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

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

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 2001^59 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)
Emergency Care vs Standard Aftercare	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., 2001^34 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., 2002^35 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)
Followup Letter and General Guidelines vs Standard Care	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.

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