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Table 1 Characteristics of the 25 studies in the meta-analysis

From: Does treatment method matter? A meta-analysis of the past 20 years of research on therapeutic interventions for self-harm and suicidal ideation in adolescents

Study

Outcome (Measures)

Age Group

% female

Therapeutic Intervention

Control

Interventions

Dose / Duration

Drop-out

Eligibility Criteria (Recruitment Setting)

    

Treatment

n

Treatment

n

Means

n

 

[2•]

SI (SIQ-HS), D (BDI II)

15–18 yrs

0%

Dialectical Behaviour Therapy for Adolescents

10

Mode Deactivation Therapy

10

6 months

0

n. r. (residential care)

[3•]

SI (HASS)

10–18 yrs

69%

Family-based Cognitive Behaviour Therapy

89

Enhanced Usual Care

92

1 month

21

Presented to ED with a suicide attempt or SI (ED)

[6•]

SH (interview developed in house)

15–18 yrs

75%

Cognitive Analytic Therapy

35

Good Clinical Care

34

9 months

8

2–9 DSM-IV criteria for BPD, and during childhood ≥1 of any personality disorder criteria, disruptive behaviour symptoms, depressive symptoms, low socioeconomic status, and abuse or neglect (ED, primary care, family, school or self-referral)

[11•]

SH (SASII), SI (BSS)

11–17 yrs

89%

Family Therapy

268

Treatment as Usual

210

6 months

99

≥2 self-harm episodes and living with a primary caregiver willing to participate (mental health services)

[14•]

SI (SIQ-JR), D (BDI-II)

12–17 yrs

83%

Attachment-Based Family Therapy

35

Enhanced Usual Care

31

3 months

13

SI (SIQ-JR score ≥ 31) and depression (BDI-II ≥ 20) (primary care services and ED)

[13•]

SI (SIQ),

D (BDI-II)

12–18 yrs

82%

Attachment-Based Family Therapy

66

Family-Enhanced Nondirective Supportive Therapy

63

4 months

14

SI (SIQ-JR ≥ 31) and depression (BDI-II ≥ 20) (ED, inpatient, mental health agencies, primary care services, schools, and community, or self-referral)

[15•]

SI (SIQ),

D (CES-D)

12–17 yrs

82%

Skills-based Treatment

15

Supportive Relationship Treatment

16

6 months

8

Presented to ED or inpatient unit after a suicide attempt (ED and inpatient)

[18•]

SI (SIQ),

D (RADS-2)

13–17 yrs

67%

Internet-based Cognitive Behaviour Therapy

19

Enhanced Usual Care

17

6 months

4

Suicide attempt within the past 3 months, or suicidal ideation (SIQ ≥ 41), alcohol or cannabis disorder, and lived with a caregiver willing to participate (inpatient)

[23•]

SH (SH interview),

SI (SIQ),

D (MFQ)

12–17 yrs

89%

Eclectic Group Therapy

181

Enhanced Usual Care

181

1.5 months

7

≥ 2 episodes of SH within the past 12 months (mental health services)

[29•]

SH (PHI),

SI (SIQ),

D (MFQ)

12–16 yrs

90%

Eclectic Group Therapy

34

Treatment as Usual

34

1 month

3

≥ 2episodes of self-harm in the past year, and ≥ 1 in the past 3 months (mental health services)

[31•]

SI (SIQ),

D (RADS-2)

13–19 yrs

82%

Internet-based Cognitive Behaviour Therapy + Treatment as Usual

26

Treatment as Usual

24

2.5 months

11

Engaged with a well-being staff member, and any level of suicidal ideation in the last 4 weeks (secondary schools)

Kaess et al., 2019

SH (SITBI-G),

D (BDI-II)

12–17 yrs

96%

Cognitive Behaviour Therapy (with elements of Dialectical Behaviour Therapy)

37

Treatment as Usual

37

4 months

2

NSSI ≥5 times in the past 6 months, and ≥ 1in the past month. (inpatient, outpatient, and community notices)

[38•]

SH (C-SSRS), SI (SIQ-R)

12–18 yrs

89%

As Safe As Possible Program (ASAP) + Treatment as Usual

34

Treatment as Usual

32

3–4 h. + TAU

6

Presented to inpatient with recent SI or a recent suicide attempt (inpatient)

[41•]

SH (CAFAS),

SI (SIQ-JR), D (RADS)

12–17 yrs

68%

Psycho-educational social network intervention + Treatment as Usual

113

Treatment as Usual

123

~ 1 h. + TAU

102

Suicide attempt or SI within the past month and score of 20 or 30 on the self-harm subscale of the CAFAS (inpatient)

[40•]

SH (No. episodes)

SI (SIQ-JR)

13–17 yrs

71%

Psychoeducational network intervention + Treatment as Usual

175

Treatment as Usual

171

~ 1 h. + TAU/telephone calls

92

Suicide attempt or SI within the past month (inpatient)

