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NHS Choices: Behind the headlines   + / -  
last updated: Wed, 26 Nov 2014 05:54:34 GMT

 Tue, 25 Nov 2014 12:00:00 GMT No proof 5:2 diet prevents cancer

"Could 5:2 diet help to ward off cancer?" is the question posed by the Mail Online after the publication of a study into experimental diets.

An honest and accurate answer to the question, based on the study, would be "we don't know".

The Mail reports on a study that gives an overview of the evidence surrounding low-calorie diets and intermittent fasting, and whether they are beneficial to our health.

But this study does not provide new evidence on the 5:2 diet or whether fasting diets ward off cancer.

As the piece didn't report the methods used to find the evidence, it is unclear whether any cherry-picking took place. That is, evidence supporting the authors' opinions may have been included, but conflicting evidence may have been ignored.

The article says we need more good-quality research on issues such as whether certain types of diet can have a wider beneficial impact on health. We would certainly agree with this view.

The best way to reduce your cancer risk is to eat a balanced diet that includes plenty of fruit and vegetables, and is low in red and processed meat and salt. 

 

Where did the story come from?

The study was carried out by researchers from many different collaborating US universities, as well as one UK and one Belgian University.

It was funded by the US National Institute on Aging Intramural Research Program and the Glenn Foundation for Medical Research, the US National Institutes for Health, the European Union's Seventh Framework Programme MOPACT, Genesis Breast Cancer Prevention (UK) and the Belgian Foundation for Scientific Medical Research.

The study was published in the peer-reviewed Proceedings of the National Academy of Sciences (PNAS).

The media reporting was generally true to the facts of the research, which focused on the speculation that a fasting diet might reduce the risk of cancer. 

But neither the Mail nor The Daily Telegraph made it clear to their readers that this study was not a systematic review, which would have given more weight to its findings. Rather, it was more of an expert opinion piece.

The Telegraph did include a useful quote from Tom Stansfeld of Cancer Research UK, who said more research was needed looking into the long-term effects of intermittent fasting.

He added: "Decades of research tell us the best way to reduce the risk of cancer through nutrition is to eat a balanced diet with plenty of fruit and veg, and low in red and processed meat and salt."

 

What kind of research was this?

This was an evidence-informed "perspective" article describing the physiological responses of people and animals to controlled variation in meal size, frequency and timing of meals, and the impact on health and disease.

The study group described how research efforts have largely ignored the importance of the frequency and timing of meals, and potential benefits of periods of no or very low energy intake. Hence, they sought to describe some of the evidence around this grey area.

They argue eating three meals a day is abnormal from an evolutionary point of view. They also describe how the habit of eating three meals a day appears to have begun when humans switched from being hunter gatherers to farmers around 12,000 years ago.

The rationale is that our bodies, which have evolved incrementally over millions of years in the context of periods of fasting, may not be best suited to this relatively modern dietary switch.

Some studies suggest restricting energy intake for as little as 16 hours can have health benefits. They say the mechanisms that mediate this benefit are metabolic shifts to using fat as an energy source, and the stimulation of cellular responses that prevent and repair molecular damage.

 

What did the research involve?

It was not clear how the evidence to inform this "perspectives" piece had been searched for, selected or synthesised, as no methods were described.

As no systematic methods were described, as would be the case with a systematic review, we cannot discount the potential influence of bias on the evidence selection, sifting and synthesis. These biases have the potential to influence the content and conclusion of the article.

What we do know is the piece considered evidence on three broad experimental diets:

  • caloric restriction (CR) – where daily calorie intake is reduced by 20-40% and meal frequency is unchanged
  • intermittent energy restriction (IER) – this involves eliminating (fasting) or greatly reducing daily food and caloric beverage intake intermittently; for example, two days a week, as is used in the popular 5:2 diet
  • time-restricted feeding (TRF) – this involves limiting daily food intake and caloric beverages to a four to six-hour period

This article also reportedly incorporated information from a workshop on eating patterns and disease. Those with a particular interest in experimental diets may find the video of the workshop interesting, though we should warn you it is more than six hours long.

The Mail Online said the IER 2-Day Diet described in the article is the forerunner to the 5:2 diet. It involves two days of eating just 600 to 1,000 calories of low-carbohydrate foods. On the other five days, the dieter eats a healthy Mediterranean diet. Women usually need 2,000 calories a day, while men need 2,500.

 

What were the basic results?

There are no clear new results presented in this article, as it presents a flowing, evidence-informed description of the state of knowledge around the timing and frequency of eating and its potential influence on health. The media picked up on the description of the IER diet section around cancer.

