Psychiatry Research Group, University of Manchester, Manchester M13 9PL, UK.
BMJ. 2011 Apr 1;342:d682. doi: 10.1136/bmj.d682.
To examine the effectiveness and cost-effectiveness of group therapy for self harm in young people.
Two arm, single (assessor) blinded parallel randomised allocation trial of a group therapy intervention in addition to routine care, compared with routine care alone. Randomisation was by minimisation controlling for baseline frequency of self harm, presence of conduct disorder, depressive disorder, and severity of psychosocial stress.
Adolescents aged 12-17 years with at least two past episodes of self harm within the previous 12 months. Exclusion criteria were: not speaking English, low weight anorexia nervosa, acute psychosis, substantial learning difficulties (defined by need for specialist school), current containment in secure care. Setting Eight child and adolescent mental health services in the northwest UK.
Manual based developmental group therapy programme specifically designed for adolescents who harm themselves, with an acute phase over six weekly sessions followed by a booster phase of weekly groups as long as needed. Details of routine care were gathered from participating centres.
Primary outcome was frequency of subsequent repeated episodes of self harm. Secondary outcomes were severity of subsequent self harm, mood disorder, suicidal ideation, and global functioning. Total costs of health, social care, education, and criminal justice sector services, plus family related costs and productivity losses, were recorded.
183 adolescents were allocated to each arm (total n = 366). Loss to follow-up was low (<4%). On all outcomes the trial cohort as a whole showed significant improvement from baseline to follow-up. On the primary outcome of frequency of self harm, proportional odds ratio of group therapy versus routine care adjusting for relevant baseline variables was 0.99 (95% confidence interval 0.68 to 1.44, P = 0.95) at 6 months and 0.88 (0.59 to 1.33, P = 0.52) at 1 year. For severity of subsequent self harm the equivalent odds ratios were 0.81 (0.54 to 1.20, P = 0.29) at 6 months and 0.94 (0.63 to 1.40, P = 0.75) at 1 year. Total 1 year costs were higher in the group therapy arm (£21,781) than for routine care (£15,372) but the difference was not significant (95% CI -1416 to 10782, P = 0.132).
The addition of this targeted group therapy programme did not improve self harm outcomes for adolescents who repeatedly self harmed, nor was there evidence of cost effectiveness. The outcomes to end point for the cohort as a whole were better than current clinical expectations. Trial registration ISRCTN 20496110.
研究针对青少年自我伤害的团体治疗的有效性和成本效益。
在常规护理的基础上，对一种团体治疗干预措施进行了为期 6 周的单次（评估者）盲法平行随机分组试验，与单纯常规护理进行比较。随机化通过最小化控制基线自我伤害频率、品行障碍、抑郁障碍和心理社会压力严重程度来实现。
年龄在 12-17 岁之间，过去 12 个月内至少有两次自我伤害发作的青少年。排除标准为：不会说英语、体重过低的神经性厌食症、急性精神病、严重学习困难（定义为需要特殊学校）、目前被安全护理机构收容。
基于手册的发展性团体治疗方案，专为自我伤害的青少年设计，急性期为 6 周的每周一次小组治疗，随后根据需要进行每周一次的小组治疗。常规护理的详细信息是从参与中心收集的。
主要结果是后续重复自我伤害发作的频率。次要结果是随后自我伤害的严重程度、情绪障碍、自杀意念和整体功能。记录了卫生、社会保健、教育和刑事司法部门服务的总成本，以及家庭相关成本和生产力损失。
183 名青少年被分配到每个组（总 n=366）。随访丢失率低（<4%）。在所有结果中，整个试验队列从基线到随访都有显著改善。在自我伤害频率的主要结果上，调整了相关基线变量后，团体治疗与常规护理的比例优势比为 0.99（95%置信区间 0.68 至 1.44，P=0.95），在 6 个月时为 0.88（0.59 至 1.33，P=0.52），在 1 年时为 0.88（0.59 至 1.33，P=0.52）。对于随后自我伤害严重程度的等效优势比，在 6 个月时为 0.81（0.54 至 1.20，P=0.29），在 1 年时为 0.94（0.63 至 1.40，P=0.75）。在团体治疗组（£21781），1 年总费用高于常规护理组（£15372），但差异无统计学意义（95%CI-1416 至 10782，P=0.132）。
对于反复自我伤害的青少年，添加这种针对性的团体治疗方案并没有改善自我伤害结果，也没有证据表明其具有成本效益。整个队列的终点结局优于当前的临床预期。试验注册 ISRCTN 20496110。
