Sarah L Rowe (presenting)¹ PhD, Krisna Patel² MSc, Rebecca S French³ PhD, Claire Henderson4, MRCPsych, PhD, Dennis Ougrin5 MD, PhD, Mike Slade6 PhD, Paul Moran7 MD, PhD
¹Division of Psychiatry, University College London
²Department of Psychosis, King’s College London, Institute of Psychiatry, Psychology and Neuroscience
³Department of Social and Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine
4Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience
5Child and Adolescent Psychiatry Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience
6School of Health Sciences, Institute of Mental Health, University of Nottingham
7 Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol
Decision-aids (DA) have been shown to increase knowledge, encourage more active participation in decision-making and lower levels of decisional conflict (O'Connor, Rostom et al, 1999). We have developed a novel web-based DA designed to help young people get support for their self-harm. A feasibility trial was conducted to test the acceptability and gather descriptive data on outcome measures.
Young people aged 12-18 years were recruited from a secondary school in London, England and screened for self-harm. Those that reported self-harming behaviour in the past year were randomised to either 1) the control condition whereby they received general information about mood and feelings or 2) the experimental condition where they completed the DA and received help-seeking options based on their personal responses. Participants were followed-up at 4 weeks. Qualitative interviews were conducted after follow-up with a subset of participants, to evaluate and explore the young person’s experience of the study and the (potential) effects of the DA.
Parental consent was a major barrier to recruitment in this study. Twenty-three young people aged 12-18 years were randomised to receiving the DA (n=10) or the control group (n=13). The DA was found to be acceptable to participants and they would recommend it to other young people who were self-harming. There were no differences in outcome measures between the groups at 4-week follow-up. Qualitative interviews suggest that the DA increased young people's awareness of different sources of support, encouraged self-reflection and reduced shame and stigma associated with disclosing.
Issues around parental consent made the population level screening process unfeasible in this study. Changing the consent process may be necessary in order to assess the potential effectiveness of the DA in a future clinical trial, and (more broadly) to engage young people that self-harm with research. The balance of protection arrangements for vulnerable populations and the ability to conduct research of a sensitive nature within an adolescent population, requires ongoing debate.
O'Connor,A. M., A. Rostom, V. Fiset, J. Tetroe, V. Entwistle, H. Llewellyn-Thomas, M. Holmes-Rovner, M. Barry and J. Jones (1999). "Decision aids for patients facing health treatment or screening decisions: systematic review." BMJ 319(7212): 731-734.