Reducing self-harm in adolescents: the RISA-IPD individual patient data meta-analysis and systematic review

Article history

The contractual start date for this research was in June 2019. This article began editorial review in September 2022 and was accepted for publication in October 2023. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The Health Technology Assessment editors and publisher have tried to ensure the accuracy of the authors’ article and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this article.

Copyright statement

Copyright © 2024 Cottrell et al. This work was produced by Cottrell et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.

2024 Cottrell et al.

Study design

We conducted a systematic review and IPD-MA of RCTs of therapeutic interventions to reduce repeat self-harm in adolescents with a history of self-harm who had consequently presented to clinical services. We registered the systematic review and IPD-MA protocol in PROSPERO (registration number CRD42019152119)13 and a published protocol provides an overview of our planned methods. 14

Inclusion criteria

Studies

All RCTs, from the first available study, with any randomised design, length of follow-up and quality, in which data relating to self-harm or suicide attempts have been collected.

We included studies in which only a subset of participants met our eligibility criteria where we were able to obtain IPD for eligible participants: studies with only a subset aged 11–18, or not all having self-harmed at least once prior to randomisation. Studies with ˂ 20 eligible participants were excluded to ensure the logistical effort in obtaining, cleaning and organising the data was commensurate with the contribution of the dataset to the analysis.

Selection methods

All titles and abstracts were initially reviewed independently by two reviewers (DC and AWH) within Covidence. The full text of any potentially eligible record was then examined independently by the same reviewers. Disagreements in screening decisions were discussed by reviewers and if agreement could not be reached, adjudicated by a further reviewer (RW).

We initially included protocols in the title/abstract screening and any other papers that were related to the main study paper to ensure a complete set of data as possible and to assist in finding study contact persons.

Where records were identified in any of the searches, but it was unclear from the study publication if they met our eligibility criteria, a clarification process was followed. Initially, additional study publications, published study protocols and/or trial registrations were sought. If this did not enable an eligibility decision to be made, direct contact was made with the study authors to seek further information. Strenuous efforts were made to establish contact, starting with e-mails to lead and corresponding authors. If this was not successful, we sent systematic e-mails to all other authors, conducted internet searches for authors who might have moved location, contacted heads of departments and used informal networks. Despite this it was not always possible to achieve successful contact and clarification.

Data collection process

Once contact details for study authors were established, a short letter of invitation accompanied by a summary of the project was sent, asking for agreement in principle to share data and inviting them to join our Study Collaborative Group (see Report Supplementary Material 1). This often led to lengthy discussion about the ethics and practicalities of data-sharing. Study authors were informed that if they had specific concerns about sharing some data items it would be possible to share a reduced dataset otherwise it would preclude involvement in the project.

In line with best practice, a formal data-sharing agreement (DSA) was drawn up for the study by the Legal Team at the Research and Innovation Service, University of Leeds (see Report Supplementary Material 1). This included a detailed list of the data we were requesting. Once study authors had agreed in principle to data-sharing, a formal request to share IPD and the DSA itself were sent to each study lead.

Once signed DSAs had been obtained, study authors were sent details of how to transfer IPD securely via the Secure File Transfer service to the Clinical Trials Research Unit (CTRU) at the University of Leeds.

Participating study authors were asked to provide pseudonymised (without identifying data) datasets in whatever format was convenient to them, along with data dictionaries, original statistical analysis plans and relevant statistical programming code, where possible. Data collection was prioritised for the primary outcome repetition of self-harm.

A copy of the raw data obtained from each study was saved in a restricted folder on receipt, prior to any modification of the data. Data were read into SAS and translated into English where required (Kaess 2019, Morthorst 2012).

Where IPD were not available, aggregated data (number of participants/events, mean, standard deviation) were extracted from study reports and publications by AWH and verified by DS. We contacted authors of studies where the full sample were eligible for further information where outcomes were collected but suitable aggregated data were not reported.

All information collected during the study was kept strictly confidential. The CTRU complies with all aspects of the 2018 Data Protection Act, which incorporates the European Union General Data Protection Regulation. At the end of the study, original datasets provided by collaborating trialists will be destroyed and the study dataset securely archived at the CTRU for a minimum of 5 years.

All principal study authors were asked to join a study collaborative group as recommended by the Cochrane Collaboration. 25 The group met virtually on two occasions. Early in the study to discuss a presentation of analysis plans, and later to discuss findings and their interpretation.

Data items

We sought the IPD, including baseline participant demographic and clinical data, details of therapeutic intervention, and outcomes as outlined in our protocol14 and in detail in the Report Supplementary Material 1. Individual study datasets were reformatted, and common variables derived to obtain a harmonised IPD dataset. Further detail relating to the methods and results of standardising and translating variables within the IPD datasets to ensure common scales and measurements across studies, and IPD integrity are described elsewhere.

Risk of bias in individual studies

We used version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB2) to assess ROB of all eligible studies. 26 Each study was rated by two assessors independently (DC and either FM, AT or ED). Assessors reviewed the primary trial publication and relevant trial registrations and associated protocol and methods papers. If disagreements could not be resolved a third assessor adjudicated (AWH). A key element of RoB2 relates to missing outcome data. In 10 of our eligible studies, outcome data had been collected in meaningfully different ways. For example, in the SHIFT Study,27 the primary outcome was obtained from routinely collected hospital data, whereas secondary outcomes were obtained from researcher interviews with participants. The primary outcome was available for almost all (96%) of the large (832) sample, but secondary outcomes were only available for 40–60% of the sample. We therefore completed up to two RoB2 assessments for each study, one for each method of data collection, for example where the primary self-harm outcome had been collected via hospital or medical records and secondary outcomes (depression, suicidal ideation, etc.) had been collected via self-report.

In line with PRISMA IPD guidance, following receipt of IPD, further adjustments were made to ROB ratings where information became available that was not in the published trial manuscripts. 12

Further methods

An overview of methods relating to the specification of outcomes and effect measures, synthesis, exploration of variation in effects, ROB across studies, and additional analyses are provided in our protocol paper and will be reported in more detail elsewhere in a statistical analysis plan publication.

Results of searches

The PRISMA diagram (see Figure 1) illustrates the number of records identified during the different searches and the number of records and studies excluded during the screening processes. A total of 3690 unique records related to 3610 studies, were identified through searching sources directly for RCTs, harvesting RCT references from systematic reviews and checking the reference lists of included studies. Following title and abstract screening 366 records related to 286 studies were eligible for full-text screening.

FIGURE 1.

PRISMA flow chart.

Following full-text review, we identified 73 studies that met our inclusion criteria, including 18 studies where the full sample was eligible, 11 studies where a part of the sample was eligible (due to participants age or prior self-harm status) and 44 studies where further enquiries were necessary to establish eligibility. Of these, 10 studies were confirmed as eligible where a part of the sample was eligible, 20 were confirmed as ineligible, 2 were ongoing studies, and in 12 cases it was not possible to confirm eligibility (we were unable to trace authors in nine cases and in three the data were no longer available to establish eligibility). The 2 ongoing and 12 unconfirmed studies excluded at this stage are summarised in Appendix 3.

At the end of this process, we identified and thus included 39 studies, where we sought IPD, of which the full sample of participants were eligible in 18 studies and a partial sample of participants were eligible in 21 studies (see Table 2, Figures 2 and 3).

FIGURE 2.

