Table 12Problem-Solving Therapy

Domains pertaining to strength of evidenceMagnitude of effectStrength of evidence
Number of studies;
# of subjects
Risk of bias (Design/Risk of bias)ConsistencyDirectnessPrecisionMagnitude of effectHigh, Moderate, Low, Insufficient
Problem-Solving Therapy plus treatment as usual versus treatment as usual (Hatcher 2011)36
 Participants re-presenting to hospital for self-harm: All consenting patients
 1; 552Low (RCT/Low)N/AIndirectImpreciseRR= 0.17 (95% CI -0.24 to 0.44); P=0.43Moderate
 Participants with self-reported self-harm: All consenting patients
 1; 412Low (RCT/Low)N/AIndirectImpreciseRR= 0.16 (95% CI -0.13 to 0.38); P=0.29Moderate
 Time to re-presentation to hospital for self-harm: All consenting patients
 1; 139Low (RCT/Low)N/AIndirectImpreciseHR= 0.81 (95% CI 0.53 to 1.25); P=0.92Moderate
 Participants re-presenting to hospital for self-harm: Consenting patients; first episode of self-harm hospitalization is index episode
 1; 306Low (RCT/Low)N/AIndirectImpreciseRR= -0.56 (95% CI -1.96 to 0.18); P=0.23Moderate
 Participants with self-reported self-harm: Consenting patients; first episode of self-harm hospitalization is index episode
 1; 220Low (RCT/Low)N/AIndirectImpreciseRR= -0.25 (95% CI -1.03 to 0.24); P=0.47Moderate
 Time to re-presentation to hospital for self-harm: Consenting patients; first episode of self-harm hospitalization is index episode
 1; 137Low (RCT/Low)N/AIndirectImpreciseHR= 1.62 (95% CI 0.82 to 3.18); P=0.16Moderate
 Participants re-presenting to hospital for self-harm: Consenting patients; repeat episode of self-harm hospitalization is index episode
 1; 246Low (RCT/Low)N/AIndirectImpreciseRR= 0.47 (95% CI 0.11 to 0.69); P=0.02; NNT=8Moderate
 Participants with self-reported self-harm: Consenting patients; repeat episode of self-harm hospitalization is index episode
 1; 192Low (RCT/Low)N/AIndirectImpreciseRR= 0.37 (95% CI 0.08 to 0.57); P=0.02; NNT=6Moderate
 Time to re-presentation to hospital for self-harm: Consenting patients; repeat episode of self-harm hospitalization is index episode
 1; 149Low (RCT/Low)N/AIndirectImpreciseHR= 0.47 (95% CI 0.26 to 0.85); P=0.01Moderate
 Participants re-presenting to hospital for self-harm: All patients
 1; 1094Low (RCT/Low)N/AIndirectImpreciseRR= 0.05 (95% CI -0.28 to 0.30); P=0.79Moderate
 Time to re-presentation to hospital for self-harm: All patients
 1; 149Low (RCT/Low)N/AIndirectImpreciseHR= 0.98 (95% CI 0.71 to 1.36); P=0.92Moderate
 Participants re-presenting to hospital for self-harm: All patients; first episode of self-harm hospitalization is index episode
 1; 674Low (RCT/Low)N/AIndirectImpreciseRR= 0.42 (95% CI -1.17 to 0.08); P=0.37Moderate
 Time to re-presentation to hospital for self-harm: All patients; first episode of self-harm hospitalization is index episode
 1; 135Low (RCT/Low)N/AIndirectImpreciseHR= 1.55 (95% CI 0.98 to 2.48); P=0.06Moderate
 Participants re-presenting to hospital for self-harm: All patients; repeat episode of self-harm hospitalization is index episode
 1; 420Low (RCT/Low)N/AIndirectImpreciseRR= 0.39 (95% CI 0.07 to 0.60); P=0.03; NNT=12Moderate
 Time to re-presentation to hospital for self-harm: All patients; repeat episode of self-harm hospitalization is index episode
 1; 194Low (RCT/Low)N/AIndirectImpreciseHR= 0.58 (95% CI 0.36 to 0.94); P=0.03Moderate
Problem-Solving Therapy versus Standard Care (Hawton 2000 as cited in Mann 2005)10
 Unclear outcome reported in Mann 2005
 1 systematic review; not reportedMedium (SR/Unclear)N/AIndirectN/ANot reportedInsufficient to Low
CBT vs Problem Solving Therapy vs Usual Care (Stewart 2009)50
Repeated in Cognitive Therapy table above
 Average number of suicide attempts
 1; 32High (RCT/High)N/AIndirectImpreciseCBT: 0.22
PST: 0.33
TAU: 0.22
No significant differences found for repetition of suicide attempts when PST group was compared to TAU
Insufficient

From: APPENDIX S, STRENGTH OF EVIDENCE RATINGS FOR PRIMARY STUDIES RELATED TO PSYCHOTHERAPY

Cover of Suicide Prevention Interventions and Referral/Follow-Up Services: A Systematic Review
Suicide Prevention Interventions and Referral/Follow-Up Services: A Systematic Review [Internet].
O'Neil ME, Peterson K, Low A, et al.
Washington (DC): Department of Veterans Affairs; 2012 Mar.

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