A Youth Culturally adapted Manual Assisted Psychological therapy (Y-CMAP) for adolescent Pakistani patients with a recent history of self-harm.

自杀是一个严重的全球公共卫生问题，在许多国家都是主要的死亡原因之一。在过去的45年里，全球自杀率上升了60%。1998年，自杀导致的全球疾病总负担为1.8%，预计到2020年将增加到2.4%。世卫组织《2013-2020年精神卫生行动计划》和所有成员国都承诺努力实现到2020年将自杀率降低10%的全球目标。世卫组织的心理健康差距行动方案将自杀列为优先条件之一，世卫组织最近的报告“预防自杀：全球当务之急”呼吁将预防自杀作为全球公共卫生议程的高度优先事项。全世界每年有80多万人死于自杀，每一次自杀都有20多人试图自杀。自我伤害是青少年自杀死亡的最强预测因素之一，使风险增加约10倍。每一次自杀都夺去了个人的生命，对朋友、家人和更广泛的社区产生了巨大的影响。高达75%的自杀发生在低收入和中等收入国家（LMIC），这些国家的治疗和支持资源和服务有限。在LMIC中，对文化上适当的自杀预防策略进行强有力的评估存在明显的差距。有自残史的人死于自杀的风险比没有自残史的人高得多。世界卫生组织建议将提供适当的治疗作为所有自杀预防策略的关键组成部分。巴基斯坦每年有超过10万起自残行为。Y-CMAP的目的是评估这种文化适应性心理治疗在有自残史的青少年患者中的临床和成本效益。我们在卡拉奇进行的研究确定了6-8次基于CBT的干预（C MAP）对最近自我伤害的成年人的有效性。在基线、3个月和6个月时进行评估。在每次随访评估中，与按性别治疗（TAU）组相比，干预组的自杀意念和绝望感较基线显著降低。来自C MAP的研究结果强调了这种干预对巴基斯坦自我伤害事件后出现的患者的卫生服务的适用性。拟议的研究将在卡拉奇、拉合尔、拉瓦尔平迪、木尔坦和海得拉巴进行。受试者将随机分配至干预（Y-CMAP）或TAU。针对青年人的现有适龄文化适应性干预措施包括评估自我伤害事件、危机技能、解决问题和管理情绪的基本认知技术、消极思维和预防复发战略。干预将在12周内分8次进行。将在基线和随机化后3个月（干预结束）、6个月和12个月进行评估。结果指标将包括问卷调查，以衡量自我伤害的重复，自杀意念的严重程度;抑郁;绝望;和生活质量。此外，定性访谈和焦点小组将提供有关参与者，治疗师和关键利益相关者的经验丰富的信息。这将为实施和发展更有效和更敏感的自我伤害管理服务提供信息。TAU将是由当地医疗、精神病和初级保健服务机构根据临床判断提供的标准常规护理。将记录每名受试者接受的任何治疗。这项试验将为未来的研究和国家临床实践指南提供信息。我们已经与卫生部建立了联系，并将进行讨论，向他们介绍结果，并试图影响政策的变化。

Suicide is a serious global public health issue ranked amongst the leading causes of death in many countries. The worldwide rates of suicide have increased by 60% in the last 45 years. The 1.8% total global burden of disease attributed to suicide in 1998 is expected to increase to 2.4% by 2020. The WHO Mental Health Action Plan 2013-2020 and all the member states have committed to work towards the global target of a 10% reduction in the suicide rate by 2020. WHO's Mental Health Gap Action Programme includes suicide as one of the priority conditions and the recent WHO report "Preventing suicide: a global imperative" calls for suicide prevention to be a high priority on the global public health agenda. More than 800,000 people across the world die due to suicide each year and for each suicide there are more than 20 people attempting suicide. Self-harm is one of the strongest predictors of death by suicide in adolescence, increasing the risk approximately 10-fold. Each suicide takes the life of the individual and has a tremendous effect on friends, family and the wider community. Up to 75% of all suicides occur in in low- and middle-income countries (LMIC) where resources and services are limited for treatment and support. There is a clear gap in the robust evaluation of culturally appropriate suicide prevention strategies in LMIC. Individuals who have a history of self-harm are at much higher risk of dying by suicide than individuals who do not have such a history. The WHO recommends offering appropriate treatment as a key component of all suicide prevention strategies.There are more than 100,000 acts of self-harm in Pakistan annually. The aim of Y-CMAP is to evaluate the clinical and cost-effectiveness of this culturally adapted psychological therapy in adolescent patients with a history of self-harm. Our study in Karachi determined the effectiveness of a 6-8 session CBT-based intervention (C MAP) in adults who had recently self-harmed. The assessments were carried out at baseline, 3 & 6 months. There was a significant reduction from baseline in suicidal ideation and hopelessness in the intervention group compared to the Treatment as Usual (TAU) group at each follow up assessment. The findings from C MAP highlight the applicability of such an intervention to health services in Pakistan for patients who present after a self-harm episode. The proposed research will be conducted in Karachi, Lahore, Rawalpindi, Multan and Hyderabad. Participants will be randomized either to the Intervention (Y-CMAP) or TAU. The existing age appropriate culturally adapted intervention (Y-CMAP) for young people includes an evaluation of the self-harm episode, crisis skills, problem solving and basic cognitive techniques to manage emotions, negative thinking and relapse prevention strategies. The intervention will be delivered in eight sessions over 12 weeks. Assessments will be conducted at baseline and at 3 months (end of intervention), 6 months and 12 months after randomization. The outcome measures will include questionnaires to measure the repetition of self-harm, severity of suicidal ideation; depression; hopelessness; and quality of life. In addition, qualitative interviews and focus groups will provide rich information regarding the experiences of participants, therapists and key stakeholders. This will inform implementation as well as the development of more effective and sensitive services for self-harm management. TAU will be standard routine care delivered by local medical, psychiatric and primary care services according to clinical judgment. A record will be kept of any treatment received by each participant. This trial will inform future research and national clinical practice guidelines. We have established contacts with the ministry of health and will enter discussions to present the results to them and attempt to influence policy change.