Aims and Objectives
Two recent systematic reviews suggest that brief psychological interventions are effective in reducing psychological distress after self-harm, and also reduce repetition of self-harm (1,2). The two best candidate interventions are Cognitive Behavioural Therapy and Psychodynamic Interpersonal Therapy (PIT). Both are supported by trial evidence and have been used routinely to treat self-harm in the NHS.
There are many trials of CBT for self-harm, so a further trial of CBT may not contribute substantially to the evidence base, whereas a definitive trial of PIT would significantly add to current knowledge. Barriers to providing treatment for self-harm include: difficulties therapists have in delivering therapy to high risk groups; the resources required to treat so many people; and the lack of definitive evidence to inform National Guidelines.
In this trial, we will be training liaison mental health nurses (who are familiar with risk) to deliver brief therapy. Liaison services have received investment in recent years and have the capacity and the desire to offer brief interventions. So, there is a clear pathway to implementation should the results of the trial be positive, which will not deplete existing psychological treatment services.
We propose a mixed-methods, multicentre individually randomised controlled trial with internal pilot, embedded qualitative study and comprehensive cost-effectiveness analysis to evaluate two main questions:
- Is PIT plus standard care effective for people who attend hospital following self-harm, when compared to standard care (according to NICE guidelines)?
- What is the cost-effectiveness of PIT plus standard care versus standard care?
- Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Hazell P, et al. Psychosocial interventions for self-harm in adults. The Cochrane database of systematic reviews. 2016(5):Cd012189.
- Hetrick SE, Robinson J, Spittal MJ, Carter G. Effective psychological and psychosocial approaches to reduce repetition of self-harm: a systematic review, meta-analysis and meta-regression. BMJ Open. 2016;6(9):e011024.
To assess the effectiveness of PIT plus standard care compared to standard care alone as measured by repetition of SH, defined as the time (in months) from randomisation to the date of hospital episode of self-harm.
Key Secondary Objectives
- Repetition of self-harm leading to hospital attendance at 6 and 12 months
- Overall recurrence of self-harm leading to hospital attendance
- Self-reported self-harm repetition
- Reliable and clinically significant improvement in quality of life/psychological global distress at 6 and 12 months
- Cost-effectiveness of PIT compared to usual care
Professor Else Guthrie
Professor Amanda Farrin
Professor Chris Bojke
Professor Navneet Kapur
Professor Mike Crawford
Professor Allan House
Associate Professor Cathy Brennan
Ms Alexandra Wright-Hughes
Ms Petra Bijsterveld
Ms Marsha McAdam