- David Brent, academic chief, child and adolescent psychiatry
- 1Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine. Pittsburgh, PA 15213, USA
The linked randomised trial (Assessment of Treatment in Suicidal Teenagers; ASSIST; doi:10.1136/bmj.d682) is the largest clinical trial so far to target self harm in adolescents, including non-suicidal self injury and suicide attempts⇑.1 Despite a promising pilot study and excellent trial management, when added to routine care the intervention of developmental group therapy did not significantly reduce the occurrence, frequency, or severity of self harm. Possible explanations for this lack of effect are that self harm is too heterogeneous for any one intervention to be effective, the effects of routine care overwhelmed those of the experimental treatment, or the treatment targeted individual rather than contextual factors.
Each group received nine or 10 sessions of routine care, much more than either condition received in the pilot study. As the authors note, the increased amount of treatment and possible improvement in routine treatment over the past decade may have overwhelmed the effect of developmental group therapy, which was essentially compared with minimal treatment in the original study.
ASSIST included adolescents who engaged in non-suicidal self injury …