Eligible studies, sample sizes and potential data availability.

FIGURE 3.

Eligible participants in partial sample eligible studies.

Individual patient data-sharing

Following our initial search in August 2019, the first DSA requests were sent in October 2019. The first signed DSA was received the same month while the last was not received until December 2020.

As shown in Figure 1, we were successful in obtaining DSAs and IPD in 28 (72%) of the 39 studies. Of the 18 full sample eligible studies, we obtained agreement for 11 (61%) studies, however: we were told that datasets for four studies were lost, these were all studies conducted before 2005; in one study the author was clear that their original ethical approval did not allow for data-sharing; and in two others the authors were concerned about permission to share and the possibility of participant identification. Of the 21 partial sample eligible studies, we obtained agreement for 17 (81%) studies, however, the dataset was lost for one study, in another study the author was clear that their original ethical approval did not allow for data-sharing, and in another the author was concerned about permission to share because of the possibility of participant identification. Further details, concerning reasons for not sharing data, are in the footnote to Table 2.

Having obtained signed DSAs our first request for IPD sharing went out in May 2020, the first dataset was received in June 2020 and the last in May 2021. IPD were cleaned and verified on receipt and data were harmonised between May 2020 and finished in March 2022. Further details of IPD integrity and harmonisation in practice are reported elsewhere.

In the process of cleaning and verifying the datasets, two studies were excluded from the final analysis (see PRISMA diagram, Figure 1). One study was an unpublished pilot and had insufficient data to derive the variables we needed for our study. In the second, the study had started as a RCT but difficulties in recruitment meant that randomisation was halted after 22 participants were recruited and thereafter participants could choose their intervention. Those 22 participants were eligible for our study but although the full dataset was available within the NIMH Data Repository, it proved impossible to identify the randomised subsample.

We concluded this stage of the review with IPD from 26/39 (66.7%) of eligible studies, providing data for 3448/4600 (75%) eligible participants (see Figures 2 and 3). These included: 10/18 (55.6%) studies in which the full study sample was eligible providing data for a total 1665/2383 (69.9%) eligible participants (range 29–832); and 16/21 (76.2%) studies where a partial sample of study participants was eligible, providing data for a total 1783/2217 (80.4%) additional eligible participants (range 35–549).

In addition, published aggregated data from seven of the full sample eligible studies will be included where possible in our secondary IPD plus aggregated meta-analysis (contributing an additional 698 participants, range 42–173).

In the five studies where a partial sample was eligible, but aggregated data were not available, we estimated 434 eligible, randomised, participants from the total 914 participants but without IPD it was not possible to confirm exactly how many participants would have been eligible, or include the participants in IPD or aggregate datasets.

Study characteristics

Table 2 provides an overview of study characteristics, and Table 3 provides a comparison of study characteristics for studies with and without IPD. The majority of studies evaluated effectiveness (76.9%) as opposed to pilot or feasibility (23.1%) and were 2-arm RCTs (87.2%) with three 2-arm Zelen RCTs, one 2-arm cluster RCT and one 3-arm RCT/patient preference design.

A greater proportion of studies without IPD were from the USA (61.5%) compared to studies that did provide IPD (26.9% from the USA), and studies without IPD tended to have been published earlier (median 13 vs. 10 years). IPD was obtained for all studies rated as low ROB overall, with a greater proportion of studies rated as high ROB where IPD were not obtained (38.5% vs. 11.5%).

Risk of bias within studies

The results of the ROB assessment can be seen in Figure 4 and Table 3. For our primary outcome, repetition of self-harm, only six studies were rated as low ROB (Cottrell 2018; Esposito Smythers 2019; Hatcher 2011 and 2015; O’Connor 2017 and Tyrer 2003) with eight rated as high risk (Brent 2009, Carter 2005, Cooney 2010, Cotgrove 1995, Diamond 2014, Donaldson 2005, Robinson 2012, Spirito 2002). The small number of low-risk studies was largely because most outcomes were via self-report from non-blinded participants (Domain 4) and most trials did not have pre-specified, published, analysis plans (Domain 5).

FIGURE 4.

Summary of ROB ratings.

Studies where we did not have IPD, tended to be rated as showing more concerns (see Table 3), with the larger differences being in D4, measurement of the outcome (42% rated low risk if we had IPD; 8% rated low risk if not), D5 selection of the reported result (31% vs. 0%) and overall ROB (23% vs. 0%).

From the thirteen studies using health records for the RISA primary self-harm outcome (either alone or in combination with self-report), six studies were rated as low ROB (as reported above), five as showing some concerns, and two were rated as high ROB (Cotgrove 1995; Carter 2005). Ten of these studies also collected secondary outcomes via self-report/interview; none remained as low risk when ROB ratings were made for secondary outcomes, two studies were rated as high risk (Morthorst 2012; Tyrer 2013) and four (Cottrell 2018; Esposito 2019; Hatcher 2011; Hatcher 2015) moved from low risk to some concerns.

Summary of evidence

This paper reports on the methods employed for searches, study screening and selection, and ROB assessment, with an overview of the outputs of the searching, selection, and quality assessment processes. We have reported in accordance with PRISMA-IPD guidelines. 12 The statistical methods and the results of the IPD and aggregate meta-analyses will be reported in separate peer-reviewed publications.

Strengths and limitations

We adopted a detailed two-step search approach that enabled a rigorous identification of RCTs. Harvesting RCTs from existing systematic reviews (search 1) and conducting supplementary literature searches for recent or unpublished RCTs (search 2) to fill gaps from search 1, limited the screening workload for reviewers. Analysis of the 39 eligible studies revealed 30 were found from harvesting RCTs from systematic review and 9 were found from the RCT update and ‘gap-filling’ searches, including one unpublished study (Diamond, 2014) discovered by following up on a trial registration record.

Our rigorous inclusion criteria and inclusion of trial registrations in the search, allowed us to minimise selection and publication bias. All records were screened independently by two authors with a third adjudicating if agreement could not be reached, enhancing the credibility and trustworthiness of findings. We were able to ensure our included studies were representative of clinical populations as a key inclusion criterion was the requirement for self-harm prior to randomisation, ensuring that studies that recruited from non-clinical samples (e.g. by screening healthy populations for suicidal ideation) were excluded.

An important strength of this study is that the IPD approach allowed us to include studies where only a part of the sample was eligible. We were able to identify 21 studies with an additional 1783 participants, more than in the studies with full sample eligibility where we had IPD. The most recent Cochrane review9 included only 17 trials with a total of 2280 participants.

We adopted a similarly rigorous approach to ROB ratings, using the well-established Cochrane tool, with each study rated independently by two authors with a third adjudicating if agreement could not be reached. Our decision to carry out two separate ratings on studies that used two different methods of data collection appears justified by our findings. Thirteen studies used health records for our primary self-harm outcome (either alone or in combination with self-report), of these six were rated as low ROB, five as showing some concerns, and two as high risk for the primary outcome. However, when ratings were made for secondary outcomes collected via self-report/interview, no studies remained as low risk, and two studies were moved to a rating of high ROB.

Working with our collaborative group of study authors added strength to the process. Authors of the studies included were able to make many helpful suggestions related to interpretation of the findings in relation to their particular study and its context.

