SCIE research briefing 17: Therapies and approaches for helping children and adolescents who deliberately self-harm (DSH)

Click here for a full alphabetical list of the references.

Reference list

(1)Pawson R., Boaz A., Grayson L., Long A., Barnes C. (2003). Types and Quality of Knowledge in Social Care. Knowledge Review 3 [Accessed 18 October 2005]. Social Care Institute for Excellence (SCIE).

This document analyses and defines the different types of knowledge and information which may inform social care research and practice.

(2)SCIE Research briefing 16 (2005 ). Deliberate self-harm (DSH) among children and adolescents: who is at risk and how is it recognised? Social Care Institute for Excellence (SCIE).

This is a research briefing on the risk factors associated with self-harm among young people.

(3)Clarke T., Sherr L., Watts C. (2000). Young People and Self Harm [Accessed 18 October 2005]. Pathways in Care. Barking & Havering Health Authority.

This report sets out the key findings and recommendations of the Young People and Self Harm project conducted in Barking and Havering Health authority. It is a multi-agency retrospective case study of children and adolescents presenting to A&E departments with self-harm.

(4)Poustie A., Neville R. (2004). Deliberate self harm cases: a primary care perspective. Nursing Standard, 18 (48), 33-36.

This study reports on the presentations and outcomes of 25 self-harm cases in an urban general practice.
Abstract available

(5)Dow P. (2004). "I feel like I'm invisible". Children talking to ChildLine about self harm [Accessed 18 October 2005]. ChildLine.

This document reports the findings of an 18-month inquiry conducted by the Mental Health Foundation and Camelot Foundation.

(6)Hawton K., Fagg J., Simkin S., Bale E., Bond A. (1997). Trends in deliberate self harm in Oxford, 1985-1995: implications for clinical services and the prevention of suicide. British Journal of Psychiatry, 171, 556-560.

This study reviews trends in DSH between 1985 and 1995 in Oxford.
Abstract available

(7)Bhugra D., Thompson N., Singh J., Fellow-Smith E. (2004). Deliberate self-harm in adolescents in West London: Socio-cultural factors. European Journal of Psychiatry, 18 (2), 91-98.

This paper reports on socio-cultural factors affecting adolescents from West London who self-harm.

(8)Hawton K., et al (1996). Deliberate poisoning and self-injury in children and adolescents under 16 years of age in Oxford 1976-1993. British Journal of Psychiatry, 169202-208.

This study reports rates for self-poisoning in Oxford between 1976 and 1993.

(9)Meltzer H., Gatward R., Goodman R., Ford T. (2001). Children and adolescents who try to harm, hurt or kill themselves [Accessed 18 October 2005]. ONS.

This analysis looks in detail at the findings of the national survey of the mental health of children and adolescents in Great Britain in 1999 about children and adolescents who attempt to harm, hurt or kill themselves.

(10)Hurry J., Storey P. (1998). Deliberate Self Harm among Young People [Accessed 18 October 2005]. Institute of Education.

This study investigates the service provided to young people (aged 12-24 years) when they present in Accident and Emergency (A & E) Departments after an episode of self-harm, and compares this with the level of provision recommended by the Department of Health and the Royal College of Psychiatrists.

(11)Hawton K., Rodham K., Evans E., Weatherall R. (2002). Deliberate self harm in adolescents: self report survey in schools in England. British Medical Journal, 325 (7374), 1207-1211.

This study aims to determine the prevalence of deliberate self harm in adolescents and to identify the factors associated with it.

(12)Hawton K., Arensman E., Townsend E., Gunnell D., Hazell P., van Heeringen K. et al. (2005). Psychosocial and pharmacological treatments for DSH. Cochrane Database of Systematic Reviews, Issue 2.

This is a systematic review of interventions for treating self-harm among all age groups

(13)Bywaters P., Rolfe A. (2005). Look Beyond the Scars [Accessed 18 October 2005]. Understanding and responding to injury and self harm. NCH.

This reports interviews with a group of young people who self-harm, and some of their partners. It was commissioned by the NCH.

(14)Bhugra D., Thompson N., Singh J., FellowSmith E. (2003). Inception rates of deliberate self-harm among adolescents in West London. International Journal of Social Psychiatry, 49 (4), 247-250.

This paper studies the rates of adolescent self-harm over a calendar year in Ealing, London.
Abstract available

(15)Harrington R., Kerfoot M., Dyer E., McGiven F., Gill J., Harrington V. et al. (1998). Randomized trial of a home-based family intervention for children who have deliberately poisoned themselves. Journal of the American Academy of Child and Adolescent Psychiatry, 37 (5), 512-518.

