Chen Xinyi, Dong Yingying, Ye Mengfei, Wang Xiang, Yan Junwei, Yao Yiying, Qi Zhihua, Qian Chao, Liu Zheng
Department of Psychiatry, Shaoxing Seventh People'S Hospital (Affiliated Mental Health Center of Shaoxing University), Shaoxing, Zhejiang, China.
Department of Behavioral Neurosciences, Science Research Center of Medical School, Shaoxing University, Shaoxing, Zhejiang, China.
BMC Psychiatry. 2025 Apr 3;25(1):328. doi: 10.1186/s12888-025-06735-1.
Non-suicidal self-injury (NSSI) is a common and serious injury behavior in children and adolescents, however, its treatment remains controversial. Here, using network meta-analysis (NMA), we compared and ranked all available therapeutic treatment interventions to explore the best treatment strategy for NSSI in children and adolescents.
We searched PubMed, Embase, the Cochrane Library and PsycINFO for randomized controlled trials used to reduce the frequency of NSSI in children and adolescents from database inception until Jan. 11, 2025. Primary outcomes were efficacy and acceptability. We estimated summary odds ratios (ORs) with credible intervals (CIs) in random effects models.
We included 28 trials comprising 6496 participants. Dialectical behavior therapy (DBT) was better than other interventions. In subgroup analysis, pharmacotherapy and psychotherapy significantly aggravated the frequency of NSSI in depression (OR = 1.53; 95% CI: 1.10 to 2.14); however, these interventions significantly reduced NSSI in patients with self-harm (OR = 0.53; 95% CI: 0.30 to 0.96). We also found that NSSI was significantly increased in the first 3 months when using SSRIs in treatment but was significantly reduced after 3 months.
Psychotherapy seems to be a better choice than pharmacotherapy, especially DBT. DBT was associated with a better reduction in the frequency of NSSI than treatment as usual, with high confidence of evidence. NSSI is frequently used to combat depression symptoms, suggesting that clinicians should pay greater attention to depression symptoms to reduce NSSI, especially in the first 3 months of treatment with SSRIs.
非自杀性自伤（NSSI）是儿童和青少年中一种常见且严重的伤害行为，然而，其治疗仍存在争议。在此，我们使用网络荟萃分析（NMA）对所有可用的治疗性干预措施进行比较和排序，以探索儿童和青少年NSSI的最佳治疗策略。
我们检索了PubMed、Embase、Cochrane图书馆和PsycINFO，以获取从数据库建立至2025年1月11日用于降低儿童和青少年NSSI频率的随机对照试验。主要结局是疗效和可接受性。我们在随机效应模型中估计了具有可信区间（CI）的汇总优势比（OR）。
我们纳入了28项试验，共6496名参与者。辩证行为疗法（DBT）比其他干预措施更好。在亚组分析中，药物治疗和心理治疗显著增加了抑郁症患者的NSSI频率（OR = 1.53；95% CI：1.10至2.14）；然而，这些干预措施显著降低了自伤患者的NSSI（OR = 0.53；95% CI：0.30至0.96）。我们还发现，使用选择性5-羟色胺再摄取抑制剂（SSRI）治疗的前3个月NSSI显著增加，但3个月后显著降低。
心理治疗似乎比药物治疗是更好的选择，尤其是DBT。与常规治疗相比，DBT与NSSI频率的更好降低相关，证据可信度高。NSSI经常被用于对抗抑郁症状，这表明临床医生应更加关注抑郁症状以减少NSSI，尤其是在使用SSRI治疗的前3个月。