There were, however, several limitations in this review. A main limitation was missing IPD, although for the full sample eligible studies we can at least include data in our secondary IPD plus aggregate meta-analysis. It is unfortunate that some authors felt unable to share data with us. Although we were seeking anonymised data and were willing to receive a reduced dataset, if study authors had concerns about participant identification, some authors felt the risk of sharing data and participants being identified was too high. Others informed us that they did not believe their original ethical approval would allow them to share anonymised data.

We were not able to obtain IPD for two important studies often cited in systematic reviews and meta-analyses as showing evidence for effectiveness of DBT. Neither of these was rated in our study as being of low ROB. The lack of availability of data that is being used in treatment recommendations is a potential concern.

Also of concern is the lack of replication of findings, especially so given that the one occasion when this occurred, Hazell et al. ’s32 replication of Wood et al. ,44 resulted in the earlier findings being contradicted.

For those authors who were willing to share data, obtaining agreement to share IPD and then obtaining the data and checking its integrity and alignment with already published results, was not straightforward. Clinical investigators were largely supportive of the aims of this project, but faced several challenges were faced. In most cases the DSA had to be signed by somebody authorised to make such decisions on behalf of the institution, not the study authors themselves. Identifying the appropriate person, and then persuading them to prioritise the DSA proved problematic in several cases. The DSA itself was also a reason for delay. Understandably, study authors outside the UK needed an agreement that complied with local legislation and governance standards. This necessitated rewriting the agreement, which in turn had to be reviewed and approved in its revised form by the legal team at the University of Leeds: some DSAs went through multiple iterations before agreement could be reached.

Scutt et al. 66 have written about their experience of obtaining IPD for two collaborative analyses. This study appears to have fared better in terms of percentage of datasets shared (29/39, 72% for this study; 78/391, 20% for Scutt et al.) but faced many of the same problems such as difficulty in contacting authors, concerns about the appropriateness of sharing, and long delays between initial requests for data and the actual sharing of that data.

The other potential limitations such as types of intervention and control groups, geographical distribution, sample size and data integrity will be discussed in a subsequent paper that will present the results of the IPD MA.

Conclusions and implications

An IPD MA provides more reliable estimates of the effects of therapeutic interventions for self-harm than conventional meta-analyses that rely on aggregated information and reported analyses. 11 It has greater potential power to detect interaction between treatment, clinical and socio-demographic characteristics, and it allows subsets of participants from trials with wide inclusion age ranges to be included.

Obtaining IPD for such analyses is possible but very time-consuming, despite clear guidance from funding bodies that researchers should share data appropriately. 67,68 In this study it is described how the researchers went about this and included copies of their approaches to potential collaborators and of their DSA in the hope that this will help other researchers. Timelines were set out to aid other researchers in planning similar projects. This research took place during the COVID-19 pandemic, and this may have added to delays but the experience of others,66 suggests that these are very time-consuming undertakings.

To facilitate future data-sharing more attention needs to be paid to seeking appropriate consent from study participants for (pseudo) anonymised data-sharing and institutions need to collaborate on template DSAs.

The relatively low number of studies rated as low ROB also suggest that researchers and funders need to consider issues of research design more carefully, although this may be improving with time.

Given the significant potential benefits of the IPD approach this study will hopefully inform future researchers in conducting similar studies.

Contributions of authors

David Cottrell (https://orcid.org/0000-0001-8674-0955) (Professor of Child and Adolescent Psychiatry) provided initial input for the study design, grant application and protocol; reviewed titles, abstracts and full text where relevant, and contributed to the ROB reviews; and is the guarantor of the review.

Alex Wright-Hughes (https://orcid.org/0000-0001-8839-6756) (Principal Statistician) provided initial input for the study design, grant application and protocol and reviewed titles, abstracts and full text where relevant, and contributed to the ROB reviews.

Amanda Farrin (https://orcid.org/0000-0002-2876-0584) (Professor of Clinical Trials and Evaluation of Complex Interventions) provided initial input for the study design, grant application and protocol.

Rebecca Walwyn (https://orcid.org/0000-0001-9120-1438) (Associate Professor of Clinical Trials Methodology) provided initial input for the study design, grant application and protocol.

Faraz Mughal (https://orcid.org/0000-0002-5437-5962) (General Practitioner and NIHR Doctoral Fellow) reviewed titles, abstracts and full text where relevant, and contributed to the ROB reviews.

Alex Truscott (https://orcid.org/0000-0002-5952-8745) (Research and Policy Officer) reviewed titles, abstracts and full text where relevant, and contributed to the ROB reviews.

Emma Diggins (https://orcid.org/0000-0002-3325-3659) (Consultant Child and Adolescent Psychiatrist and NIHR Doctoral Research Fellow) reviewed titles, abstracts and full text where relevant, and contributed to the ROB reviews.

Donna Irving (https://orcid.org/0000-0001-8439-6038) (Medical, Healthcare and AFBI Librarian) designed and carried out the literature searches.

Peter Fonagy (https://orcid.org/0000-0003-0229-0091) (Professor of Contemporary Psychoanalysis and Developmental Science) provided initial input for the study design, grant application and protocol.

Dennis Ougrin (https://orcid.org/0000-0003-1995-5408) (Professor of Child and Adolescent Psychiatry and Global Mental Health) provided initial input for the study design, grant application and protocol.

Daniel Stahl (https://orcid.org/0000-0001-7987-6619) (Reader in Biostatistics) provided initial input for the study design, grant application and protocol.

Judy Wright (https://orcid.org/0000-0002-5239-0173) (Senior Information Specialist) provided initial input for the study design, grant application and protocol; designed and carried out the literature searches.

All the authors read, had the opportunity to comment on, and approved the final manuscript.

Acknowledgements

The authors would like to thank all the Chief Investigators of the studies identified in the search, and their team colleagues, including organisational legal departments for their help in clarifying issues of eligibility and agreeing data-sharing agreements. They would also like to thank the members of our Independent Steering Committee and the PPI representatives who assisted us throughout. They also thank William Cragg, Regulatory and Governance Affairs Officer at the Clinical Trials Research Unit at Leeds, and Lucy Sheehan, administrative assistant to the project for their helpful contributions. Special thanks are due to Ms Karen Ogier, Contracts Manager, Research and Innovation Service Legal Team, University of Leeds. Without her help with agreeing data-sharing agreements this study would not have been possible.

Data-sharing statement

The data from the individual studies in this report were obtained under formal data-sharing agreements which do not allow further sharing of the data. Any queries should be submitted to the corresponding author.

Ethics statement

Formal ethical approval for the project was provided by the University of Leeds, Faculty of Medicine and Health Ethics Committee – MREC 18-098.

Information governance statement

The project was sponsored by the University of Leeds (Grant Number: RG.PSRY.116370). An independent Study Steering Group including independent clinical and statistical experts with relevant expertise and a PPI representative provided independent oversight of the project. Under the Data Protection legislation, the University of Leeds is the Data Controller, and you can find out more about how we handle personal data, including how to exercise your individual rights and the contact details for our Data Protection Officer here: https://dataprotection.leeds.ac.uk/.

Disclosure of interests

Full disclosure of interests: Completed ICMJE forms for all authors, including all related interests, are available in the toolkit on the NIHR Journals Library report publication page at https://doi.org/10.3310/GTNT6331.

