干预措施预防儿童和青少年自我伤害
Appendices
Appendix 1. CCDANCTR Search Strategy
Search Strategy 1956 to 2015:
CCDANCTR
Date range searched: 01.01.56 to 30.01.15.
#1. ((deliberat* or self*) NEXT (destruct* or harm* or injur* or mutilat* or poison*)):ab,ti,kw,ky,emt,mh,mc
#2. DSH:ab
#3. (parasuicid* or “para suicid*”)
#4. (suicid* NEAR2 (attempt* or episod* or frequen* or future or histor* or multiple or previous* or recur* or repeat* or repetition)):ab,ti,kw,ky,emt,mh,mc
#5. “post suicid*”
#6. (suicid* and (BPD or “borderline personality disorder”))
#7. (overdos* or “over dos*”)
#8. ((crisis or suicid*) NEAR (emergenc* or hospital or outpatient or “repeat* attend*” or “frequent* attend*” )):ab,ti,kw,ky,emt,mh,mc
#9. (#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8)
Notes: ab: abstract; ti: title; kw: keywords; ky: additional keywords; emt: EMTREE headings; mh: MeSH headings; mc: MeSH checkwords.
Appendix 2. EMBASE, MEDLINE, PreMEDLINE, PsycINFO and CENTRAL Search Strategies
Search Strategy 1998 to 2013:
EMBASE, MEDLINE, PreMEDLINE, PsycINFO (OVID SP interface)
Date range searched: 01.01.1998 to 13.10.2013.
1. automutilation/ or drug overdose/ or exp suicidal behavior/
2. 1 use emez
3. overdose/ or self‐injurious behavior/ or self mutilation/ or suicide/ or suicidal ideation/ or suicide, attempted/
4. 3 use mesz, prem
5. drug overdoses/ or self destructive behavior/ or exp self injurious behavior/ or attempted suicide/ or suicidal ideation/ or suicide/ or suicide prevention/ or suicide prevention centers/ or suicidology/
6. 5 use psyh
7. (auto mutilat$ or automutilat$ or cutt$ or head bang$ or head bang$ or overdos$ or (self adj2 cut$) or self destruct$ or selfdestruct$ or self harm$ or selfharm$ or self immolat$ or selfimmolat$ or self inflict$ or selfinflict$ or self injur$ or selfinjur$ or selfmutilat$ or self mutilat$ or self poison$ or selfpoison$ or suicid$).ti,ab.
8. or/2,4,6‐7
9. exp "clinical trial (topic)"/ or exp clinical trial/ or crossover procedure/ or double blind procedure/ or placebo/ or randomization/ or random sample/ or single blind procedure/
10. 9 use emez
11. exp clinical trial/ or exp "clinical trials as topic"/ or cross‐over studies/ or double‐blind method/ or placebos/ or random allocation/ or single‐blind method/
12. 11 use mesz, prem
13. (clinical trials or placebo or random sampling).sh,id.
14. 13 use psyh
15. (clinical adj2 trial$).ti,ab.
16. (crossover or cross over).ti,ab.
17. (((single$ or doubl$ or trebl$ or tripl$) adj2 blind$) or mask$ or dummy or doubleblind$ or singleblind$ or trebleblind$ or tripleblind$).ti,ab.
18. (placebo$ or random$).ti,ab.
19. treatment outcome$.md. use psyh
20. animals/ not human$.mp. use emez
21. animal$/ not human$/ use mesz
22. (animal not human).po. use psyh
23. (or/10,12,14‐19) not (or/20‐22)
24. 8 and 23
CENTRAL (Wiley interface)
Date range searched: 01.01.1998 to 13.10.2013.
