Randomized trial of a home-based family intervention for children who have deliberately poisoned themselves
Open accessAbstract
Objective To establish whether an intervention given by child psychiatric social workers to the families of children and adolescents who had attempted suicide by taking an overdose reduced the patients' suicidal feelings and improved family functioning.Method One hundred sixty-two patients, aged 16 or younger, who had deliberately poisoned themselves were randomly allocated to routine care (n = 77) or routine care plus the intervention (n = 85). The intervention consisted of an assessment session and four home visits by the social workers to conduct family problem-solving sessions. The control group received no visits. Both groups were assessed at the time of recruitment and 2 and 6 months later. The primary outcome measures were the Suicidal Ideation Questionnaire, the Hopelessness Scale, and the Family Assessment Device.Results There were no significant differences in the primary outcomes between the intervention and control groups at either of the outcome assessments. Parents in the intervention group were more satisfied with treatment (mean difference 1.4 [95% confidence interval 0.6 to 2.1]). A subgroup without major depression had much less suicidal ideation at both outcome assessments (analysis of covariance p < .01) compared with controls.Conclusions The home-based family intervention resulted in reduced suicidal ideation only for patients without major depression.
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One trial was rated unclear risk for sequence generation because it was not clear whether opaque sealed envelopes were shuffled to ensure random sequence generation.
“We rated one trial as having an unclear risk of bias for this item as although opaque, sealed envelopes were used, it is unclear whether these were shuffled to ensure random sequence generation (Harrington 1998).”
From Interventions for self-harm in children and adolescents (2021) · cites this paper as Harrington 1998
The Recruitment section says the opaque, sealed envelopes were “randomly assorted by an assistant” before use. Although it does not specify shuffling as the method, it does report random ordering, contrary to the claim that the paper leaves it unclear whether the envelopes were arranged to generate a random sequence. (LLM, conf=0.83)
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Experimental — accuracy not yet measuredIn Harrington 1998, the review judged blinding of participants to be at high risk of bias because participants could have known their allocation.
“Of participants High risk Comment: The nature of this study means that participants could have known to which group they had been allocated”
From Interventions for self-harm in children and adolescents (2021) · cites this paper as Harrington 1998
The Recruitment section (page not available) says participants were assigned to home-based family intervention plus routine care or routine care alone, and that allocation was concealed from outcome assessors. This supports the possibility that participants could know their allocation, but the trial does not itself judge participant blinding to be at high risk of bias; that is the review’s assessment. (LLM, conf=0.79)
Experimental — accuracy not yet measuredHome-based family intervention is based on the premise that self-harm in young people may relate to family dysfunction and that improving family functioning could reduce suicidal ideation and self-harm.
“The basis of this therapy is that SH in young people may relate to family dysfunction and that this therapeutic approach could help families function better and hence reduce the risk of suicidal ideation and SH (Harrington 1998).”
From Interventions for self-harm in children and adolescents (2021) · cites this paper as Harrington 1998
In the seven trials that recorded treatment adherence, it was measured in various ways, including the proportion completing the full treatment course and the proportion attending the first appointment.
“In the seven trials that recorded information on treatment adherence, this was assessed using a variety of methods including: the proportion of participants that completed the full course of treatment (Donaldson 2005; Harrington 1998; Rossouw 2012a), the proportion attending their first appointment ( Ougrin 2011a)”
From Interventions for self-harm in children and adolescents (2021) · cites this paper as Harrington 1998
Harrington 1998 reported greater parent satisfaction with the home-based family intervention at initial follow-up.
“However, Harrington 1998 did report that parents were more satisfied with the home-based family intervention at initial follow-up.”
From Interventions for self-harm in children and adolescents (2021) · cites this paper as Harrington 1998
For four trials, the review classified intention-to-treat analyses as low risk of bias (36.4%), although the methods used were unclear.
“For four trials, the authors reported having conducted analyses on an intention-to-treat basis we therefore classified them as having a low risk of bias for this item (36.4%); although the methods used to conduct these analyses were not clear (Donaldson 2005;Harrington 1998;Mehlum 2014;Wood 2001a).”
From Interventions for self-harm in children and adolescents (2021) · cites this paper as Harrington 1998
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References 30 · Cited by 281
Research works printed but not linked: 2
- [7]7. Hawron K, Catalan J (1982). ArrnnpydSukU/e. Oxford, England: Oxford Medical Publications
- [17]17. Machin D. Campbell MJ (1987). Stlltistical Tables fir thl Disign ofClinical .Trill/s. Oxford. England: Blackwell
- Authors
- HARRINGTON, R., KERFOOT, M., DYER, E., McNIVEN, F., GILL, J., HARRINGTON, V., WOODHAM, A., & BYFORD, S.
- Affiliations
- Royal Manchester Children's Hospital (GB)
- University of Manchester (GB)
- St Mary's Hospital (GB)
- University of York (GB)
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 1998-05
- Volume
- 37
- Issue
- 5
- Pages
- 512-518
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W1972726065
- Semantic Scholar
- b79f43cd5d692dbce989aae5a5675acd3981f81e
- Cited by
- 281
- References
- 30
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 17 · 2020: 6 · 2019: 8 · 2018: 9 · 2017: 4 · 2016: 11 · 2015: 17 · 2014: 21 · 2013: 12 · 2012: 9
- FWCI
- 14.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Keywords
- adolescent suicide attempts, self-poisoning, suicidal ideation, family problem solving, family functioning, hopelessness, major depressive disorder, parental satisfaction, home visits
- MeSH terms
- Adolescent, Child, Family Relations, Family Therapy, Home Care Services, Humans, Motivation, Outcome and Process Assessment, Health Care, Poisoning, Risk Factors, Social Work, Psychiatric, Suicide, Attempted, Self-Injurious Behavior, Drug Overdose
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