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Background: Adopting a common elements approach, this practitioner review aims to highlight specific treatment elements that are common to interventions with demonstrated benefits in randomized controlled trials (RCTs) for reducing suicide attempts and self‐harm in youth. Identification of common treatment elements among effective interventions offers a key strategy for clarifying the most robust features of effective interventions and improving our ability to implement effective treatment and decrease the lag between scientific advances and clinical care. Methods: A systematic search of RCTs evaluating interventions targeting suicide/self‐harm in youth (ages 12–18) yielded a total of 18 RCTs assessing 16 different manualized interventions. An open coding process was used to identify common elements present within each intervention trial. Twenty‐seven common elements were identified and classified into format, process, and content categories. All trials were coded for the inclusion of these common elements by two independent raters. RCTs were also classified into those where trial results supported improvements in suicide/self‐harm behavior (n = 11 supported trials) and those without supported evidence (n = 7 unsupported trials). Results: Compared with unsupported trials, the 11 supported trials shared the following elements: (a) inclusion of therapy for both the youth and family/caregivers; (b) an emphasis on relationship‐building and the therapeutic alliance; (c) utilization of an individualized case conceptualization to guide treatment; (d) provided skills training (e.g. emotion regulation skills) to both youth and their parents/caregivers; and (e) lethal means restriction counseling as part of self‐harm monitoring and safety planning. Conclusions: This review highlights key treatment elements associated with efficacy that community practitioners can incorporate in their treatments for youth presenting with suicide/self‐harm behaviors. [ABSTRACT FROM AUTHOR]

Clinical guidelines recommend intensive community care service treatment (ICCS) to reduce adolescent psychiatric inpatient care. We have previously reported that the addition of ICCS led to a substantial decrease in hospital use and improved school re-integration. The aim of this study is to undertake a randomised controlled trial (RCT) comparing an inpatient admission followed by an early discharge supported by ICCS with usual inpatient admission (treatment as usual; TAU). In this paper, we report the impact of ICCS on self-harm and other clinical and educational outcomes. 106 patients aged 12–18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomisation, we compared the two treatment arms on the number and severity of self-harm episodes, the functional impairment, severity of psychiatric symptoms, clinical improvement, reading and mathematical ability, weight, height and the use of psychological therapy and medication. At six-month follow-up, there were no differences between the two groups on most measures. Patients receiving ICCS were significantly less likely to report multiple episodes (five or more) of self-harm (OR = 0.18, 95% CI: 0.05–0.64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28.2–208.6) fewer days in hospitals if they were in the ICCS group compared to TAU. The addition of ICCS to TAU may lower the risk of multiple self-harm and may reduce the duration of inpatient stay, especially in those patients admitted for private care. Early discharge with ICCS appears to be a viable alternative to standard inpatient treatment. [ABSTRACT FROM AUTHOR]

Background Intensive community services may provide an alternative to inpatient care but there is little systematic evidence of their efficacy. This article provides a systematic review of randomized controlled trials ( RCTs) reporting efficacy of intensive community services versus inpatient care in youth. Method Data sources were identified by searching Medline, Psych INFO and EMBASE databases as of December 2014. RCTs comparing intensive community services versus inpatient care in children and adolescents (through age 18) were included. Results Six unique RCTs including 569 youth were identified. The RCTs examined the efficacy of specialist outpatient treatment, multisystemic therapy, day patient treatment, intensive home treatment and supported discharge services versus inpatient care. Using intensive community services was associated with clinical improvements similar to inpatient care in most studies. Where differences in clinical outcomes existed, they tended to favour intensive community treatment. Using intensive community services was associated with shorter hospitalizations, lower costs and greater patient satisfaction. There were no independent replications of the results. Few studies investigated the use of intensive community treatment as an alternative to inpatient care in children and adolescents with severe immediate risk to self and others. Conclusions Intensive community services appear to be a viable alternative to inpatient care. Independent replication of results achieved by specific intensive community treatment models is a research priority. [ABSTRACT FROM AUTHOR]

