Efficacy of mentalization-based therapy in treating self-harm: A systematic review and meta-analysis.

INTRODUCTION: Mentalization-based therapy (MBT) and its adapted version for adolescents (MBT-A) are repeatedly highlighted as promising treatments for reducing self-harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self-harm, recent meta-analyses have yielded mixed results. To inform best-practice clinical decision-making, we conducted a systematic review and meta-analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(-A) in reducing self-harm (primary outcome) and symptoms of BPD and depression (secondary outcomes). METHODS: Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre-post, three RCTs) and five MBT-A studies (two pre-post, three RCTs). Aggregated effect sizes were estimated using random-effects models. Meta-regressions were conducted to assess the effect of moderator variables (treatment duration, drop-out rates, and age) on effect sizes. RESULTS: Overall, both MBT and MBT-A demonstrated promising effects in reducing self-harm (g = -0.82, 95% CI -1.15 to -0.50), borderline personality disorder (g = -1.08, 95% CI -1.38 to -0.77), and depression (g = -1.1, 95% CI -1.52 to -0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(-A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = -0.56, 95% CI -0.88 to -0.24). CONCLUSION: Although the pre-post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(-A) to control conditions, so that prioritizing the application of MBT (-A) for the treatment of self-harm is not supported. Possible explanations and further implications are discussed.

Evidence that implementation intentions reduce self-harm in the community.

OBJECTIVES: Implementation intentions are 'IF-THEN' plans that encourage goal-intended behaviour. This study was designed to test whether an intervention encouraging the formation of implementation intentions can reduce self-harm in the community. DESIGN: A randomized controlled design was used. METHODS: At pre-intervention, outcome variables (self-harm in both specified and unspecified critical situations and suicidality) and potential moderators of implementation intentions (goal intention, mental imagery, and exposure to self-harm) were measured using self-report questionnaires. The participants (N = 469, aged 18-66 years, 86.4% female, 6.8% male and 6.7% other) were then randomized to either an experimental (implementation intention) or control task. At three-months post-intervention, self-report questionnaires were used again to measure the outcome variables. RESULTS: There were no overall differences between the conditions at post-intervention. However, goal intention and mental imagery, but not exposure to self-harm, moderated the effects of condition on self-harm in specified critical situations. At high (mean + 1SD) levels of both goal intention and mental imagery, the experimental condition reported self-harming less frequently in the situations specified in their implementation intentions. CONCLUSIONS: Implementation intentions therefore represent a useful intervention for reducing self-harm in specified critical situations for people in the community who wish to avoid self-harm and those who frequently experience self-harm and suicide related mental imagery.

[Borderline personality disorder and non-suicidal self-injury: the role of mindfulness training in risk reduction].

INTRODUCTION: Due to patients diagnosed with borderline personality disorder (BPD) can engage risky behaviors, it is necessary to develop evidence based interventions in healthcare that can help to reduce the most pressing problems. BPD-specific cognitive therapy-based mindfulness training (MBCT) can be a solution to this challange. LITERATURE REVIEW: Non-suicidal self-injury (NSSI) is a significant predictor of subsequent suicide attempts and occurs in 80% of BPD patients. It is related to impulse- and emotion-dysregulation (cognitive-emotional model), as well as the deficit of mindfulness skills, which are also key difficulties in BPD (emotional cascade model, mindfulness deficit theory). The cognitive-emotional reactivity model of NSSI based on the reactivity model in recurrent depression, the four-function model and theories above. The model differs situational, cognitive, emotional, physiological, and behavioral factors that can trigger or maintain NSSI, and it also helps to determine intervention points. STUDY PROTOCOL: Our hypothesis is that the 8-week MBCT training is more effective in developing mindfulness skills, emotion- and impulse control, and in reducing self-harm also than waiting list or supportive therapy. Participants are BPD patients with NSSI, in a quasi-experimental repeated measure design, planned sample size is N=60 per group. Before the training there is a two-stage interview procedure, patients fill out a questionnaire survey and they have to sign a suicide prevention contract. The planned waiting time between the first interview and the start of the training is 8-12 weeks. The group sessions are based on the MBCT training protocol designed to reduce the risk of suicide, supplemented with BPD-specific elements (specific psychoeducation, loving-kindness meditation). DISCUSSION: Based on the effectiveness of small-sample research, our aim is to test the effectiveness of MBCT training among BPD patients based on the above protocol.

