Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial
Husain N., Tofique S., Kiran T., Pierce M., Chaudhry IB., Omair Husain M., Memon R., Waqas A., Gire N., Edwards S., Bassitt P., Shakoor S., Zaddeh ZF., Arshad U., Colucci E., Mughal F., Shahid S., Panagioti M., Nizami AT., Jafri F., Naeem F., Emsley R., Ansari MA., Sultan S., Aggarwal S., Williams C., Chaudhry N.
OBJECTIVE To evaluate the clinical effectiveness of the YCMAP intervention (Youth Culturally Adapted Manual Assisted Problem Solving) for adolescents after self-harm in Pakistan. DESIGN Multicentre, randomised controlled trial that compared YCMAP with enhanced treatment as usual. SETTINGS General practices, emergency departments, medical wards of participating hospitals, and community centres across Karachi, Hyderabad, Lahore, Multan, and Rawalpindi. PARTICIPANTS Adolescents with a recent history of self-harm identified at participating health centres by treating physicians between 5 November 2019 and 31 August 2021. INTERVENTION The YCMAP group received up to 10 treatment sessions over three months; the intervention was based on the principles of cognitive behaviour therapy. MAIN OUTCOME MEASURE The primary outcome was the repetition of self-harm at 12 months after randomisation. Secondary outcomes were distress, hopelessness, suicidal ideation, and health related quality of life at three, six, nine, and 12 months after randomisation. Participants’ satisfaction with the services was assessed at three and 12 months after randomisation. RESULTS This trial was conducted between November 2019 and February 2023 and included 684 adolescents randomised to YCMAP (n=342) or enhanced treatment as usual (n=342). The YCMAP group had a significantly lower risk of self-harm repetition than the enhanced treatment as usual group at 12 months after randomisation (odds ratio 0.20, 95% confidence interval 0.06 to 0.70, P=0.006). YCMAP participants showed a statistically significant reduction in distress, hopelessness, and suicidal ideation at three months, but these differences were not statistically significant at 12 months. YCMAP participants also reported significantly better quality of life and satisfaction with services at three months, with these effects sustained at all follow-up points. CONCLUSION The YCMAP intervention was shown to be beneficial in self-harm prevention among adolescents. Further research and replication of findings in diverse settings are recommended to strengthen the evidence base for this public health intervention.