The research said: "IER/fasting can forestall and even reverse disease processes in animal models of various cancers, cardiovascular disease, diabetes and neurodegenerative disorders", citing a single source on the molecular mechanisms of fasting.

It then goes on to describe four general biological mechanisms by which IER might protect cells against injury and disease.

It also suggests future directions for research and society-wide implications, highlighting how recommendations for healthy patterns of meal frequency and timing may emerge as more evidence gathers consensus.

 

How did the researchers interpret the results?

The researchers indicated that, "If sufficient evidence does emerge to support public health and clinical recommendations to alter meal patterning, there will be numerous forces at play in the acceptance or resistance to such recommendations."

These, they said, included the cultural tradition dictating three meals a day, the food industry's vested interest in making people eat frequently, and the ability or willingness of health systems to emphasise prevention through lifestyle modification, overtreatment and medicalisation.

 

Conclusion

This evidence-informed article presents an overview of, and perspective on, the potential mechanisms through which low calorie or intermittent fasting diets may be beneficial to the body.

The information provided by the authors is certainly interesting. But this study does not provide new or compelling evidence proving that fasting diets actually lead to a lower risk of disease or postponement of death.

This does not appear to be a systematic review, where the authors would search the global literature to identify all relevant evidence on the effects of different eating patterns on health outcomes.

As the piece reported no methods, we do not know how evidence for the article was searched for, selected or synthesised, and it therefore has the potential to be biased. 

The main contribution of this study is as a discussion starter. From the evidence included in the piece, it seems clear there is relatively little definitive evidence pointing to the best pattern or timing of meals. In this void of evidence, there may be misinformation.

For example, the researchers say that despite equivocal and even contradictory scientific evidence, breakfast is often touted as a weight-control aid, but recent evidence has suggested it may not be.

In addressing or clarifying potential misinformation, the article says we need more clarity about these still grey issues through more and better research.

The authors also say we need to ensure that the best available evidence is informing public guidelines and knowledge on these topics. It is tough to argue against this.

Intermittent fasting diets such as the 5:2 diet may not be suitable for pregnant women and people with specific health conditions, such as diabetes or a history of eating disorders.

Because it is a fairly radical approach to weight loss, it is wise to speak to your GP first if you are considering trying intermittent fasting for yourself.
 
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

The 5:2 diet helps beat cancer and Alzheimer's, study finds. The Daily Telegraph, November 24 2014

Could 5:2 diet help to ward off cancer? Scientists say having longer periods without food could be good for us. Mail Online, November 24 2014

Links To Science

Mattson MP, Allison DB, Fontana L, et al. Meal frequency and timing in health and disease. PNAS. Published online November 17 2014

 Tue, 25 Nov 2014 11:20:00 GMT Can a yoghurt a day reduce diabetes risk?

"Eating a small portion of yoghurt every day may reduce diabetes risk," The Independent reports.

This news comes from a US study that assessed the eating habits of more than 100,000 people and then followed them up every four years, looking for new diagnoses of type 2 diabetes.

Pooling the results of this study with 14 other studies, the researchers estimated each serving of yoghurt – 244 grams (g) – a day decreased the risk of developing type 2 diabetes by around 18%.

There was no significant link between total dairy intake or intake of other specific dairy products and type 2 diabetes.

A challenge facing this and similar studies is making sure all relevant outside influencing factors (confounders) have been accounted for, which is very tricky to do in practise.

If this has not been done conclusively, yoghurt consumption may be acting as a marker of a healthier lifestyle in general and has no direct influence on diabetes risk, which may be the case here.

We also don't know what sort of yoghurt the participants consumed. For example, many low-fat yoghurts are very high in sugar, which could contribute to weight gain.

It is therefore possible yoghurt may reduce the risk of developing diabetes, but may increase the risk of other diseases.

Current advice to reduce the risk of type 2 diabetes remains the same: eat a healthy diet, maintain a healthy weight, avoid smoking, moderate alcohol consumption, and take regular exercise.

 

Where did the story come from?

The study was carried out by researchers from Harvard School of Public Health and was funded by the US National Institutes of Health.

One of the study's authors declared a competing interest as he "holds membership of Unilever North America Scientific Advisory Board".

Unilever produces a huge number of commonly yoghurts. It is not clear to what extent this conflict of interest may have influenced the study design, methodology or interpretation.

