Effective Brief Interventions for Reducing Self-Harm in Patients with a History of Self-Injury

Impact of Self-Harm on Suicide Risk

Need for Effective Interventions

Individuals who engage in self-harm may be at a higher risk for attempting and completing suicide. While long-term psychological treatments aimed at reducing self-harm in psychiatric outpatients have shown some effectiveness, there is a pressing need for brief, acute interventions.

Study Overview

Research Context

Researchers in the UK investigated the effectiveness of a brief psychological intervention designed to prevent repeat self-harm among inpatients admitted to a psychiatric facility following a suicide attempt. Their findings were published in the journal Lancet Psychiatry.

Intervention Methodology

The intervention utilized a volitional help sheet (VHS) grounded in behavior change theory. This tool encouraged patients to create “if-then” plans to help them avert self-harm. In these plans, “if” pertains to a situation that may trigger self-harm (e.g., “if I feel the urge to self-harm”), while “then” specifies a proactive step to prevent it (e.g., “then I will call my psychologist”).

Trial Design

A 6-month randomized controlled trial was conducted at a psychiatric hospital in Edinburgh, UK. Eligible participants included patients aged 16 and older who had been admitted after a self-harm attempt and had at least one prior incident of self-harm. Out of 1,308 patients screened, 518 met the criteria and were randomly assigned to either the VHS treatment group, which received standard care plus the VHS, or the control group, which received standard care alone.

Blinding and Implementation

To minimize bias, clinical staff and those gathering medical data were blinded to the group assignments. Patients were guided to complete the VHS in private settings, selecting relevant situations and solutions from the sheet. They retained the top copy, while researchers collected a carbon copy to verify plan completion. Two months post-enrollment, the treatment group received a follow-up VHS sheet by mail.

Data Collection and Analysis

Metrics Evaluated

Over the following six months, researchers collected data from hospital records and medical charts to assess the frequency of repeat self-harm incidents, the number of times each patient re-presented, and the duration before re-presentation. They also analyzed the average hospital costs associated with self-harm events between the intervention and control groups, alongside sociodemographic information including age, marital status, and self-harm history.

Comparative Results

Upon comparing the treatment and control groups, the researchers found no significant differences in the incidence of repeat self-harm within the six-month period. Additionally, there were no notable differences in the frequency of re-presentations, the duration until re-presentation, or the average hospital service costs by group.

Insights and Future Research Directions

Potential Benefits for Specific Populations

Despite the overall findings, further analysis indicated that the intervention may offer advantages to individuals with a history of hospitalization for self-harm. Specifically, patients with such a background who did not receive the VHS were more prone to re-present to emergency services. Conversely, those with a prior history who did receive the intervention experienced a nearly 70% reduction in emergency department visits and a 55% decrease in hospital readmissions.

Tailoring Psychological Interventions

The results imply that psychological interventions should be customized to meet the specific needs of patients. Individuals with a history of self-harm might derive greater benefit from brief acute interventions such as the VHS.

Need for Further Investigation

Additional research is essential to validate these findings, given that many analyses were exploratory and unplanned. The potential effects of the follow-up treatment at two months, as well as patient perceptions of the intervention, require further exploration. Future studies should also consider the possible negative impacts of interventions like the VHS on patients without a self-harm history.

Conclusion

The study highlights the importance of developing targeted psychological interventions for at-risk populations, especially those with a history of self-harm, to effectively reduce future incidents and improve overall mental health outcomes.

Written By: Suzanne M. Robertson, Ph.D.