Can psychotherapy reduce suicide and self harm in young people?

Written by Mark Smith

Mark is a qualified and experienced psychotherapist who works as an IAPT NHS clinician and in private practice. He has a number of years of experience working with patients with mental health issues. Mark is also a freelance trainer who regularly delivers workshops and seminars on a diverse range of mental health disorders and interventions. He is particularly interested in addiction theory and therapy, anger management, outcome measures in psychotherapy and mental health disorders. He holds a PhD and is a member of both the BACP and BABCP;

In recent weeks suicide prevention has been the focus of much publicity. Much of this is of course due to stark fact that around 800,000 people take their own lives around the globe each year (WHO, 2014). This month also marked World Suicide Prevention Day and the theme this year was ‘Preventing Suicide: Reaching Out and Saving Lives’.

We elves also made our very own significant contribution to this debate by dedicating our latest expert campfire discussion to the subject of Suicide prevention in young people. Elf experts discussed the prevalence (Suicide is the second leading cause of death in 15-29 year olds worldwide – WHO, 2014) and the importance of compassion in preventing suicide and self-harm in young people. If you missed it, you can watch the broadcast below.

I was therefore most pleased to be asked to write my latest blog on a recent systematic review and meta-analysis on therapeutic interventions for the prevention of suicide attempts and self-harm in adolescents. This according to the authors, was the first published meta-analysis of randomised controlled trials (RCTs) evaluating therapeutic interventions (TIs) in reducing both suicidal behaviour and non-suicidal self-harm in adolescents.



The authors (led by Dr. Ougrin from the Institute of Psychiatry, King’s College London and South London and Maudsley NHS Foundation Trust) searched the Cochrane, Medline, PsychINFO, EMBASE, and PubMed databases (as of May 2014) for articles which presented data on the efficacy of therapeutic interventions on suicide, non-suicidal self-injury (NSSI) or self-harm (the authors used the term “self-harm,” referring to the broad definition used in the UK and Europe that includes NSSI, suicide attempts, and self-harm with undetermined intent). Inclusion criteria are stated as being:

RCTs of specific TIs, defined as a theoretically coherent, manualized (or otherwise replicable) psychological, social, or pharmacological intervention, versus control treatment or placebo, in adolescents through age 18 years who have self-harmed at least once.

Self-harm was the primary outcome measure in the meta-analysis.

The authors’ used an impressive array of statistical tests to examine: pooled risk differences; pooled mean effect size; estimated variance of the true effect sizes; sensitivity and meta-regression analyses; estimates of heterogeneity. Meta-regression was performed to assess the influence of the number of sessions, length of follow-up periods, family, proportion of females, proportion of patients taking psychotropic medication, mean age, characterisation of the control group, quality of the study, and outcome measure (suicide only/suicide and self-harm) on the effect size. Finally, they also looked at publication bias.


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