Meta-analysis of the effects of different intervention modalities on non-suicidal self-injury in adolescents
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摘要:
目的 探讨不同干预方式对青少年非自杀性自伤(NSSI)的干预效果，为制定青少年NSSI的干预策略提供循证依据。 方法 检索中国知网、万方、维普、中国生物医学文献数据库、Web of Science、PubMed、Embase、Cochrane Library等数据库，筛选有关青少年NSSI干预的随机对照研究，检索时间为建库至2025年3月5日。运用Stata 17.0和Review Manager 5.3软件进行网状Meta分析，以标准均数差(SMD)及95%CI为效应指标，比较各干预方式之间的效果差异，并进行效果排序。 结果 最终纳入26篇文献，共2 034名NSSI青少年，包括辩证行为疗法、情绪调节干预、心智化基础疗法、家庭干预、削减计划、认知行为疗法、叙事治疗、阶梯式护理干预、积极心理干预、接纳承诺疗法10种干预方式。结果显示，与常规干预组相比，积极心理干预[SMD值(95%CI)=-2.12(-3.51~-0.74)]、阶梯式护理干预[SMD值(95%CI)=-2.07(-3.43~-0.71)]、辩证行为疗法[SMD值(95%CI)=-1.70(-2.60~-0.80)]、认知行为疗法[SMD值(95%CI)=-1.54(-2.61~-0.48)]、接纳承诺疗法[SMD值(95%CI)=-1.50(-2.68~-0.32)]在减轻青少年NSSI行为方面差异均有统计学意义(P值均＜0.05)。积极心理干预、阶梯式护理干预、辩证行为疗法效果均优于心智化基础疗法及削减计划(SMD值分别为-2.08，-2.03，-1.66，-2.06，-2.01，-1.64，P值均＜0.05)；累积排序概率图下面积显示，积极心理干预在改善青少年NSSI上效果可能更好(82.5)。 结论 积极心理干预在多种干预方式中表现出对青少年NSSI最佳的改善效果，推荐在临床干预中优先考虑。 Abstract:Objective To explore the effectiveness of different intervention modalities on non-suicidal self-injury (NSSI) in adolescents, so as to provide an evidence-based basis for the intervention strategy of NSSI in adolescents. Methods Randomized controlled trials on interventions for adolescent NSSI were retrieved from databases, such as CNKI, Wanfang, VIP, CBM, Web of Science, PubMed, Embase, and Cochrane Library, spanning from the inception of these databases to March 5, 2025. Network Meta-analysis was performed by using Stata 17.0 and Review Manager 5.3 software, and the standardized mean difference (SMD) and 95%CI were used as the effect indicators to compare the differences in the effectiveness of the interventions and rank the effect. Results A total of 26 articles with 2 034 adolescents with NSSI were included in the study, including 10 intervention modalities: dialectical behavior therapy, emotional regulation intervention, mentalization-based therapy, family therapy, cutting down programme, cognitive behavioral therapy, narrative therapy, stepped care approach, positive psychological intervention, and acceptance and commitment therapy. The results showed that compared with the treatment as usual, positive psychological intervention [SMD(95%CI)=-2.12(-3.51 to-0.74)], stepped care intervention [SMD(95%XI)=-2.07(-3.43 to-0.71)], and dialectical behavior therapy [SMD(95%CI)=-1.70(-2.60 to-0.80)], cognitive behavioral therapy [SMD(95%CI)=-1.54(-2.61 to-0.48)], and acceptance and commitment therapy [SMD(95%CI)=-1.50(-2.68 to-0.32)] were statistically significant differences in reducing adolescents' NSSI behaviors(P < 0.05). Positive psychological intervention, stepped care intervention, and dialectical behavior therapy were more effective than the mentalization-based therapy and the cutting down programme (SMD=-2.08, -2.03, -1.66, -2.06, -2.01, -1.64, P < 0.05); the area under the cumulative ranking probability graph revealed that positive psychological intervention may have the best effect in improving NSSI among adolescents (82.5). Conclusions Positive psychological interventions show the best results in improving adolescent NSSI among multiple intervention modalities. It is recommended to give priority to positive psychological interventions in clinical interventions. -
