Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-31T15:06:35.409Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2018

Carmel McAuliffe ,
Breda C. McLeavey ,
Tony Fitzgerald ,
Paul Corcoran ,
Bernie Carroll ,
Louise Ryan ,
Brian O'Keeffe ,
Eva Fitzgerald ,
Portia Hickey  and
Mary O'Regan
...Show all authors
Carmel McAuliffe*
Affiliation:
Health Service Executive South/National Suicide Research Foundation, Cork, and Department of Epidemiology & Public Health, University College Cork, Ireland
Breda C. McLeavey
Affiliation:
Health Service Executive South, Department of Psychiatry, Cork University Hospital, Ireland
Tony Fitzgerald
Affiliation:
Department of Epidemiology and Public Health, University College Cork, Ireland
Paul Corcoran
Affiliation:
National Suicide Research Foundation, Cork, Ireland
Bernie Carroll
Affiliation:
Health Service Executive West, St Joseph's Hospital, Limerick, Ireland
Louise Ryan
Affiliation:
Health Service Executive West, St Joseph's Hospital, Limerick, Ireland
Brian O'Keeffe
Affiliation:
Health Service Executive West, Tevere Day Hospital, Limerick, Ireland
Eva Fitzgerald
Affiliation:
National Suicide Research Foundation, Cork, Ireland
Portia Hickey
Affiliation:
National Suicide Research Foundation, Cork, Ireland
Mary O'Regan
Affiliation:
National Suicide Research Foundation, Cork, Ireland
Jillian Mulqueen
Affiliation:
Health Service Executive West, St Joseph's Hospital, Limerick, Ireland
Ella Arensman
Affiliation:
National Suicide Research Foundation, and Department of Epidemiology & Public Health, University College Cork, Ireland
*
Carmel M. McAuliffe, National Suicide Research Foundation, Western Gateway Building, Western Road, Cork, Ireland. Email: [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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.

Type
Papers
Information
The British Journal of Psychiatry , Volume 204 , Issue 5 , May 2014 , pp. 383 - 390
Copyright
Copyright © Royal College of Psychiatrists, 2014 

Footnotes

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.

References

1 National Suicide Research Foundation. National Registry of Deliberate Self Harm: Annual Report 2011. National Suicide Research Foundation, 2012.Google Scholar
2 Gunnell, D, Frankel, S. Prevention of suicide: aspirations and evidence. BMJ 1994; 308: 1227–33.CrossRefGoogle ScholarPubMed
3 Harris, EC, Barraclough, B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 1997; 170: 205–28.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar
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: 446–53Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar
11 Linehan, MM, Camper, P, Chiles, JA, Strosahl, K, Shearin, EL. Interpersonal problem solving and parasuicide. Cog Therapy Res 1987; 11: 1–12.Google Scholar
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: 33–49.CrossRefGoogle ScholarPubMed
13 Pollock, LR, Williams, JM. Problem solving and suicidal behavior. Suicide Life Threat Behav 1998; 28: 375–87.Google Scholar
14 Pollock, LR, Williams, JM. Problem-solving in suicide attempters. Psychol Med 2004; 34: 163–7.Google Scholar
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.CrossRefGoogle ScholarPubMed
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: 1–17.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
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: 45–55.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar
21 Schotte, DE, Clum, GA. Suicide ideation in a college population: a test of a model. J Consult Clin Psychol 1982; 50: 690–6.Google Scholar
22 Schotte, DE, Clum, GA. Problem-solving skills in suicidal psychiatric patients. J Consult Clin Psychol 1987; 55: 49–54.Google Scholar
23 Tarrier, N, Taylor, K, Gooding, P. Cognitive-behavioral interventions to reduce suicide behavior: a systematic review and meta-analysis. Behav Modif 2008; 32: 77–108.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
28 Arensman, E, McAuliffe, C, Corcoran, P, Perry, IJ. Findings of the POPMACT study. Psychol Med 2004; 34: 1143–4.Google Scholar
29 Nezu, AM, Nezu, CM, Perri, MG. Problem-Solving Therapy for Depression: Theory, Research and Clinical Guidelines. Wiley, 1989.Google Scholar
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: 97–104.Google Scholar
31 Raistrick, DS, Dunbar, G, Davidson, RJ. Development of a questionnaire to measure alcohol dependence. Br J Addict 1983; 78: 89–95.Google Scholar
32 Fitzmaurice, GM, Laird, NM, Ware, JH. Applied Longitudinal Analysis. John Wiley & Sons, 2004.Google Scholar
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.Google Scholar
34 Platt, J, Spivak, G. Measures of Interpersonal Cognitive Problem Solving for Adults and Adolescents. Hahnemann Medical College and Hospital, 1977.Google Scholar
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.Google Scholar
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.Google Scholar
37 Beck, AT, Steer, RA, Raineri, WF. Scale for suicide ideation: psychometric properties of a self-report version. J Clin Psychol 1988; 44: 499–505.Google Scholar
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.Google Scholar
39 Beck, AT, Weissman, A, Lester, D, Trexler, L. The measure of pessimism: the hopelessness scale. J Consult Clin Psychol 1974; 42: 861–5.Google Scholar
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.Google Scholar
41 Barratt, ES. Factor analysis of some psychometric measures of impulsiveness and anxiety. Psychol Rep 1965; 16: 547–54.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
45 Foote, B, Smolin, Y, Neft, DI, Lipschitz, D. Dissociative disorders and suicidality in psychiatric outpatients. J Nerv Ment Dis 2008; 196: 29–36.Google Scholar
46 Beck, AT, Schuyler, D, Herman, J. Development of suicidal intent scales. In The Prediction of Suicide (eds Beck, AT, Resnik, HLP, Lettieri, DJ): 45–56. Charles Press, 1974.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.