@article{ref1,
title="Problem-solving therapy for people who present to hospital with self-harm: Zelen randomised controlled trial",
journal="British journal of psychiatry",
year="2011",
author="Hatcher, Simon and Sharon, Cynthia and Parag, Varsha and Collins, Nicola",
volume="199",
number="4",
pages="310-316",
abstract="BACKGROUND: Presentations to hospital with self-harm are common, associated with suicide and have an increased mortality, yet there is no accepted effective intervention. AIMS: To investigate whether problem-solving therapy would improve outcomes in adults presenting to hospital with self-harm, compared with usual care. METHOD: A Zelen randomised controlled trial was conducted in four district health boards in New Zealand. A second hospital presentation with self-harm at 1 year for all episodes, plus separate comparisons of first-time and repeat presentations at the index episode, were the a priori primary outcomes. The trial registration number was ACTRN12605000337673. RESULTS: In an intention-to-treat analysis of all randomised patients (n = 1094) there was no significant difference at 12 months in the proportion of people who had presented again with self-harm when comparing all episodes (intervention 13.4%, usual care 14.1%; relative risk reduction RR = 0.05, 95% CI -0.28 to 0.30, P = 0.79) or where the index episode was the first episode (intervention 13.4%, usual care 9.4%, RR = -0.42, 95% CI -1.17 to 0.08, P = 0.37). Where the index episode was repeated self-harm, those who received therapy were less likely to present again with self-harm (intervention 13.5%, usual care 22.1%, RR = 0.39, 95% CI 0.07 to 0.60, number needed to treat 12, P = 0.03). CONCLUSIONS: Problem-solving therapy is not recommended for everyone who presents to hospital with self-harm. Among adults with a history of self-harm it may be an effective intervention.<p /> <p>Language: en</p>",
language="en",
issn="0007-1250",
doi="10.1192/bjp.bp.110.090126",
url="http://dx.doi.org/10.1192/bjp.bp.110.090126"
}