The study was published in the peer-reviewed medical journal BioMed Central (BMC) Medicine. It is an open access journal, meaning that anyone can read the full research publication for free.

Generally, the media reported the study accurately. But many sources chose to suggest that, "it might be a good idea to eat yoghurt regularly" without due consideration for the potential downsides of this advice.

For example, eating low-fat, high-sugar yoghurt may contribute to weight gain and weight-related diseases other than type 2 diabetes. It could also potentially increase the risk of tooth decay, particularly in children.

It also wasn't made clear what type of yoghurt was consumed, or that the association between yoghurt and diabetes may still be influenced by other factors.

 

What kind of research was this?

This was a meta-analysis combining the results of three large prospective cohort studies.

The researchers attest that the relation between the consumption of different types of dairy and the risk of type 2 diabetes remains uncertain.

They therefore aimed to evaluate the association between total dairy and individual types of dairy consumption and incident type 2 diabetes in US adults.

Type 2 diabetes is a condition where the person can't control their blood glucose, either because the body doesn't produce enough insulin or the body's cells don't react to insulin.

The rapid rise in the number of adults in Westernised nations such as the UK developing type 2 diabetes is caused by:

  • increasing obesity levels
  • a lack of exercise
  • an increase in unhealthy diets
  • an ageing population

Read more about risk factors for type 2 diabetes.

 

What did the research involve?

The research team used existing data on 41,436 men in the Health Professionals Follow-Up Study (1986-2010), 67,138 women in the Nurses' Health Study (1980-2010), and 85,884 women in the Nurses' Health Study II (1991-2009) to look at the links between diet and type 2 diabetes.

Diet was assessed by validated food frequency questionnaires and data was updated every four years. Incident type 2 diabetes was confirmed by a validated supplementary questionnaire.

Every two years, data was gathered and updated on risk factors for chronic diseases, such as body weight, cigarette smoking, physical activity, medication use and family history of diabetes, as well as history of chronic diseases such as high blood pressure and high cholesterol.

Among participants in the two nurse studies, information on menopausal status, post-menopausal hormone use and oral contraceptive use was also gathered.

The researchers analysed their results in three phases, with each phase adjusting for more and more potentially confounding factors.

The fully adjusted analysis took account of the following potential confounders:

  • age
  • calendar time with updated information at each two-year questionnaire cycle
  • body mass index (BMI)
  • total energy intake
  • race
  • smoking
  • physical activity
  • alcohol consumption
  • menopausal status
  • menopausal hormone use (Nurses' Health Study II participants only)
  • oral contraceptive use (Nurses' Health Study II participants only)
  • family history of diabetes
  • diagnosed with high blood pressure or high cholesterol at baseline
  • trans-fat intake (a type of unsaturated fat often found in processed foods)
  • glycaemic load (eating foods known to raise blood glucose levels)

As well as intakes of:

  • red and processed meat
  • nuts
  • sugar-sweetened beverages
  • coffee
  • other types of dairy foods

The team extended their work by conducting an updated meta-analysis that combined the new results from the three large cohort studies described above with findings from previous studies.

This previous research included prospective studies with cohort, case cohort or nested case-control design investigating the association between the intake of dairy products and the risk of type 2 diabetes. Literature was searched for up until October 2013.

In studies that reported the intakes by grams (g), they used 177g as a serving size for total dairy products, and 244g as a serving size for milk and yoghurt intake to recalculate the intakes to a common scale (servings per day).

 

What were the basic results?

During 3,984,203 person years of follow-up, they documented 15,156 cases of incident type 2 diabetes.

After adjustment for age, BMI and other lifestyle and dietary risk factors, total dairy consumption was not associated with type 2 diabetes risk.

The pooled hazard ratio (HR) (95% confidence interval [CI] of type 2 diabetes for one serving per day increase in total dairy was 0.99, 95% CI 0.98 to 1.01), so the this result was not statistically significant.

Among different types of dairy products, neither low-fat nor high-fat dairy intake was appreciably associated with risk of type 2 diabetes.

However, yoghurt intake was consistently and inversely associated with type 2 diabetes risk across the three cohorts with a pooled HR of 0.83 (95% CI 0.75 to 0.92) for one serving per day increment (trend analysis).

For added validity, they conducted a meta-analysis of 14 additional prospective cohorts with 459,790 participants and 35,863 incident type 2 diabetes cases.

The pooled relative risks (RRs) (95% CIs) were 0.98 (0.96, 1.01) and 0.82 (0.70, 0.96) for one serving of total dairy per day and one serving of yoghurt per day, respectively.