[39•]

SI (SIQ-JR), D (RADS-2)

14–19 yrs

80%

Motivational Interviewing

27

Enhanced Usual Care

22

~ 1 h. + TAU

3

SI, a recent suicide attempt, or both depression and substance abuse (ED)

[47•]

SH (No. episodes),

SI (SIQ-JR)

12–18 yrs

95%

Dialectical Behaviour Therapy for Adolescents

86

Individual and Group Supportive Therapy

87

6 months

40

≥1 lifetime suicide attempts, suicidal ideation (≥24 SIQ-JR) in the past month, ≥3 lifetime SH, including 1 in the 12 weeks before screening, and ≥ 3 BPD criteria (ED, inpatient, outpatient, and community services)

[51•]

SH (No. episodes), SI (SIQ-JR), D (MADRS)

12–18 yrs

88%

Dialectical Behaviour Therapy for Adolescents

39

Enhanced Usual Care

38

4.75 months

0

≥3 self-harm episodes, ≥1 within past 16 weeks; ≥2 DSM-IV BPD criteria (or 1, with ≥2 subthreshold-level criteria) (outpatient)

[56•]

SH (No. episodes)

12–18 yrs

81%

Therapeutic Assessment

35

Assessment as usual

34

~ 7 h.

1

Not engaged with psychiatric services, presented to emergency services with SH, and referred for psychosocial assessment (ED or community services)

[59•]

SH (ASQ-R)

12–17 yrs

75%

Resourceful Adolescent-Parent Program

22

Treatment as Usual

18

1.5 months

8

≥1 episode of suicidal behaviour (SI, suicide attempt, or SH) within the past 2 months, living with 1+ parent, and a primary diagnosis of either major depression, posttraumatic stress disorder, or anxiety disorder (ED and primary care)

[64•]

SH (RTSHI),

D (MFQ)

13–18 yrs

85%

Mentalization-based Therapy for Adolescents

40

Treatment as Usual

40

12 months

37

≥1 episode of SH within the past month (community mental health services and ED)

[65•]

SH (No. episodes)

14–19 yrs

88%

Emotion regulation group training (with elements of Cognitive Behaviour Therapy and Dialectical Behaviour Therapy)

14

Treatment as Usual

17

4.25 months

12

Mood instability due to increased reactivity, two forms of potentially self-damaging impulsivity, recurrent SH, inappropriate, intense anger, or difficulty controlling anger (outpatient)

[66•]

SH (No. episodes)

14–19 yrs

96%

Emotion regulation group training (with elements of Cognitive Behaviour Therapy and Dialectical Behaviour Therapy)

48

Treatment as Usual

49

4.25 months

9

≥2 DSM-IV BPD criteria (outpatient)

[68•]

SI (BSS),

D (BDI-II)

12–18 yrs

66%

Intensive Interpersonal Psychotherapy-Adolescent

35

Treatment as Usual

38

1.5 months

3

Moderate-severe depression (BDI > 19), suicide ideation or previous suicidal attempt (BSS > 0), moderate-severe anxiety, or significant hopelessness in the past 2 weeks (secondary schools)

[73•]

SH (interview;),

SI (SIQ),

D (MFQ)

12–16 yrs

78%

Eclectic Group Therapy

32

Treatment as Usual

29

2 months

1

≥1 SH episode in the past year and referred following an episode of SH (mental health services)

  1. n. r. not reported. Outcomes: D Depressive Symptoms, SH Self-harm, SI Suicidal Ideation, Measures: ASQ-R Adolescent Suicide Questionnaire-Revised, BDI-II Beck Depression Inventory-II, BSI-D Brief Symptom Inventory-Depression items, BSI-SI Brief Symptom Inventory-Suicidal Ideation items, BSS Beck Scale for Suicide Ideation, CAFAS Child and Adolescent Functional Assessment Scale, CES-D Center of Epidemiologic Studies-Depression Scale, C-SSRS Columbia Suicide Severity Rating Scale, HASS Harkavy-Asnis Suicide Scale, MADRS Montgomery–Åsberg Depression Rating Scale, MFQ Mood and Feelings Questionnaire, PHI Parasuicide History Interview, RADS Reynolds Adolescent Depression Scale, RADS-2 Reynolds Adolescent Depression Scale, RTSHI Risk-Taking and Self-Harm Inventory, SASII Suicide Attempt Self-Injury Interview, SIQ Suicide Ideation Questionnaire, SIQ-HS Suicide Ideation Questionnaire High school Form, SIQ-JR Suicidal Ideation Questionnaire Junior, SITBI-G Self-Injurious Thoughts and Behaviours Interview-German version. Eligibility criteria: BPD Borderline Personality Disorder, ED Emergency Department