Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching.

BACKGROUND: Although deliberate self-harm is a strong predictor of suicide, evidence for effective interventions is missing. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and general mortality. METHODS: In this matched cohort study all people who, after deliberate self-harm, received a psychosocial therapy intervention at suicide prevention clinics in Denmark during 1992-2010 were compared with people who did not receive the psychosocial therapy intervention after deliberate self-harm. We applied propensity score matching with a 1:3 ratio and 31 matching factors, and calculated odds ratios for 1, 5, 10, and 20 years of follow-up. The primary endpoints were repeated self-harm, death by suicide, and death by any cause. FINDINGS: 5678 recipients of psychosocial therapy (followed up for 42·828 person-years) were matched with 17,034 individuals with no psychosocial therapy in a 1:8 ratio. During 20 year follow-up, 937 (16·5%) recipients of psychosocial therapy repeated the act of self-harm, and 391 (6·9%) died, 93 (16%) by suicide. The psychosocial therapy intervention was linked to lower risks of self-harm than was no psychosocial therapy (odds ratio [OR] 0·73, 95% CI 0·65-0·82) and death by any cause (0·62, 0·47-0·82) within a year. Long-term effects were identified for repeated self-harm (0·84, 0·77-0·91; absolute risk reduction [ARR] 2·6%, 1·5-3·7; numbers needed to treat [NNT] 39, 95% CI 27-69), deaths by suicide (OR 0·75, 0·60-0·94; ARR 0·5%, 0·1-0·9; NNT 188, 108-725), and death by any cause (OR 0·69, 0·62-0·78; ARR 2·7%, 2·0-3·5; NNT 37, 29-52), implying that 145 self-harm episodes and 153 deaths, including 30 deaths by suicide, were prevented. INTERPRETATION: Our findings show a lower risk of repeated deliberate self-harm and general mortality in recipients of psychosocial therapy after short-term and long-term follow-up, and a protective effect for suicide after long-term follow-up, which favour the use of psychosocial therapy interventions after deliberate self-harm. FUNDING: Danish Health Insurance Foundation; the Research Council of Psychiatry, Region of Southern Denmark; the Research Council of Psychiatry, Capital Region of Denmark; and the Strategic Research Grant from Health Sciences, Capital Region of Denmark.

Collaborative assessment and management of suicidality method shows effect.

INTRODUCTION: Previous studies confirm the effect of collaborative assessment and management of suicidality (CAMS) in an experimental setup, but there is a need to test CAMS with regard to its effectiveness and feasibility in a real-life clinical context. The purpose of this study was to investigate CAMS in a Danish population in such a context. MATERIAL AND METHODS: In the present descriptive study, CAMS treatment was administered to a total of 42 patients referred during 1 August 2008 to 30 September 2009 to The Centre of Excellence in Suicide Prevention due to suicidal thoughts or a suicide attempt. Qualitative and quantitative data were obtained before and after CAMS treatment. Five major suicidal markers were regularly assessed. The patients' experiences of the importance of the treatment were studied as endpoints. RESULTS: A total of 81% of the patients completed treatment and 68% hereof completed the final evaluation. 74% from this group judged the sessions to be the main factor in the elimination of their suicidality. A significant decrease was observed in the five suicidal markers recorded for the 42 patients included. One patient attempted suicide and another patient committed suicide. CONCLUSION: CAMS was assessed to be effective and useful in a real-life clinical context. Further studies in larger patient populations are needed as are studies to determine whether the CAMS method may be applied with equal effect to all patient groups. FUNDING: not relevant. TRIAL REGISTRATION: Danish Data Protection Agency.