Adding group psychotherapy to routine care does not improve outcomes in adolescents who repeatedly self-harm.

ED FROM Green JM, Wood AJ, Kerfoot MJ, et al. Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation. BMJ 2011;342:d682. Correspondence to: Professor Jonathan M Green, Psychiatry Research Group, University of Manchester, Manchester M13 9PL, UK; jonathan.green@manchester. ac.uk Sources of funding: Funded by The Health Foundation and sponsored by the University of Manchester. Notes and references are available online only at http://ebmh.bmj.com About 10% of adolescents will have self-harmed by the time they are 16. Self-harm is one of the strongest predictors of suicide. Green and colleagues undertook a large and well-conducted trial of developmental group psychotherapy (DGP) versus usual care, and no clinical or fi nancial advantages of DGP were found. Among the possible explanations, it may be that the number of treatment sessions (about 10) was insuffi cient as treatment effects may take longer to develop. Adolescents, however, have a high treatment drop out rate.1 The well-conducted usual care may have reduced possible differences in effi cacy of DGP. Finally, it may be that the natural history of self-harm in adolescents is better then previously thought and the result represents a regression to the mean. There are no independently replicated studies demonstrating a reduction of self-harm repetition in adolescents published till date. Defi nition of self-harm compounds the problem. Many US authors research adolescents with suicidal and non-suicidal self-harm separately; many others (including Green and colleagues) research self-harm irrespectively of the suicidal intent. Trials of cognitive–behavioural therapy (CBT), dialectic behaviour therapy (DBT), mentalisation-based therapy and family therapy are yet to report results. It is clear, however, that several wider systems (school, family and peers) play important roles in modifying adolescent self-harm,2 and future research must take these into account. A judicial use of adult self-harm literature may be sensible in the absence of evidence-based interventions for adolescents. DBT and CBT (especially its problem solving component) tend to reduce suicidal self-harm in adults. Second-generation antipsychotics, mood stabilisers and ω-3 fatty acids may be of some benefi t in adults with Borderline Personality Disorder many of whom self-harm.