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Quality Measures Database

Detailed Results


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Preventive Psychotherapy for Self-Harm in Youth Overall Rank: 97
For young people who have self-harmed several times, consideration may be given to offering developmental group psychotherapy with other youth who have repeatedly self-harmed. This should include at least six sessions. Extension of the group therapy may also be offered; the precise length of this therapy should be decided jointly by the clinician and the service user.
Domain : Youth
Young people 12 to 19 years of age and conditions common in this population.
Additional Domain(s) : Patients with Acute Conditions, Psychotherapy
Rationale
Children and young people who self-harm have a number of special needs, given their vulnerability. Physical treatments will follow similar principles as for adults.

For adolescents there is strong evidence suggesting that there is a clinically significant difference favouring group therapy over standard aftercare on reducing the likelihood of repetition, although the numbers were small. For other therapies and outcomes there is insufficient evidence of effectiveness. The evidence reviewed here suggests that there are surprisingly few specific interventions for people who have self-harmed that have any positive effect. The GDG came to the conclusion that, at the present time, there was insufficient evidence to support any recommendation for interventions specifically designed for people who self harm.

While there may be some evidence for the treatment of subgroups of service users, such as those diagnosed with borderline personality disorder, the studies were too small to make recommendations. However, the positive outcome for adolescents who have repeatedly self-harmed receiving group therapy is encouraging; although, because of the rather selective group this was applied to, this approach is in need of further investigation.

Moreover, the GDG came to the conclusion that referral for further treatment after an act of self-harm should be determined by the overall needs of the service user, rather than by the fact that they have self-harmed per se. This draws attention to the reliance on repetition as the primary outcome measure in many studies whereas outcomes relevant to service users such as depression status or quality of life may be more relevant.
Primary Reference
The National Institute for Clinical Excellence. Self-harm. The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. November 2004. P. 68, Section 4.9.1.13, P. 178, Section 9.9.1.6.
Retrieved on Aug 3, 2006 from: http://www.nice.org.uk/page.aspx?o=cg016niceguideline
Level of Evidence
II: Less rigorous studies specifically focused on primary mental health care or extrapolated from higher quality studies from secondary mental health care.

Summarized CommentsAdd Comment
  • * Primary vs. secondary? I think it’s more like secondary.
  • * I am not sure if group-work is always culturally appropriate.
  • Possible concern about group dynamic for this population, but this is more anecdotal than related to literature findings.
Variation in Results
Ratings-based Rank
Relevance 97
Actionability 106
Overall Importance 83
 
Stakeholder Rank
Academics 96
Clinicians 103
Consumers 101
Decision Makers 89
 
Special Group Rank
First Nations 66
Rural Areas 90
Federal Stakeholders 78
Regional Rank
BC AB SK MB ON QC NB NS PE NL YT NT NU
66 82 75 131 91 81 142 110 150 105 80 70 156
 
Overall Rank

      

97


SA13e (B145)

 
Distribution of Survey Respondent Ratings
Relevance
100
90
80
70
60
50
40
30
20
10
0
0.8 0.55 0.74 1.79 3.44 13.1 26.02 38.29 15.27
1 2 3 4 5 6 7 8 9
Low High
Actionability
100
90
80
70
60
50
40
30
20
10
0
1.47 2.53 2.53 3.52 10 13.01 34.58 20.76 11.61
1 2 3 4 5 6 7 8 9
Low High
Overall Importance
100
90
80
70
60
50
40
30
20
10
0
6.08 41.74 52.18
3 2 1

3 = can live without
2 = nice to have
1 = indispensable
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