#1. MeSH descriptor: [Drug Overdose], this term only
#2. MeSH descriptor: [Self‐Injurious Behavior], this term only
#3. MeSH descriptor: [Self Mutilation], this term only
#4. MeSH descriptor: [Suicide], this term only
#5. MeSH descriptor: [Suicide, Attempted], this term only
#6. MeSH descriptor: [Suicidal Ideation], this term only
#7. auto mutilat*" or automutilat* or cutt* or "head bang*" or headbang* or overdos* or "self destruct*" or selfdestruct* or "self harm*" or selfharm* or "self immolat*" or selfimmolat* or "self inflict*" or selfinflict* or "self injur*" or selfinjur* or selfmutilat* or "self mutilat*" or "self poison*" or selfpoison* or suicid*:ti
#8. "auto mutilat*" or automutilat* or cutt* or "head bang*" or "head bang*" or overdos* or "self destruct*" or selfdestruct* or "self harm*" or selfharm* or "self immolat*" or selfimmolat* or "self inflict*" or selfinflict* or "self injur*" or selfinjur* or selfmutilat* or "self mutilat*" or "self poison*" or selfpoison* or suicid*:ab
#9. #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8
Appendix 3. Journals hand‐searched for relevant literature in the original version of this review
1. Archives of Suicide Research (1995‐1998);
2. Crisis (1980‐1998);
3. Suicide and Life‐Threatening Behavior (1971‐1998);
4. Der Nervenarzt (1950‐1979);
5. Journal of Adolescence (1978‐1996);
6. Journal of Affective Disorders (1994‐1996);
7. Journal of the American Academy of Child and Adolescent Psychiatry (1978‐1996);
8. Journal of Clinical Psychiatry (1978‐1996);
9. Journal of Psychiatric Research (1961‐1972) and (1985‐1996);
10. Social Psychiatry (1966‐1987), and
11. Social Psychiatry & Psychiatric Epidemiology (1988‐1996).
Appendix 4. Data collection and analysis methods used for the original review
Selection of studies
In the original version of this review, Sarah Stockton, Librarian at the University of Oxford, conducted the systematic search for trials. Two out of TTS, EA, ET, and KH then independently screened the titles of identified trials for relevancy. A distinction was made between:
1) eligible studies, in which any psychological and/or psychopharmacological treatment was compared with a control (e.g. standard or less intensive types of aftercare or medication), and;
2) ineligible general treatment studies, without any control treatment.
A second screening was then undertaken in which two of TTS, EA, ET, and KH independently screened the full text of relevant studies with reference to the following inclusion criteria:
1. All participants must have engaged in SH (self‐poisoning or self‐injury) shortly prior to randomisation;
2. Studies must have reported the number of participants engaging in a repeat episode of SH as an outcome measure;
3. Study participants must have been randomised to the treatment and control groups.
Data extraction and management
Data extraction was carried out by EA and second member of the review group (TTS, ET, or KH) using a standardised data extraction form. Members of the review team extracted data independently from one another. Disputes were resolved through consensus discussions with a third member of the review group, with assistance from the CCDAN editorial base.
We extracted data from each eligible trial concerning the characteristics of patients, the details of the interventions used, and information on the number of participants engaging in a repeat episode of SH during the follow‐up period. Where these details were unclear, corresponding authors were contacted to provide additional clarification.
Assessment of risk of bias
For the original version of this review, the quality of the studies was rated by three independent review authors (EA and ET plus another member of the review group). Review authors were blind to authorship according to the recommended Cochrane criteria for quality assessment (Sackett 1997).
Given that the quality of concealment of allocation can affect the results of trials (Schulz 1995), studies were assigned a quality of concealment rating ranging from C (poor quality) to A (high quality). Trials rated as inadequately concealed, for example via reference to an open random number table, were given a rating of C. Trials that did not provide adequate details about how the randomisation procedure was carried out were given a rating of B, and trials that were deemed to have taken adequate measures to conceal allocation, for example through the use of serially numbered, opaque, sealed envelopes and numbered or coded bottles or containers, were rated as A quality. Where the concealment of allocation was not clearly reported (i.e. where trials were initially in category B), we contacted corresponding authors for more information. Where raters disagreed as to the category to which a trial should be been allocated, the final rating was made by consensus discussion in consultation with TTS, KH, and a third member of the review group.
