BackgroundSelf‐harm is very common in young people and is associated with suicide. Rates of both self‐harm and suicide have increased in young people, particularly in females. There is a clear need to identify new approaches to prevent repeat self‐harm.MethodWe significantly update and build on previous reviews with the aim of identifying issues in research relevant to clinical practice. We identify challenges in developing, implementing and evaluating treatments for self‐harm in children and adolescents, suggest a way forward for research, and provide clear and practical guidance for clinicians on how to apply current research evidence in the real world.ResultsCurrently, there is limited evidence for effective interventions, other than some support for dialectical behaviour therapy for adolescents (DBT‐A). To improve research and, by extension, clinical practice, future studies need to address psychosocial factors associated with youth self‐harm and suicide, investigate the critical mechanism(s) of action, ensure trials are sufficiently powered and representative, and involve young people more actively in the design, implementation and evaluation of these approaches. Consideration should also be given to alternative research designs, such as pragmatic or adaptive clinical trials, as well as registry‐based randomised controlled trials which leverage administrative data collected in routine clinical practice, to help meet these goals.ConclusionsRecommendations for practice include undertaking comprehensive assessment and formulation, and offering DBT‐A where indicated. There should be further development and evaluation (with input from young people) of Cognitive Behavioural‐based Therapy adapted for young people. Greater attention to the role of the therapeutic relationship and family involvement (where possible) is also an important considerations, irrespective of the specific therapeutic modality. Finally, more consideration should be given to improving staff training to ensure all clinical staff feel equipped to treat young people who self‐harm in a person‐centred and compassionate manner.

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从业者评论：年轻人自残的治疗方法 – 研究和临床实践的挑战和建议


背景自残在年轻人中很常见，与自杀有关。年轻人的自残和自杀率都有所增加，尤其是女性。显然需要确定防止重复自我伤害的新方法。方法我们显著更新和建立在以前的综述基础上，目的是确定与临床实践相关的研究中的问题。我们确定了开发、实施和评估儿童和青少年自残治疗面临的挑战，提出了研究前进的道路，并为临床医生提供了有关如何在现实世界中应用当前研究证据的清晰实用指导。结果目前，除了对青少年辩证行为疗法 （DBT-A） 的一些支持外，有效干预措施的证据有限。为了改进研究，进而改进临床实践，未来的研究需要解决与青少年自残和自杀相关的社会心理因素，调查关键作用机制，确保试验具有足够的效力和代表性，并让年轻人更积极地参与这些方法的设计、实施和评估。还应考虑替代研究设计，例如实用或适应性临床试验，以及基于注册的随机对照试验，这些试验利用在常规临床实践中收集的管理数据来帮助实现这些目标。结论实践建议包括进行全面评估和制定，并在有指征时提供 DBT-A。应该进一步开发和评估（在年轻人的意见下）适合年轻人的基于认知行为的疗法。 无论具体的治疗方式如何，更多地关注治疗关系和家庭参与的作用（在可能的情况下）也是一个重要的考虑因素。最后，应更多地考虑改善员工培训，以确保所有临床工作人员都感到有能力以以人为本和富有同情心的方式治疗自残的年轻人。