The effectiveness and acceptability of formal versus informal mindfulness among university students with and without recent nonsuicidal self-injury: Protocol for an online, parallel-group, randomized controlled trial.

BACKGROUND: Mindfulness-based programming comprising both formal (FM) and informal (IM) mindfulness practice is increasingly offered to university students. However, difficulties with emotion regulation, self-criticism, and a potentially complex relationship with their body may undermine the benefits of FM for students with a history of nonsuicidal self-injury (NSSI), given its requirement of sustained attention on thoughts, emotions, and bodily sensations. IM may be better tolerated by these students. This protocol describes a randomized controlled trial comparing a brief FM practice, a brief IM practice, and an active control task in university students with and without recent NSSI. METHODS: Recruitment began in November 2022. An online, parallel-group, single-blind, randomized controlled trial will compare a 10-min, single-session FM practice, a 10-min, single session IM practice, and a 10-min, single session active control task in university students with and without recent NSSI. Outcomes will be assessed immediately pre-intervention and within five minutes post-intervention. The primary outcome will be state mindfulness. Secondary outcomes will be state stress, state well-being, and acceptability. Students with a history of NSSI are expected to report (i) greater improvements in state mindfulness, stress, and well-being, and (ii) greater acceptability in the IM condition, relative to the FM and control conditions. This distinction is not expected to occur in the no-NSSI comparison group. CONCLUSION: This trial is the first to parse out the impacts of FM versus IM practice among university students with and without a history of self-injury. Findings will be relevant to academic and clinical audiences within university settings.

Adapting a codesign process with young people to prioritize outcomes for a systematic review of interventions to prevent self-harm and suicide.

BACKGROUND: Research and clinical outcomes that matter to people with lived experience can significantly differ from those outcomes studied by researchers. To inform a future Cochrane review of suicide and self-harm prevention interventions, we aimed to work with young people with relevant lived experience to agree on priority outcomes. DESIGN: Four participatory codesign workshops were completed across two sites (New Zealand, United Kingdom) with 28 young people in total. We iteratively adapted the methods over the course of the study. RESULTS: 'Improved coping' and 'safer/more accepting environment to disclose' were the final top-rated outcomes. 'Reduction of self-harm' was considered a low priority as it could be misleading, stigmatizing and was considered a secondary consequence of other improvements. In contrast to typical research outcomes, young people emphasized the diversity of experience, the dynamic nature of improvement and holistic and asset-based framing. Methodologically, dialogue using design materials (personas) to thematically explore outcomes was effective in overcoming the initial challenge of disparate quantitative ratings. DISCUSSION: The results will directly inform the development of a Cochrane review, enabling identification of whether and how outcomes of most importance to young people are measured in trials. Rather than producing discrete measurable outcomes that could be easily added to the systematic review, the young people challenged the academic conceptualization of outcomes, with implications for future evidence synthesis and intervention research, and for future codesign. PATIENT OR PUBLIC CONTRIBUTION: Young people with lived experience were codesigners of the outcomes, and their feedback informed iterative changes to the study methods.

Effect of Offering Care Management or Online Dialectical Behavior Therapy Skills Training vs Usual Care on Self-harm Among Adult Outpatients With Suicidal Ideation: A Randomized Clinical Trial.