This study investigates an intervention given by child psychiatric social workers to the families of children and adolescents who had attempted suicide by taking an overdose.
Abstract available

(16)Nadkarni A., Parkin A., Dogra N., Stretch D.D., Evans P.A. (2000). Characteristics of children and adolescents presenting to accident and emergency departments with deliberate self-harm. Journal of Accident and Emergency Medicine, 17 (2), 98-102.

This study provides a description of the characteristics of children and adolescents presenting to the accident and emergency (A&E) department with deliberate self harm.
Full text available

(17)House A., Owens D., Patchett L. (1999). Deliberate self-harm. Quality in Health Care, 8137-143.

This paper reviews literature on self-harm.

(18)Hawton K., Houston K., Shepperd R. (1999). Suicide in young people: study of 174 cases, aged under 25 years, based on coroners' and medical records. British Journal of Psychiatry, 175, 271-276.

This article reports on the personal characteristics of a 174 suicide cases.
Abstract available

(19)Hulten A., Jiang G.X., Wasserman D., Hawton K., Hjelmeland H., De Leo D. et al. (2001). Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors. European Child & Adolescent Psychiatry, 10 (3), 161-169.

This Swedish study seeks to identify patterns and risk factors for repetition of suicide attempts by older teenagers.
Abstract available

(20)Zahl D.L., Hawton K. (2004). Repetition of deliberate self-harm and subsequent suicide risk: long-term follow-up study of 11,583 patients. British Journal of Psychiatry, 185, 70-75.

This study investigates the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition.

(21)Webb L. (2002). Deliberate self-harm in adolescence: a systematic review of psychological and psychosocial factors. Journal of Advanced Nursing, 38 (3), 235-244.

This is a systematic review of the research literature considering the psychological and psychosocial factors associated with adolescent deliberate self-harm (DSH).

(22)Hawton K., Kingsbury S., Steinhardt K., James A., Fagg J. (1999). Repetition of deliberate self-harm by adolescents: the role of psychological factors. Journal of Adolescence, 22 (3), 369-378.

This study examines the relationship between psychological variables and repetition of deliberate self-harm by adolescents admitted to a general hospital having taken an overdose.

(23)Fergusson D., Woodward L., Horwood L. (2000). Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychological Medicine, 30 (1), 23-39.

This New Zealand study examines associations between childhood circumstances, adolescent mental health and life events, and the development of suicidal behaviour in young people aged between 15 and 21 years.

(24)Wood A., Trainor G., Rothwell J., Moore A., Harrington R. (2001). Randomized trial of group therapy for repeated deliberate self-harm in adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 40 (11), 1246-1253.

This trial compares group therapy with routine care in adolescents who had deliberately harmed themselves on at least two occasions within a year.
Abstract available

(25)Donaldson D., Spirito A., Esposito-Smythers C. (2005). Treatment for adolescents following a suicide attempt: results of a pilot trial. Journal of the American Academy of Child & Adolescent Psychiatry, 44 (2), 113-120.

This US trial compares the efficacy of a skills-based treatment protocol and a supportive relationship therapy for adolescents after a suicide attempt.
Abstract available

(26)Katz L.Y., Cox B.J., Gunesekara S., Miller A.L. (2004). Feasibility of Dialectical Behavior Therapy for suicidal adolescent inpatients. Journal of the American Academy of Child & Adolescent Psychiatry, 43 (3), 276-282.

This Canadian study evaluates the feasibility of dialectical behavior therapy (DBT) implementation in a general child and adolescent psychiatric inpatient unit and provides preliminary effectiveness data on DBT versus treatment as usual (TAU).
Abstract available

(27)Evans K., Tyrer P., Catalan J., Schmidt U., Davidson K., Dent J. et al. (1999). Manual-assisted cognitive-behaviour therapy (MACT): a randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine, 29 (1), 19-25.

This trial investigates the effectiveness of a manual-based treatment ranging from bibliotherapy (six self-help booklets) alone, to six sessions of cognitive therapy linked to the booklets, The treatment contains elements of dialectical behaviour therapy (DBT).
Abstract available

(28)Tyrer P., Jones V., Thompson S., Catalan J., Schmidt U., Davidson K. et al. (2003). Service variation in baseline variables and prediction of risk in a randomised controlled trial of psychological treatment in repeated parasuicide: the POMACT study. International Journal of Social Psychiatry, 49 (1), 58-69.

