Supporting adolescents with self-harm: a brief psychological intervention to reduce self-harm in adolescence
| ISRCTN | ISRCTN81846131 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN81846131 |
| IRAS number | 312523 |
| Secondary identifying numbers | IRAS 312523, CPMS 53021 |
- Submission date
- 13/12/2022
- Registration date
- 13/12/2022
- Last edited
- 15/04/2025
- Recruitment status
- No longer recruiting
- Overall study status
- Ongoing
- Condition category
- Mental and Behavioural Disorders
Plain English Summary
Background and aims
Suicide is a leading cause of death in young people, and previous self-harm is the strongest predictor of suicide. Rates of self-harm in adolescents range from 6.9% to 15.9% and every year young people in crisis visit emergency departments (ED) having self-harmed. Most EDs have a paediatric psychiatric liaison team of mental health practitioners who conduct a comprehensive psychosocial assessment as per current guidelines. Psychosocial assessment includes an evaluation of risk and needs, but many young people do not experience this as therapeutic and do not engage in follow-up. The period after discharge from ED is associated with the highest risks of repeat self-harm and suicide, suggesting that this period in the care pathway presents a unique opportunity to intervene quickly so that young people can be supported to find alternative ways of coping. This study is testing the effects of a new approach to assessment along with a brief psychological therapy delivered in the community to see if it can help reduce self-harm and future crisis.
Who can participate?
Mental health practitioners, carers and young people aged 12-19 years who visit recruiting emergency departments with self-harm or suicidal ideation with recent self-harm
What does the study involve?
Participants who are identified as eligible for the study will be contacted for consent by a researcher within 48 hours of their visit to the emergency department. A computer will randomly allocate them to either the SASH approach or treatment as usual. Young people who are allocated to the SASH approach will be offered a therapeutic assessment and up to six follow-up appointments with the same practitioner over an 8-week period, as well as two letters including details of the contacts. Carers may be invited to join sessions according to the young person's preference and the carer's need, and/or be invited to one or two standalone sessions, inclusive of the six sessions delivered overall. Participants in the treatment as usual group will receive a standard psychosocial assessment and care. All participants will be asked to complete a research interview at 6 months and those with a mobile phone will be sent a brief electronic questionnaire to complete every 2 weeks within the 6-month period.
What are the possible benefits and risks of participating?
Participating in a study whilst young people are in distress may present a risk of further distress. If the practitioners or the researchers feel that the research is too overwhelming, they will stop the process immediately. Some young people may value talking about their experiences and being listened to, as well as contributing to research aiming to help other young people who self-harm.
Where is the study run from?
City, University of London (UK)
When is the study starting and how long is it expected to run for?
May 2022 to September 2025
Who is funding the study?
The Kavli Trust (Norway)
Who is the main contact?
Maria Long, maria.long@city.ac.uk
Contact information
Public
City, University of London
Myddelton Street Building
Myddelton St
London
EC1R 4QU
United Kingdom
 ORCID ID |
0000-0002-6920-9676 |
|---|---|
| Phone | +44 (0)7966616082 |
| maria.long@city.ac.uk |
Study information
| Study design | Multicentre interventional assessor-blind randomized controlled trial |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Randomised controlled trial |
| Study setting(s) | Hospital |
| Study type | Treatment |
| Participant information sheet | Not available in web format, please use the contact details to request a patient information sheet |
| Scientific title | A brief psychological intervention to reduce self-harm in adolescence |
| Study acronym | SASH |