Importance: People at risk of self-harm or suicidal behavior can be accurately identified, but effective prevention will require effective scalable interventions. Objective: To compare 2 low-intensity outreach programs with usual care for prevention of suicidal behavior among outpatients who report recent frequent suicidal thoughts. Design, Setting, and Participants: Pragmatic randomized clinical trial including outpatients reporting frequent suicidal thoughts identified using routine Patient Health Questionnaire depression screening at 4 US integrated health systems. A total of 18 882 patients were randomized between March 2015 and September 2018, and ascertainment of outcomes continued through March 2020. Interventions: Patients were randomized to a care management intervention (n = 6230) that included systematic outreach and care, a skills training intervention (n = 6227) that introduced 4 dialectical behavior therapy skills (mindfulness, mindfulness of current emotion, opposite action, and paced breathing), or usual care (n = 6187). Interventions, lasting up to 12 months, were delivered primarily through electronic health record online messaging and were intended to supplement ongoing mental health care. Main Outcomes and Measures: The primary outcome was time to first nonfatal or fatal self-harm. Nonfatal self-harm was ascertained from health system records, and fatal self-harm was ascertained from state mortality data. Secondary outcomes included more severe self-harm (leading to death or hospitalization) and a broader definition of self-harm (selected injuries and poisonings not originally coded as self-harm). Results: A total of 18 644 patients (9009 [48%] aged 45 years or older; 12 543 [67%] female; 9222 [50%] from mental health specialty clinics and the remainder from primary care) contributed at least 1 day of follow-up data and were included in analyses. Thirty-one percent of participants offered care management and 39% offered skills training actively engaged in intervention programs. A total of 540 participants had a self-harm event (including 45 deaths attributed to self-harm and 495 nonfatal self-harm events) over 18 months following randomization: 172 (3.27%) in care management, 206 (3.92%) in skills training, and 162 (3.27%) in usual care. Risk of fatal or nonfatal self-harm over 18 months did not differ significantly between the care management and usual care groups (hazard ratio [HR], 1.07; 97.5% CI, 0.84-1.37) but was significantly higher in the skills training group than in usual care (HR, 1.29; 97.5% CI, 1.02-1.64). For severe self-harm, care management vs usual care had an HR of 1.03 (97.5% CI, 0.71-1.51); skills training vs usual care had an HR of 1.34 (97.5% CI, 0.94-1.91). For the broader self-harm definition, care management vs usual care had an HR of 1.10 (97.5% CI, 0.92-1.33); skills training vs usual care had an HR of 1.17 (97.5% CI, 0.97-1.41). Conclusions and Relevance: Among adult outpatients with frequent suicidal ideation, offering care management did not significantly reduce risk of self-harm, and offering brief dialectical behavior therapy skills training significantly increased risk of self-harm, compared with usual care. These findings do not support implementation of the programs tested in this study. Trial Registration: ClinicalTrials.gov Identifier: NCT02326883.

Evaluating the Effectiveness of a Brief Mindfulness Activity in University Students With Non-Suicidal Self-Injury Engagement.

Current theoretical frameworks posit that engagement in non-suicidal self-injury (NSSI) is due to an inability to regulate one's emotions. In turn, mindfulness-based interventions have been shown to enhance emotion regulatory processes in those who engage in NSSI. OBJECTIVE: The purpose of the present study was to determine whether a brief mindfulness activity was differentially effective at increasing state mindfulness and decreasing stress following a stress induction task in university students with versus without a history of NSSI engagement. METHOD: The sample consisted of two groups of participants who identified as women: participants with a history of NSSI engagement (NSSI; n = 57; Mage=20.09, SD = 2.05) and participants without (no-NSSI; n = 87; Mage=20.22, SD = 1.94). All participants were asked to complete pre-intervention measures of state mindfulness and stress and were randomly assigned to either a mindfulness activity (body scan) or control task condition. Following the completion of their respective activities, a Stroop stress induction task was conducted and participants completed post-intervention measures of state mindfulness and stress. RESULTS: Two 3-way mixed ANOVAs (Time X NSSI status X Condition) were conducted and revealed significant time by condition interactions for both state mindfulness, Wilk's Λ = .93, F(1, 140) = 10.70, p = .001, ηp2 = .07, and stress, Wilk's Λ = .97, F(1, 140) = 4.21, p = .04, ηp2 = .03. As such, both groups (NSSI/no-NSSI) demonstrated similar increases in state mindfulness and decreases in stress in response to the brief mindfulness activity following the stress induction. Implications for future research and practice will be discussed.HIGHLIGHTSThe brief mindfulness activity effectively increased state mindfulness.The brief mindfulness activity effectively decreased stress.Benefits were experienced similarly among both groups (NSSI/no-NSSI).

