Problem-solving therapy for people who present to hospital with self-harm: Zelen randomised controlled trial

2013 ◽  
Vol 2013 ◽  
pp. 112-115
Author(s):  
J.L. Krupnick
Keyword(s):  
Problem Solving ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Problem Solving Therapy ◽  
Self Harm ◽  
Randomised Controlled

scholarly journals Problem-solving therapy for people who present to hospital with self-harm: Zelen randomised controlled trial

2011 ◽  
Vol 199 (4) ◽  
pp. 310-316 ◽  
Author(s):  
Simon Hatcher ◽  
Cynthia Sharon ◽  
Varsha Parag ◽  
Nicola Collins
Keyword(s):  
Problem Solving ◽  
Randomised Controlled Trial ◽  
Usual Care ◽  
Controlled Trial ◽  
Effective Intervention ◽  
Number Needed To Treat ◽  
Problem Solving Therapy ◽  
Significant Difference ◽  
Self Harm ◽  
Randomised Controlled

BackgroundPresentations to hospital with self-harm are common, associated with suicide and have an increased mortality, yet there is no accepted effective intervention.AimsTo investigate whether problem-solving therapy would improve outcomes in adults presenting to hospital with self-harm, compared with usual care.MethodA Zelen randomised controlled trial was conducted in four district health boards in New Zealand. A second hospital presentation with self-harm at 1 year for all episodes, plus separate comparisons of first-time and repeat presentations at the index episode, were the a priori primary outcomes. The trial registration number was ACTRN12605000337673.ResultsIn an intention-to-treat analysis of all randomised patients (n = 1094) there was no significant difference at 12 months in the proportion of people who had presented again with self-harm when comparing all episodes (intervention 13.4%, usual care 14.1%; relative risk reduction RR = 0.05, 95% CI −0.28 to 0.30, P = 0.79) or where the index episode was the first episode (intervention 13.4%, usual care 9.4%, RR =–0.42, 95% CI −1.17 to 0.08, P = 0.37). Where the index episode was repeated self-harm, those who received therapy were less likely to present again with self-harm (intervention 13.5%, usual care 22.1%, RR = 0.39, 95% CI 0.07 to 0.60, number needed to treat 12, P = 0.03).ConclusionsProblem-solving therapy is not recommended for everyone who presents to hospital with self-harm. Among adults with a history of self-harm it may be an effective intervention.

scholarly journals The ACCESS study: Zelen randomised controlled trial of a package of care for people presenting to hospital after self-harm

2015 ◽  
Vol 206 (3) ◽  
pp. 229-236 ◽  
Author(s):  
Simon Hatcher ◽  
Cynthia Sharon ◽  
Allan House ◽  
Nicola Collins ◽  
Sunny Collings ◽  
...  
Keyword(s):  
Problem Solving ◽  
Randomised Controlled Trial ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Premature Mortality ◽  
Problem Solving Therapy ◽  
The People ◽  
Self Harm ◽  
Randomised Controlled ◽  
Clinical Trials Registry

BackgroundThe problem of people presenting to hospitals with self-harm is important because such presentations are common, there is a clear link to suicide and a high premature mortality. However, the best treatment for this population is unclear.AimsTo see whether a package of measures, that included regular postcards and problem-solving therapy, improved outcomes at 1 year compared with usual care in people who presented to hospital with self-harm (the ACCESS study: trial registration Australian and New Zealand Clinical Trials Registry ACTRN12609000641291).MethodThe design of the study was a Zelen randomised controlled trial. The primary outcome was re-presentation to hospital with self-harm within 12 months of the index episode.ResultsThere were no significant differences in the primary outcome and most of the secondary outcomes between the two groups. About half the people offered problem-solving therapy did not receive it, for various reasons.ConclusionsThe package as offered had little effect on the proportion of people re-presenting to hospital with self-harm. The dose of problem-solving therapy may have been too small to have an effect and there was a difficulty engaging participants in active treatment.

scholarly journals Postcard intervention for repeat self-harm: randomised controlled trial

2010 ◽  
Vol 197 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Annette L. Beautrais ◽  
Sheree J. Gibb ◽  
Alan Faulkner ◽  
David M. Fergusson ◽  
Roger T. Mulder
Keyword(s):  
Emergency Department ◽  
New Zealand ◽  
Randomised Controlled Trial ◽  
Outcome Measures ◽  
Suicidal Behaviour ◽  
Controlled Trial ◽  
Elevated Risk ◽  
Emergency Department Presentation ◽  
Self Harm ◽  
Randomised Controlled

BackgroundSelf-harm and suicidal behaviour are common reasons for emergency department presentation. Those who present with self-harm have an elevated risk of further suicidal behaviour and death.AimsTo examine whether a postcard intervention reduces self-harm re-presentations in individuals presenting to the emergency department.MethodRandomised controlled trial conducted in Christchurch, New Zealand. The intervention consisted of six postcards mailed during the 12 months following an index emergency department attendance for self-harm. Outcome measures were the proportion of participants re-presenting with self-harm and the number of re-presentations for self-harm in the 12 months following the initial presentation.ResultsAfter adjustment for prior self-harm, there were no significant differences between the control and intervention groups in the proportion of participants re-presenting with self-harm or in the total number of re-presentations for self-harm.ConclusionsThe postcard intervention did not reduce further self-harm. Together with previous results this finding suggests that the postcard intervention may be effective only for selected subgroups.

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