Key words:
- Intervention /
- Self-injurious behavior /
- Mental health /
- Meta-analysis /
- Adolescent
1) 利益冲突声明 所有作者声明无利益冲突。 -
图 1 不同干预方式对青少年NSSI影响文献筛选流程
Figure 1. Literature screening process of the effects of different intervention modalities on NSSI in adolescents
图 3 不同干预方式对青少年NSSI影响的Meta分析
注：PPI为积极心理干预，TAU为常规干预，SCA为阶梯式护理方法，DBT为辩证行为疗法，CBT为认知行为疗法，ACT为接纳承诺疗法，NT为叙事治疗，FT为家庭干预，SPI为支持心理干预，ERI为情绪调节干预，MBT为心智化基础疗法，CDP为削减计划。
Figure 3. Meta-analysis of the effects of different interventions on NSSI in adolescents
图 4 纳入文献的发表偏倚
注：PPI为积极心理干预，TAU为常规干预，SCA为阶梯式护理方法，DBT为辩证行为疗法，CBT为认知行为疗法，ACT为接纳承诺疗法，NT为叙事治疗，FT为家庭干预，SPI为支持心理干预，ERI为情绪调节干预，MBT为心智化基础疗法，CDP为削减计划。
Figure 4. Publication bias testing of the included literature
表 1 不同干预方式对青少年NSSI影响纳入文献的基本特征
Table 1. Basic characteristics of included literature on screening process of the effects of different intervention modalities on NSSI in adolescents
第一作者与年份 国家 年龄/岁 样本量 干预方式 干预时间/min 干预频次 干预周期 测评工具 试验组 对照组 试验组 对照组 试验组 对照组 Mehlum[14](2014) 挪威 15.9±1.4 15.3±1.6 39 38 DBT TAU 60~120 1次/周 19周 LPC Morthorst[15](2022) 丹麦 15.2±1.3 14.9±1.4 15 15 ERI TAU — 1次/周 12周 DSHI Rossouw[16](2012) 英国 15.4±1.3 14.8±1.2 40 40 MBT TAU 50 1次/周 3月 RTSHI-A Haga[17](2018) 挪威 15.9±1.4 15.3±1.6 39 38 DBT TAU 60~120 1~2次/周 19周 LPC Bjureberg[18](2023) 瑞典 15.0±1.3 15.0±1.2 77 77 ERI TAU — 1次/周 12周 DSHI Cottrell[19](2018) 美国 14.3±1.4 14.4±1.4 73 56 FT TAU 85 1次/月 12月 SASII Beck[20](2020) 丹麦 15.7±1.1 15.9±1.0 39 45 MBT TAU 90 1次/周 30周 RTSHI-A Griffiths[21](2019) 英国 15.4±1.3 15.7±1.4 22 26 MBT TAU 85 1次/周 12周 RTSHI-A Kaess[22](2020) 瑞士 14.6±1.3 15.2±1.1 37 37 CDP TAU — 1次/周 2~4月 SITBI Rockstroh[23](2023) 德国 14.2±1.2 14.2±1.2 36 36 CDP TAU — 1次/周 6月 SITBI 章明慧[24](2024) 中国 11.1±1.5 11.3±1.5 71 71 DBT TAU — — 8周 ANSAQ 王玉萍[25](2022) 中国 15.7±3.1 15.5±2.9 44 42 CBT TAU 60~90 1次/周 5周 ANSAQ 张雅怡[26](2024) 中国 15.0±1.5 14.9±1.5 26 29 NT SPI 60 2次/周 3周 青少年自我伤害问卷 张春娜[27](2023) 中国 14.4±2.4 14.8±2.1 44 44 NT TAU 60 1次/周 - ANSAQ 曹玉婷[28](2024) 中国 15.8±1.8 15.7±1.9 50 50 SCA TAU 30 2~4次/周 6周 ANSAQ 陈琳[29](2023) 中国 12~18 12~18 44 46 SCA TAU 30 2~3次/周 2周 青少年自我伤害问卷 梁巧玲[30](2022) 中国 15.9±2.5 16.2±2.3 38 38 PPI TAU 60~80 1次/周 3月 青少年自我伤害问卷 韩利[31](2023) 中国 16.1±0.7 16.1±0.7 43 44 FT TAU 60 1次/周 8周 OSI 胡知仲[32](2022) 中国 16.1±1.7 14.8±1.7 12 12 ACT DBT 90 1次/周 8周 ANSAQ 苏晓云[33](2022) 中国 16.3±1.3 16.2±1.5 45 45 DBT TAU — — 6周 ANSAQ 张岩岩[34](2023) 中国 12~18 12~18 15 15 ACT TAU 60 1次/周 8周 ANSAQ 彭惠子[35](2021) 中国 15.1±1.5 15.7±1.7 15 15 CBT SPI 60 1~2次/周 6周 青少年自我伤害问卷 陈秋雨[36](2023) 中国 15.5±1.7 15.5±2.1 19 20 CBT TAU 30 2次/周 4周 ANSAQ 薛毅[37](2022) 中国 14.2±1.7 14.7±1.5 60 60 ACT TAU 30~50 1次/周 6周 ANSAQ 李国红[38](2024) 中国 15.3±2.2 14.3±2.3 30 30 PPI TAU 60~80 1次/周 2月 OSI 娄凤艳[39](2024) 中国 15.8±0.7 15.9±0.8 46 46 CBT TAU 60~90 1次/周 5周 ANSAQ 注：LPC—终生自杀计数访谈；DSHI—蓄意自伤问卷；SITBI—自我伤害想法和行为访谈；RTSHI-A—青少年冒险和自残量表；SASII—自杀未遂自伤访谈；ANSAQ—青少年非自杀性自伤行为问卷；OSI—渥太华自伤量表；TAU—常规干预；SPI—支持性心理干预。 
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