Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: Systematic review and narrative synthesis.
Robert Griffiths, Alison Dawber, Tim McDougall and 2 others
PMID 34626155WHAT IT FOUND
DBT-informed ward approaches and staff training were reported to reduce self-harm in some studies, but the evidence was low quality and components were delivered together, so no single approach can be recommended.
Safe kit use was not linked to lower self-harm frequency.
Key findings
01Five of the seven included studies tested DBT-informed interventions, and most interventions combined several elements.
02Three studies reported significant reductions in self-harm rates with DBT-based interventions, but all seven studies used non-randomized designs and were generally judged low methodological quality.
03Ward environment changes reduced the proportion of patients self-harming but not overall rates; a safe kit showed no link between use and self-harm frequency.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only seven studies met inclusion criteria, and the authors state this small number limits the clinical utility of the review findings. All included studies used non-randomized or descriptive designs, so they cannot show that an intervention caused the change. Most studies were conducted at one site, which limits generalizability. Interventions were heterogeneous and usually delivered as multiple components at once, so the review cannot tell which part might have reduced self-harm. Self-harm outcomes were measured inconsistently, often with routine incident reports or unpublished tools, which can miss or misclassify events. Some studies had incomplete data: Loveridge recruited 50, 39 completed, and 23 were analysed; 53% of historical control data were missing in McDonell. Most studies did not involve people with lived experience of inpatient self-harm in designing the intervention.
Declared interests
This review was funded by The Burdett Trust for Nursing. The supplied text does not report other author conflicts of interest.
The easy way to misread this
Do not conclude that DBT, safe kits, or ward activity changes have been proven to reduce self-harm. The included studies were non-randomized, generally low quality, and delivered several components together, so the evidence cannot show which part worked.