McCabe Rose, O'Keeffe Sally, Ougrin Dennis, Priebe Stefan, Martin Peter, Feng Yan, Temple Rachel, Long Maria
Department of Global, Public and Population Health and Policy, City St George's University of London, London, UK.
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
BMJ Open. 2025 Sep 14;15(9):e101015. doi: 10.1136/bmjopen-2025-101015.
Self-harm is the strongest predictor of suicide in young people. Self-harm presentations to the emergency department (ED) are associated with repeat self-harm and suicide. Rapid follow-up contact after ED offers an opportunity to intervene before self-harm becomes an established coping strategy. Despite recent progress in self-harm treatment, currently, there are no evidence-based interventions to prevent future self-harm and suicide offered to young people after visits to the ED. Preliminary evidence suggests therapeutic assessment and rapid follow-up contacts may reduce self-harm and improve engagement in follow-up care. In this study, we assess the clinical and cost-effectiveness of a brief psychological intervention, supporting adolescents with self-harm (SASH), in addition to standard care in a randomised controlled trial, compared with standard care only. As per National Institute for Health and Care Excellence guidelines, standard care involves at least one follow-up by a mental health professional within 7 days of ED discharge.
The SASH intervention comprises up to six follow-up contacts with a mental health professional delivered over approximately 2 months for young people and their carers using a solution-focused approach, shortly after presenting to the ED. Participants are aged 12-18, presenting to the ED with self-harm or suicidal ideation (with self-harm in the past month), with capacity to consent. We aim to recruit 144 young people into the trial who will be randomised on a 1:1 basis to the SASH intervention or treatment as usual. Participants are assessed postintervention/standard care and at 6-month follow-up after randomisation. Self-reported self-harm is assessed via text message survey every 2 weeks during the 6-month follow-up period. The primary outcome is self-reported episodes of self-harm in the past month assessed at 6 months by summing three behavioural domains of the self-injurious thoughts and behaviours interview. We hypothesise that the therapeutic relationship with the mental health practitioner will mediate this relationship. Secondary outcomes include symptoms of depression and anxiety, frequency of reattendance at ED, death by suicide, school attendance, well-being and additional domains of self-harm-related behaviour and thoughts in the past month. The trial will also consider service use, costs to carer and carer health-related quality of life to evaluate the costs and cost-effectiveness of the intervention.
London-Riverside Nation Health Service REC (22/LO/0400) provided a favourable ethical opinion. Findings will be disseminated through social media, a website, scientific papers, conferences and reports, in collaboration with our Young Person's Lived Experience Advisory Group.
ISRCTN81846131.
13.0, 30.06.2025.
自我伤害是年轻人自杀最强的预测因素。前往急诊科（ED）就诊的自我伤害行为与反复自我伤害及自杀相关。急诊科就诊后迅速进行随访联系，为在自我伤害成为既定应对策略之前进行干预提供了机会。尽管近期在自我伤害治疗方面取得了进展，但目前尚无基于证据的干预措施可用于预防年轻人在急诊科就诊后未来的自我伤害及自杀行为。初步证据表明，治疗性评估和快速随访联系可能会减少自我伤害行为，并提高后续护理的参与度。在本研究中，我们在一项随机对照试验中，除标准护理外，评估一种简短心理干预措施——支持青少年自我伤害干预（SASH）的临床效果和成本效益，并将其与仅采用标准护理进行比较。根据英国国家卫生与临床优化研究所的指南，标准护理包括在急诊科出院后7天内至少由一名心理健康专业人员进行一次随访。
SASH干预措施包括在年轻人及其照顾者在急诊科就诊后不久，采用以解决问题为导向的方法，与心理健康专业人员进行多达六次的随访联系，为期约2个月。参与者年龄在12至18岁之间，因自我伤害或自杀意念（过去一个月内有自我伤害行为）前往急诊科就诊，且有同意的能力。我们的目标是招募144名年轻人参与试验，他们将按1:1的比例随机分配至SASH干预组或常规治疗组。在干预/标准护理后以及随机分组后的6个月随访时对参与者进行评估。在6个月的随访期内，每2周通过短信调查评估自我报告的自我伤害情况。主要结局是在6个月时通过汇总自我伤害想法和行为访谈的三个行为领域来评估过去一个月内自我报告的自我伤害事件。我们假设与心理健康从业者的治疗关系将介导这种关联。次要结局包括抑郁和焦虑症状、再次前往急诊科就诊的频率、自杀死亡情况、上学出勤率、幸福感以及过去一个月内自我伤害相关行为和想法的其他领域。该试验还将考虑服务使用情况、照顾者的成本以及照顾者与健康相关的生活质量，以评估干预措施的成本和成本效益。
伦敦-河畔国民保健服务研究伦理委员会（22/LO/0400）给出了有利的伦理意见。研究结果将通过社交媒体、网站、科学论文、会议和报告等形式，与我们的年轻人生活经历咨询小组合作进行传播。
ISRCTN81846131。
13.0，2025年6月30日。