Reducing Self-harm in Adolescents. An individual participant data meta-analysis (RISA-IPD): systematic review protocol.

INTRODUCTION: Up to 10% of adolescents report self-harm in the previous year. Non-fatal repetition is common (18% in 1 year), death from any cause shows a fourfold and suicide a 10-fold excess. Despite the scale of the problem, there is insufficient evidence for effective interventions for self-harm. Those who self-harm do so for a variety of different reasons. Different treatments may be more effective for subgroups of adolescents; however, little is known about which subgroups are appropriate for further study. This protocol outlines a systematic review and individual participant data meta-analysis (IPD-MA) to identify subgroups of adolescents for which therapeutic interventions for self-harm show some evidence of benefit. METHODS AND ANALYSIS: A systematic literature search was conducted in August 2019 (including Cochrane Library, Embase, trial registers and other databases). An update search is planned. Study selection will identify randomised controlled trials examining interventions to reduce self-harm in adolescents who have self-harmed and presented to services. Identified research teams will be invited to contribute data and form a collaborative group. Two-stage IPD-MA will be used to evaluate effectiveness of different therapeutic interventions compared with any active or non-active control on repetition of self-harm, general psychopathology, depression, suicidal ideation, quality of life and death. Subgroup analyses will identify adolescent subgroups in whom different therapeutic interventions may be more effective. Meta-regression will explore moderating study and intervention effects. Sensitivity analyses will incorporate aggregate data from studies lacking IPD and test the robustness of results to methods for handling missing data, within-study clustering, non-adherence and study quality. ETHICS AND DISSEMINATION: Ethical approval is provided by the University of Leeds, Faculty of Medicine and Health Ethics Committee (18-098). Outcomes will inform research recommendations and will be disseminated internationally through the collaborative group, a service user advisory group, open-access peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42019152119.

Are digital interventions effective in reducing suicidal ideation and self-harm? A systematic review.

Background: There is a significant lack of outcomes research examining the effectiveness of digital interventions for reducing suicidal ideation and self-harm.Aims: To systematically review the effectiveness of digital interventions for reducing suicidal ideation and self-harm in adult populations. The possible mediating effects of depression are also discussed.Methods: The databases Pubmed, Medline, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, IEEEXplore, ACM and CRESP were searched. Only randomised controlled trials (RCTs) were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Studies were assessed for methodological quality and risk of bias using standard assessment criteria.Results: Fourteen RCTs were reviewed, reporting data on 3455 participants. Although findings were more consistent for the effectiveness of online Cognitive Behavioural Therapy (CBT), Mindfulness-Based CBT and Dialectical Behavioural Therapy, there was insufficient research to consider any as evidence-based treatments for suicidal ideation and self-harm.Conclusions: Digital interventions for suicidal ideation and self-harm can be a safe and acceptable option for individuals unwilling or unable to access face-to-face interventions. However, further research is needed to understand the types of interventions that could support people and the risk-benefit ratio of digital interventions for these individuals.

Predictors of Dropout From a 20-Week Dialectical Behavior Therapy Skills Group for Suicidal Behaviors and Borderline Personality Disorder.

