Susanna Jernelöv

Self-harm is a serious and growing public health concern among adolescents, strongly associated with suicide risk and mental health problems. It imposes significant societal costs through increased demand for psychiatric and emergency medical care, school absenteeism, and parental sick leave, both short- and long-term. Early interventions, including parental support and psychological treatment focused on emotion regulation may help prevent further deterioration. There is a clear need for brief, accessible treatments tailored to patients within child and adolescent psychiatry services (CAMHS), as well as for effective collaboration models between families and CAMHS. Following a promising feasibility study, we now want to assess the effectiveness of a novel group-based intervention, ERGT-A, for self-harming adolescents and their parents in a single blinded clinical randomized controlled effectiveness study including 166 adolescents (ages 13–18). The control group will receive TAU and cross over to ERGT-A treatment after the primary end-point. This study combines quantitative measures and repeated assessments to identify change processes and long-term effects. This project involves parents, and bridges the gap between research and practice, promoting early intervention and long-term health for a vulnerable and growing patient group.

Research problem and specific questions Self-harm in adolescents is a serious and growing concern, inked to increased risk of suicide attempts, psychiatric disorders, substance use, and inpatient care. Early detection and intervention is crucial for improving long-term outcomes and well-being. Although clinical guidelines recommend treatments focusing on emotion regulation, access remains largely restricted to specialist clinics, leaving many adolescents at risk of receiving no or non-specific care. To adress this, we have developed a group-based emotion regulation treatment for self-harming adolescents, showing promising results. The group format integrates well into healthcare structures, fosters social skills training, and reduces stigma – key challenges for this patient group. Schools are primary environments in adolescents' lives and often the first to identify self-harm. However, limited knowledge of appropriate responses and concerns about contagion effects creates barriers to effective management. Strengthening collaboration between healthcare and schools is essential to enhance early detection and support. Data and Method A single-blind randomized controlled trial will be conducted to evaluate the effectiveness of this novel treatment. Adolescents (N=166) age 13–17, will be randomized to emotion regulation treatment plus treatment-as-usual (TAU) or TAU only. The content of TAU will be carefully monitored. Cost-effectiveness, mechanisms of change, and treatment effects up to 12 months post-treatment will be assessed. Focus group interviews with school health professionals will be conducted to identify collaboration needs between schools and healthcare. Societal Relevance and utilization This unique project addresses a critical scientific and clinical challenge by increasing access to treatment for self-harming adolescents. By mitigating the long-term health and social consequences associated with self-harm the project aims to improve outcomes for affected youth. Strengthening collaboration between healthcare, families and schools will enhance early detection and timely interventions. Plan for project realisation The project team consists of researchers with expertise in self-harm, emotion regulation, clinical trials, and child and adolescent psychiatry. Feasibility has been tested, infrastructure is being developed, and recruitment will be carried out through established collaboration with regional and national child and adolescent psychiatry clinics.