| Study hypothesis | Current study hypothesis as of 13/06/2023: Main hypothesis: a brief psychological intervention of therapeutic assessment and solution-focused follow-up contacts will reduce repeat self-harm in adolescents presenting with self-harm in an Emergency Department (ED). Further research questions: 1. Does the intervention improve secondary outcomes, i.e. repeat ED attendance for self-harm, wellbeing, symptoms of depression and anxiety, and negative experiences of care? 2. How is the intervention experienced by minority ethnic, same-sex attracted and gender-diverse adolescents and how should it be adapted to address ethnicity, sexuality and gender? 3. Is the intervention cost-effective? Previous study hypothesis: Main hypothesis: a brief psychological intervention of therapeutic assessment and solution-focused follow-up contacts will reduce repeat self-harm in adolescents presenting with self-harm in an Emergency Department (ED). Further research questions: 1. Does the intervention improve secondary outcomes, i.e. repeat ED attendance for self-harm, social functioning, emotional and behavioural difficulties, and negative experiences of care? 2. How is the intervention experienced by minority ethnic, same-sex attracted and gender-diverse adolescents and how should it be adapted to address ethnicity, sexuality and gender? 3. Is the intervention cost-effective? |
| Ethics approval(s) | Approved 23/08/2022, London - Riverside Research Ethics Committee (Ground Floor, Temple Quay House, 2 The Square, Bristol, BS1 6PN, UK; +44 (0)207 104 8150, +44 (0)207 104 8013; riverside.rec@hra.nhs.uk), ref: 22/LO/0400 |
| Condition | Self-harm in adolescents |
| Intervention | Current interventions as of 13/06/2023: Consenting participants are randomly allocated to one of two groups. Participants will be randomised to the intervention or control arm with a 1:1 ratio. The researchers will use randomized permuted blocks stratified by clinical site and whether the young person has presented to the emergency department more than once. Control group: Participants receive treatment as usual based on recommended NICE care which consists of a comprehensive psychosocial assessment, including assessment of needs, risk assessment and development of an integrated care and risk management plan; and relevant aftercare if there are ongoing safety concerns. Intervention group: Participants receive an initial session comprising of a therapeutic assessment, enhanced and personalised safety planning and up to six solution-focused rapid follow-up contacts. Carers may be invited to participate in joint sessions with the young person or offered one or two standalone sessions, organised around some or all of the following elements, according to need: signposting, psychoeducation around self-harm, emotional support, improving understanding of the SASH intervention. At 3 and 6 months after the ED presentation, adolescents will receive personalised letters from the practitioner to remind them of the safety plan and support networks. Therapeutic assessment and rapid solution-focused follow-up contacts after self-harm presentations are manualised. Previous interventions: Consenting participants are randomly allocated to one of two groups. Participants will be randomised to the intervention or control arm with a 1:1 ratio. The researchers will use randomized permuted blocks stratified by clinical site. Control group: Participants receive treatment as usual based on recommended NICE care which consists of a comprehensive psychosocial assessment, including assessment of needs, risk assessment and development of an integrated care and risk management plan; and relevant aftercare if there are ongoing safety concerns. Intervention group: Participants receive an initial session comprising of a therapeutic assessment, enhanced and personalised safety planning and three solution-focused rapid follow-up contacts. At 3 and 6 months after the ED presentation, adolescents will receive personalised letters from the practitioner to remind them of the safety plan and support networks. Therapeutic assessment and rapid solution-focused follow-up contacts after self-harm presentations are manualised. |
| Intervention type | Behavioural |
| Primary outcome measure | Number of self-harm episodes during the past month measured using a modified version of the Self-Injurious Thoughts and Behaviours Interview Short Form at baseline and 6 months |
| Secondary outcome measures | 1. Depression measured by the short version of the Moods and Feelings Questionnaire (MFQ) at baseline and 6 months 2. Anxiety measured by the Generalised Anxiety Disorder Assessment (GAD-7) at baseline and 6 months 3. Repeat ED attendance due to self-harm: identified in ED medical records, measured by count at baseline and 6 months 4. Death by suicide, i.e., cause of death is intentional self-harm or undetermined intent: NHS /local authority/coroner records, captured at 6 months 5. School attendance, obtained from the adolescent’s school, measured by count at baseline and 6 months 6. General wellbeing measured by the Warwick-Edinburgh Mental Wellbeing 14-item scale at baseline and 6 months 7. Experiences of care in A&E measured by the adapted Negative