Primary conflicts of interests: David Cottrell was Co-Chair of the NIHR Advanced Fellowship Panel and Chair of TSC BeST (PHR NIHR 12/211/54) and IVY DMEC (NIHR127408) at the time the award that funded this research was granted. Alex Wright-Hughes has received grants from NIHR (HTA NIHR131334, 17/117/11 and PGfAR RP-PG-1016-20005). Amanda Farrin was member of the NIHR funding committee (HTA Clinical Trials and Evaluation until Nov 2018), the NIHR CTU Standing Advisory Committee, and is a NIHR Senior Investigator. She has received grants from NIHR (Infrastructure and methodological funding: NIHR155210 and NIHR135115; HTA: NIHR156616, NIHR131334, 17/33/03, 16/162/01, 15/130/11 and 15/43/07; HS&DR: NIHR151848, NIHR132197, 16/04/13 and 16/04/06; PGfAR: RP-DG-0218-10001, RP-PG-0617-20001, RP-PG-1016-20005, RP-PG-1016-20007, RP-PG-0216-20003, RP-PG-0615-20019 and RP-PG-0514-20009; EME: 15/74/01; MRC/NIHR: TMRP/WG/15 and HRB-TMRN-2017-1). Rebecca Walwyn declares NIHR Advanced Fellowship NIHR301709 and has received grants from NIHR (PGfAR: RP-PG-1210-12010; NIHR Infrastructure: NIHR30485; HS&DR: 16/04/13), MRC (MR/P026761/1) and EPSRC (EP/W001020/1). Faraz Mughal declares NIHR Doctoral Fellowship NIHR300957, Chair of DMEC NIHR ASSURED programme RP-PG-0617-20004, Member SSC CASCADE study NIHR RfPB NIHR203506 and Co-lead of NIHR School for Public Health Research PHRESH consortium Public Mental Health Theme. Faraz Mughal is also a member of the current NICE self-harm clinical guideline development committee. Emma Diggins declares NIHR Doctoral Fellowship NIHR302297. Peter Fonagy has received funding from the Applied Research Collaboration North Thames and provides training on self-harm to the Anna Freud National Centre for Children and Families where he is CEO. Dennis Ougrin has received grants from NIHR (NIHR127408) and MRC (MR/R004927/1). Judy Wright has received grants and income from NIHR (PGfAR: RP-PG-1016-20003 and RP-PG-1016-20005; EME: NIHR129268; HTA: 17/83/01, 15/57/66, NIHR128815 and 11/25/03; i4i: NIHR202909 and NIHR202164; HS&DR: NIHR131506, NIHR151848 and NIHR131016; PHR: NIHR135081; NHSX AI: AI_AWARD02266; GHRG: 17/63/130; RIGHT: NIHR200806.

Department of Health and Social Care disclaimer

This publication presents independent research commissioned by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, MRC, NIHR Coordinating Centre, the Health Technology Assessment programme or the Department of Health and Social Care.

This article was published based on current knowledge at the time and date of publication. NIHR is committed to being inclusive and will continually monitor best practice and guidance in relation to terminology and language to ensure that we remain relevant to our stakeholders.

Study registration details

This study is registered as PROSPERO CRD42019152119.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/117/11.

About this article

The contractual start date for this research was in June 2019. This article began editorial review in September 2022 and was accepted for publication in October 2023. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The Health Technology Assessment editors and publisher have tried to ensure the accuracy of the authors’ article and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this article.

Copyright

Copyright © 2024 Cottrell et al. This work was produced by Cottrell et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.

Introduction

The search strategies listed here were used to identify systematic reviews of interventions for self-harm in adolescents.

Information resources searched

Cochrane Database of Systematic Reviews (Wiley) Issue 6 of 12, June 2019

EMBASE Classic + EMBASE (Ovid) 1947 to 2019 June 20

Epistemonikos www.epistemonikos.org/

Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily 1946 to June 20, 2019

PROSPERO www.crd.york.ac.uk/prospero/

PsycInfo (Ovid) 1806 to June Week 2 2019

Search strategies

Cochrane Database of Systematic Reviews Issue 6 of 12, June 2019

Date searched: 6 June 2019

Records found: 8

ID Search Hits

1. #1 MeSH descriptor: [Self-Injurious Behavior] this term only 271

2. #2 MeSH descriptor: [Suicide] this term only 601

3. #3 MeSH descriptor: [Suicide, Attempted] this term only 360

4. #4 MeSH descriptor: [Drug Overdose] this term only 127

5. #5 MeSH descriptor: [Self Mutilation] this term only 33

6. #6 (selfharm* or selfinjur* or selfinflict* or ‘self harm*’ or ‘self injur*’ or ‘self inflict*’):ti 284

7. #7 ((self or themsel* or onesel*) near/2 (aggress* or harm* or cutt* or immolat* or inflict* or injur* or mutilat* or poison* or damag* or destruct*)):ti 379

8. #8 (auto near/2 (aggress* or mutilat*)):ti 4

9. #9 (automutilat* or ‘auto mutilation*’ or autoaggress* or ‘auto agress*’):ti 4

10. #10 suicid*:ti 1481

11. #11 (parasuicid* or para-suicid*):ti 31

12. #12 ((deliberat* or intentional or intended) near/2 (overdos* or poison* or self poison*)):ti 79

13. #14 (overdos* or poison):ti 222

14. #15 NSSI:ti 0

15. #16 (headbang* or head-bang*):ti 0

16. #17 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 2423

17. #18 MeSH descriptor: [Adolescent] this term only 99,786

18. #19 (teenage* or adolescen* or youth)  134,000

19. #20 MeSH descriptor: [Young Adult] this term only 218

20. #21 (young* adj (people* or person* or adult* or m?n or wom?n)) 1132

21. #22 MeSH descriptor: [Child] this term only 1093

22. #23 (school* adj2 (pupil* or student*)).tw. 9485

23. #24 ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) adj (yr? or year?)).tw. 9484

24. #25 ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) adj4 (old or age?)) 354

25. #26 (teen or teens or juvenil*) 4791

26. #27 #18 or #19 or #20 or #21 or #22 or #23 or #24 or #26 143,881

27. #28 #17 and #27 730

Limit to Cochrane Database of Systematic Reviews 8

EMBASE Classic + EMBASE (Ovid) 1947 to 2019 June 20

Date searched: 21 June 2019

Records found: 322

------------ ------------- -------------- ------------ ----------- --

1. *automutilation/ (7762)

2. *suicide/ or *suicide, attempt/ (40,508)

3. *Drug Overdose/ (9293)

4. (selfharm* or selfinjur* or selfinflict* or ‘self harm*’ or ‘self injur*’ or ‘self inflict*’).ti. (5763)

5. ((self or themsel* or onesel*) adj2 (aggress* or harm* or cutt* or immolat* or inflict* or injur* or mutilat* or poison* or damag* or destruct*)).ti. (8760)

6. (auto adj (aggress* or mutilat*)).ti. (75)

7. (automutilat* or ‘auto mutilation*’ or autoaggress* or ‘auto agress*’).ti. (292)

8. suicid*.ti. (48,944)

9. (parasuicid* or para-suicid*).ti. (418)

10. ((deliberat* or intentional or intended) adj2 (overdos* or poison* or self poison*)).ti. (535)

11. (poison adj2 (deliberat* or intentional or intended)).ti. (4)

12. (overdos* adj2 (deliberat* or intentional or intended)).ti. (191)

13. NSSI.ti. (56)

14. (headbang* or head-bang*).ti. (86)

15. or/1-14 (74,633)

