Arensman E, Townsend E, Hawton K, Bremner S, Feldman E, Goldney R, Gunnell D, Hazell P, Van Heeringen K, House A, Owens D, Sakinofsky I, Träskman-Bendz L
Department of Clinical and Health Psychology, University of Leiden, The Netherlands.
Suicide Life Threat Behav. 2001 Summer;31(2):169-80. doi: 10.1521/suli.31.2.169.21516.
Development of effective treatments for patients following deliberate self-harm (self-poisoning or self-injury) is a very important element in suicide prevention. The randomized controlled trial (RCT) is the mainstay of evaluation of treatments. In a systematic review of the literature, the effectiveness of treatments based on RCTs was examined and the quality of the RCTs was assessed. Twenty trials were identified, and where possible, these were grouped on the basis of similarities among the types of treatment. In this paper, we examine the methodological aspects of the trials and consider what may be learned that will assist in the design of future studies in this field. The methodological quality of the trials was reasonable, but most trials included too few participants to detect clinically important differences in rates of repeated self-harm. In planning future trials, the following major issues should be addressed: investigators should perform power calculations to determine the number of subjects necessary to detect clinically important effects, provide information on method of randomization and interventions, use standard measures of outcome, and focus on homogeneous subgroups of patients. Improving the methodology of future studies in this field will be essential if sound evidence is to be obtained which can inform effective service provision for deliberate self-harm patients.
为蓄意自伤（自我中毒或自我伤害）患者开发有效的治疗方法是自杀预防中非常重要的一环。随机对照试验（RCT）是治疗评估的主要手段。在一项文献系统综述中，对基于随机对照试验的治疗效果进行了检查，并对随机对照试验的质量进行了评估。共识别出20项试验，并在可能的情况下，根据治疗类型的相似性对这些试验进行了分组。在本文中，我们研究了试验的方法学方面，并思考可以从中吸取哪些经验教训，以帮助设计该领域未来的研究。试验的方法学质量是合理的，但大多数试验纳入的参与者太少，无法检测出重复自伤率临床上的重要差异。在规划未来的试验时，应解决以下主要问题：研究人员应进行功效计算，以确定检测临床上重要效果所需的受试者数量，提供随机化方法和干预措施的信息，使用标准的结局测量方法，并关注患者的同质亚组。如果要获得可靠的证据，为蓄意自伤患者提供有效的服务，改进该领域未来研究的方法学将至关重要。