 

How did the researchers interpret the results?

The researchers' main conclusion was that, "Higher intake of yoghurt is associated with a reduced risk of T2D [type 2 diabetes], whereas other dairy foods and consumption of total dairy are not appreciably associated with incidence of T2D."

They added that, "The consistent findings for yoghurt suggest that it can be incorporated into a healthy dietary pattern. However, randomised clinical trials are warranted to further examine the causal effects of yoghurt consumption, as well as probiotics on body weight and insulin resistance."

 

Conclusion

This analysis of three large cohort studies, and a meta-analysis of 14 more, came up with estimates that each serving per day of yoghurt (244g) decreases the relative risk of developing type 2 diabetes by 18%.

It suggests other dairy foods and consumption of total dairy are not associated with type 2 diabetes. It was not clear over what time period this risk reduction was achieved, as follow-up times varied, but the maximum was 30 years.

The research team pointed out that their findings on total dairy intake were consistent with some, but not all, previous studies. Differences between this and previous studies may be because the current study used longer-term follow-up (more than 10 years).

The study had a number of strengths, including its large sample size, use of prospective data and ability to take account of a large number of confounding factors. 

But, as with all studies, there are also limitations to consider.

What sort of yoghurt was consumed?

Firstly, what sort of yoghurt we are talking about here? Greek, natural or added sugar, low-fat or full-fat?

From the study data presented, there are few distinctions made and all types of yoghurt are lumped together in the analysis.

This means it is not possible to know which types of yoghurt are potentially beneficial. This may depend on the levels of sugar, fat and probiotic bacteria, or other constituents.

For example, many low-fat yoghurts are very high in sugar, which could contribute to weight gain and increase the risk of harms from other weight-related diseases.

Other health outcomes not considered

This study focused exclusively on the risk of developing type 2 diabetes. The effect of diet on other diseases was not studied, so any compensating effects would go unnoticed.

For example, those eating yoghurt may be at a reduced risk of developing type 2 diabetes, but at an increased risk of developing another disease.

Were all the confounders accounted for?

Also, despite adjusting for a number of potential confounding factors, it's difficult to know whether all relevant factors have been fully accounted for.

Yoghurt consumption may be a marker of a healthy lifestyle in general, which could be associated with reduced risk of this chronic disease.

This result seems to be consistently found across the three large cohort studies and 14 other studies, which gives it some credibility.

But a systematic review and meta-analysis would be the best way to assess the link. This would ensure that all relevant material is considered. There is no guarantee that important studies were excluded from the meta-analysis of the current study, which could influence its findings.

This type of study typically feeds into the development or updating of national guidelines, which consider all the available evidence before deciding on what dietary advice to give the public. 

For now, current lifestyle advice to reduce the risk of type 2 diabetes remains the same: aim for a balanced diet high in fruit and vegetables and low in sugar, salt and saturated fats, take regular exercise in line with recommendations, avoid smoking, and moderate your alcohol consumption.

Read more about what eating a healthy, balanced diet entails. 

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Links To The Headlines

A yoghurt a day could reduce your risk of diabetes, scientists find. The Independent, November 24 2014

How yoghurt could stave off diabetes: Just two spoonfuls a day cut odds of developing the disease by a fifth. Daily Mail, November 25 2014

A yoghurt a day may cut diabetes risk. The Times, November 25 2014

A yoghurt a day keeps diabetes away, say scientists. Daily Mirror, November 25 2014

A tablespoon of yoghurt could be key to beating diabetes, reveals new study. Daily Express, November 25 2014

Links To Science

Chen M, Sun Q, Giovannucci E, et al. Dairy consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. BMC Medicine. Published online November 25 2014

 Mon, 24 Nov 2014 11:30:00 GMT Therapy reduces risk of suicide or self-harm

“Talk therapy sessions can help reduce the risk of suicide among high-risk groups,” BBC News reports.

The headline is prompted by a large Danish study that took place over a 20-year period.

Researchers matched those who had received different psychosocial (“talking therapy”) interventions after a self-harm attempt with those who had not received a psychosocial intervention, and then compared relevant outcomes.

People who received psychological interventions had reduced risk of further self-harm, but not suicide, within the first year. Looking at longer-term follow-up, psychological interventions were associated with reduced risk of both self-harm and suicide.

However, it may be difficult to isolate the direct effect of the psychological intervention. People who had received psychological interventions were recruited from treatment clinics that required them not to be in need of psychiatric admission.