16. Adolescent/ (1,577,703)

17. (teenage* or adolescen* or youth).tw. (406,857)

18. young adult/ (295,046)

19. (young* adj (people* or person* or adult* or m?n or wom?n)).tw. (240,389)

20. child/ (1,862,127)

21. (school* adj2 (pupil* or student*)).tw. (25,707)

22. (teen or teens or juvenil*).tw. (113,717)

23. ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) adj4 (old or age?)).tw. (989,096)

24. ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) adj (yr? or year?)).tw. (750,109)

25. or/16-24 [Adolescents] (3,888,109)

26. 15 and 25 (20,956)

27. ((systematic adj2 review*) or meta-analys* or ‘meta analysis’ or ‘meta-regression’ or ‘meta regression’).ti. (199,945)

28. limit 26 to (meta analysis or ‘systematic review’) (276)

29. 26 and 27 (189)

30. 28 or 29 [SRs + Self Harm + Adolescents] (322)

Epistemonikos www.epistemonikos.org/

Date searched: 6 June 2019

Records found: 392

1. (advanced_title_en:(advanced_title_en:(advanced_title_en:(advanced_title_en:(Self-Injurious Behavior)) OR advanced_title_en:(suicid*) OR advanced_title_en:(Drug Overdose) OR advanced_title_en:((selfharm* OR selfinjur* OR selfinflict* OR ‘self harm*’ OR ‘self injur*’ OR ‘self inflict*’).) OR advanced_title_en:(((self OR themsel* OR onesel*) AND (aggress* OR harm* OR cutt* OR immolat* OR inflict* OR injur* OR mutilat* OR poison* OR damag* OR destruct*)).)) OR advanced_title_en:((automutilat* OR ‘auto mutilation*’ OR autoaggress* OR ‘auto agress*’)) OR advanced_title_en:((parasuicid* OR para-suicid*)) OR advanced_title_en:(((deliberat* OR intentional OR intended) AND (overdos* OR poison* OR self poison*))) OR advanced_title_en:((poison AND (deliberat* OR intentional OR intended))) OR advanced_title_en:((overdos* AND (deliberat* OR intentional OR intended)).) OR advanced_title_en:(NSSI) OR advanced_title_en:((headbang* OR head-bang*))) OR advanced_abstract_en:(advanced_title_en:(advanced_title_en:(advanced_title_en:(Self-Injurious Behavior)) OR advanced_title_en:(suicid*) OR advanced_title_en:(Drug Overdose) OR advanced_title_en:((selfharm* OR selfinjur* OR selfinflict* OR ‘self harm*’ OR ‘self injur*’ OR ‘self inflict*’).) OR advanced_title_en:(((self OR themsel* OR onesel*) AND (aggress* OR harm* OR cutt* OR immolat* OR inflict* OR injur* OR mutilat* OR poison* OR damag* OR destruct*)).)) OR advanced_title_en:((automutilat* OR ‘auto mutilation*’ OR autoaggress* OR ‘auto agress*’)) OR advanced_title_en:((parasuicid* OR para-suicid*)) OR advanced_title_en:(((deliberat* OR intentional OR intended) AND (overdos* OR poison* OR self poison*))) OR advanced_title_en:((poison AND (deliberat* OR intentional OR intended))) OR advanced_title_en:((overdos* AND (deliberat* OR intentional OR intended)).) OR advanced_title_en:(NSSI) OR advanced_title_en:((headbang* OR head-bang*)))) AND (advanced_title_en:((teenage* OR adolescen* OR youth OR young OR pupil OR student OR schoolchild OR child OR teen* OR juvenil*) OR ((‘11’ OR ‘12’ OR ‘13’ OR ‘14’ OR ‘15’ OR ‘16’ OR ‘17’ OR ‘18’ OR ‘19’) AND (year? OR yr? OR old OR age?)).) OR advanced_abstract_en:((teenage* OR adolescen* OR youth OR young OR pupil OR student OR schoolchild OR child OR teen* OR juvenil*) OR ((‘11’ OR ‘12’ OR ‘13’ OR ‘14’ OR ‘15’ OR ‘16’ OR ‘17’ OR ‘18’ OR ‘19’) AND (year? OR yr? OR old OR age?)).)) [Filters: classification = systematic-review, protocol = no] 392

Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily 1946 to June 20, 2019

Date searched: 21 June 2019

Records found: 346

--------- ------------ ------------- ------------- ------------- ----

1. Self-Injurious Behavior/ (7200)

2. suicide/ or suicide, attempted/ (51,983)

3. Drug Overdose/ (10,369)

4. Self Mutilation/ (3180)

5. (selfharm* or selfinjur* or selfinflict* or ‘self harm*’ or ‘self injur*’ or ‘self inflict*’).ti. (4978)

6. ((self or themsel* or onesel*) adj2 (aggress* or harm* or cutt* or immolat* or inflict* or injur* or mutilat* or poison* or damag* or destruct*)).ti. (7491)

7. (auto adj (aggress* or mutilat*)).ti. (75)

8. (automutilat* or ‘auto mutilation*’ or autoaggress* or ‘auto agress*’).ti. (222)

9. suicid*.ti. (40,905)

10. (parasuicid* or para-suicid*).ti. (332)

11. ((deliberat* or intentional or intended) adj2 (overdos* or poison* or self poison*)).ti. (413)

12. (poison adj2 (deliberat* or intentional or intended)).ti. (3)

13. (overdos* adj2 (deliberat* or intentional or intended)).ti. (138)

14. NSSI.ti. (52)

15. (headbang* or head-bang*).ti. (70)

16. or/1-15 (80,097)

17. Adolescent/ (1,939,543)

18. (teenage* or adolescen* or youth).tw. (304,577)

19. young adult/ (749,895)

20. (young* adj (people* or person* or adult* or m?n or wom?n)).tw. (173,989)

21. child/ (1,620,458)

22. (school* adj2 (pupil* or student*)).tw. (20,810)

23. ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) adj (yr? or year?)).tw. (471,642)

24. ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) adj4 (old or age?)).tw. (618,630)

25. (teen or teens or juvenil*).tw. (87,194)

26. or/17-25 (3,594,742)

27. and/16,26 (28,777)

28. ((systematic adj2 review*) or meta-analys* or ‘meta analysis’ or ‘meta-regression’ or ‘meta regression’).ti. (162,612)

29. limit 27 to (meta analysis or ‘systematic review’) (290)

30. 27 and 28 (271)

31. 29 or 30 [srs + self harm + adolescents] (346)

PROSPERO www.crd.york.ac.uk/prospero/

Date searched: 6 June 2019

Records found: 123

1. #1 MeSH DESCRIPTOR Suicide, Attempted

2. #2 MeSH DESCRIPTOR Suicide 190

3. #3 MeSH DESCRIPTOR Self-Injurious Behavior 91

4. #4 MeSH DESCRIPTOR Self Mutilation 0

5. #5 selfharm* or selfinjur* or selfinflict* or ‘self harm*’ or

1. ‘self injur*’ or ‘self inflict*’:TI 72

1. #6 ((self or themsel* or onesel*) adj2 (aggress* or harm* or cutt*

1. or immolat* or inflict* or injur* or mutilat* or poison* or damag* or destruct*)) :TI 78

1. #7 (auto adj (aggress* or mutilat*)) :TI 0

2. #8 suicid* or parasuicid* or para-suicid*:TI 256

3. #9 (automutilat* or ‘auto mutilation*’ or autoaggress* or ‘auto agress*’):TI 6

