Katrina Witt1, Daniela Pache de Moraes2, Tatiana Taylor Salisbury3, Ella Arensman4, David Gunnell5, Philip Hazell6, Ellen Townsend7, Kees van Heeringen8, Keith Hawton9. 1. Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK. 2. Discipline of Medicine, Pontifícia Universidade Católica do Paraná, Brazil. 3. Institute of Psychiatry, Psychology and Neurology, King's College London, London, UK; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 4. National Suicide Research Foundation and School of Public Health, University College Cork, Republic of Ireland. 5. School of Social and Community Medicine, University of Bristol, Bristol, UK. 6. Discipline of Psychiatry, Sydney Medical School, Sydney, Australia. 7. Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK. 8. Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Gent University, Gent, Belgium. 9. Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK. Electronic address: keith.hawton@psych.ox.ac.uk.
Abstract
BACKGROUND: Randomized controlled trials (RCTs) are the mainstay of evaluations of the efficacy of psychosocial interventions. In a recent Cochrane systematic review we analysed the efficacy of cognitive behavioural-based psychotherapies compared to treatment as usual (TAU) in adults who self-harm. In this study we examine the content and reporting quality of TAU in these trials and their relationship to outcomes. METHODS: Five electronic databases (CCDANCTR-Studies and References, CENTRAL, MEDLINE, EMBASE, and PsycINFO) were searched for RCTs, indexed between 1 January 1998 and 30 April 2015, of cognitive-behavioural interventions compared to TAU for adults following a recent (within six months) episode of self-harm. Comparisons were made between outcomes for trials which included different categories of TAU, which were grouped as: multidisciplinary treatment, psychotherapy only, pharmacotherapy only, treatment by primary care physician, minimal contact, or unclear. RESULTS: 18 trials involving 2433 participants were included. The content and reporting quality of TAU varied considerably between trials. The apparent effectiveness of cognitive behavioural psychotherapy varied according to TAU reporting quality and content. Specifically, effects in favour of cognitive-behavioural psychotherapy were strongest in trials in which TAU content was not clearly described (Odds Ratio: 0.29, 95% Confidence Interval 0.15-0.62; three trials) compared to those in which TAU comprised multidisciplinary treatment (Odds Ratio: 0.79, 95% CI 0.63 to 0.97; 12 trials). LIMITATIONS: The included trials had high risk of bias with respect to participant and clinical personnel blinding, and unclear risk of bias for selective outcome reporting. CONCLUSIONS: TAU content and quality represents an important source of heterogeneity between trials of psychotherapeutic interventions for prevention of self-harm. Before clinical trials begin, researchers should plan to carefully describe both aspects of TAU to improve the overall quality of investigations.
BACKGROUND: Randomized controlled trials (RCTs) are the mainstay of evaluations of the efficacy of psychosocial interventions. In a recent Cochrane systematic review we analysed the efficacy of cognitive behavioural-based psychotherapies compared to treatment as usual (TAU) in adults who self-harm. In this study we examine the content and reporting quality of TAU in these trials and their relationship to outcomes. METHODS: Five electronic databases (CCDANCTR-Studies and References, CENTRAL, MEDLINE, EMBASE, and PsycINFO) were searched for RCTs, indexed between 1 January 1998 and 30 April 2015, of cognitive-behavioural interventions compared to TAU for adults following a recent (within six months) episode of self-harm. Comparisons were made between outcomes for trials which included different categories of TAU, which were grouped as: multidisciplinary treatment, psychotherapy only, pharmacotherapy only, treatment by primary care physician, minimal contact, or unclear. RESULTS: 18 trials involving 2433 participants were included. The content and reporting quality of TAU varied considerably between trials. The apparent effectiveness of cognitive behavioural psychotherapy varied according to TAU reporting quality and content. Specifically, effects in favour of cognitive-behavioural psychotherapy were strongest in trials in which TAU content was not clearly described (Odds Ratio: 0.29, 95% Confidence Interval 0.15-0.62; three trials) compared to those in which TAU comprised multidisciplinary treatment (Odds Ratio: 0.79, 95% CI 0.63 to 0.97; 12 trials). LIMITATIONS: The included trials had high risk of bias with respect to participant and clinical personnel blinding, and unclear risk of bias for selective outcome reporting. CONCLUSIONS: TAU content and quality represents an important source of heterogeneity between trials of psychotherapeutic interventions for prevention of self-harm. Before clinical trials begin, researchers should plan to carefully describe both aspects of TAU to improve the overall quality of investigations.
Authors: Katrina G Witt; Sarah E Hetrick; Gowri Rajaram; Philip Hazell; Tatiana L Taylor Salisbury; Ellen Townsend; Keith Hawton Journal: Cochrane Database Syst Rev Date: 2021-04-22
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Authors: Katrina G Witt; Sarah E Hetrick; Gowri Rajaram; Philip Hazell; Tatiana L Taylor Salisbury; Ellen Townsend; Keith Hawton Journal: Cochrane Database Syst Rev Date: 2021-03-07
Authors: Patricia A Gooding; Daniel Pratt; Yvonne Awenat; Richard Drake; Rachel Elliott; Richard Emsley; Charlotte Huggett; Steven Jones; Navneet Kapur; Fiona Lobban; Sarah Peters; Gillian Haddock Journal: BMC Psychiatry Date: 2020-06-16 Impact factor: 3.630