The British Journal of Psychiatry
Brief psychological intervention after self-harm: randomised controlled trial from Pakistan
Nusrat Husain, Salahuddin Afsar, Jamal Ara, Hina Fayyaz, Raza ur Rahman, Barbara Tomenson, Munir Hamirani, Nasim Chaudhry, Batool Fatima, Meher Husain, Farooq Naeem, Imran B. Chaudhry
  • Declaration of interest




Self-harm is a major risk factor for completed suicide.


To determine the efficacy of a brief psychological intervention - culturally adapted manual-assisted problem-solving training (C-MAP) - delivered following an episode of self-harm compared with treatment as usual (TAU).


The study was a randomised controlled assessor-masked clinical trial (trial registration: NCT01308151). All patients admitted after an episode of self-harm during the previous 7 days to the participating medical units of three university hospitals in Karachi, Pakistan, were included in the study. A total of 250 patients were screened and 221 were randomly allocated to C-MAP plus treatment as usual (TAU) or to TAU alone. All patients were assessed at baseline, at 3 months (end of intervention) and at 6 months after baseline. The primary outcome measure was reduction in suicidal ideation at 3 months. The secondary outcome measures included hopelessness, depression, coping resources and healthcare utilisation.


A total of 108 patients were randomised to the C-MAP group and 113 to the TAU group. Patients in the C-MAP group showed statistically significant improvement on the Beck Scale for Suicide Ideation and Beck Hopelessness Inventory, which was sustained at 3 months after the completion of C-MAP. There was also a significant reduction in symptoms of depression compared with patients receiving TAU.


The positive outcomes of this brief psychological intervention in patients attempting self-harm are promising and suggest that C-MAP may have a role in suicide prevention.


  • Funding

    This study was jointly funded by the University of Manchester and Pakistan Institute of Learning and Living. The sponsor of the study had no role in the study design, data collection, analysis of the data, data interpretation or writing of the manuscript.

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