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Group problem-solving skills training for self-harm: randomised controlled trial

  • Carmel McAuliffe (a1), Breda C. McLeavey (a2), Tony Fitzgerald (a3), Paul Corcoran (a4), Bernie Carroll (a5), Louise Ryan (a5), Brian O'Keeffe (a6), Eva Fitzgerald (a4), Portia Hickey (a4), Mary O'Regan (a4), Jillian Mulqueen (a5) and Ella Arensman (a7)...
Abstract
Background

Rates of self-harm are high and have recently increased. This trend and the repetitive nature of self-harm pose a significant challenge to mental health services.

Aims

To determine the efficacy of a structured group problem-solving skills training (PST) programme as an intervention approach for self-harm in addition to treatment as usual (TAU) as offered by mental health services.

Method

A total of 433 participants (aged 18–64 years) were randomly assigned to TAU plus PST or TAU alone. Assessments were carried out at baseline and at 6-week and 6-month follow-up and repeated hospital-treated self-harm was ascertained at 12-month follow-up.

Results

The treatment groups did not differ in rates of repeated self-harm at 6-week, 6-month and 12-month follow-up. Both treatment groups showed significant improvements in psychological and social functioning at follow-up. Only one measure (needing and receiving practical help from those closest to them) showed a positive treatment effect at 6-week (P = 0.004) and 6-month (P = 0.01) follow-up. Repetition was not associated with waiting time in the PST group.

Conclusions

This brief intervention for self-harm is no more effective than treatment as usual. Further work is required to establish whether a modified, more intensive programme delivered sooner after the index episode would be effective.

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Copyright
Corresponding author
Carmel M. McAuliffe, National Suicide Research Foundation, Western Gateway Building, Western Road, Cork, Ireland. Email: info@nsrf.ie
Footnotes
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This work was supported by funding from the Health Service Executive (HSE) South, HSE Mid-West, the HSE National Office for Suicide Prevention, the Health Research Board and Pobal-Dormant Accounts Fund in Ireland.

Declaration of interest

None.