Meanwhile, those who did not receive psychological treatment were reported to include people who needed psychiatric admission, or chose not to receive suicide prevention treatment. These factors could mean that this comparison group were at increased risk of subsequent harm and death to begin with.

Also, the situation in the UK might be slightly different to Denmark. Despite this, any research that could help prevent suicides is always valuable.

 

Where did the story come from?

The study was carried out by researchers from the University of Copenhagen in Denmark and the Johns Hopkins Bloomberg School of Public Health in the US, in addition to other research institutions in Denmark and Norway. Funding was provided by the Danish Health Insurance Foundation; the Research Council of Psychiatry, Region of Southern Denmark; the Research Council of Psychiatry, Capital Region of Denmark; and the Strategic Research Grant from Health Sciences, Capital Region of Denmark.

The study was published in the peer-reviewed medical journal The Lancet Psychiatry.

BBC News was generally representative of the research’s findings, but inaccurately described participants as having “attempted suicide”. The research included participants who had self-harmed. Not all instances of self-harm are suicide attempts, so it is a mistake to conflate the two terms. For some people, certain types of self-harming, such as cutting, are a way of coping with overwhelming emotional distress, rather than an attempt to end their life.

It was not clear from the study what proportion of the self-harming events were attempted suicide.

 

What kind of research was this?

This was a cohort study comparing people who did and did not receive a psychosocial (talking) therapy after deliberate self-harm, and examined the outcomes of further self-harm, suicide or death from other causes. 

The researchers say that self-harm is a strong predictor of suicide. Research indicates that within the first year after self-harming, about 16% of people self-harm again; 0.5 to 1.8% die by suicide; and 2.3% die from another cause. However, evidence for the effectiveness of psychological interventions following self-harm is said to be missing, and this study aimed to investigate this.

 

What did the research involve?

This study compared people in Denmark who received a psychological intervention following a first episode of self-harm with those who received standard care, over the 18-year period between January 1992 and December 2010. They calculated the risk of repeated self-harm, suicide and dying of any cause after the first instance of self-harm, and compared the risks between the two groups for differences that might be due to the psychological intervention. 

The people who received psychological interventions were identified from one of seven suicide prevention clinics in Denmark. These clinics are said to receive people who are thought to be at risk of suicide, but not in need of psychiatric admission or other outpatient programmes. For the purposes of this study, participation was considered to be attendance for at least one psychological treatment session that was focused on suicide prevention. The seven different clinics used various types of therapy, including cognitive, problem-solving, crisis, dialectical behaviour, integrated care, psychodynamic, systemic, psychoanalytic approaches and support from social workers.

The controls who did not receive a psychological intervention were people who had presented to hospital with an episode of self-harm during the study period, but who did not receive any psychological intervention. They could receive any form of standard care, including admission to a psychiatric hospital, referral to outpatient treatment or a general practitioner, or discharge without referral.

The reasons why these people did not receive a psychological intervention were variable, including:

  • living in an area remote from services
  • being referred for other treatment (including hospital admission)
  • not wanting to be referred for suicide prevention treatment

All people were linked via their Danish ID numbers to the Danish Civil Register, National Registry of Patients, Psychiatric Central Registry and Registry of Causes of Death. Follow-up was to the end of 2011, giving a follow-up period for the people in the study of 1 to 20 years.

The main outcomes examined were self-harm, death by suicide, and death by any cause. People who did and did not receive psychological interventions were matched for various potentially confounding factors, including:

  • study period (1992 to 2000 or 2001 to 2011)
  • age
  • gender
  • educational level
  • socioeconomic status
  • previous episodes of self-harm
  • specific psychiatric diagnoses

 

What were the basic results?

The study included a total of 5,678 people in the psychological intervention group and 17,034 matched people who had not received a psychological intervention after self-harm. Around two-thirds were women and most were in the 15 to 49 age bracket. Around 10% had a previous episode of self-harm.

During the first year of follow-up, 6.7% of people receiving a psychological intervention had a repeated self-harm attempt, compared with 9.0% of the no psychological intervention group. Psychosocial therapy was associated with a 27% reduced risk of self-harm within one year (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.65 to 0.82). The absolute risk reduction (ARR), measuring how much the risk of self-harm is reduced in those who received the psychosocial therapy, was 2.3% (95% CI 1.5 to 3.1%). The number needed to treat (NNT) was 44 (95% CI 33 to 67), indicating that 44 people would need to receive psychosocial therapy after a self-harm attempt to prevent one person self-harming within one year.