Background: Repeated self-harm in adolescents is common and associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm there have been few systematic reviews of the topic. Aims: The main aim of this article is to review randomised controlled trials (RCTs) reporting efficacy of specific pharmacological, social or psychological therapeutic interventions (TIs) in reducing self-harm repetition in adolescents presenting with self-harm. Method: Data sources were identified by searching Medline, PsychINFO, EMBASE, and PubMed from the first available year to December 2010. RCTs comparing specific TIs versus treatment as usual or placebo in adolescents presenting with self-harm were included. Results: Fourteen RCTs reported efficacy of psychological and social TIs in adolescents presenting with self-harm. No independently replicated RCTs have been identified reporting efficacy of TIs in self-harm reduction. Developmental Group Psychotherapy versus treatment as usual was associated with a reduction in repeated self-harm, however, this was not replicated in subsequent studies. Multisystemic Therapy (MST) versus psychiatric hospitalisation was associated with a reduction of suicidal attempts in a sample of adolescents with a range of psychiatric emergencies. However, analyses focusing only on the smaller subgroup of adolescents presenting with deliberate self-harm at the initial psychiatric emergency, did not indicate significant benefits of MST versus hospitalisation. Conclusions: Further research is urgently needed to develop TIs for treating self-harm in adolescents. MST has shown promise but needs to be evaluated in a sample of adolescents with self-harm; dialectic behavioural therapy and cognitive behavioural therapy for self-harm require RCTs to evaluate efficacy and effectiveness. [ABSTRACT FROM AUTHOR]

The article presents a discussion on self-harm (SH), including a brief history of the concept, its evolution and the factors that have influenced its course over time. Topics include the wider concepts that underline contemporary definitions of self-harm, namely self-injury and self-poisoning, its history in Great Britain since 1945, and the social and cultural factors that affect its perception. Some of the debates over self-harm definitions and research are also considered.

The preceding article by Hawton and colleagues reporting on a prospective study of adolescents presenting with self-harm to Accident and Emergency departments (A&E) is one of the largest epidemiological studies to examine the long-term outcomes of selfharm in children and adolescents. After a median of 6 years nearly 30% re-presented to A&E with self-harm and 1% died, half of those due to likely suicide and the rest mainly due to accidents. It may be that many accidental deaths were also suicides judging from the method of death. In comparison to adults presenting with self-harm, the absolute risk of suicide was lower despite a high self-harm repetition rate. Self-injury by cutting was a strong independent predictor of suicide as was previous psychiatric treatment and previous self-harm. Finally the eventual method of suicide was different from that used at either the first or the last episode of selfharm. This is at odds with the data generated by adult literature which consistently shows that those with the most violent methods of selfharm, e.g. attempted hanging or shooting, tend to also die using these methods. In summary the field of adolescent self-harm is of immense importance and requires urgent research to develop our ability to predict those likely to die of suicide, and to offer effective treatment to those at risk. The article by Hawton and colleagues is an important step in our understanding of the risk factors of suicide in those adolescents who present with self-harm and in highlighting the overlapping nature of self-injury and self-poisoning in relation to suicide. [ABSTRACT FROM AUTHOR]

The author comments on a study by Jonathan M. Green and colleagues which examined whether adding developmental group psychotherapy (DGP) to routine care is effective in improving outcome in adolescents who repeatedly self-harmed. The study found that adding DGP to routine care did not decrease the frequency of self-harm, thus is not a cost-effective addition to routine care.

Objective: Victimized adolescents have an increased risk of self-injurious thoughts and behaviors. However, poor understanding of causal and non-causal mechanisms underlying this observed risk limits the development of interventions to prevent premature death in adolescents. This study tested whether pre-existing family-wide and individual vulnerabilities account for victimized adolescents' increased risk of self-injurious thoughts and behaviors.Method: Participants were 2,232 British children followed from birth to 18 years of age as part of the Environmental Risk Longitudinal Twin Study. Adolescent victimization (maltreatment, neglect, sexual victimization, family violence, peer/sibling victimization, cyber victimization, and crime victimization) was assessed through interviews with participants and co-informant questionnaires at the 18-year assessment. Suicidal ideation, self-harm, and suicide attempt in adolescence were assessed through interviews with participants at 18 years.Results: Victimized adolescents had an increased risk of suicidal ideation (odds ratio [OR] 2.40, 95% CI 2.11-2.74), self-harm (OR 2.38, 95% CI 2.10-2.69), and suicide attempt (OR 3.14, 95% CI 2.54-3.88). Co-twin control and propensity score matching analyses showed that these associations were largely accounted for by pre-existing familial and individual vulnerabilities, respectively. Over and above their prior vulnerabilities, victimized adolescents still showed a modest increase in risk for suicidal ideation (OR 1.45, 95%CI 1.10-1.91) and self-harm (OR 1.50, 95% CI 1.18-1.91) but not for suicide attempt (OR 1.28, 95% CI 0.83-1.98).Conclusion: Risk for self-injurious thoughts and behaviors in victimized adolescents is explained only in part by the experience of victimization. Pre-existing vulnerabilities account for a large proportion of the risk. Therefore, effective interventions to prevent premature death in victimized adolescents should not only target the experience of victimization but also address pre-existing vulnerabilities. [ABSTRACT FROM AUTHOR]