Measures of treatment effect
RevMan, version 3.0, was used to calculate summary odds ratios and accompanying 95% CIs for the number of participants engaging in a repeat episode of SH during the follow‐up period.
Unit of analysis issues
1. Cluster trials
Clustering was an issue in one included study (Bennewith 2002), however, as the authors reported adjusting for the effects of clustering in their primary analyses, we reproduced the data from this study as if it came from a non‐cluster randomised study.
2. Studies with multiple treatment groups
One included study presented data for multiple treatment groups (Hirsch 1982). As both treatment groups were prescribed antidepressants in this study, we combined the data from these two treatment arms.
Dealing with missing data
Where data on the primary outcome measure were incomplete or excluded from the study, corresponding author(s) were contacted to obtain further information. Some authors used intention to treat analyses to account for missing data using a variety of different methods which are discussed within the 'Risk of bias' tables. We as review authors did not attempt to impute data for those studies in which intention‐to‐treat analyses had not been conducted, however. Instead, the effects of missing data were discussed in the text of the review.
Assessment of heterogeneity
Clinical heterogeneity was examined using the Chi2 test. Where this statistic was significant, potential causes of heterogeneity were investigated as outlined in the "Subgroup analysis and investigation of heterogeneity" section below.
Assessment of reporting biases
To assess whether any meta‐analysis reported in this review are affected by reporting bias, we planned to construct funnel plots to investigate the likelihood that the results of our meta‐analysis were affected by reporting bias. We were unable to undertake these analyses, however, due to the very small number of trials included in our meta‐analyses.
Data synthesis
The Mantel‐Haenszel fixed‐effect method was used to calculate pooled summary ORs and accompanying 95% CIs.
Subgroup analysis and investigation of heterogeneity
In analyses resulting in significant heterogeneity, as indicated by the Chi2 test, an investigation into the source of this heterogeneity was conducted. We had planned to conduct subgroup analyses by repeater status and gender, however, there were insufficient studies with appropriate data to enable these analyses to be undertaken.
Sensitivity analysis
Sensitivity analyses were undertaken where appropriate (e.g., in relation to risk of bias of included trials in the relative intensity of treatment).
Prisma flow diagram
Risk of bias graph: Review authors' judgements for each risk of bias item presented as percentages across all included studies.
Risk of bias summary graph: Review authors' judgements about each risk of bias item for each included study.
Comparison 1: Dialectical behaviour therapy/mentalisation for adolescents vs. Treatment as usual or other routine management, Outcome 1: Repetition of SH post‐intervention
Comparison 1: Dialectical behaviour therapy/mentalisation for adolescents vs. Treatment as usual or other routine management, Outcome 2: Frequency of SH post‐intervention
Comparison 1: Dialectical behaviour therapy/mentalisation for adolescents vs. Treatment as usual or other routine management, Outcome 3: Number of individual psychotherapy sessions attended
Comparison 1: Dialectical behaviour therapy/mentalisation for adolescents vs. Treatment as usual or other routine management, Outcome 4: Number of family therapy sessions attended
Comparison 1: Dialectical behaviour therapy/mentalisation for adolescents vs. Treatment as usual or other routine management, Outcome 5: Number completing full course of treatment
Comparison 1: Dialectical behaviour therapy/mentalisation for adolescents vs. Treatment as usual or other routine management, Outcome 6: Depression scores post‐intervention
Comparison 1: Dialectical behaviour therapy/mentalisation for adolescents vs. Treatment as usual or other routine management, Outcome 7: Hopelessness scores post‐intervention
