Interventions for Suicide and Self-Injury: A Meta-Analysis of Randomized Controlled Trials Across Nearly 50 Years of Research
Interventions for Suicide and Self-Injury: A Meta-Analysis of Randomized Controlled Trials Across Nearly 50 Years of Research
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DOI：
10.1037/bul0000305
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发表时间：
2020-12-01
影响因子：
22.4
通讯作者：
Franklin, Joseph C.
中科院分区：
文献类型：
--
作者：
Fox, Kathryn R.;Huang, Xieyining;Franklin, Joseph C.
自我伤害的想法和行为（SITBs）是影响广泛的个人和社区的主要公共卫生问题。尽管在开发和改进治疗方法以减少SITB方面做出了重大努力，但SITB干预措施的有效性仍不清楚。为了提供SITB治疗疗效的综合总结，我们对已发表的试图减少SITB的随机对照试验（RCT）进行了荟萃分析。纳入了来自1，125项独特RCT的591篇已发表文章，其中包括过去50年的3，458个效应量。随机效应荟萃分析得出了令人惊讶的结果：在所有SITB结果中，总体干预效果都很小;尽管50年来RCT的数量几乎呈指数级增长，但干预效果并没有改善;所有SITB干预措施都产生了类似的小效果，没有干预措施比其他干预措施显着且持续地强;在随访评估中，总体上较小的干预效果基本保持不变;各年龄组的疗效相似，但对儿童/青少年人群的效果略弱，很少有研究关注老年人;以及主要的样本和研究特征（例如，对照组类型、治疗目标、样本量、干预长度）并不一致地调节治疗效果。这项荟萃分析表明，需要进行根本性的改变，以促进SITB干预效果的进展。特别是，强有力的干预措施针对病理学的必要原因，但对SITB原因（相对于SITB相关因素和风险因素）知之甚少。因此，优先进行旨在查明和针对造成结构性贸易壁垒的共同必要原因的研究，将使这一领域受益。
Self-injurious thoughts and behaviors (SITBs) are major public health concerns impacting a wide range of individuals and communities. Despite major efforts to develop and refine treatments to reduce SITBs, the efficacy of SITB interventions remains unclear. To provide a comprehensive summary of SITB treatment efficacy, we conducted a meta-analysis of published randomized controlled trials (RCTs) that have attempted to reduce SITBs. A total of 591 published articles from 1,125 unique RCTs with 3,458 effect sizes from the past 50 years were included. The random-effects meta-analysis yielded surprising findings: The overall intervention effects were small across all SITB outcomes; despite a nearexponential increase in the number of RCTs across five decades, intervention efficacy has not improved; all SITB interventions produced similarly small effects, and no intervention appeared significantly and consistently stronger than others; the overall small intervention effects were largely maintained at follow-up assessments; efficacy was similar across age groups, though effects were slightly weaker for child/adolescent populations and few studies focused on older adults; and major sample and study characteristics (e.g., control group type, treatment target, sample size, intervention length) did not consistently moderate treatment efficacy. This meta-analysis suggests that fundamental changes are needed to facilitate progress in SITB intervention efficacy. In particular, powerful interventions target the necessary causes of pathology, but little is known about SITB causes (vs. SITB correlates and risk factors). The field would accordingly benefit from the prioritization of research that aims to identify and target common necessary causes of SITBs.