This study looks at the variation in service policies exercised by five centres involved in a randomised trial of a new therapy.
Abstract available

(29)Tyrer P., Thompson S., Schmidt U., Jones V., Knapp M., Davidson K. et al. (2003). Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study. Psychological Medicine, 33 (6), 969-976.

This is a large randomized trial of brief, manual-assisted cognitive behaviour therapy (MACT), versus treatment as usual (TAU), for deliberate self-harm for adults.
Abstract available

(30)Linehan M.M., Armstrong H.E., Suarez A., Allmon D., Heard H.L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48 (12), 1060-1064.

This is a US randomized clinical trial to evaluate the effectiveness of a cognitive-behavioral therapy, ie, dialectical behavior therapy, for the treatment of chronically parasuicidal women who met criteria for borderline personality disorder.
Abstract available

(31)Linehan M.M., Heard H.L., Armstrong H.E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50 (12), 971-974.

This is a US randomized clinical trial to evaluate whether the superior performance of dialectical behavior therapy (DBT), a psychosocial treatment for borderline personality disorder, compared with treatment-as-usual in the community, is maintained during a 1-year posttreatment follow-up.
Abstract available

(32)Raj M.A.J., Kumaraiah V., Bhide A.V. (2001). Cognitive-behavioural intervention in deliberate self-harm. Acta Psychiatrica Scandinavica, 104 (5), 340-345.

This Indian study examines the efficacy of cognitive behaviour therapy (CBT) in the management of adult deliberate self-harm (DSH) patients.
Abstract available

(33)Tyrer P., Byford S., Schmidt U., Jones V., Davidson K., Knapp M. et al. (2004). Differential effects of manual assisted cognitive behaviour therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study. Journal of Personality Disorders, 18 (1), 102-116.

This is a randomized trial of manual assisted cognitive behaviour therapy (MACT) for adults who self-harm.

(34)Byford S., Knapp M., Greenshields J., Ukuoumunne O.C., Jones V., Thompson S. et al. (2003). Cost-effectiveness of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: a decision-making approach. Psychological Medicine, 33 (6), 977-986.

This is a randomized trial to evaluate the cost-effectiveness of manual-assisted cognitive behaviour therapy (MACT) in the treatment of self-harm among adults.
Abstract available

(35)Smith A., Clarke J. (2003). Self harm self help / support groups(PDF). Mental Health Foundation.

This is small exploratory study of self-harm support group for adults.

(36)Payne H., Butler I. (2003). Promoting the mental health of children in need [Accessed 18 October 2005]. Research in Practice..

This is number 9 of the Quality Protects Research Briefings series.

(37)Trainor G., Wood A. (2001). Learning to live with life. Mental Health Care, 4 (8), 273-275.

This is a brief overview of the findings of a randomized trial of developmental group therapy for helping adolescents who self-harm.

(38)Huey S.J., Henggeler S.W., Rowland M.D., Halliday-Boykins C.A., Cunningham P.B., Pickrel S.G. et al. (2004). Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies. Journal of the American Academy of Child & Adolescent Psychiatry, 43 (2), 183-190.

This US randomized trial evaluates the efficacy of multisystemic therapy (MST) in reducing attempted suicide among predominantly African American youths referred for emergency psychiatric hospitalization.
Abstract available

(39)Rathus J.H., Miller A.L. (2002). Dialectical Behavior Therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behavior, 32 (2), 146-157.

This is a quasi-experimental investigation of an adaptation of Dialectical Behavior Therapy (DBT) for a group of suicidal adolescents with borderline personality features.
Abstract available

(40)Hawton K., Hall S., Simkin S., Bale E., Bond A., Codd S. et al. (2003). Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, 1990-2000. Journal of Child Psychology and Psychiatry, 44 (8), 1191-1198.

This is a survey of the trends and characteristics in self-harm among young people in Oxford.
Abstract available

(41)Kress V., Gibson D.M., Reynolds C.A. (2004). Adolescents who self-injure: implications and strategies for school counselors. Professional School Counseling, 7 (3), 195-201.

This article explores strategies for school counsellors to use when seeking to manage self-harm among adolescents and provide appropriate support.
Full text available

(42)Froeschle J., Moyer M. (2004). Just cut it out: legal and ethical challenges in counseling students who self-mutilate. Professional School Counseling, 7 (4), 231-235.

This is a US review of the literature examining issues faced by school counsellors in relation to students who self-harm.

