Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.

Methods

Multicentre, randomised controlled trialthat compared YCMAP with enhanced treatment as usual.

多中心、随机对照试验，比较了YCMAP与增强的常规治疗。

settings

General practices, emergency departments, medical wards of participating hospitals, and community centres across Karachi, Hyderabad, Lahore, Multan, and Rawalpindi.

在卡拉奇、海得拉巴、拉合尔、木尔坦和拉瓦尔品第的普通诊所、急诊科、参与医院的内科病房以及社区中心。

Methods

Adolescents with a recent history of self-harm identified at participating health centres by treating physicians between 5 November 2019 and 31 August 2021.

2019年11月5日至2021年8月31日期间，参与卫生中心的治疗医生识别出有近期自伤史的青少年。

intervention

The YCMAP group received up to 10 treatment sessions over three months; the intervention was based on the principles of cognitive behaviour therapy.

YCMAP 组在三个月内接受了最多10次治疗会话；该干预基于认知行为疗法的原则。

main_outcome_measure

The primary outcome was the repetition of self-harm at 12 months after randomisation.

主要结果是在随机化后12个月时自我伤害的重复。

Secondary outcomes were distress, hopelessness, suicidal ideation, and health related quality of life at three, six, nine, and 12 months after randomisation.

次要结果包括随机化后三个月、六个月、九个月和十二个月时的痛苦、绝望感、自杀意念以及与健康相关的生活质量。

Participants' satisfaction with the services was assessed at three and 12 months after randomisation.

在随机化后三个月和十二个月评估了参与者对服务的满意度。

Results

This trial was conducted between November 2019 and February 2023 and included 684 adolescents randomised to YCMAP (n=342) or enhanced treatment as usual (n=342).

该试验于2019年11月至2023年2月进行，纳入了684名青少年，随机分为YCMAP组（n=342）和加强常规治疗组（n=342）。

The YCMAP group had a significantly lower risk of self-harm repetition than the enhanced treatment as usual group at 12 months after randomisation (odds ratio 0.20, 95% confidence interval0.06 to 0.70, P=0.006).

随机化后12个月，YCMAP组的自伤重复风险显著低于加强常规治疗组（比值比0.20，95%置信区间0.06至0.70，P=0.006）。

YCMAP participants showed a statistically significant reduction in distress, hopelessness, and suicidal ideation at three months, but these differences were not statistically significant at 12 months.

YCMAP参与者在三个月时显示出显著减少的痛苦、绝望感和自杀意念，但在12个月时这些差异不再具有统计学意义。

YCMAP participants also reported significantly better quality of life and satisfaction with services at three months, with these effects sustained at all follow-up points.

YCMAP参与者在三个月时报告了显著更好的生活质量和服务满意度，这些效果在所有后续随访点均得到维持。

Conclusions

The YCMAP intervention was shown to be beneficial in self-harm prevention among adolescents.

YCMAP干预措施在青少年自我伤害预防中显示出益处。

Further research and replication of findings in diverse settings are recommended to strengthen the evidence base for this public health intervention.

建议在不同环境中进行进一步研究和结果复制，以加强这一公共卫生干预措施的证据基础。

trial_registration

ClinicalTrials.gov NCT04131179 and ISRCTN registry ISRCTN57325925.

临床试验注册：ClinicalTrials.gov NCT04131179 和 ISRCTN 注册 ISRCTN57325925。