Optimizing outcome and improving accessibility to psychological treatment for adolescent self-injury: randomized controlled trial

Research problem and specific questionsSelf-injury is a growing and urgent health crisis among youth and the strongest risk factor for suicide attempts. Scalable and evidence-based treatments are needed but lacking.

We have recently shown that a brief digital treatment, IERITA (Internet-delivered Emotion Regulation Individual Therapy for Adolescents), can be efficacious and cost-effective compared to treatment as usual only.

However, not all patients respond sufficiently to the standard treatment procedure, and established efficacy does not guarantee successful uptake in regular care. This project aims to implement and evaluate IERITA in real-world settings and optimize treatment outcomes.

The key question concerns the effectiveness and cost-effectiveness of changing to an adapted version of IERITA compared to continuing standard IERITA for adolescents at risk of continued self-injury after treatment (non-remission).

Data and methodFirst, a classification tool to predict non-remission will be developed and subsequently used in the second step: a randomized controlled trial (N=341) comparing adaptable to standard IERITA.

Adolescents allocated to adaptable IERITA and classified as likely non-remission in treatment week four will change to adapted IERITA (e.g., personalized dose and treatment delivery) for the remaining eight weeks.

Several clinically relevant outcomes will be measured using blinded assessment, including remission (primary outcome), self-injury frequency, suicidality, and functional impairment. Participants will be followed up one- three- and twelve months post-treatment and in national registers. Societal relevance and utilisationSelf-injury is rapidly increasing, posing severe risks for youths.

The queue to healthcare services is long, and current treatments are costly and not widely or equally accessible.

If this project is successful, more youths across the country could receive effective early intervention for self-injury, with the hope of reduced waiting times, equal care, and suicide preventive effects. Plan for project realisationThe project will be conducted within child and adolescent mental health services.

In previous studies, we have successfully collaborated with several regions. Patient organizations and health professionals will contribute to increasing relevance and feasibility.

The budget includes salaries (applicant, project coordinator, patient organization, blinded assessors) and operating costs.