Treatment dropout among individuals with borderline personality disorder (BPD) is associated with negative psychosocial outcomes. Identifying predictors of dropout among this population is critical to understanding how to improve treatment retention. The present study extends the current literature by examining both static and dynamic predictors of dropout. Chronically suicidal outpatients diagnosed with BPD (N = 42) were randomly assigned to a 20-week dialectical behavior therapy (DBT) skills training group. Static and dynamic predictors were assessed at baseline, 5, 10, 15, 20 weeks, and 3 months post-intervention. A post-hoc two-stage logistic regression analysis was conducted to predict dropout propensity. Receiving disability benefits at baseline and decreases in mindfulness were associated with significantly increased probability of dropout. Clinicians working with chronically self-harming outpatients diagnosed with BPD would benefit from prioritizing clinical interventions that enhance mindfulness in order to decrease dropout propensity.

Group therapy for excoriation disorder: Psychodrama versus support therapy.

BACKGROUND: Excoriation disorder (ED) is characterized by recurring excoriation of the skin resulting in tissue damage, usually associated with emotional deregulation. Psychotherapy is a valuable treatment; however, no studies emphasize the patients' interactional aspect, nor the potential benefit of group treatment. METHODS: We recruited a convenience sample of 38 individuals with ED according to DSM-5 criteria, in which 19 individuals proceeded to treatment, 10 with psychodrama group therapy (PGT), and 9 with support group therapy (SGT) in an open pilot study. RESULTS: The entire sample presented improvement of skin excoriation on both self-report and clinician rating and improvement of social adjustment; however, there was no difference between groups (ie, time × group interaction). Also, there was no relevant change for anxiety, depression, or emotional regulation throughout treatment. Emotional deregulation was associated with excoriation severity as well as depression, anxiety, and social maladjustment, both at the beginning and end of treatment. CONCLUSIONS: Although both groups showed improvement of skin picking, the results contradict our primary hypothesis that PGT would have a superior efficacy to SGT for patients with ED. The findings encourage future studies of group interventions for ED in larger samples with a focus on emotional regulation enhancement.

Helping or Heightening Vulnerability? Midwives as Arbiters of Risk for Women Experiencing Self-Directed Violence in Urban Sri Lanka.

The response of midwives to women engaging in self-directed violence (SDV) may affect women's care and outcomes. The author explored midwives' understanding of SDV through semi-structured focus groups and in-depth interviews with 11 Public Health Midwives in urban Sri Lanka. Thematic analysis identified four key themes: (a) perceived dimensions of women's risk and vulnerability to SDV, (b) midwives as arbiters of risk, (c) representations of women engaging in SDV, and (d) midwives' perceived capacity to respond. Given their proximity to communities, trustworthiness as sites of disclosure, and respectability as women and guardians of ideal womanhood in Sri Lankan society, midwives occupy a powerful position in the health system through which to alleviate or reinforce women's risk to SDV. Yet, investment in developing their skills and role to respond to the growing phenomenon of SDV among women in Sri Lanka must consider the context within which midwives assess and select their responses.

Employing a Harm-Reduction Approach Between Women and Girls Within Indigenous Familial Relationships.

It is important to recognize that experiences of racial and gendered violence are a sad legacy of colonialism. The experiences of historical trauma are on-going. These affect the mental and physical wellbeing of individuals, families and communities. Addressing historical trauma through community-informed practices is central to creating space for meaningful change. This paper outlines results from a seven-week activity-based research workshop conducted on three separate occasions with urban-based First Nations and Metis women and girls (aged 8-12). Using a decolonizing theoretical framework, this paper examines data collected within three specific arts-based activities: empowerment bracelets, "I'm proud of you" charm bracelets and "Who I am" pictures. Women were hesitant to discuss future plans, as many were not confident that their daughters would be in contact with their maternal families when they become teenagers. Girls observed and mimicked the thoughts and actions of their mothers, step-mothers, aunts, older sisters and grandmothers. They demonstrated the role they already play within the discourse of what it means to be female living within their communities. This paper concludes with the implicit harm reduction approach women and girls used when exploring the impacts of trauma while envisioning a healthier future.

