![]() ![]() ![]() ![]() There was a statistically and clinically significant reduction in other outcomes including suicidal ideation (− 3.6 (− 4.9, − 2.4)), depression (− 7.1 (− 8.7, − 5.4)), hopelessness (− 2.6 (− 3.4, − 1.8), and improvement in health-related QoL and coping resources after completion of the intervention in the CMAP plus E-TAU arm compared to the E-TAU arm. The number of self-harm repetitions for CMAP plus E-TAU was lower ( n = 17) compared to the E-TAU arm ( n = 23) at 12-month post-randomisation, but the difference was not statistically significant ( p = 0.407). We screened 3786 patients for eligibility and 901 eligible, consented patients were randomly assigned to the CMAP plus E-TAU arm ( n = 440) and E-TAU arm ( N = 461). Repetition of self-harm at 12-month post-randomisation was the primary outcome and secondary outcomes included suicidal ideation, hopelessness, depression, health-related quality of life (QoL), coping resources, and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation. The intervention (CMAP) is a manual-assisted, cognitive behaviour therapy (CBT)-informed problem-focused therapy, comprising six one-to-one sessions delivered over three months. Patients presenting after a self-harm episode ( n = 901) to participating recruitment sites were assessed and randomised (1:1) to one of the two arms CMAP with enhanced treatment as usual (E-TAU) or E-TAU. The study sites were all participating emergency departments, medical wards of general hospitals and primary care centres in Karachi, Lahore, Rawalpindi, Peshawar, and Quetta, Pakistan. This was a rater-blind, multicenter randomised controlled trial. This study aims to investigate the effectiveness of a culturally adapted manual-assisted problem-solving intervention (CMAP) for patients presenting after self-harm. Culturally appropriate strategies for the prevention of self-harm and suicide are needed but the evidence is very limited from low- and middle-income countries (LMICs). Self-harm is an important predictor of a suicide death. ![]()
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