■自我伤害在青少年中很常见,是一个主要的公共卫生问题。缺乏有效干预措施的证据。与传统的荟萃分析相比,个体患者数据荟萃分析有可能提供更可靠的自我伤害治疗干预措施效果估计。探索哪种治疗方法最适合某些群体。
■一项关于治疗性干预措施的随机对照试验的系统评价和个体患者数据荟萃分析,目的是减少有自我伤害史并提供给临床服务的青少年的重复自我伤害。主要结果是自我伤害的重复。用于搜索的方法,研究筛选和选择,并描述了偏差风险评估,概述了搜索的输出,选择和质量评估过程。遵循系统审查和荟萃分析指导的首选报告项目。
■我们总共确定了39项符合条件的研究,来自10个国家,我们在那里寻找个体患者数据(IPD),其中18项研究的全部样本参与者符合资格,21项研究的部分样本参与者符合资格.我们从3448名符合条件的参与者的26项研究中获得了IPD。对于我们的主要结果,自我伤害的重复,只有6项研究被评为低偏倚风险,10项被评为高风险(尽管其中2项仅针对次要结局).
■获取个体患者数据进行荟萃分析是可能的,但非常耗时,尽管资助机构明确指导研究人员应该适当地分享他们的数据。需要更加注意寻求研究参与者的适当同意以进行(伪)匿名数据共享,并且机构需要就商定的模板数据共享协议进行合作。研究人员和资助者需要更仔细地考虑研究设计问题。我们的下一步是分析我们收集的所有数据,看看它是否会告诉我们更多关于我们如何防止年轻人重复自我伤害的信息。
■本文介绍了由美国国立卫生与护理研究所(NIHR)健康技术评估计划资助的独立研究,奖励编号为17/117/11。这篇研究文章的简单语言摘要可在NIHR期刊库网站https://doi.org/10.3310/GTNT6331上找到。
自我伤害在年轻人中很常见,导致自杀死亡的风险增加。到目前为止,研究还没有提供明确的证据,说明当年轻人出现在伤害自己的服务机构时,哪些干预措施可以帮助防止自我伤害的重复发生。了解可能有帮助的一种方法是汇集许多不同临床试验的结果-这被称为荟萃分析。这已经使用研究文章中发表的数据完成,但没有得出更清晰的结论。在某种程度上,这是因为已发表的文章中可用的信息是零散且不一致的,这使得汇集信息并对其进行分析,困难。一种更有用的方法是向领导临床试验的研究人员询问其原始的“原始”数据,然后汇总并分析所有数据-这被称为个体患者数据荟萃分析。这还有一个额外的好处,那就是可以包括只有一些参与者是年轻人的研究。我们做到了,并且能够识别更多的研究参与者以及他们的数据,与早期的荟萃分析相比。在这篇文章中,我们描述了我们是如何搜索相关研究的,以及我们用于从其他研究人员那里获取个体患者数据的方法.我们还描述了我们对我们确定的研究的研究质量的评级。我们发现了更多的研究,总共有更多的参与者,比以前的汇集研究研究。收集其他研究人员的数据非常耗时,并不是每个人都愿意或能够分享他们的数据。当我们评估我们发现的研究质量时,许多人质量不高。我们的下一步是分析我们收集的所有数据,看看它是否会告诉我们更多关于我们如何防止年轻人重复自我伤害的信息。
UNASSIGNED: Self-harm is common in adolescents and a major public health concern. Evidence for effective interventions is lacking. An individual patient data meta-analysis has the potential to provide more reliable estimates of the effects of therapeutic interventions for self-harm than conventional meta-analyses, to explore which treatments are best suited to certain groups.
UNASSIGNED: A systematic
review and individual patient data meta-analysis of randomised controlled trials of therapeutic interventions to reduce repeat self-harm in adolescents who had a history of self-harm and presented to clinical services. Primary outcome was repetition of self-harm. The methods employed for searches, study screening and selection, and risk of bias assessment are described, with an overview of the outputs of the searching, selection and quality assessment processes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance is followed.
UNASSIGNED: We identified a total 39 eligible studies, from 10 countries, where we sought Individual Patient Data (IPD), of which the full sample of participants were eligible in 18 studies and a partial sample of participants were eligible in 21 studies. We obtained IPD from 26 studies of 3448 eligible participants. For our primary outcome, repetition of self-harm, only 6 studies were rated as low risk of bias with 10 rated as high risk (although 2 of these were for secondary outcomes only).
UNASSIGNED: Obtaining individual patient data for meta-analyses is possible but very time-consuming, despite clear guidance from funding bodies that researchers should share their data appropriately. More attention needs to be paid to seeking appropriate consent from study participants for (pseudo) anonymised data-sharing and institutions need to collaborate on agreeing template data-sharing agreements. Researchers and funders need to consider issues of research design more carefully. Our next step is to analyse all the data we have collected to see if it will tell us more about how we might prevent repetition of self-harm in young people.
UNASSIGNED: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/117/11. A plain language summary of this research article is available on the NIHR Journals Library Website https://doi.org/10.3310/GTNT6331.
Self-harm is very common in young people and leads to an increased risk of death by suicide. Research so far has not provided clear evidence about which interventions can help to prevent self-harm repetition when young people present to services having harmed themselves. One way to understand what might help is to pool the results from lots of different clinical trials – this is known as a meta-analysis. This has already been done using the data published in research articles but has not led to clearer conclusions. In part this is because the information available in published articles is patchy and inconsistent which makes pooling the information and analysing it, difficult. A more useful approach is to ask researchers who led the clinical trials for their original ‘raw’ data and then pool and analyse all that data – this is known as an individual patient data meta-analysis. This has the added benefit that it is possible to include studies where only some of the participants are young people. We did this, and were able to identify many more study participants along with their data, compared to earlier meta-analyses. In this article, we describe how we searched for relevant research studies and the methods we used to obtain individual patient data from other researchers. We also describe our rating of the research quality of the studies we identified. We identified more studies, with many more participants in total, than in previous pooled study research. Gathering the data from other researchers was very time-consuming and not everyone was willing or able to share their data. When we rated the quality of the studies that we found, many were not of high quality. Our next step is to analyse all the data we have collected to see if it will tell us more about how we might prevent repetition of self-harm in young people.