There was no significant difference between groups in rates of suicide within one year, but overall mortality rates within one year were slightly lower in the psychological intervention group (1,122 compared with 1,824 per 10,000), which also meant a significant reduction in overall mortality rate (OR 0.62, 95% CI 0.47 to 0.82). When considering the longer term effects over the full 20 years of follow-up, psychological intervention was associated with a 16% decreased risk of repeated self-harm (OR 0.84, 95% CI 0.77 to 0.91), with an ARR of 2.6% (95% CI 1.5to 3.7) and NNT of 39 people (95% CI 27 to 69).

When looking at overall follow-up, psychological therapy was also associated with a 25% reduced risk of death from suicide (OR 0.75, 0.60 to 0.94), with an ARR of 0.5% (95% CI 0.1 to 0.9) and a NNT of 188 people to prevent one suicide (95% CI 108 to 725). It was also associated with significant reduction of death from any cause (OR 0.69, ARR 2.7%, NNT 37).

The results altogether suggested that during the 20 years of follow-up, 145 self-harm episodes and 153 deaths were prevented by psychological interventions, with 30 of these deaths from suicide.

 

How did the researchers interpret the results?

The researchers conclude that their findings, “show a lower risk of repeated deliberate self-harm and general mortality in recipients of psychosocial therapy after short-term and long-term follow-up, and a protective effect for suicide after long-term follow-up, which favour the use of psychosocial therapy interventions after deliberate self-harm”.

 

Conclusion

The researchers report that this is the largest follow-up study of psychosocial interventions offered after deliberate self-harm attempts. Compared to standard care, it found that psychosocial interventions were associated with a reduced risk of repeated self-harm and death from any cause within the first year of follow-up. In the longer term, psychosocial interventions were associated with reduced risks of self-harm, death from any cause and suicide, specifically.

The study benefits from its large sample size, long duration of follow-up and reliable methods of identifying participants and their outcomes. There are, however, some points to be considered when interpreting the findings.

Possible selection bias

The reasons that people did not receive a psychological treatment could have put them at higher risk of subsequent harm to start with, potentially explaining all or some of the risk difference between the two groups. Though the people who did and did not receive psychological treatments were matched for various factors, this may not have been comprehensive, and some selection bias may still be present. For example, all the people who were receiving psychological treatments had been referred to suicide prevention clinics because they were not considered to be in need of psychiatric admission or other outpatient treatment following their self-harm attempt. Meanwhile, those who did not receive psychological treatment were reported to include people who needed psychiatric admission, or chose not to receive suicide prevention treatment after their self-harm attempt.

This makes it difficult to isolate the effect of the psychological intervention compared with selection biases and other confounding factors. It could be that the reduced risk seen in the psychological intervention group is not solely a result of the intervention, but that there were other risk factors among the non-treated group that were increasing their risk of further self-harm/suicide attempts and so confounding the association.

However, some degree of selection bias is inevitable in this type of study. The only way to remove it completely would be to randomise people to treatment or no treatment, which could never be done for ethical reasons.

Uncertainty about most effective intervention

It is also difficult to conclude many treatment implications from this study in terms of what would be the best type of psychological intervention to use after a self-harm attempt (a wide variety of interventions were used in this study), whether the optimal type differs according to the individual (e.g. according to mental health diagnosis[es]), and what would be the optimal treatment duration.

Results may not be applicable to the UK

The results also apply to Denmark, which may differ from other countries – for example, in terms of healthcare and mental health services, and population health, psychosocial and environmental influences. This may mean that the results are less applicable to this country.

People in the UK who present to health services following self-harm or a suicide attempt receive assessment by specialist mental health professionals, followed by referral, hospital admission or discharge, and follow-up care and treatment as appropriate to their individual situation.

Getting help

If you are reading this because you are having suicidal thoughts, try to ask someone for help. It may be difficult at this time, but it's important to know you are not beyond help and you are not alone.

Speak to a person you trust (such as a friend or family member), make an urgent appointment with your GP or contact your local A&E department. The Samaritans (08457 90 90 90) also operates a 24-hour service available every day of the year.

Read more about getting help for suicidal or self-harming thoughts, as well as spotting possible warning signs in family members and friends.

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Links To The Headlines

Suicide risk reduced after talk therapy, study suggests. BBC News, November 24 2014

Talking therapy 'can stop suicide'. Mail Online, November 24 2014

Links To Science

Erlangsen A, Lind BD, Stuart EA, et al. Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching. The Lancet Psychiatry. Published online November 24 2014


 

 
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