RAND Corporation, United States of America.
RAND Corporation, United States of America.
J Subst Abuse Treat. 2022 Aug;139:108782. doi: 10.1016/j.jsat.2022.108782. Epub 2022 Apr 16.
Self-injurious thoughts and behaviors (SITB) are of increasing concern among adolescents, especially those who use substances. Some evidence suggests that existing evidence-based substance use treatments (EBTs) could impact not only their intended substance use targets but also SITB. However, which types of substance use treatments may have the greatest impact on youth SITB is not yet clear. Based on prior literature showing that family support and connection may buffer youth from SITB, we initially hypothesized that family-based EBTs would show greater improvement in SITB compared to those receiving individually focused EBTs and that the size of the effects would be small given the comparison between two active, evidence-based interventions, and base rates of SITB.
In a sample of 2893 youth in substance use treatment, we compared the effectiveness of individually and family-based EBTs in reducing SITBs. The study used entropy balancing and regression modeling to balance the groups on pre-treatment characteristics and examine change in outcomes over a one-year follow-up period.
Both groups improved in self-injury and suicide attempts over the one-year study period, but only youth in individual treatment improved in suicidal ideation. However, the study found no significant difference between the changes over time in the two groups for any outcome. As expected, effect sizes were small and power was constrained in this study given the rarity of the outcomes, but effect sizes are similar to those observed with substance use outcomes.
The results provide important exploratory evidence on the potential relative effectiveness of these two treatments for SITBs. This study supports prior findings that EBTs for youth substance use may help to improve SITB and suggests that different treatment formats (individual or family-based) could result in different benefits for SITB outcomes.
自伤思想和行为（SITB）在青少年中越来越受到关注，尤其是那些使用物质的青少年。一些证据表明，现有的基于证据的物质使用治疗（EBTs）不仅可能影响其预期的物质使用目标，还可能影响 SITB。然而，哪种类型的物质使用治疗可能对青少年 SITB 产生最大影响尚不清楚。基于先前的文献表明，家庭支持和联系可以缓冲青少年的 SITB，我们最初假设，与接受个体化聚焦 EBT 的青少年相比，基于家庭的 EBT 会在 SITB 方面显示出更大的改善，并且由于比较两种积极的、基于证据的干预措施，以及 SITB 的基础率，效应的大小将是微不足道的。
在一个 2893 名青少年物质使用治疗的样本中，我们比较了个体化和基于家庭的 EBT 在减少 SITB 方面的效果。该研究使用熵平衡和回归建模来平衡两组在治疗前的特征，并在一年的随访期间检查结果的变化。
两组在一年的研究期间都在自我伤害和自杀企图方面有所改善，但只有接受个体化治疗的青少年在自杀意念方面有所改善。然而，研究发现，在任何结果方面，两组随时间的变化都没有显著差异。正如预期的那样，由于研究结果的罕见性，效应大小较小，并且本研究的效能受到限制，但效应大小与观察到的物质使用结果相似。
研究结果为这两种治疗方法对 SITB 的潜在相对有效性提供了重要的探索性证据。这项研究支持了先前的发现，即针对青少年物质使用的 EBT 可能有助于改善 SITB，并表明不同的治疗模式（个体化或基于家庭的）可能对 SITB 结果产生不同的益处。