Footnotes
References
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1 National Suicide Research Foundation. National Registry of Deliberate Self Harm: Annual Report 2011. National Suicide Research Foundation, 2012.
2 Gunnell, D, Frankel, S. Prevention of suicide: aspirations and evidence. BMJ 1994; 308: 1227–33.
3 Harris, EC, Barraclough, B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 1997; 170: 205–28.
4 Sinclair, JM, Hawton, K, Gray, A. Six year follow-up of a clinical sample of self-harm patients. J Affect Disord 2009; 121: 247–52.
5 Zahl, DL, Hawton, K. Repetition of deliberate self-harm and subsequent suicide risk: long-term follow-up study of 11,583 patients. Br J Psychiatry 2004; 185: 70–5.
6 O'Loughlin, S, Sherwood, J. A 20 year review of trends in deliberate self harm in a British town 1981-2000. Soc Psychiatry Psychiatr Epidemiol 2005 40: 446–53
7 Arensman, E, Townsend, E, Hawton, K, Bremner, S, Feldman, E, Goldney, R, et al. Psychosocial and pharmacological treatment of patients following deliberate self-harm: the methodological issues involved in evaluating effectiveness. Suicide Life Threat Behav 2001; 31: 169–80.
8 Hawton, K, Arensman, E, Townsend, E, Bremner, S, Feldman, E, Goldney, R, et al. Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ 1998; 317: 441–7.
9 National Collaborating Centre for Mental Health. Self-harm. The Short-Term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care. National Clinical Practice Guideline Number 16. The British Psychological Society and The Royal College of Psychiatrists, 2004.
10 Royal Australian and New Zealand College of Psychiatrists. Self-harm. Australian Treatment Guide for Consumers and Carers. The Royal Australian and New Zealand College of Psychiatrists, 2009.
11 Linehan, MM, Camper, P, Chiles, JA, Strosahl, K, Shearin, EL. Interpersonal problem solving and parasuicide. Cog Therapy Res 1987; 11: 112.
12 McLeavey, BC, Daly, RJ, Murray, CM, O'Riordan, J, Taylor, M. Interpersonal problem-solving deficits in self-poisoning patients. Suicide Life Threat Behav 1987; 17: 3349.
13 Pollock, LR, Williams, JM. Problem solving and suicidal behavior. Suicide Life Threat Behav 1998; 28: 375–87.
14 Pollock, LR, Williams, JM. Problem-solving in suicide attempters. Psychol Med 2004; 34: 163–7.
15 Rotheram-Borus, MJ, Trautman, PD, Dopkins, SC, Shrout, PE. Cognitive style and pleasant activities among female adolescent suicide attempters. J Consult Clin Psychol 1990; 58: 554–61.
16 Dieserud, G, Roysamb, E, Braverman, MT, Dalgard, OS, Ekeberg, O. Predicting repetition of suicide attempt. A prospective study of 50 suicide attempters. Arch Suicide Res 2003; 7: 117.
17 Kehrer, CA, Linehan, MM. Interpersonal and emotional problem solving skills and parasuicide among women with borderline personality disorder. J Pers Disord 1996; 10: 153–63.
18 McAuliffe, C, Corcoran, P, Keeley, HS, Arensman, E, Bille-Brahe, U, De Leo, D, et al. Problem-solving ability and repetition of deliberate self-harm: a multicentre study. Psychol Med 2006; 36: 4555.
19 Rudd, MD, Joiner, T, Rajab, MH. Relationships among suicide ideators, attempters, and multiple attempters in a young-adult sample. J Abnorm Psychol 1996; 105: 541–50.
20 Sandin, B, Chorot, P, Santed, MA, Valiente, RM, Joiner, TE. Negative life events and adolescent suicidal behavior: a critical analysis from the stress process perspective. J Adolesc 1998; 21: 415–26.
21 Schotte, DE, Clum, GA. Suicide ideation in a college population: a test of a model. J Consult Clin Psychol 1982; 50: 690–6.
22 Schotte, DE, Clum, GA. Problem-solving skills in suicidal psychiatric patients. J Consult Clin Psychol 1987; 55: 4954.
23 Tarrier, N, Taylor, K, Gooding, P. Cognitive-behavioral interventions to reduce suicide behavior: a systematic review and meta-analysis. Behav Modif 2008; 32: 77108.
24 McLeavey, BC, Daly, RJ, Ludgate, JW, Murray, CM. Interpersonal problem-solving skills training in the treatment of self-poisoning patients. Suicide Life Threat Behav 1994; 24: 382–94.
25 Brown, GK, Ten Have, T, Henriques, GR, Xie, SX, Hollander, JE, Beck, AT. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA 2005; 294: 563–70.
26 Slee, N, Garnefski, N, van der Leeden, R, Arensman, E, Spinhoven, P. Cognitive–behavioural intervention for self-harm: randomised controlled trial. Br J Psychiatry 2008; 192: 202–11.
27 Tyrer, P, Thompson, S, Schmidt, U, Jones, V, Knapp, M, Davidson, K, et al. Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study. Psychol Med 2003; 33: 969–76.
28 Arensman, E, McAuliffe, C, Corcoran, P, Perry, IJ. Findings of the POPMACT study. Psychol Med 2004; 34: 1143–4.
29 Nezu, AM, Nezu, CM, Perri, MG. Problem-Solving Therapy for Depression: Theory, Research and Clinical Guidelines. Wiley, 1989.
30 Platt, S, Bille-Brahe, U, Kerkhof, A, Schmidtke, A, Bjerke, T, Crepet, P, et al. Parasuicide in Europe: the WHO/EURO multicentre study on parasuicide. I. Introduction and preliminary analysis for 1989. Acta Psychiatr Scand 1992; 85: 97104.
31 Raistrick, DS, Dunbar, G, Davidson, RJ. Development of a questionnaire to measure alcohol dependence. Br J Addict 1983; 78: 8995.
32 Fitzmaurice, GM, Laird, NM, Ware, JH. Applied Longitudinal Analysis. John Wiley & Sons, 2004.
33 Platt, JJ, Spivack, G, Bloom, W. Manual for the Means-Ends Problem-Solving Procedure (MEPS): A Measure of Interpersonal Problem-Solving Skill. Hahneman Medical College and Hospital, Department of Mental Health Sciences, Hahneman Community MH/MR Center, 1975.
34 Platt, J, Spivak, G. Measures of Interpersonal Cognitive Problem Solving for Adults and Adolescents. Hahnemann Medical College and Hospital, 1977.
35 Stansfeld, SA, Marmot, MG. Deriving a survey measure of social support: the reliability and validity of the Close Persons Questionnaire. Soc Sci Med 1992; 35: 1027–35.
36 Surtees, PG, Wainwright, NW, Brayne, C. Psychosocial aetiology of chronic disease: a pragmatic approach to the assessment of lifetime affective morbidity in an EPIC component study. J Epidemiol Community Health 2000; 54: 114–22.
37 Beck, AT, Steer, RA, Raineri, WF. Scale for suicide ideation: psychometric properties of a self-report version. J Clin Psychol 1988; 44: 499505.
38 Beck, AT, Steer, RA, Ball, R, Ranieri, W. Comparision of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess 1996; 67: 588–97.
39 Beck, AT, Weissman, A, Lester, D, Trexler, L. The measure of pessimism: the hopelessness scale. J Consult Clin Psychol 1974; 42: 861–5.
40 Beck, AT, Epstein, N, Brown, G, Steer, RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56: 893–7.
41 Barratt, ES. Factor analysis of some psychometric measures of impulsiveness and anxiety. Psychol Rep 1965; 16: 547–54.
42 Schwarzer, R, Jerusalem, M. Generalized self-efficacy scale. In Measures in Health Psychology: A User's Portfolio: Causal and Control Beliefs (eds Weinman, J, Wright, S, Johnston, M): 35–7. nferNelson, 1995.
43 McLeavey, BC. Self-poisoning: a study of psychological characteristics and an alternative treatment method. Department of Applied Psychology, University College Cork, doctoral dissertation, 1986.
44 Carter, GL, Clover, K, Whyte, IM, Dawson, AH, D'Este, C. Postcards from the EDGE project: randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning. BMJ 2005; 331: 805.
45 Foote, B, Smolin, Y, Neft, DI, Lipschitz, D. Dissociative disorders and suicidality in psychiatric outpatients. J Nerv Ment Dis 2008; 196: 2936.
46 Beck, AT, Schuyler, D, Herman, J. Development of suicidal intent scales. In The Prediction of Suicide (eds Beck, AT, Resnik, HLP, Lettieri, DJ): 4556. Charles Press, 1974.
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Group problem-solving skills training for self-harm: randomised controlled trial

  • Carmel McAuliffe (a1), Breda C. McLeavey (a2), Tony Fitzgerald (a3), Paul Corcoran (a4), Bernie Carroll (a5), Louise Ryan (a5), Brian O'Keeffe (a6), Eva Fitzgerald (a4), Portia Hickey (a4), Mary O'Regan (a4), Jillian Mulqueen (a5) and Ella Arensman (a7)...
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