Comparison 1: Dialectical behaviour therapy/mentalisation for adolescents vs. Treatment as usual or other routine management, Outcome 8: Suicidal ideation scores post‐intervention
Comparison 2: Group‐based psychotherapy vs. Treatment as usual or other routine management, Outcome 1: Repetition of SH at six months
Comparison 2: Group‐based psychotherapy vs. Treatment as usual or other routine management, Outcome 2: Repetition of SH at 12 months
Comparison 2: Group‐based psychotherapy vs. Treatment as usual or other routine management, Outcome 3: Depression scores at six months
Comparison 2: Group‐based psychotherapy vs. Treatment as usual or other routine management, Outcome 4: Depression scores at 12 months
Comparison 2: Group‐based psychotherapy vs. Treatment as usual or other routine management, Outcome 5: Suicidal ideation scores at six months
Comparison 2: Group‐based psychotherapy vs. Treatment as usual or other routine management, Outcome 6: Suicidal ideation scores at 12 months
| CBT‐based psychotherapy compared to treatment as usual | ||||||
| Patient or population: children and adolescents who engage in SH. | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Treatment as usual | CBT‐based psychotherapy | |||||
| Repetition of SH at six months | Study population | OR 1.88 | 39 | ⊕⊝⊝⊝ | Quality was downgraded as information on allocation concealment, participant blinding, outcome assessor blinding, and selective outcome reporting was not adequately described. The trial was further downgraded as the same therapists delivered both the intervention and control treatments leading to possible confounding which could have led to a reduction in the demonstrated effect. | |
| 111 per 1000 | 190 per 1000 | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Risk of bias was rated as VERY SERIOUS as information on allocation concealment, participant blinding, outcome assessor blinding, and selective outcome reporting was not adequately described raising the possibility of selection bias, performance bias, detection bias, and reporting bias. Given that the same therapists delivered both the intervention and control treatments in this trial, there is also the possibility of confounding which could have led to a reduction in the demonstrated effect. 2 Imprecision was rated as SERIOUS owing to the wide confidence interval associated with the estimate of treatment effect. | ||||||
| Dialectical behaviour therapy or mentalisation for adolescents compared to treatment as usual or other routine management | ||||||
| Patient or population: children and adolescents who engage in SH. | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Treatment as usual | Interventions for patients with multiple episodes of SH or emerging personality problems | |||||
| Dialectical behaviour therapy for adolescents (DBT‐A) | ||||||
| Repetition of SH at post‐intervention | 151 per 1000 | 113 per 1000 (21 per 439) | OR 0.72 (0.12 to 4.40) | 105 (2 RCTs) | ⊕⊕⊝⊝ | Quality was downgraded as neither participants nor clinical personnel were blind as to treatment allocation. Quality was further downgraded due to imprecision in the effect size estimate. |
| Frequency of SH at post‐intervention | The mean frequency of SH episodes at post‐intervention in the intervention group was 0.79 lower (2.78 lower to 1.20 higher) | ‐ | 104 (2 RCTs) | ⊕⊕⊝⊝ | Quality was downgraded as neither participants nor clinical personnel were blind as to treatment allocation. Quality was further downgraded due to imprecision in the effect size estimate. | |
| Mentalisation | ||||||
| Repetition of SH at post‐intervention | 829 per 1000 | 557 per 1000 (303 to 790) | OR 0.26 (0.09 to 0.78) | 71 (1 RCT) | ⊕⊕⊕⊝ | Quality was downgraded as the nature of this intervention means it is unlikely participants and clinical personnel would have been blind to treatment allocation. |
| *The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Risk of bias was rated as SERIOUS as the nature of the intervention means that clinical personnel could not have remained blind to treatment allocation suggesting that performance and detection bias may have been present. 2 Imprecision was rated as SERIOUS owing to the wide confidence interval associated with the estimate of treatment effect. | ||||||
