Effectiveness of systemic family therapy versus treatment as usual for young people after self-harm: a pragmatic, phase 3, multicentre, randomised controlled trial
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BACKGROUND: Self-harm in adolescents is common and repetition occurs in a high proportion of these cases. Scarce evidence exists for effectiveness of interventions to reduce self-harm. METHODS: This pragmatic, multicentre, randomised, controlled trial of family therapy versus treatment as usual was done at 40 UK Child and Adolescent Mental Health Services (CAMHS) centres. We recruited young people aged 11-17 years who had self-harmed at least twice and presented to CAMHS after self-harm. Participants were randomly assigned (1:1) to receive manualised family therapy delivered by trained and supervised family therapists or treatment as usual by local CAMHS. Participants and therapists were aware of treatment allocation; researchers were masked. The primary outcome was hospital attendance for repetition of self-harm in the 18 months after group assignment. Primary and safety analyses were done in the intention-to-treat population. The trial is registered at the ISRCTN registry, number ISRCTN59793150. FINDINGS: Between Nov 23, 2009, and Dec 31, 2013, 3554 young people were screened and 832 eligible young people consented to participation and were randomly assigned to receive family therapy (n=415) or treatment as usual (n=417). Primary outcome data were available for 795 (96%) participants. Numbers of hospital attendances for repeat self-harm events were not significantly different between the groups (118 [28%] in the family therapy group vs 103 [25%] in the treatment as usual group; hazard ratio 1·14 [95% CI 0·87-1·49] p=0·33). Similar numbers of adverse events occurred in both groups (787 in the family therapy group vs 847 in the treatment as usual group). INTERPRETATION: For adolescents referred to CAMHS after self-harm, having self-harmed at least once before, our family therapy intervention conferred no benefits over treatment as usual in reducing subsequent hospital attendance for self-harm. Clinicians are therefore still unable to recommend a clear, evidence-based intervention to reduce repeated self-harm in adolescents. FUNDING: National Institute for Health Research Health Technology Assessment programme.
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A study of family therapy versus usual treatment for adolescents who had harmed themselves showed no reduction in suicides with family therapy.
“A study of family therapy as compared with usual treatment for adolescents who had harmed themselves showed no reduction in suicides with family therapy.72”
From Suicide (2020) · cites this paper as [72]
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- Authors
- Cottrell, D. J., Wright-Hughes, A., Collinson, M., Boston, P., Eisler, I., Fortune, S., Graham, E. H., Green, J., House, A. O., Kerfoot, M., Owens, D. W., Saloniki, E.-C., Simic, M., Lambert, F., Rothwell, J., Tubeuf, S., & Farrin, A. J.
- Affiliations
- University of Leeds (GB)
- King's College London (GB)
- University of Manchester (GB)
- University of Kent (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- Corresponding author
- Cottrell, David J
- ORCID
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 5
- Issue
- 3
- Pages
- 203-216
- ISSN
- 2215-0366 (ISSN-L)
- PMC
- PMC5835764
- OpenAlex
- W2786348565
- Cited by
- 109
- References
- 41
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 11 · 2023: 15 · 2022: 7 · 2021: 24 · 2020: 16 · 2019: 8 · 2018: 11
- FWCI
- 17.33
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The Lancet Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Kent Academic Repository (University of Kent) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (07/33/01)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- self-harm, adolescents, family therapy, systemic family therapy, child and adolescent mental health services, hospital visits, repeat self-harm, usual care, adverse events, manualized intervention
- MeSH terms
- Adolescent, Child, Family Therapy, Female, Humans, Male, Surveys and Questionnaires, Self-Injurious Behavior, Treatment Outcome
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