4. #10 overdos* or poison*:TI 44

5. #11 NSSI 3

6. #12 headbang* or head-bang* 0

7. #13 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR

1. #11 OR #12 356

1. #14 MeSH DESCRIPTOR Adolescent 1686

2. #15 MeSH DESCRIPTOR Young adult 195

3. #16 MeSH DESCRIPTOR Child 3884

4. #17 teenage* or adolescen* or youth or young or teen or teens or juvenil* 7962

5. #18 (school* adj2 (pupil* or student*)) 1424

6. #19 #14 OR #15 OR #16 OR #17 OR #18 15,151

7. #20 #15 AND #21 123

PsycInfo (Ovid) 1806 to June Week 2 2019

Date searched: 21 June 2019

Records found: 164

------------- ----------- --------------- -------------- -------------

1. *Self-Injurious Behavior/ (3109)

2. *suicide/ or ATTEMPTED SUICIDE/ (29,252)

3. *Drug Overdoses/ (1341)

4. *Self-Mutilation/ (1006)

5. (selfharm* or selfinjur* or selfinflict* or ‘self harm*’ or ‘self injur*’ or ‘self inflict*’).ti. (4830)

6. ((self or themsel* or onesel*) adj2 (aggress* or harm* or cutt* or immolat* or inflict* or injur* or mutilat* or poison* or damag* or destruct*)).ti. (6406)

7. (auto adj (aggress* or mutilat*)).ti. (18)

8. (automutilat* or ‘auto mutilation*’ or autoaggress* or ‘auto agress*’).ti. (30)

9. suicid*.ti. (33,008)

10. (parasuicid* or para-suicid*).ti. (346)

11. ((deliberat* or intentional or intended) adj2 (overdos* or poison* or self poison*)).ti. (114)

12. (poison adj2 (deliberat* or intentional or intended)).ti. (3)

13. (overdos* adj2 (deliberat* or intentional or intended)).ti. (20)

14. NSSI.ti. (65)

15. (headbang* or head-bang*).ti. (43)

16. or/1-15 (43,517)

17. (teenage* or adolescen* or youth).tw. (302,025)

18. (young* adj (people* or person* or adult* or m?n or wom?n)).tw. (94,804)

19. (school* adj2 (pupil* or student*)).tw. (68,733)

20. ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) adj (yr? or year?)).tw. (154,851)

21. ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) adj4 (old or age?)).tw. (271,489)

22. (teen or teens or juvenil*).tw. (36,683)

23. or/17-22 (647,709)

24. and/16,23 (13,081)

25. ((systematic adj2 review*) or meta-analys* or ‘meta analysis’ or ‘meta-regression’ or ‘meta regression’).ti. (30,089)

26. limit 24 to (meta analysis or ‘systematic review’) (164)

27. 24 and 26 (164)

28. 26 or 27 (164)

Introduction

The search strategies listed here were used to identify reports of randomised controlled trials of interventions for self–harm in adolescents.

We searched all information resources in 2019 and ran update searches on a limited set of databases in 2020 and 2021. Minor modifications were made to some search strategies between 2019 and 2021 which increased their sensitivity. These modifications are described in the main manuscript.

The most recent search strategy conducted in each information resource is reported.

Information resources searched

ClinicalTrials.gov https://clinicaltrials.gov/

Cochrane Central Register of Controlled Trials (Wiley) Issue 1 of 12, January 2022

Conference Proceedings Citation Index – Science (Web of Science) 1990+

Conference Proceedings Citation Index – Social Science & Humanities (Web of Science) 1990+

Dissertations & Theses A&I (ProQuest)

EMBASE Classic + EMBASE (Ovid) 1947 to 2022 January 20

Epistemonikos www.epistemonikos.org/

Europe PMC Grantfinder https://europepmc.org/grantfinder

Headspace National Youth Mental Health Foundation https://headspace.org.au/

International Clinical Trials Registry Platform https://apps.who.int/trialsearch/

Ovid MEDLINE(R) ALL 1946 to January 20, 2022

National Health and Medical Research Council (Australia) www.nhmrc.gov.au/

APA PsycInfo (Ovid) 1806 to January Week 3 2022

Search strategies

ClinicalTrials.gov https://clinicaltrials.gov/

Date searched: 13 August 2019

Records found: 165

self harm OR overdose OR ‘self inflict*’OR ‘self injur*’ | Suicide, Attempted OR suicide OR self harm

Applied Filters: Child (birth–17)

Cochrane Central Register of Controlled Trials. (Wiley) Issue 1 of 12, January 2022

Date searched: 21 January 2022

Records found: 1308

ID Search

1. #1 MeSH descriptor: [Self-Injurious Behavior] this term only

2. #2 MeSH descriptor: [Suicide] this term only

3. #3 MeSH descriptor: [Suicide, Attempted] this term only

4. #4 MeSH descriptor: [Suicide, Completed] this term only

5. #5 MeSH descriptor: [Drug Overdose] this term only

6. #6 MeSH descriptor: [Self Mutilation] this term only

7. #7 (selfharm* or selfinjur* or selfinflict*):ti,ab,kw

8. #8 ((self or themsel* or onesel*) near/2 (aggress* or harm* or cutt* or immolat* or inflict* or injur* or mutilat* or poison* or damag* or destruct*)):ti,ab,kw

9. #9 (autoaggress* or ‘auto aggress*’ or auto-aggress):ti,ab,kw

10. #10 (automutilat* or ‘auto mutilat*’ or auto-mutilat*):ti,ab,kw

11. #11 suicidality:ti,ab,kw

12. #12 (parasuicid* or para-suicid*):ti,ab,kw

13. #13 (suicid* near/2 (attempt* or behavio* or intent* or intend* or commit*)):ti,ab,kw

14. #14 (suicid* near/2 (death or die* or morality or complete)):ti,ab,kw

15. #15 ((deliberat* or intentional or intended) near/2 (overdos* or poison* or self poison*)):ti,ab,kw

16. #16 (poison near/2 (deliberat* or intention* or intended)):ti,ab,kw

17. #17 (overdos* or poison):ti,ab,kw

18. #18 NSSI:ti,ab,kw

19. #19 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #15 or #16 or #17 or #18

20. #20 MeSH descriptor: [Adolescent] this term only

21. #21 (teenage* or adolescen* or youth or child*):ti,ab,kw

22. #22 MeSH descriptor: [Young Adult] this term only

23. #23 (young* near/2 (people* or person* or adult* or m?n or wom?n)):ti,ab,kw

24. #24 MeSH descriptor: [Child] this term only

25. #25 (school* near/2 (pupil* or student*)):ti,ab,kw

26. #26 ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) near/4 (old or age?)):ti,ab,kw

27. #27 (teen or teens or juvenil*):ti,ab,kw

28. #28 #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27

29. #29 #19 and #28 with Publication Year from 2015 to 2021, in Trials 1097 records

Conference Proceedings Citation Index – Science (Web of Science) 1990–present and

Conference Proceedings Citation Index – Social Science & Humanities (Web of Science) 1990–present (searched simultaneously)

Date searched: 12 August 2019

Records found: 83

1. # 12 83 #11 AND #10

2. # 11 712,424 TS = (clinical trial*) OR TS = (research design) OR TS = (comparative stud*) OR TS = (evaluation stud*) OR TS = (controlled trial*) OR TS = (follow-up stud*) OR TS = (prospective stud*) OR TS = (random*) OR TS = (placebo*) OR TS = (single blind*) OR TS = (double blind*)