| Group‐based psychotherapy compared to treatment as usual | ||||||
| Patient or population: children and adolescents who engage in SH. | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Treatment as usual | Group‐based psychotherapy | |||||
| Repetition of SH at six months | Study population | OR 1.72 | 430 | ⊕⊕⊝⊝ | Quality was downgraded as the nature of this intervention means it is unlikely participants and clinical personnel would have been blind to treatment allocation. Quality was further downgraded due to imprecision in the effect size estimate. | |
| 726 per 1000 | 820 per 1000 | |||||
| Repetition of SH at 12 months | Study population | OR 0.8 | 490 | ⊕⊕⊝⊝ | Quality was downgraded as the nature of this intervention means it is unlikely participants and clinical personnel would have been blind to treatment allocation. Quality was further downgraded due to imprecision in the effect size estimate. | |
| 588 per 1000 | 533 per 1000 | |||||
| *The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Risk of bias was rated as SERIOUS as the nature of the intervention means that clinical personnel could not have remained blind to treatment allocation suggesting that performance and detection bias may have been present. 2 Imprecision was rated as SERIOUS owing to the wide confidence interval associated with the estimate of treatment effect. | ||||||
| Therapeutic assessment compared to treatment as usual (i.e., standard psychosocial assessment) for self‐harm in children and adolescents | ||||||
| Patient or population: children and adolescents who engage in SH. | ||||||
| Outcomes | Illustrative comparative risks* | Relative effect | Number of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Standard psychosocial assessment | Therapeutic assessment | |||||
| Repetition of SH at 12 months | Study population | OR 0.75 | 69 | ⊕⊕⊝⊝ | Quality was downgraded as the nature of this intervention means it is unlikely participants and clinical personnel would have been blind to treatment allocation. Quality was further downgraded due to imprecision in the effect size estimate. | |
| 147 per 1000 | 115 per 1000 | |||||
| Repetition of SH at 24 months | Study population | OR 0.69 | 69 | ⊕⊕⊝⊝ | Quality was downgraded as the nature of this intervention means it is unlikely participants and clinical personnel would have been blind to treatment allocation. Quality was further downgraded due to imprecision in the effect size estimate. | |
| 265 per 1000 | 199 per 1000 | |||||
| *The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Risk of bias was rated as SERIOUS as the nature of the intervention means that clinical personnel could not have remained blind to treatment allocation suggesting that performance and detection bias may have been present. 2 Imprecision was rated as SERIOUS owing to the wide confidence interval associated with the estimate of treatment effect. | ||||||
| Compliance enhancement plus treatment as usual (i.e., standard disposition planning) compared to treatment as usual | ||||||
| Patient or population: children and adolescents who engage in SH. | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Treatment as usual | Standard disposition planning | |||||
| Repetition of SH by six months | Study population | OR 0.67 | 63 | ⊕⊝⊝⊝ | Quality was downgraded as the nature of this intervention means it is unlikely participants and clinical personnel would have been blind to treatment allocation. Quality was further downgraded as details on blinding of outcome assessors, incomplete data and selective reporting was not adequately described. Lastly, due to imprecision in the effect size estimate, quality was further downgraded. | |
| 147 per 1000 | 104 per 1000 | |||||
