Nusrat Husain, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Salahuddin Afsar, FRCP, Dow University of Health Sciences, Karachi, Pakistan; Jamal Ara, FCPS, United Medical and Dental College of Karachi, Karachi, Pakistan; Hina Fayyaz, PMDCP, Pakistan Institute of Learning and Living, Karachi, Pakistan; Raza ur Rahman, FCPS, Dow University of Health Sciences, Karachi, Pakistan; Barbara Tomenson, MSc, Institute of Population Health, University of Manchester, UK; Munir Hamirani, FCPS, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan; Nasim Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Batool Fatima, PMDCP, School of Public Health, Boston University, Boston, USA; Meher Husain, MD, Lancashire Care NHS Foundation Trust, UK; Farooq Naeem, PhD, Queens University, Kingston, Ontario, Canada; Imran B. Chaudhry, MD, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
Br J Psychiatry. 2014 Jun;204(6):462-70. doi: 10.1192/bjp.bp.113.138370. Epub 2014 Mar 27.
Self-harm is a major risk factor for completed suicide.
To determine the efficacy of a brief psychological intervention - culturally adapted manual-assisted problem-solving training (C-MAP) - delivered following an episode of self-harm compared with treatment as usual (TAU).
The study was a randomised controlled assessor-masked clinical trial (trial registration: ClinicalTrials.gov NCT01308151). All patients admitted after an episode of self-harm during the previous 7 days to the participating medical units of three university hospitals in Karachi, Pakistan, were included in the study. A total of 250 patients were screened and 221 were randomly allocated to C-MAP plus treatment as usual (TAU) or to TAU alone. All patients were assessed at baseline, at 3 months (end of intervention) and at 6 months after baseline. The primary outcome measure was reduction in suicidal ideation at 3 months. The secondary outcome measures included hopelessness, depression, coping resources and healthcare utilisation.
A total of 108 patients were randomised to the C-MAP group and 113 to the TAU group. Patients in the C-MAP group showed statistically significant improvement on the Beck Scale for Suicide Ideation and Beck Hopelessness Inventory, which was sustained at 3 months after the completion of C-MAP. There was also a significant reduction in symptoms of depression compared with patients receiving TAU.
The positive outcomes of this brief psychological intervention in patients attempting self-harm are promising and suggest that C-MAP may have a role in suicide prevention.
自残是自杀完成的一个主要风险因素。
确定一种简短心理干预措施 - 文化适应性手动辅助问题解决训练（C-MAP） - 在自残发作后与常规治疗（TAU）相比的疗效。
该研究是一项随机对照评估者盲法临床试验（试验注册：ClinicalTrials.gov NCT01308151）。所有在过去 7 天内因自残而入住参与研究的巴基斯坦卡拉奇三所大学医院的医疗单位的患者均被纳入研究。共筛查了 250 名患者，其中 221 名被随机分配到 C-MAP 加常规治疗（TAU）或单独 TAU 组。所有患者均在基线时、3 个月（干预结束时）和基线后 6 个月进行评估。主要结局测量是 3 个月时自杀意念的减少。次要结局指标包括绝望感、抑郁、应对资源和医疗保健利用情况。
共有 108 名患者被随机分配到 C-MAP 组，113 名患者被随机分配到 TAU 组。C-MAP 组的患者在贝克自杀意念量表和贝克绝望量表上表现出统计学上的显著改善，这种改善在 C-MAP 完成后 3 个月持续存在。与接受 TAU 的患者相比，抑郁症状也显著减轻。
这种针对试图自残的患者的简短心理干预的积极结果令人鼓舞，并表明 C-MAP 可能在预防自杀方面发挥作用。
