Cognitive-behavioural therapy for deliberate self-harm Slee, N.

Citation

Slee, N. (2008, April 24). Cognitive-behavioural therapy for deliberate self-harm. Retrieved from https://hdl.handle.net/1887/12835

Version: Not Applicable (or Unknown)

License: Leiden University Non-exclusive license Downloaded from: https://hdl.handle.net/1887/12835

Note: To cite this publication please use the final published version (if applicable).

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;^\jgZ&# Flow of participants through the study

Assessed for eligibility (n= 100)

Enrollment

Is it Randomized? Yes (n=90)

Excluded (n=10)

Reasons:

Being unable to converse in Dutch (n= 2) Having cognitive impairments (n=1) Living outside the region of Leiden (n=5) Not wanting to complete interview (n=2)

Allocated to TAU (n= 42)

Received allocated intervention (n= 42) Did not receive allocated intervention (n= 0) Allocation

Follow-Up

Analysis Analyzed (n=42)

Excluded from analysi (n= 0) Allocated to CBT (n= 48)

Received allocated intervention (n= 40) Did not receive allocated intervention (n=8)

Reasons: Not wanting to be in therapy (n=4),

getting an alternative treatment (n=1), moving (n=2)

or running away from home (n=1)

Lost to follow-up (n= 9)

Reasons: suicide (n=2), severe psychological problems (n=3),

moving (n=1),

being sentenced to prison (n=1), being too busy (n=2)

Lost to follow-up (n= 0) Discontinued intervention (n= 0)

Analyzed (n= 40)

Excluded from analysis (n= 8)

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Procedure

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Design

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++

Description of the primary and secondary outcome measures

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t /[chi]² p

Gender (chi² CBT 97% female (n=39) 1.77 .18

TAU 91% female (n=38)

Mean age (t-test) CBT 23.9 years (SD=6.4) -1.18 .24

TAU 25.4 years (SD=4.5)

Living situation (chi²) CBT 73% (n=29) lived alone, 27% (n=11) lived together with someone else 1.07 .59

TAU 74% (n=31) lived alone, 26% (n=11) lived together with someone else

Marital status (chi²) CBT 73% (n=29) unmarried, 8% (n=3) married, 17% (n=7) widowed, 2% (n=1) divorced 4.35 .36

TAU 78% (n=33) unmarried, 5% (n=2) married, 10% (n=3) widowed, 7% (n=4) divorced

Educational level (chi²) CBT primary school (27%, n=11), secondary school (34%, n=14),

lower education , (13%, n=5), higher education/university (25%, n=10) 12.41 .13

TAU primary school (19%., n=8), secondary school (35%, n=15), lower education,

(25%, n=10), higher education/university (21%, n=9)

Job status (chi²) CBT 38% (n=15) went to school/studies, 25% (n=10) had a full-time or part-time job,

37% (n=15) lived on social security 11.84 .34

TAU 19% (n=8) went to school/studies, 27% (n=11) had a full-time or part-time job,

36% (n=15) lived on social security

Nationality (chi²) CBT 90% (n=36) Dutch, 5% (n=2) other European, 5% (n=2) Turkish/Moroccan 7.08 .42

TAU 93% (n=39) Dutch, 5% (n=2) other European, 2% (n=1) Turkish

IVWaZ&#Characteristics of the study sample for CBT (n=40) and TAU (n=42)

+,

t /[chi]2 p

Psychiatric co-morbidity (t-test) CBT on average 3.6 diagnoses per person (SD=3.0) -1.15 .25

TAU aon average 4.5 diagnoses per person (SD=4.1)

Range of diagnosis (chi²) CBT 88% (n=35) mood-; 65% (n=26) anxiety-; 10% (n=4) eating-

and 5% (n=2) somatoform disorder; 10% (n=4) alcohol/drug abuse

TAU 90% (n=16) mood-; 46% (n=19) anxiety-; 24% (n=10) eating-

and 3%(n=1) somatoform disorder 24%(n=10) alcohol/drug abuse

History of DSH (chi²) 82% (n=33) in CBT and 70% (n=30) in TAU reported 10 or more

previous episodes of DSH (self-poisoning and/or self-injury) .73 .47

Self mutilation past 3 months (t-test)¹ CBT (92 %, n=37); TAU (57% , n=24) 1.54 .13

Suicidal acts past 3 months (t-test)² CBT (45%, n=18); TAU (81% , n=34) -1.91 .06

Index episode of DSH (chi²) self-poisoning 83% (n=33) in CBT and 91% (n=38) in TAU;

self-injury 17% (n=7) in CBT and 9% (n=4) in TAU 4.69 .70

Suicide Intent index episode (t-test)³ range (0-30); CBT: 10.83 (6.65); TAU: 12.58 (6.84) 8.27 .94

Motives index episode (chi²) get relief from a terrible state of mind (92%), want to die (67%),

escape impossible situation (64%); similar for CBT & TAU 19.80 .14

Psychotropic Medication at baseline (chi²) 53% (n=21) of the patients in CBT and 71% (n=30) of the patients in TAU 3.12 .08