A small-scale study investigating staff and student perceptions of the barriers to a preventative approach for adolescent self-harm in secondary schools in Wales-a grounded theory model of stigma.

OBJECTIVES: Grounded theory analysis of secondary school staff and pupil perceptions about the barriers to preventative work for adolescent self-harm within the secondary school setting in Wales. STUDY DESIGN: Qualitative and grounded theory. METHODS: Two secondary schools in Wales were purposefully sampled for variation. Four group interviews took place using qualitative research methods (Participatory Rapid Appraisal) with six school-based professionals and six students aged more than 16 years. Three pupil participants had long-term experience themselves of self-harming behaviours; all the remaining participants had encountered pupils who self-harmed. The research interviews were transcribed verbatim, generating school context-dependent information. This was analysed through the logic of abduction using the constant comparative grounded theory method because of its ability to focus on axial coding for context. The ontology that shaped this work was critical realism within a public health paradigm. RESULTS: A theoretical model of stigma resulted from the grounded theory analytical process, specifically in relation to staff and student perceptions about adolescent self-harm within the institutional context. This meant that social-based behaviours in the secondary school setting centred on the topic and behaviour of adolescent self-harm were structured by stigma. CONCLUSIONS: The findings of this study offer an explanation on the exclusion of adolescent self-harm from preventative work in secondary schools. The stigma model demonstrates that adolescent self-harm is excluded from the socio-cultural norms of the institutional setting. Applying the UK Equality Act (2010), this is discrimination. Further research on the institutional-level factors impacting adolescent self-harm in the secondary school context in England and Wales is now urgently needed.

Comparative effect of antipsychotics on risk of self-harm among patients with schizophrenia.

OBJECTIVE: To investigate the association of different antipsychotic treatments with hospitalization due to self-harm among patients with schizophrenia. METHOD: This retrospective cohort study was based on Taiwan's universal health insurance database. Patients aged 15-45 years with a newly diagnosed schizophrenic disorder in 2001-2012 were included. The study outcome was the first hospitalization due to self-harm or undetermined injury after the diagnosis of schizophrenic disorders. The exposure status of antipsychotics was modeled as a time-dependent variable. The analyses were stratified by antipsychotic dosage based on defined daily dose (DDD). RESULTS: Among 70 380 patients with a follow-up of 500 355 person-years, 2272 self-harm hospitalization episodes were identified. Compared with none or former use, current use of several second-generation antipsychotics with a dose of one DDD or above, including amisulpride, aripiprazole, clozapine, risperidone, and sulpiride, was associated with decreased risk of self-harm hospitalization, with clozapine showing the strongest effect (adjusted rate ratio = 0.26, 95% confidence interval 0.15-0.47). CONCLUSION: The protective effect on self-harm may vary across different antipsychotics. Further studies are needed to replicate the findings.

Rationale and study design of a trial of mindfulness-based cognitive therapy for preventing suicidal behavior (MBCT-S) in military veterans.