| *The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Risk of bias was rated as VERY SERIOUS as the nature of the intervention means that participants and clinical personnel could not have remained blind to treatment allocation suggesting that performance and detection bias may have been present. Additionally, details on blinding of outcome assessors, incomplete data and selective reporting was not adequately described. 2 Imprecision was rated as SERIOUS owing to the wide confidence interval associated with the estimate of treatment effect. | ||||||
| Home‐based family intervention compared to treatment as usual | ||||||
| Patient or population: children and adolescents who engage in SH. | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding | |||||
| Treatment as usual | Home‐based family intervention | |||||
| Repetition of SH at six months | Study population | OR 1.02 | 149 | ⊕⊕⊝⊝ | Quality was downgraded as the nature of this intervention means it is unlikely participants and clinical personnel would have been blind to treatment allocation. | |
| 147 per 1000 | 149 per 1000 | |||||
| *The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Risk of bias was rated as SERIOUS as the nature of the intervention means that participants and clinical personnel could not have remained blind to treatment allocation suggesting that performance and detection bias may have been present. | ||||||
| Remote contact interventions compared to treatment as usual | ||||||
| Patient or population: children and adolescents who engage in SH. | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Treatment as usual | Emergency card | |||||
| Repetition of SH at 12 months | Study population | OR 0.5 | 105 | ⊕⊝⊝⊝ | Quality was downgraded as an open random numbers table was used to generate the allocation sequence and, as allocation was not concealed, there is possible selection bias. Quality was further downgraded as the nature of this intervention means it is unlikely participants and clinical personnel would have been blind to treatment allocation and, as no details on outcome assessor blinding were provided, performance and detection bias cannot be ruled out. Lastly, there was an error in the randomisation sequence such that five participants in the intervention group either did not receive emergency cards, or alternatively, received them only after a delay thereby invalidating follow‐up data for these five individuals. | |
| 121 per 1000 | 64 per 1000 | |||||
| *The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Risk of bias was rated as VERY SERIOUS as the nature of the intervention means that participants and clinical personnel could not have remained blind to treatment allocation suggesting that performance and detection bias may have been present. Additionally, as an open random numbers table was used to generate the allocation sequence and, as allocation was not concealed, there is possible selection bias. There was also an error in the randomisation sequence resulting in five participants in the intervention group either not receiving the cards, or alternatively, not receiving them until after a substantial delay thereby invalidating follow‐up data for these individuals. 2 Imprecision was rated as SERIOUS owing to the wide confidence interval associated with the estimate of treatment effect. | ||||||
| Reference | Method 1 | |||
| Self‐poisoning (any) n (%) | Self‐poisoning (alcohol) n (%) | Self‐injury (any) n (%) | Combined self‐ poisoning and self‐injury n (%) | |
| 94 (89.6) | 7 (6.6) | 2 (1.9) | ||
| 33 (84.6) | ||||
| 5 (2.7) | 67 (36.6) | 111 (60.7) | ||
| 162 (100) | ||||
| 28 (40.0) | 37 (52.8) | 5 (7.2) | ||
| 54 (85.7) | ||||
| 1 Refers to method used for the index episode. 2 The method used by the remaining two (1.9%) participants was not reported. 3 The method used by the remaining six (15.4%) participants was not reported. 4 The method used by the remaining nine (14.3%) participants was not reported. | ||||
| Reference | Psychiatric diagnosis1 | |||||||||||
| Major depression n (%) | Any other disorder n (%) | Any anxiety disorder n (%) | Post‐ traumatic stress disorder n (%) | Any eating disorder n (%) | Alcohol use disorder/ dependence n (%) | Drug use disorder/ dependence n (%) | Substance use disorder/ dependence n (%) | Oppositional defiance disorder n (%) | Conduct disorder n (%) | Any other behaviour disorder n (%) | Borderline personality disorder n (%) | |