(43)Milia D. (1996). Art therapy with a self-mutilating adolescent girl. American Journal of Art Therapy, 34 (4), 98-106.

This article reports on a case study of a self-harming girl who expressed her distress through art.

(44)Chitsabesan P., Harrington R., Harrington V., Tomenson B. (2003). Predicting repeat self-harm in children--how accurate can we expect to be? European Child & Adolescent Psychiatry, 1223-29.

This study examines which variables predict repetition of deliberate self-harm in children.

(45)Bowen A.C.L., John A.M.H. (2001). Gender differences in presentation and conceptualization of adolescent self-injurious behaviour: implications for therapeutic practice. Counselling Psychology Quarterly, 14 (4), 357-379.

This reviews the current knowledge on gender differences in self-harm among adolescents.

(46)MacLeod A.K., Tata P., Evans K., Tyrer P., Schmidt U., Davidson K. et al. (1998). Recovery of positive thinking within a high-risk parasuicide group: results from a pilot randomized controlled trial. British Journal of Clinical Psychology, 37, 371-379.

This is a trial of the effect of positive thinking on rates of suicide and factors associated with suicide risk.

(47)Guthrie E., Kapur N., Mackway-Jones K., Chew-Graham C., Moorey J., Mendel E. et al. (2001). Randomised controlled trial of brief psychological intervention after deliberate self poisoning. British Medical Journal, 323 (7305), 135-139.

This trial looks at the effects of a brief psychological intervention (brief psychodynamic interpersonal therapy) compared with usual treatment for adult patients after deliberate self poisoning.
Full text available

(48)Bennewith O., Stocks N., Gunnell D., Peters T.J., Evans M.O., Sharp D.J. (2002). General Practice-based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial. British Medical Journal, 324 (7348), 1254-1261.

This study evaluates the impact of a general practice-based intervention on the incidence of repeat episodes of deliberate self harm among adults.
Full text available

(49)Warm A., Murray C., Fox J. (2002). Who helps? Supporting people who self-harm. Journal of Mental Health, 11 (2), 121-130.
This paper presents findings from a survey in which self-harmers were asked to indicate who they had consulted for help in the past and their level of satisfaction with these various sources of professional help.

(50)Storey P., Hurry J., Jowitt S., Owens D., House A. (2005). Supporting young people who repeatedly self-harm. Journal of the Royal Society for the Promotion of Health, 125 (2), 71-75.
This paper explores the views and experiences of 74 young people aged 16-22 who had presented to A&E with self-harm.

(51)Burgess S., Hawton K., Loveday G. (1998). Adolescents who take overdoses: outcome in terms of changes in psychopathology and the adolescents' attitudes to their overdoses. Journal of Adolescence, 21 (2), 209-218.
This is a study of treatment, compliance and outcomes for a small group of adolescents who had overdosed.
Abstract available

(52)National Institute of Clinical Excellence (2004). Self-harm. The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. National Institute of Clinical Excellence. Title link : http://www.nice.org.uk/pdf/CG016NICEguideline.pdf [Accessed 18 October 2005].
This is good practice guidance for primary and secondary health professionals working with people who self-harm.

(53)Cooper M.A., Glasper E.A. (2001). Deliberate self-harm in children: the nurse's therapeutic style. British Journal of Nursing, 10 (1), 34-40.
This article examines child health nursing skills in the management of deliberate self-harm in children and young people.
Abstract available

(54)Smith M. (2002). Half in love with easeful death? Social work with adolescents who harm themselves. Journal of Social Work Practice, 16 (1), 55-65.
This paper offers possible explanations as to why adolescents harm themselves, provides extracts from three interviews conducted with young women in residential care who have engaged in self-harming behaviours, and discusses the impact of suicidal behaviour in residential care settings.

(55)Storey P., Hurry J., Brownjohn C. (2004). Deep wounds. Community Care, 1517.
This article discusses how and when young people who self-harm are recognised.

(56)Crawford T., Geraghty W., Street K., Simonoff E. (2003). Staff knowledge and attitudes towards deliberate self-harm in adolescents. Journal of Adolescence, 26 (5), 623-633.

This study investigates knowledge, attitudes and training needs concerning deliberate self-harm (DSH) in adolescents, amongst a variety of professionals involved in the assessment and management of adolescence who self-harm.
Abstract available

(57) Machoian L. (2001). Cutting voices: self-injury in three adolescent girls. Journal of Psychosocial Nursing and Mental Health Services, 39 (11), 22-29.

This is a qualitative US study examining the reasons why adolescent girls self-harm.
Abstract available