3. # 10 646 #9 AND #8

4. # 9 178,643 TS = (teenage* OR teen OR teens OR juvenil* OR adolescen* OR youth OR child*) OR TS = (school* adj2 (pupil* or student*))

5. # 8 3,874 #7 OR #6 OR #5 OR #4 OR #3 OR #2 OR #1

6. # 7 20 TS = (overdos* near/2 (deliberat* or intentional or intended))

7. # 6 33 TS = (poison near/2 (deliberat* or intentional or intended))

8. # 5 288 TS = (suicid* near/2 (death or die* or morality or complete*))

9. # 4 1,631 TS = (suicid* near/2 (attempt* or behavio* or intent* or intend* or commit*))

10. # 3 262 TS = (suicid* near/2 (death or die* or morality or complete))

11. # 2 1,785 TS=((self or themsel* or onesel*) near/2 (aggress* or harm* or cutt* or immolat* or inflict* or injur* or mutilat* or poison* or damag* or destruct*))

12. # 1 1,161 TS=(‘Self-Injurious Behavio$r’ OR ‘Self Mutilation’ OR suicidality OR ‘attempted suicide’ OR selfharm* OR selfinjur* OR selfinflict* OR ‘self harm*’ OR ‘self injur*’ OR ‘self inflict*’ OR autoaggress* or ‘auto aggress*’ or auto-aggress* OR automutilat* or ‘auto mutilat*’ or auto-mutilat* OR NSSI)

Dissertations & Theses A&I (ProQuest) 1743–present

Date searched: 13 August 2019

Records found: 43

1. ((ti(selfharm* OR selfinjur* OR selfinflict* OR (‘self harm’ OR ‘self harming’) OR (‘self injuring’ OR ‘self injurious’ OR ‘self injury’) OR (‘self inflicted’)) OR ti((self OR themsel* OR onesel*) NEAR/2 (aggress* OR harm* OR cutt* OR immolat* OR inflict* OR injur* OR mutilat* OR poison* OR damag* OR destruct*)) OR (ti(auto NEAR/1 (aggress* OR mutilat*)) OR ti(auto NEAR/1 (aggress* OR mutilat*)) OR ti(automutilat* OR ‘auto mutilation*’ OR autoaggress* OR ‘auto aggress*’) OR ti(suicide*) OR ti(parasuicid* OR para-suicide*) OR ti(deliberat* OR intentional OR intended NEAR/2 overdos* OR poison* OR self poison*) OR (poison NEAR/2 (deliberat* OR intentional OR intended)) OR ti((overdos* NEAR/2 (deliberat* OR intentional OR intended))) OR ti(overdos* NEAR/2 (deliberat* OR intentional OR intended)) OR (overdos* NEAR/2 (deliberat* OR intentional OR intended)) OR ti(NSSI))) OR (su(Self-Injurious Behavio?r) OR su(drug overdose) OR su(suicide) OR su(attempted suicide) OR su(self mutilation)))

2. AND

3. (su(Adolescent) OR su(young adult) OR su(child) OR diskw((teenage* OR adolescen* OR youth OR child*)) OR diskw((young* NEAR/1 (people* OR person* OR adult* OR m?n OR wom?n))) OR diskw((school* NEAR/2 (pupil* OR student*))) OR diskw(teen OR teens OR juvenil*))

4. AND

5. (recurr* OR repeat* OR repetiti* OR re-occur* OR re occur* OR regress* OR history OR once OR twice OR episode*) AND noft(‘clinical trial*’ OR ‘controlled trial*’ OR random* OR ‘single blind*’ OR ‘double blind*’ OR ‘research design’ OR ‘comparative stud*’ OR ‘evaluation stud*’ OR ‘follow-up stud*’ OR ‘prospective stud*’)

EMBASE Classic + EMBASE (Ovid) 1947 to 2022 January 20

Date searched: 21 January 2022

Records found: 603

---------- ----------- ---------- -------------- ----------- ---------

1. automutilation/ (21,466)

2. suicide/ (65,020)

3. exp *Drug Overdose/ or *Opiate Overdose/(9984)

4. *suicide attempt/ (13,098)

5. (selfharm* or selfinjur* or selfinflict*).tw,kw. (424)

6. ((self or themsel* or onesel*) adj2 (aggress* or harm* or cutt* or immolat* or inflict* or injur* or mutilat* or poison* or damag* or destruct*)).tw,kw. (29,538)

7. (automutilat* or ‘auto mutilat*’ or auto-mutilat*).tw,kw. (235)

8. (autoaggress* or ‘auto aggress*’ or auto-aggress).tw,kw. (1582)

9. suicidality.tw,kw. (10,333)

10. (parasuicid* or para-suicid*).tw,kw. (937)

11. (suicid* adj2 (death or die* or morality or complete)).tw,kw. (5095)

12. (suicid* adj2 (attempt* or behavio* or intent* or intend* or commit*)).tw,kw. (41,385)

13. (poison adj2 (deliberat* or intentional or intended)).tw,kw. (23)

14. (overdos* adj2 (deliberat* or intentional or intended)).tw,kw. (1094)

15. NSSI.tw,kw. (1573)

16. or/1-15 [Self harm or suicide] (137,489)

17. Adolescent/ (1,783,960)

18. (teenage* or adolescen* or youth or child*).tw,kw. (2,370,688)

19. young adult/ (441,173)

20. (young* adj (people* or person* or adult* or m?n or wom?n)).tw,kw. (288,529)

21. child/ (2,161,751)

22. (school* adj2 (pupil* or student*)).tw. (31,569)

23. (teen or teens or juvenil*).tw. (129,776)

24. ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) adj4 (old or age?)).tw,kw. (1,199,060)

25. high school student/ (8980)

26. or/17-25 [Adolescents] (4,900,580)

27. 16 and 26 (45,396)

28. exp randomized controlled trial/ (695,793)

29. exp double-blind procedure/ (194,102)

30. exp single-blind procedure/ (44,931)

31. exp crossover-procedure/ (69,529)

32. ((singl* or doubl* or trebl* or tripl*) adj (blind* or mask*)).tw. (264,910)

33. placebo/ (386,669)

34. placebo*.tw. (342,596)

35. randomization/ (93,063)

36. trial.ti. (356,469)

37. clinical trial*.tw. (612,502)

38. (randomly or randomis* or randomiz*).tw,kw. (1,432,485)

39. controlled clinical trial/ (465,155)

40. or/28-39 [RCT or CCT] (2,439,340)

41. exp animals/ not exp humans/ (5,677,771)

42. exp nonhuman/ not exp human/ (4,918,051)

43. exp experimental animal/ (775,489)

44. exp veterinary medicine/ (60,630)

45. animal experiment/ (2,770,425)

46. or/41-45 [Animal studies] (8,163,567)

47. 40 not 46 [Final RCT search] (2,168,486)

48. 27 and 47 (2757)

49. limit 48 to yr=‘2018 -Current’ (778)

50. limit 49 to conference abstracts (175)

51. 49 not 50 (603)