Effects Questionnaire (NEQ) at baseline 8. Separate dimensions of self-harm measured by the Self-Injurious Thoughts and Behaviors Interview (SITBI) Short Form): Number of reported episodes, in the past month, of the below, measured at baseline and 6 months: 8.1. Self-injury without suicidal intent 8.2. Suicide attempts 8.3. Self-injury with unclear or ambiguous intent 9. Dichotomized self-harm (any self-harm in the last month) measured by the SITBI Short Form at baseline and 6 months 10. Additional dimensions of self-harm measured by the SITBI Short Form: Number of reported episodes, in the last month, of the below, measured at 6 months: 10.1. Suicidal ideation 10.2. Suicide plan 10.3. Thoughts of non-suicidal self-injury 11. Number of self-harm episodes reported via text message survey (Ecological Momentary Assessment) every 2 weeks Resource use: 1. Health and quality-adjusted life-years (QALYs) measured and calculated using the Child Health Utility 9D (CHUD9) at baseline and 6 months 2. Cost of health and social care services use for children measured by the Client Service Receipt Inventory adapted for young people, collected by either the young person or parent/guardian (if applicable) according to participant preference, measured at baseline and 6 months 3. Costs of productivity lost and out-out-pocket service for guardians measured by the Client Service Receipt Inventory at baseline and 6 months Parent-reported data: 1. Guardians’ self-reported health-related quality of life measured using EQ-5D-5L at baseline and 6 months 2. Cost of health and social care services use for children as measured by Client Service Receipt as detailed above, at baseline and 6 months |
| Overall study start date | 05/05/2022 |
| Overall study end date | 30/09/2025 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Mixed |
| Lower age limit | 12 Years |
| Upper age limit | 19 Years |
| Sex | Both |
| Target number of participants | 144 |
| Participant inclusion criteria | Current inclusion criteria as of 13/06/2023: Children and adolescents age 12-19 years who present to recruiting emergency departments with self-harm OR suicidal ideation with recent (in the past month) self-harm Previous inclusion criteria: Children and adolescents age 12-19 years |
| Participant exclusion criteria | Current exclusion criteria as of 13/06/2023: 1. Intellectual disability as judged by a clinician 2. Currently experiencing an episode of psychosis 3. Registered with a GP outside of the mental health Trust catchment area 4. Need for more intensive care (e.g. tier 3.5 or an inpatient admission) Previous exclusion criteria: 1. Intellectual disability (IQ less than 70) 2. Diagnosis of psychosis 3. Registered with a GP outside of the mental health Trust catchment area 4. Need for more intensive care (e.g. tier 3.5 or an inpatient admission) |
| Recruitment start date | 11/05/2023 |
| Recruitment end date | 28/02/2025 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centres
Isleworth
TW7 6AF
United Kingdom
London
E9 6SR
United Kingdom
London
E13 8SL
United Kingdom
London
E1 1BB
United Kingdom
Uxbridge
UB8 3NN
United Kingdom
Harrow
HA1 3UJ
United Kingdom
London
SW10 9NH
United Kingdom
London
W2 1NY
United Kingdom
Sponsor information
University/education
Northampton Square
London
EC1V 0HB
England
United Kingdom
| Phone | +44 (0)207 040 5060 |
|---|---|
| ResearchSupport@city.ac.uk | |
| Website | https://www.city.ac.uk/ |
"ROR" |
https://ror.org/04489at23 |
Funders
Funder type
Charity
Private sector organisation / Trusts, charities, foundations (both public and private)
- Alternative name(s)
- The Kavli Trust, Kavli Trust, O. Kavli og Knut Kavlis Almennyttige Fond
- Location
- Norway
Results and Publications
| Intention to publish date | 30/04/2026 |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Data sharing statement to be made available at a later date |
| Publication and dissemination plan | Planned publication in a high-impact peer-reviewed journal. |
| IPD sharing plan | The data-sharing plans for the current study are unknown and will be made available at a later date |
Editorial Notes
15/04/2025: The overall study end date was changed from 30/04/2025 to 30/09/2025.
16/01/2025: The recruitment end date was changed from 31/12/2024 to 28/02/2025.
17/07/2024: The recruitment end date was changed from 31/07/2024 to 31/12/2024.
23/02/2024: The recruitment end date was changed from 01/02/2024 to 31/07/2024.
13/06/2023: The following changes were made to the study record:
1. The study hypothesis, interventions, inclusion and exclusion criteria were updated.
2. The recruitment start date was changed from 01/02/2023 to 11/05/2023.
24/05/2023: Internal review.
13/12/2022: Trial's existence confirmed by the HRA.
