Systematic Review and Individual Participant Data Meta-Analysis: Reducing Self-Harm in Adolescents: Pooled Treatment Effects, Study, Treatment, and Participant Moderators

Abstract

Objective

Self-harm is common in adolescents and a major public health concern. Evidence for effective interventions that stop repetition is lacking. This individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs) aimed to provide robust estimates of therapeutic intervention effects and explore which treatments are best suited to different subgroups.

Method

Databases and trial registers to January 2022 were searched. RCTs compared therapeutic intervention to control, targeted adolescents ages 11 to 18 with a history of self-harm and receiving clinical care, and reported on outcomes related to self-harm or suicide attempt. Primary outcome was repetition of self-harm 12 months after randomization. Two-stage random-effects IPD meta-analyses were conducted overall and by intervention. Secondary analyses incorporated aggregate data from RCTs without IPD.

Results

The search identified 39 eligible studies; 26 provided IPD (3,448 participants), and 7 provided aggregate data (698 participants). There was no evidence that interventions were more or less effective than controls at preventing repeat self-harm by 12 months in IPD (odds ratio 1.06 [95% CI 0.86, 1.31], 20 studies, 2,949 participants) or IPD and aggregate data (odds ratio 1.02 [95% CI 0.82, 1.27], 22 studies, 3,117 participants) meta-analyses and no evidence of heterogeneity of treatment effects on study and treatment factors. Across all interventions, participants with multiple prior self-harm episodes showed evidence of improved treatment effect on self-harm repetition 6 to 12 months after randomization (odds ratio 0.33 [95% CI 0.12, 0.94], 9 studies, 1,771 participants).

Conclusion

This large-scale meta-analysis of RCTs provided no evidence that therapeutic intervention was more, or less, effective than control for reducing repeat self-harm. Evidence indicating more effective interventions in youth with 2 or more self-harm incidents was observed. Funders and researchers need to agree on a core set of outcome measures to include in subsequent studies.

Plain language summary

Self-harm is common in adolescents and linked to higher risks of repeated self-harm and suicide. This meta-analysis of 33 randomized controlled trials involving 4,146 adolescents found that therapeutic interventions were no more effective than standard care at preventing repeat self-harm at 12 months. However, interventions were more effective in youth with 2 or more self-harm incidents. The authors discuss limitations posed by the lack of uniform outcome measures for self-harm.

Clinical guidance

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  No single, specific intervention can be conclusively recommended for preventing repetition of self-harm in youth.
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  Young people with multiple prior episodes of self-harm are at heightened risk and may be more likely to benefit from treatment.

Study preregistration information

Reducing Self-harm in Adolescents: An Individual Participant Data Meta-analysis; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=152119.