Loading...
Self-harm in adolescents is recurrent, increases risk for serious suicide attempts, and is associated with high lifetime medical costs. In a randomized, controlled, multisite trial conducted in the U.K., researchers examined the effectiveness and cost-effectiveness of a developmental group psychotherapy program previously shown to be effective for adolescents who engage in self-harm.
The 366 participants, aged 12 to 17, had at least two episodes of self-harm in the past year. The group intervention integrated cognitive-behavioral therapy, dialectical behavioral therapy, and psychotherapy in 6 weekly sessions plus a booster phase (weekly sessions as patients needed). Cases and controls received usual specialty mental health care. There was little attrition from either group, and the intervention was well-received.
Overall, no between-group differences were seen. Both groups improved substantially from baseline, most notably in the proportions who engaged in high-frequency self-harm (33% at baseline, 13% at 6 months, 7% at 12 months); self-poisoning (63%, 26%, and 15%, respectively); and any self-harm (100%, 80%, and 60%). Total costs (for accommodations, health services, social care, education, and criminal justice) were nonsignificantly higher for intervention recipients than for controls.
Green JM et al. Group therapy for adolescents with repeated self harm: Randomised controlled trial with economic evaluation. BMJ 2011 Apr 1; 342:d682. (http://dx.doi.org/10.1136/bmj.d682)
Comment
All participants demonstrated significant improvement, regardless of treatment group. These results differ from the positive results of a previous, small, single-site trial. Usual care involved assessments and substantial care by primary care physicians and mental health nurses, perhaps reflecting the increasing development of services for problem teens. Therefore, the amount of care received by controls may have limited the study's ability to find an additional effect for the intervention. Alternatively, making the intervention brief and user-friendly may have decreased its effectiveness. In any case, the intervention cost somewhat more and was not cost-effective.