BACKGROUND: Although suicide ranks 10th as a cause of death in the United States, and 1st among active military personnel, there are surprisingly few evidence-based therapies addressing suicidality, and development of new treatments is limited. This paper describes a clinical trial testing a novel therapy for reducing suicide risk in military veterans. The intervention, Mindfulness-Based Cognitive Therapy for Preventing Suicide Behavior (MBCT-S), is a 10-week group intervention adapted from an existing treatment for depression (Mindfulness-Based Cognitive Therapy - MBCT). MBCT-S incorporates the Safety Planning Intervention, which is currently implemented throughout the Veterans Health Administration (VHA) for veterans at high suicide risk. METHODS: MBCT-S is being tested in a VHA setting using an intention-to-treat, two-group randomized trial design in which 164 high suicide risk veterans are randomized to either VHA Treatment As Usual (TAU; n=82) or TAU+MBCT-S (n=82). Our primary outcome measure, suicide-related event, defined to include suicide preparatory behaviors, self-harm behavior with suicidal or indeterminate intent, suicide-related hospitalizations and Emergency Department (ED) visits, will be measured through five assessments administered by blinded assessors between baseline and 12months post-baseline. We will measure suicide attempts and suicide deaths as a secondary outcome, because of their anticipated low incidence during the study period. Secondary outcomes also include severity of suicidal ideation, hopelessness and depression. SIGNIFICANCE: This study has the potential to significantly enhance the quality and efficiency of VHA care for veterans at suicide risk and to substantially improve the quality of life for veterans and their families.

Is psychotherapy effective for reducing suicide attempt and non-suicidal self-injury rates? Meta-analysis and meta-regression of literature data.

OBJECTIVE: To determine the efficacy of psychotherapy interventions for reducing suicidal attempts (SA) and non-suicidal self-injury (NSSI). METHODS: Meta-analysis of randomized controlled trials (RCTs) comparing psychotherapy interventions and treatment as usual (TAU; including also enhanced usual care, psychotropic treatment alone, cognitive remediation, short-term problem-oriented approach, supportive relationship treatment, community treatment by non-behavioral psychotherapy experts, emergency care enhanced by provider education, no treatment) for SA/NSSI. RCTs were extracted from MEDLINE, EMBASE, PsycINFO and Cochrane Library and analyzed using the Cochrane Collaboration Review Manager Software and Comprehensive Meta-analysis. RESULTS: In the 32 included RCTs, 4114 patients were randomly assigned to receive psychotherapy (n = 2106) or TAU (n = 2008). Patients who received psychotherapy were less likely to attempt suicide during the follow-up. The pooled risk difference for SA was -0.08 (95% confidence intervals = -0.04 to -0.11). The absolute risk reduction was 6.59% (psychotherapy: 9.12%; TAU: 15.71%), yielding an estimated number needed to treat of 15. Sensitivity analyses showed that psychotherapy was effective for SA mainly in adults, outpatients, patients with borderline personality disorder, previously and non-previously suicidal patients (heterogeneous variable that included past history of SA, NSSI, deliberate self-harm, imminent suicidal risk or suicidal ideation), long- and short-term therapies, TAU only as a control condition, and mentalization-based treatment (MBT). No evidence of efficacy was found for NSSI, with the exception of MBT. Between-study heterogeneity and publication bias were detected. In the presence of publication bias, the Duval and Tweedie's "trim and fill" method was applied. CONCLUSION: Psychotherapy seems to be effective for SA treatment. However, trials with lower risk of bias, more homogeneous outcome measures and longer follow-up are needed.

The Relationship Between Mindfulness, Depressive Symptoms, and Non-Suicidal Self-Injury Amongst Adolescents.

Mindfulness is often part of treatment for non-suicidal self-injury (NSSI); however, there has been limited research examining the role of mindfulness in NSSI. Thus, the current study sought to investigate the relationship among mindfulness, depressive symptoms, and NSSI (past year) in adolescents (N = 764; 56.8% female, M age = 14.42, SD = 0.64) with consideration of gender. Adolescents with recent NSSI (n = 74; 83.8% female, M age = 14.36, SD = 0.56) and a matched for age and gender no-NSSI group completed measures of mindfulness and depression. Findings revealed that mindfulness and depressive symptoms were negatively correlated, although significantly less so for the NSSI group. Second, the NSSI group reported greater depressive symptoms and less mindfulness. Finally, mindfulness was found to partially mediate the effect of depressive symptoms on NSSI. The present study is the first to provide empirical support for the protective role of mindfulness in NSSI.