Psychosocial interventions for self-harm in low-income and middle-income countries: systematic review and theory of change

• Published in: Social Psychiatry and Psychiatric Epidemiology Vol. 56; no. 10; pp. 1729 - 1750
• Main Authors: Aggarwal, Shilpa, Patton, George, Berk, Michael, Patel, Vikram
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2021; Springer; Springer Nature B.V
• Subjects: Analysis; Behavior therapy; Behavioral health care; Cognition & reasoning; Cognitive Behavioral Therapy; Cognitive therapy; Developing Countries; Epidemiology; Evaluation; Humans; Income; Intervention; Low income groups; Medicine; Medicine & Public Health; Original Paper; Psychiatry; Psychological aspects; Psychosocial Intervention; Psychotherapy; Randomized Controlled Trials as Topic; Risk assessment; Self destructive behavior; Self-Injurious Behavior - therapy; Systematic review; Taxonomy; Psychosocial interventions; Theory of change; Low- and middle-income countries; Self-harm
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-020-02005-5

Purpose To synthesise the evidence on effectiveness, acceptability and the delivery mechanisms of psychosocial interventions for self-harm in low and middle income countries and to develop a pathway of change specific for self-harm interventions. Method Studies reporting one or more patient or implementation outcomes of a psychosocial intervention targeting self-harm and conducted in low- and middle-income countries were included. Taxonomy of treatment components and a theory of change map was created using information from the studies. Results We identified thirteen studies including nine randomised controlled trials (RCT), three non-RCTs, and a single experimental case design study. A single study using postcard contact and another using cognitive behaviour therapy (CBT) reported a reduction in self-harm attempts. Suicidal ideations were significantly reduced with CBT, volitional help sheets and postcard contact in different studies. Suicide risk assessment, problem solving and self-validation were the most frequently used elements in interventions. Goal-setting was the technique used most commonly. Cultural adaptations of psychotherapies were used in two studies. High attrition rates in psychotherapy trials, limited benefit of the delivery of treatment by non-specialist providers, and variable benefit observed using phone contact as a means to deliver intervention were other important findings. Conclusion There were no strong positive findings to draw definitive conclusions. Limited availability and evidence for culturally adapted interventions in self-harm, lack of evaluation of task sharing using evidence based interventions as well as a dearth in evaluation and reporting of various intervention delivery models in low- and middle-income countries were major literature gaps.