Psychotherapy at baseline (chi²) 43% (n=17) of the patients in CBT and 55% (n=23) of the patients in TAU 4.74 .09

1 Suicide Intent was measured with the Suicide Intent Scale; Motives were measured with the Reasons for Overdose Scale.

2 Suicide Intent was measured with the Suicide Intent Scale; Motives were measured with the Reasons for Overdose Scale.

3 Suicide Intent was measured with the Suicide Intent Scale; Motives were measured with the Reasons for Overdose Scale.

IVWaZ'#Characteristics of the study sample for CBT (n=40) and TAU (n=42)(continued)

9-month outcome of treatment

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+-

Baseline 3 months 6 months 9 months

N(CBT/TAU) 40/42 40/37 40/34 40/33

M (SD) M(SD) M(SD) M(SD)

Primary outcome measure (t-tests)

DSH in the past 3 months CBT 14.42 (10.51) 5.63(9.04) 5.30(9.44) 1.18(4.22)*

TAU 11.62 (11.42) 5.65(9.24) 4.03(7.16) 4.58(8.37) Suicide in the past 3 months CBT - - - -

TAU - - 1 1

Secondary outcome measures¹(t-tests)

Depression (BDI-II) CBT 31.35 (12.85) 21.15 (13.48)* 16.58 (13.70)** 11.58 (12.12)**

TAU 34.67 (14.01) 30.08(18.63) 28.56(18.62) 29.61 (17.51) Anxiety (SCL-90) CBT 30.60 (8.67) 24.95(9.02) 24.20(8.14) 19.78 (7.70)**

TAU 28.05 (10.51) 28.78(12.00) 29.03(11.57) 27.36(11.08) Self-Esteem (RSCQ) CBT 16.38 (3.24) 18.13(4.35) 19.15(3.71)* 20.58(4.36)**

TAU 15.38 (4.46) 16.11(5.65) 16.85(5.56) 16.70(5.10) Suicide-Cognitions Scale (SCS) CBT 58.33(14.86) 46.63(16.56)* 42.48(19.67)* 36.60(17.05)**

TAU 63.29 (19.47) 59.70(24.48) 56.26(22.50) 54.88(19.05) Perceived burdens. (SCS) CBT 6.65(2.01) 4.98(2.41) 4.75(2.67)* 3.88(2.03)**

TAU 6.88 (2.33) 6.24(2.82) 6.21(2.57) 5.76(2.35) Helplessness (SCS) CBT 15.85(4.97) 12.90(4.78)* 11.95(5.90)** 10.38(4.80)**

TAU 17.55 (5.83) 17.11(7.36) 16.32(6.79) 15.97(5.25) Poor distress tolerance (SCS) CBT 19.38(5.33) 15.13(5.92)* 13.65(6.61)* 11.65(5.73)**

TAU 20.88 (6.29) 19.24(7.84) 18.09(7.88) 17.52(6.77) Unlovability (SCS) CBT 16.45(5.21) 13.63(5.56) 12.13(6.14)* 10.70(5.56)**

TAU 17.98 (6.14) 17.11(7.40) 15.64(6.50) 15.64(5.90) Problem-solving (CISS) CBT 27.00(10.42) 31.18(11.05) 32.55(11.66) 36.25(11.50)**

TAU 25.76 (13.45) 26.97(13.19) 25.70 (13.99) 26.24(13.13) Use of health care services/usual care (chi² tests)

Psychotropic Medication CBT 53% (n=21) 38%*(n=15) 42%*(n=17) 46% (n=18)

TAU 71% (n=30) 59% (n=25) 57% (n=24) 70% (n=29) Psychotherapy CBT 43% (n=17) 21% (n=8) 28% (n=11) 52% (n=21)

TAU 55% (n=23) 83% (n=35) 72% (n=30) 72% (n=30) Psychiatric Hospitalisations CBT none 2% (n=1) 6% (n=3) 2%* (n=1) TAU none 14% (n=6) 16% (n=7) 21% (n=9)

* indicates signifi cance at .05 level; ** indicates signifi cance at .01 level

1 BDI-II is the Beck Depression Inventory II; SCL-90 is the Symptom Checklist-90; RSCQ is the Robson Self- Concept Questionnaire (short version); SCS is the Suicide Cognitions Scale; CISS is the Coping Inventory for Stressful Situations.