Epistemonikos www.epistemonikos.org/

Date searched: 21 January 2022

Records found: 244

1. (title:(suicid* OR overdose OR selfharm* OR selfinjur* OR selfinflict* OR ‘self harm*’ OR ‘self injur*’ OR ‘self inflict*’) OR abstract:(suicid* OR overdose OR selfharm* OR selfinjur* OR selfinflict* OR ‘self harm*’ OR ‘self injur*’ OR ‘self inflict*’))

2. AND

3. (title:(teenage* OR adolescen* OR youth OR child) OR abstract:(teenage* OR adolescen* OR youth OR child))

Limited by publication type to Primary Study

Limited by study design to RCT

Europe PMC Grantfinder

Date searched: 13 August 2019

Records found: 19

Suicide and child, Suicide and children, Suicide and adolescent, Suicide and adolescence

Self harm and child, Self harm and children, Self harm and adolescent, Self harm and adolescence

Self injury and child, self injury and children, self injury and adolescent, self injury and adolescence

Headspace research database https://headspace.org.au/health-professionals/research-database/

Date searched: 21 January 2022

Records found: 65

Searched research database by completing the filtered search as follows:

Mental health or substance use problem: Suicide and Self-Harm (any)

Stage of Illness: all

Treatment/Intervention: all

Publication date: 2015 – all

Keyword: (left blank)

Advanced options: Randomized Controlled Trials selected

International Clinical Trials Registry Platform (WHO)

https://apps.who.int/trialsearch/

Date searched: 13 August 2019

Records found: 260 records for 211 trials

Title = suicide OR self-harm or self injur* or overdose

Condition = suicide OR self-harm or self injur* or overdose. Search In Clinical trials in Children 2015–2019

Ovid MEDLINE(R) ALL <1946 to February 10, 2021>

Date searched: 21 January 2022

Records found: 556

Search Strategy:

--------------------------------------------------------------------

1. Self-Injurious Behavior/ (8940)

2. suicide/ or suicide, attempted/ or Suicide, Completed/ (59,340)

3. Drug Overdose/ (12,975)

4. Self Mutilation/ (3229)

5. (selfharm* or selfinjur* or selfinflict*).tw,kw. (31)

6. ((self or themsel* or onesel*) adj2 (aggress* or harm* or cutt* or immolat* or inflict* or injur* or mutilat* or poison* or damag* or destruct*)).tw,kw. (22,943)

7. (automutilat* or ‘auto mutilat*’ or auto-mutilat*).tw,kw. (134)

8. (autoaggress* or ‘auto aggress*’ or auto-aggress).tw,kw. (1024)

9. suicidality.tw,kw. (7687)

10. (suicid* adj2 (death or die* or morality or complete)).tw,kw. (4035)

11. (suicid* adj2 (attempt* or behavio* or intent* or intend* or commit*)).tw,kw. (30,296)

12. (parasuicid* or para-suicid*).tw,kw. (667)

13. (poison adj2 (deliberat* or intentional or intended)).tw,kw. (15)

14. (overdos* adj2 (deliberat* or intentional or intended)).tw,kw. (610)

15. NSSI.tw,kw. (1379)

16. or/1-15 [self harm] (104,019)

17. Adolescent/ (2,152,902)

18. (teenage* or adolescen* or youth or child*).tw,kw. (1,751,741)

19. young adult/ (973,874)

20. (young* adj (people* or person* or adult* or m?n or wom?n)).tw,kw. (209,824)

21. child/ (1,810,341)

22. (school* adj2 (pupil* or student*)).tw,kw. (26,573)

23. ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) adj4 (old or age?)).tw,kw. (744,797)

24. (teen or teens or juvenil*).tw,kw. (100,553)

25. or/17-24 [adolescents] (4,453,304)

26. and/16,25 [self harm and adolescents] (41,221)

27. randomized controlled trial.pt. (556,317)

28. controlled clinical trial.pt. (94,655)

29. randomized.ab. (547,747)

30. placebo.ab. (224,928)

31. clinical trials as topic.sh. (198,920)

32. randomly.ab. (374,356)

33. trial.ti. (255,048)

34. 27 or 28 or 29 or 30 or 31 or 32 or 33 (1,421,253)

35. exp animals/ not humans.sh. (4,945,885)

36. 34 not 35 [Cochrane RCT precision maximising search filter] (1,307,487)

37. 26 and 36 (2026)

38. limit 37 to yr=‘2018 -Current’ (556)

National Health and Medical Research Council www.nhmrc.gov.au/

Date searched: 21 January 2022

Records found: 32 (screened and none downloaded)

Searched website for – suicide, ‘self harm’, ‘self injury’ (separate searches)

Browsed publications

APA PsycInfo <1806 to February Week 1 2021>

Date searched: 21 January 2022

Records found: 397

Search Strategy:

--------- ---------- ---------- --------- ---------- ---------- ------

1. Self-Injurious Behavior/ (4924)

2. suicide/ or ATTEMPTED SUICIDE/ (36,443)

3. Drug Overdoses/ (2264)

4. Self-Mutilation/ (1156)

5. head banging/ or self-inflicted wounds/ or self-poisoning/ (1158)

6. (selfharm* or selfinjur* or selfinflict*).tw,id. (52)

7. ((self or themsel* or onesel*) adj2 (aggress* or harm* or cutt* or immolat* or inflict* or injur* or mutilat* or poison* or damag* or destruct*)).tw,id. (22,100)

8. (automutilat* or ‘auto mutilat*’ or auto-mutilat*).tw,id. (48)

9. (autoaggress* or ‘auto aggress*’ or auto-aggress).tw,id. (188)

10. suicidality.tw,id. (8395)

11. (parasuicid* or para-suicid*).tw,id. (775)

12. (suicid* adj2 (attempt* or behavio* or intent* or intend* or commit*)).tw,id. (29,356)

13. (suicid* adj2 (death or die* or morality or complete)).tw,id. (3486)

14. (poison adj2 (deliberat* or intentional or intended)).tw,id. (6)

15. (overdos* adj2 (deliberat* or intentional or intended)).tw,id. (117)

16. NSSI.tw,id. (1668)

17. or/1-16 (68,651)

18. (teenage* or adolescen* or youth or child*).tw,id. (953,530)

19. (young* adj (people* or person* or adult* or m?n or wom?n)).tw,id. (112,383)

20. (school* adj2 (pupil* or student*)).tw,id. (75,619)

21. ((‘11’ or ‘12’ or ‘13’ or ‘14’ or ‘15’ or ‘16’ or ‘17’ or ‘18’ or ‘19’) adj4 (old or age?)).tw,id. (300,758)

22. (teen or teens or juvenil*).tw,id. (40,159)

23. or/18-22 (1,205,845)

24. and/17,23 (24,744)

25. exp clinical trials/ or experimental design/ (24,819)

26. exp treatment effectiveness evaluation/ (26,970)

27. exp mental health program evaluation/ (2253)

28. exp random sampling/ (910)

29. randomi*.tw. (98,224)

30. (clinic* adj4 trial*).tw. (41,513)

31. (random* adj5 (assign* or allocat* or assort*)).tw. (48,723)

32. (crossover or cross-over).tw. (11,165)

33. ((singl* or doubl* or tripl* or trebl*) adj (blind* or mask*)).tw. (27,755)

34. exp placebo/ (6166)

35. placebo*.tw. (42,695)

36. or/25-35 [Trials] (216,603)

37. 24 and 36 (1008)

38. limit 37 to yr=‘2015 -Current’ (397)