| 23 (79.3) | 24 (82.7) | 7 (24.1) | 9 (31.0) | 8 (27.6) | ||||||||
| Information on psychiatric diagnosis not provided. | ||||||||||||
| 9 (29.0) | 6 (19.3) | 14 (45.2) | 14 (45.2) | |||||||||
| 227 (62.0) | 122 (22.2) | |||||||||||
| 109 (67.3) | 17 (10.5) | |||||||||||
| 41 (56.9) | 3 (4.2) | 5 (6.9)2 | ||||||||||
| 17 (22.1) | 29 (37.7) | 33 (42.9) | 13 (16.9) | 6 (7.8) | 2 (2.6) | 15 (20.5) | ||||||
| 77 (96.2) | 35 (43.7) | 27.5 (28.0) | 58 (72.5) | |||||||||
| 1 (2.2) | 6 (13.0) | 4 (8.7) | 6 (13.0) | 5 (10.9) | 6 (13.0) | |||||||
| 52 (83.9) | 42 (68.8)2 | |||||||||||
| 1 All diagnoses refer to current, rather than lifetime, diagnoses. The total percentages were more than 100% in some studies due to comorbidity. 2 Conduct disorder or oppositional defiance disorder. 3 The authors state that 53/70 (75.7%) participants had previous contact with mental health services. Diagnoses are only provided in broad categories, however. Specifically, 42/70 (60.0%) were diagnosed with an "emotional disorder," 9/70 (12.8%) were diagnosed with a "disruptive disorder," and 2/70 (2.8%) were diagnosed with "another disorder." 4 Information on psychiatric diagnoses were available for only 46 of the 63 participants. | ||||||||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Repetition of SH post‐intervention Show forest plot | 3 | Odds Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 1.1.1 DBT‐A | 2 | 105 | Odds Ratio (M‐H, Random, 95% CI) | 0.72 [0.12, 4.40] |
| 1.1.2 Mentalisation | 1 | 71 | Odds Ratio (M‐H, Random, 95% CI) | 0.26 [0.09, 0.78] |
| 1.2 Frequency of SH post‐intervention Show forest plot | 2 | 104 | Mean Difference (IV, Random, 95% CI) | ‐0.79 [‐2.78, 1.20] |
| 1.2.1 DBT‐A | 2 | 104 | Mean Difference (IV, Random, 95% CI) | ‐0.79 [‐2.78, 1.20] |
| 1.3 Number of individual psychotherapy sessions attended Show forest plot | 2 | 106 | Mean Difference (IV, Random, 95% CI) | 9.14 [‐4.39, 22.66] |
| 1.3.1 DBT‐A | 2 | 106 | Mean Difference (IV, Random, 95% CI) | 9.14 [‐4.39, 22.66] |
| 1.4 Number of family therapy sessions attended Show forest plot | 2 | 106 | Mean Difference (IV, Random, 95% CI) | 0.93 [‐7.01, 8.86] |
| 1.4.1 DBT‐A | 2 | 106 | Mean Difference (IV, Random, 95% CI) | 0.93 [‐7.01, 8.86] |
| 1.5 Number completing full course of treatment Show forest plot | 1 | 80 | Odds Ratio (M‐H, Random, 95% CI) | 1.35 [0.56, 3.27] |
| 1.5.1 Mentalisation | 1 | 80 | Odds Ratio (M‐H, Random, 95% CI) | 1.35 [0.56, 3.27] |
| 1.6 Depression scores post‐intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.6.1 DBT‐A | 1 | 77 | Mean Difference (IV, Random, 95% CI) | ‐2.39 [‐5.02, 0.24] |
| 1.6.2 Mentalisation | 1 | 80 | Mean Difference (IV, Random, 95% CI) | ‐2.28 [‐2.81, ‐1.75] |
| 1.7 Hopelessness scores post‐intervention Show forest plot | 2 | 101 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.13 [‐0.93, 0.67] |
| 1.7.1 DBT‐A | 2 | 101 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.13 [‐0.93, 0.67] |
| 1.8 Suicidal ideation scores post‐intervention Show forest plot | 2 | 100 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.62 [‐1.07, ‐0.16] |
| 1.8.1 DBT‐A | 2 | 100 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.62 [‐1.07, ‐0.16] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Repetition of SH at six months Show forest plot | 2 | 430 | Odds Ratio (M‐H, Random, 95% CI) | 1.72 [0.56, 5.24] |
| 2.2 Repetition of SH at 12 months Show forest plot | 3 | 490 | Odds Ratio (M‐H, Random, 95% CI) | 0.80 [0.22, 2.97] |
| 2.3 Depression scores at six months Show forest plot | 2 | 420 | Mean Difference (IV, Random, 95% CI) | 0.40 [‐2.76, 3.55] |
| 2.4 Depression scores at 12 months Show forest plot | 3 | 473 | Mean Difference (IV, Random, 95% CI) | ‐0.93 [‐4.03, 2.17] |
| 2.5 Suicidal ideation scores at six months Show forest plot | 2 | 421 | Mean Difference (IV, Random, 95% CI) | 1.27 [‐7.74, 10.28] |
| 2.6 Suicidal ideation scores at 12 months Show forest plot | 3 | 471 | Mean Difference (IV, Random, 95% CI) | ‐1.51 [‐9.62, 6.59] |
