Intervenciones para el daño autoinfligido en niños y adolescentes
Información
- DOI:
- https://doi.org/10.1002/14651858.CD012013Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 21 diciembre 2015see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Trastornos mentales comunes
- Copyright:
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- Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
KH had the idea for the review. All authors extracted data and assessed risk of bias for included studies. Both TTS and KW conducted the statistical analyses. KH, TTS, and KW wrote the initial version of the report and all authors contributed to the writing of drafts. All authors also approved the final version of the review for publication.
Sources of support
Internal sources
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University Department of Psychiatry, Warneford Hospital, Oxford, UK
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Oxford Health NHS Foundation Trust, UK
External sources
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NHS Executive Anglia and Oxford Research and Development Program, UK
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NIHR Service Delivery and Organisation programme, UK
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Personal funding to KH as an NIHR Senior Investigator, UK
Declarations of interest
PH is the author of one of the trials included in the review.
Acknowledgements
We thank Emily Cooney, Andrew Cotgrove, Jonathon Green, Philip Hazell, Lars Mehlum, Dennis Ougrin, Trudie Rossouw, and Anthony Spirito for providing us with unpublished data.
We also thank Andrea Cipriani, Jane Dennis, Jessica Sharp, and Catriona Shatford for advice on data extraction and management issues.
This project has previously been supported by the National Co‐ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO). KH is funded by Oxford Health NHS Foundation Trust. He is a National Institute for Health Research (NIHR) Senior Investigator and personal funding from NIHR helped support this update. The opinions expressed are solely those of the authors.
Version history
| Published | Title | Stage | Authors | Version |
| 2015 Dec 21 | Interventions for self‐harm in children and adolescents | Review | Keith Hawton, Katrina G Witt, Tatiana L Taylor Salisbury, Ella Arensman, David Gunnell, Ellen Townsend, Kees Heeringen, Philip Hazell | |
Differences between protocol and review
In the original protocol for this review, we planned to assess dichotomous outcome data (i.e., repetition of self‐harm and suicide) using the Peto odds ratio. Following revisions to iterations of the Cochrane Handbook (Higgins 2011) and new statistical advice, however, we have instead used the Mantel‐Haenszel method in this update. For this version of the review we have also expanded the range of outcomes assessed to include depression, hopelessness, problem‐solving, and suicidal ideation. We have also used the I2 statistic, rather than the Chi2 test, to summarise between‐study heterogeneity in this version in light of revisions to the Cochrane Handbook (Higgins 2011).
We also planned to assess methodological quality of included trials by the means recommended by the contemporary version of the Cochrane Handbook (Higgins 2011). For this version of the review we have therefore created 'Risk of bias' and 'Summary of findings' tables as per current recommendations. We have also refined the unit of analysis section, as per current recommendations, to include Zelen designed trials and trials that report adjusted effect sizes.
We have also added three sensitivity analyses: one for trials which employed Zelen's method of randomisation; one for trials that contributed to substantial (> 75%) levels of heterogeneity; and a third for trials that included a small minority (< 15%) of adult participants. Given the increasing use of enhanced usual care, rather than TAU, in trials in this area, we also added one sub‐group analysis to determine whether comparator choice influenced the pattern of results observed.
As we were unable to rank outcomes in a hierarchy in the present review, and given the absence of consensus rankings particularly for hopelessness, suicidal ideation, and problem‐solving, we have instead used the most common measure in any meta‐analysis and report results from any other measure in the text of the review. In future updates of this review, we will adopt any accepted outcome hierarchies.
Notes
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Anti-Anxiety Agents [therapeutic use];
- Antidepressive Agents [*therapeutic use];
- Antipsychotic Agents [*therapeutic use];
- Behavior Therapy [methods];
- Family Therapy;
- Patient Compliance [statistics & numerical data];
- Problem Solving;
- Psychotherapy [*methods];
- Psychotherapy, Group;
- Randomized Controlled Trials as Topic;
- Recurrence;
- Secondary Prevention [methods];
- Self-Injurious Behavior [*prevention & control, psychology];
- Suicide Prevention;
- Theory of Mind;
Medical Subject Headings Check Words
Adolescent; Child; Female; Humans; Male;
PICO
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] |
