Dennis Ougrin

The full invasion of Ukraine by Russia in February 2022 has resulted in relentless stressors upon the Ukrainian population. Numerous studies of people in Ukraine indicates the elevated rates of anx...

Drama therapy is delivered to children in schools; however, little empirical data evaluating the quantitative effect is currently available. This observation study of ten children undergoing drama therapy for emotional distress (anxiety, depression, trauma) addressed this gap. The Strengths and Difficulties Questionnaire and the Revised Child Anxiety and Depression Scale (RCADS) assessed both group and individual change. Child-, parent- and teacher-reported distress symptoms reduced, particularly internalizing symptoms and those measured via the RCADS. Studies with a larger sample, allowing for subgroup analyses, are recommended.

Background: Children growing up in low‐resource settings are at greater risk for lifelong psychiatric problems. They are both more likely to have risk factors for early psychopathology and to be less likely to seek help and engage support for these problems. Resource‐oriented therapeutic models—those that emphasise strengths of individuals and harness positive personal and social resources—may be particularly crucial in reducing the lifelong health inequalities that could arise amongst children growing up in socially deprived areas. Methods: We used network analysis to investigate the use of personal (different emotion regulation (ER) strategies) and social (social connectedness, religion, recreational activities) resources of children living in East London ( N = 867, M _age = 8.76 (0.95), 49% female) and their mental health outcomes using self‐ and teacher‐reported questionnaires (data collected November 2022–2023). Results: We found that family, peer, and school connectedness were the most central elements of the network, whilst negative ER strategies seemed to be a part of the cluster of anxiety and depression symptoms. Conclusion: Our findings highlight the importance of harnessing both internal strengths and positive social resources when thinking about intervention programmes for symptoms of emotional disorders in children growing up in deprived areas. Identifying strategies for nurturing social connectedness in children's closest environment is also crucial.

Summary: When thoroughly assessed, the prevalence of attention-deficit hyperactivity disorder (ADHD) in children/adolescents is estimated at 5%. There is no evidence that ADHD is over-diagnosed in the UK. Indeed, available data point to under-diagnosis, even though rigorous updated post-COVID-19 pandemic data are not available. Some cases may be misdiagnosed due to low-quality assessment, poor adherence to national guidance or inappropriate differential diagnosis. Beyond the controversy around over- or under-diagnosis and over-medicalisation of ordinary behaviours or emotions, the main issue is that UK clinical services cannot adequately support individuals with ADHD who need help. There is a risk that the narrative claiming ‘ADHD is over-diagnosed’ could be used to deny people with properly-diagnosed ADHD the care they deserve.

Self‐harm is defined as self‐injury or self‐poisoning, irrespective of the presence of suicidal intent. It includes both non‐suicidal self‐injury and attempted suicide. The lifetime prevalence of self‐harm is approximately 20% in young people. The initial assessment for self‐harm should contain an evaluation of risk, a safety plan and a therapeutic element, which should be focused on understanding the nature of self‐harm, instilling hope and linking young people with follow‐up treatment. Dialectical Behaviour Therapy should be offered to young people with severe self‐harm. School‐based interventions, such as the Youth Aware of Mental Health programme, could prevent self‐harm in young people.

Background: Self-harm is common in adolescents and a major public health concern. Evidence for effective interventions is lacking. An individual participant data meta-analysis has potential to provide more reliable estimates of the effects of therapeutic interventions than conventional meta-analyses and to explore which treatments are best suited to certain groups. Methods: A systematic review and individual participant data meta-analysis of randomised controlled trials of therapeutic interventions to reduce repeat self-harm in adolescents with a history of self-harm and who had presented to clinical services. We searched Cochrane Library, EMBASE, trial registers and other databases for randomised controlled trials published in January 2022. Eligible randomised controlled trials compared any therapeutic intervention against a control, aimed to reduce self-harm in adolescents (11–18 years old), with past self-harm presenting to clinical services, and collected outcome data on self-harm or suicide attempts. Interventions reviewed were grouped into nine categories: cognitive–behavioural therapy; dialectical behaviour therapy; family therapy; group therapy; mentalisation based, psychodynamic, cognitive analytic therapy; multisystemic therapy; problem-solving, psychoeducation, support; postcards, tokens, documents (postcards/tokens); and other single session, brief interventions. Control interventions were all either treatment as usual or enhanced treatment as usual and were not usually well described. There were no ‘no treatment’ controls except in the postcard/document/token studies. Primary outcome was repetition of self-harm at 12 months. Other outcomes included repetition of self-harm at other time points, overall mental health, depressive symptoms, thoughts of suicide, quality of life and death. Two-stage random-effects individual participant data meta-analyses were conducted overall and by intervention, and to examine interaction between treatment received and participant characteristics. Secondary analyses incorporated aggregate data from randomised controlled trials without individual participant data. Metaregression explored moderating study effects. Results: We identified 39 eligible studies, from 10 countries, where we sought individual participant data (18 studies with full sample eligibility, 21 with partial sample eligibility). We obtained individual participant data from 26 studies of 3448 eligible participants. We used published data from a further seven studies where individual participant data were not available for a combined individual participant data aggregate data meta-analysis (698 participants). For our primary outcome, repetition of self-harm, only six studies were rated as low risk of bias. There was no evidence that intervention/s were more or less effective than controls at preventing repeat self-harm by 12 months using individual participant data (odds ratios 1.06, 95% confidence interval 0.86 to 1.31) or individual participant data + aggregate data (odds ratios 1.02, 95% confidence interval 0.82 to 1.27) and no evidence of heterogeneity of treatment effects on study and treatment factors. We found no evidence that intervention was more or less effective than control for secondary outcomes, except general psychopathology and suicidal ideation at 12 and 6 months, respectively. Across all interventions, participants with multiple prior self-harm episodes showed evidence of improved treatment effect on self-harm repetition 6–12 months after randomisation [odds ratios 0.33 (95% confidence interval 0.12 to 0.94), studies = 9, n = 1771]. Modest evidence suggesting differential treatment effects based on participants’ age, gender, self-harm method, and anxiety levels are noted. Limitations: A significant limitation was missing individual participant data where authors were unable to share data; we offset this by including published data in secondary individual participant data plus aggregate meta-analysis. A wide range of interventions were evaluated and lacked replication. There was variability in the definitions and timings of outcomes, measures used for data collection, and available moderator data, with little consistency across studies. Conclusions: More attention needs to be paid to seeking appropriate consent from study participants for data-sharing. We found no evidence that any therapeutic intervention (overall or by intervention) was more or less effective than control for reducing repeat self-harm. We are therefore unable to recommend any specific intervention to prevent repetition of self-harm in adolescents. We observed evidence and trends indicating more effective interventions within specific subgroups. Analysis was constrained due to scarcity of data concerning common baseline characteristics, outcomes, and follow-up lengths. We recommend efficient, adaptive platform trial designs to tackle research questions and ascertain the most effective interventions for different groups, covering available treatments. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/117/11.