollment) Number (%) of Participants with DSH during Followup Odds Ratio (95% CI) or Reported Statistics
Interpersonal Psychotherapy vs Standard Aftercare Guthrie, et al., 200160 Patients presenting to an emergency department with deliberate self-poisoning, but not requiring inpatient psychiatric treatment 18-65 Intervention: Weekly sessions of home-based interpersonal psychotherapy by nurse therapists for 1 mo

Control: Standard aftercare

 6 mos Intervention: 5/58 (8.6)

Control: 17/61 (27.9)

 No OR given; between-group difference, 19.3 (8.6-30.0); P <0.001
Psychoanalytically Oriented Partial Hospitalization vs Standard Aftercare Bateman and Fonagy, 1999,58 200159 b Patients with borderline personality disorder who did not have bipolar or psychotic disorder, substance abuse, mental impairment, or organic brain disorder attending a psychiatric clinic 16-65 Intervention: Partial hospitalization on psychiatric unit for 18 mos

Control: Standard aftercare for 18 mos

 36 mos Intervention: 4/22 (18.2)

Control: 2/19 (63.2)

 No OR given; P <0.004 (Fisher exact test)
Emergency Care vs Standard Aftercare Evans, et al., 199962 Bristol, UK

Patients referred from several general hospitals for psychiatric evaluation after DSH and who were not considered dangerous to self or others

 Adults Intervention: Card offering 24-hr phone crisis consultation with psychiatrist for 6 mos

Control: Standard aftercare

 6 mos Intervention: 70/417 (16.8)

Control: 59/410 (14.4)

 Overall OR: 1.20 (0.82-1.75)
Subgroup analysis dichotomized by prior history of DSH           OR for prior DSH: 1.85(1.14-3.03)

OR for no prior DSH: 0.64 (0.34-1.22)
Brief Contact By Letter vs Standard Aftercare Motto and Bostrom, 200132 Persons admitted for depressive or suicidal illnesses to 9 psychiatric inpatient facilities in San Francisco, CA, who continued with therapy for ≥30 days post-discharge Mean age, 34.4 Intervention: Brief contact using letters sent over varying time periods for 5 yrs

Control: No further contact

 ≤ 15 yrs Intervention: 15/389 (3.9)

Control: 21/454 (4.6)

 OR not reported; patients with suicide as cause of death 5 yrs post-intervention

Intervention: 3.9%

Control: 4.6%
Outpatient Day Hospitalization vs Usual Care Rudd, et al., 199633 Patients referred from 2 mental health clinics, 1 emergency department, and 1 inpatient psychiatric unit who had a suicide attempt, mood disorder and suicide ideation, or substance abuse and suicide ideation without psychosis or personality disorder Mean age, 22 (SD = 2.3 yrs) Intervention: Outpatient intensive structured group treatment by mental health professionals for 2 wks

Control: Standard aftercare

 1 yr Several measures of suicidal ideation and behavior (including Modified Scale for Suicidal Ideation and the Suicide Probability Scale) analyzed; no difference between intervention and control groups
Fluoxetine (Antidepressant) vs Placebo Montgomery, et al., 199461 Patients without current major depression with a history of ≥2 suicide attempts, identified from a psychiatric clinic NR Intervention: Fluoxetine twice a wk in psychiatric clinic for 6 mos

Control: Placebo twice a wk for 6 mos

 6 mos Intervention: 18/54 (33.3)

Control: 18/53 (34.0)

 NA
Fluphenazine (Antipsychotic) vs Placebo Battaglia, et al., 199963 Non-psychotic patients with a suicide attempt in the previous 30 days who had ≥2 prior suicide attempts recruited from a psychiatric emergency department 18-65 Intervention: Low-dose intramuscular injection monthly for 6 mos

Control: Ultra-low-dose intramuscular injection monthly for 6 mos

 6 mos Intervention: Change of -0.16 in rate of serious self-harm behaviors per mo over 6 mos

Control: Change or -0.06 rate of serious self-harm behaviors per mo over 6 mos

 P = 0.146 (Mann-Whitney test)
Dialectical Behavioral Therapy vs Usual Care Koons, et al., 200134  b Women veterans with borderline personality disorder without schizophrenia, bipolar disorder, substance abuse, or antisocial personality disorder 21-46 Intervention: Dialectical behavioral therapy by mental health professional for 6 mos

Control: Enhanced standard aftercare

 6 mos Intervention: 1/10 (10)

Control: 2/10 (20)

 NA
Followup Letter and General Guidelines vs Standard Care Bennewith, et al., 200235  c Patients without substance abuse or DSH secondary to psychosis with a new episode of DSH; identified from a DSH case register based on weekly reports from local hospitals' accident and emergency departments 16-95 Intervention: One-time education and consultation letter on DSH management provided to primary care physicians whose patients had recent DSH episode

Control: Standard aftercare

 12 mos Intervention: 211/964 (21.9)

Control: 189/968 (19.5)

 Overall OR: 1.17 (0.94-1.47)
Subgroup analysis dichotomized by prior history of DSH           Prior DSH OR: 0.57 (0.33-0.98)

No prior DSH OR: 1.32 (1.02-1.70)

Note: CI, confidence interval; DSH, deliberate self-harm; NA, not available; NR, not reported; OR, odds ratio; SD, standard deviation.

a Not in Hawton, et al. review. 18
b Inclusion criteria required diagnosis of borderline personality disorder; all others required DSH.
c Primary care treatment setting; all other studies conducted in specialty care settings.

Return to Document

 
AHRQ Advancing Excellence in Health Care