Table 48Summary study characteristics of single trials comparing psychosocial interventions versus treatment as usual

Compliance enhancement versus treatment as usualCase management versus treatment as usualSupportive contact versus treatment as usualGP letter to patient/enhanced care versus treatment as usualIntensive inpatient and community treatment versus treatment as usual
Total number of trials (N)1 RCT (516)1 RCT (467)1 RCT (1867)1 RCT (1932)1 RCT (240)
Study IDVANHEERINGEN1995CLARKE2002FLEISCHMANN2008*BENNEWITH 2002VANDERSANDE1997
Diagnosis15% had a diagnosis of mood disorder, 3% of anxiety disorder17% had psychiatric history, 13% alcohol problems, 3% schizoaffective disorderNot reportedNot reported32% had diagnosis of mood disorder and adjustment disorder
Recruitment settingPatients treated in A&E after a suicide attemptPatients presenting to hospital for deliberate self-harmPatients attending an emergency care setting with a diagnosis of self-harm or self-poisoningParticipants found in hospital case register for self-harmPatients admitted to hospital following a suicide attempt
Treatment lengthUnclearUp to 6 months18 monthsUnclearFlexible appointments usually on weekly basis
CountryBelgiumUKBrazilUKNetherlands
InterventionCompliance enhancement plus usual care – home visits were made to participants who did not keep outpatient appointments, the reasons for not attending appointments were discussed and the patient was encouraged to attend.Case management consisting of psychosocial assessment, a negotiated care plan and ‘open access’ to a case manager who helped the patient identify and access suitable services plus usual care.Treatment as usual plus brief intervention (‘information about suicidal behaviour as a sign of psychological and/or social distress, risk and protective factors, basic epidemiology, repetition, alternatives to suicidal behaviours, and referral options’) plus follow-up contact (via phone or visits; referral support) at 1, 2, 4, 7 and 11 weeks, and 4, 6, 12 and 18 months).Letter from GP for consultation in surgeryBrief psychiatric unit admission, encouraging participants to contact unit on discharge. CPN assigned to establish therapeutic relationship with the patient. Treament by CPN based on problem-solving approach. Outpatient therapy plus 24-hour emergency access to unit.
ControlOutpatients appointments only; non-compliant participants were not visited.Usual care consisting of triage, medical and psychosocial assessment and treatment as required. For patients who were admitted from A&E for further treatment, usual treatment generally involved a request for a psychiatric assessment.Treatment as usual ‘according to the norms prevailing in the respective emergency departments’ (typically, treatment for somatic problems).Usual GP care. No structured feedback about patient management. GPs in control group had initiated contact with only 15% (97 out of 642) of patients, compared with 58% (352 out of 612) in the intervention group.Usual care. Patients were assigned by the routine clinical service and could consist of all currently available alternative treatments. 75% were discharged from hospital; of these patients, almost 90% were referred to an outpatient clinic. 25% were referred for hospitalisation in a psychiatric clinic.

Note. *New studies since short-term guideline (NICE, 2004a).

From: 7, PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS

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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