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：自残年轻人的治疗——研究和临床实践的挑战和建议


背景 自残在年轻人中非常常见，并且与自杀有关。年轻人，尤其是女性的自残和自杀率有所上升。显然需要找到新的方法来防止重复的自残。方法我们在以前的评论的基础上进行了重大更新和发展，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方法的挑战，提出了研究的前进方向，并为临床医生如何在现实世界中应用当前的研究证据提供了明确和实用的指导。结果目前，有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心理社会因素，调查关键的行动机制，确保试验有足够的动力和代表性，并让年轻人更多地参与。积极参与这些方法的设计、实施和评估。还应考虑替代研究设计，例如实用性或适应性临床试验，以及利用常规临床实践中收集的管理数据的基于注册的随机对照试验，以帮助实现这些目标。结论实践建议包括进行全面评估和配方，并在有指示的情况下提供 DBT-A。应该进一步开发和评估适合年轻人的认知行为疗法（根据年轻人的意见）。 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（如果可能）的作用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人为本和富有同情心的方式治疗自残的年轻人。