IVWaZ(#Primary and secondary outcome measures: means and standard deviations at baseline and follow-up (n=82)

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Variables¹ Time Condition² Time X Cohen’s d Cohen’s d Cohen’s d Condition

B(SE) B(SE) B(SE) 3 months 6 months 9 months

(post-treatment) (follow-up) (follow-up)

n=40/37 n=40/34 n=40/33

DSH -.794(.177)* 2.892(2.089) -.576(.241)* .0 .06 .53

Depression (BDI-II) -.515(.223)* -4.047(2.956) -1.617(.302)* .56 .75 1.24 Anxiety (SCL-90) -.065(.174 -.748(2.018) -1.038(.235)* .37 .22 .82 Suicide Cognitions total (SCS) -.835(.304)* -6.339(3.661) -1.497(.411)* .64 .67 1.03 Perceived burdensomeness (SCS) -.106(.039)* -.489(.465) -.175(.052)* .49 .56 .88 Helplessness (SCS) -.142(.089) -1.987(1.120) -.457(.132)* .69 .70 1.13 Poor distress tolerance (SCS) -.328(.106)* -1.797(1.248) -.514(.143)* .60 .62 .96 Unlovability (SCS) -.268(.097)* -2.074(1.168) -.349(.130)* .54 .56 .88 Self-esteem (RSCQ) .141(.066)* .852(.810) .309(.089)* .41 .50 .83 Problem-solving (CISS) -.072(.215) .999(2.382) 1.068(.290)* .35 .54 .83

* indicates signifi cance at .05 level

1 BDI-II is the Beck Depression Inventory II; SCL-90 is the Symptom Checklist-90; RSCQ is the Robson Self-Concept Questionnaire (short version); SCS is the Suicide Cognitions Scale; CISS is the Coping Inventory for Stressful Situations.

2 “Condition” means baseline differences between CBT and TAU

IVWaZ)MLA Effects for Time, Condition and Time X Condition and Cohen's d effect sizes for differences on outcome measures between CBT and TAU for n=82

,&

Variables¹ Time Condition² Time X Cohen’s d Cohen’s d Cohen’s d Condition

B(SE) B(SE) B(SE) 3 months 6 months 9 months

(post-treatment) (follow-up) (follow-up)

n=40/33 n=40/33 n=40/33

DSH -.728(.178)* 3.361(2.233) -.604(.239)* .02 .05 .39

Depression (BDI-II) -.458(.246) -2.613(3.189) -1.694(.331)* .50 .41 1.24 Anxiety (SCL-90) -.025(.179) -1.608(2.211) -1.102(.241)* .36 .46 .82 Suicide Cognitions total (SCS) -.747(.306)* -4.637(4.103) -1.607(.412)* .58 .64 1.03 Perceived burdensomeness (SCS) -.093(.039)* -.298(.529) -.196(.052)* .44 .56 .88 Helplessness (SCS) -.116(.100) -1.658(1.230) -.470(.134)* .66 .68 1.13 Poor distress tolerance (SCS) -.308(.107)* 1.271(1.385) -.534(.143)* .53 .58 .96 Unlovability (SCS) -.230(.096)* - 1.409(1.319) -.407(.129)* .49 .58 .88 Self-esteem (RSCQ) .139(.067)* .683(.904) .326(.090)* .36 .47 .83 Problem-solving (CISS) -.163(.218) -.434(2.541) 1.137(.293)* .35 .47 .83

* indicates signifi cance at .05 level

1 BDI-II is the Beck Depression Inventory II; SCL-90 is the Symptom Checklist-90; RSCQ is the Robson Self-Concept Questionnaire (short version); SCS is the Suicide Cognitions Scale; CISS is the Coping Inventory for Stressful Situations.

2 “Condition” means baseline differences between CBT and TAU

IVWaZ*#MLA Effects for Time, Condition and Time X Condition and Cohen's d effect sizes for differences on outcome measures between CBT and TAU for completers (n=73)

Use of health care services during the study period

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Variables¹ Time Condition² Time X Cohen’s d Cohen’s d Cohen’s d

Condition

B(SE) B(SE) B(SE) 3 months 6 months 9 months

(post-treatment) (follow-up) (follow-up)

n=48/42 n=48/42 n=48/42

DSH -.610(.163)* 2.225(2.069) -.637(.224)* .08 .15 .49 Depression (BDI-II) -.438(.218)* -3.996(2.809) -1.434(.299)* .56 .77 1.19

Anxiety (SCL-90) -.033(.152) .865(1.993) -.945(.209)* .38 .47 .77 Suicide Cognitions total (SCS) -.678(.267)* -6.077(3.633) -1.373(.367)* .61 .68 .98 Perceived burdensomeness (SCS) -.095(.034)* -.470(.462) -.156(.047)* .48 .56 .82 Helplessness (SCS) -.110(.084) -1.906(1.109) -.403(.116)* .64 .67 1.00 Poor distress tolerance (SCS) -.247(.093)* - 1.643(1.233) -.487(.127)* .55 .61 .89 Unlovability (SCS) -.226(.087)* -2.049(1.168) -.328(.120)* .56 .64 .89 Self-esteem (RSCQ) .106(.058)* .742(.814) .298(.079)* .33 .48 .77 Problem-solving (CISS) -.144(.180) .917(2.412) .996(.247)* .38 .50 .77

* indicates signifi cance at .05 level

1 BDI-II is the Beck Depression Inventory II; SCL-90 is the Symptom Checklist-90; RSCQ is the Robson Self-Concept Questionnaire (short version); SCS is the Suicide Cognitions Scale; CISS is the Coping Inventory for Stressful Situations.

2 “Condition” means baseline differences between CBT and TAU

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LOCF method (n=90)

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