Comparative efficacy and acceptability of psychotherapeutic, pharmacological, and combination treatments for non-suicidal self-injury in children and adolescents: a systematic review and network meta-analysis

BackgroundNon-suicidal self-injury (NSSI) is a common and serious injury behavior in children and adolescents, however, its treatment remains controversial. Here, using network meta-analysis (NMA), we compared and ranked all available therapeutic treatment interventions to explore the best treatment strategy for NSSI in children and adolescents.MethodsWe searched PubMed, Embase, the Cochrane Library and PsycINFO for randomized controlled trials used to reduce the frequency of NSSI in children and adolescents from database inception until Jan. 11, 2025. Primary outcomes were efficacy and acceptability. We estimated summary odds ratios (ORs) with credible intervals (CIs) in random effects models.ResultsWe included 28 trials comprising 6496 participants. Dialectical behavior therapy (DBT) was better than other interventions. In subgroup analysis, pharmacotherapy and psychotherapy significantly aggravated the frequency of NSSI in depression (OR = 1.53; 95% CI: 1.10 to 2.14); however, these interventions significantly reduced NSSI in patients with self-harm (OR = 0.53; 95% CI: 0.30 to 0.96). We also found that NSSI was significantly increased in the first 3 months when using SSRIs in treatment but was significantly reduced after 3 months.ConclusionPsychotherapy seems to be a better choice than pharmacotherapy, especially DBT. DBT was associated with a better reduction in the frequency of NSSI than treatment as usual, with high confidence of evidence. NSSI is frequently used to combat depression symptoms, suggesting that clinicians should pay greater attention to depression symptoms to reduce NSSI, especially in the first 3 months of treatment with SSRIs.