Professor of Social Work,Centre for Social Work Research,University of East London,UK.
Professor of Public Health,Institute for Health and Human Development,University of East London,UK.
Br J Psychiatry. 2019 Jun;214(6):320-328. doi: 10.1192/bjp.2019.33. Epub 2019 Feb 28.
Preventing suicide and self-harm is a global health priority. Although there is a growing evidence base for the effectiveness of psychoanalytic and psychodynamic psychotherapies for a range of disorders, to date there has been no systematic review of its effectiveness in reducing suicidal and self-harming behaviours.AimsTo systematically review randomised controlled trials of psychoanalytic and psychodynamic psychotherapies for suicidal attempts and self-harm.
We searched PubMed, PsycINFO, Psycharticles, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials for randomise controlled trials of psychoanalytic and psychodynamic psychotherapies for reducing suicide attempts and self-harm.
Twelve trials (17 articles) were included in the meta-analyses. Psychoanalytic and psychodynamic therapies were effective in reducing the number of patients attempting suicide (pooled odds ratio, 0.469; 95% CI 0.274-0.804). We found some evidence for significantly reduced repetition of self-harm at 6-month but not 12-month follow-up. Significant treatment effects were also found for improvements in psychosocial functioning and reduction in number of hospital admissions.
Psychoanalytic and psychodynamic psychotherapies are indicated to be effective in reducing suicidal behaviour and to have short-term effectiveness in reducing self-harm. They can also be beneficial in improving psychosocial well-being. However, the small number of trials and moderate quality of the evidence means further high-quality trials are needed to confirm our findings and to identity which specific components of the psychotherapies are effective.Declaration of interestNone.
预防自杀和自伤是全球卫生重点。尽管精神分析和心理动力学心理疗法在治疗一系列障碍方面的有效性有越来越多的证据，但迄今为止，尚未对其减少自杀和自伤行为的有效性进行系统评价。
系统评价精神分析和心理动力学心理疗法治疗自杀企图和自伤的随机对照试验。
我们在 PubMed、PsycINFO、Psycharticles、CINAHL、EMBASE 和 Cochrane 对照试验中心注册库中搜索了旨在减少自杀企图和自伤的精神分析和心理动力学心理疗法的随机对照试验。
12 项试验（17 篇文章）纳入了荟萃分析。精神分析和心理动力学疗法在减少自杀企图的患者数量方面有效（合并优势比，0.469；95%置信区间，0.274-0.804）。我们发现，在 6 个月而不是 12 个月的随访中，有证据表明重复自伤的次数显著减少。在改善心理社会功能和减少住院次数方面也发现了显著的治疗效果。
精神分析和心理动力学心理疗法可有效减少自杀行为，并在短期内减少自伤行为。它们还可以有益于改善心理健康。然而，试验数量少，证据质量中等，意味着需要进一步开展高质量的试验来证实我们的发现，并确定心理疗法的哪些特定成分有效。
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