Should intensive multi-modal intervention versus treatment as usual be used for people who self-harm?

Quality assessmentNo. of patientsEffectQualityImportance
No. of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsIntensive multi-modal interventionTAURelative risk (95% CI)Absolute
Per protocol repetition of self-harm – at last follow-up
2Randomised trialsNo serious limitationsSerious1No serious indirectnessSerious2None25/125 (20%)28/120 (23.3%)RR 0.67 (0.18 to 2.49)77 fewer per 1000 (from 191 fewer to 348 more)⊕⊕○○
LOW
CRITICAL
-15.8%52 fewer per 1000 (from 130 fewer to 235 more)
Suicides – during follow-up
1Randomised trials----None3/76 (3.9%)1/74 (1.4%)RR 1.24 (0.21 to 7.3)3 more per 1000 (from 11 fewer to 85 more)-CRITICAL
-1.4%3 more per 1000 (from 11 fewer to 88 more)
Attendance at treatment – at 12 months
1Randomised trials----None119/140 (85%)64/143 (44.8%)Not pooledNot pooled--
-44.8%Not pooled
Attendance (better indicated by lower values)
1Randomised trials----None140134-Not pooled--
Depression (better indicated by lower values)
1Randomised trialsNo serious limitations--Serious2,3None9450-SMD 0.31 lower (0.66 lower to 0.03 higher)--
Hopelessness (better indicated by lower values)
1Randomised trialsNo serious limitations--Serious2,3None9450-SMD 0.26 lower (0.61 lower to 0.08 higher)--
1

Moderate heterogeneity (50 to 79%).

2

Not statistically significant.

3

Total sample size is lower than 400 participants.

From: Appendix 17, GRADE evidence profiles

Cover of Self-Harm: Longer-Term Management
Self-Harm: Longer-Term Management.
NICE Clinical Guidelines, No. 133.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2012.
Copyright © 2012, The British Psychological Society & The Royal College of Psychiatrists.

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