Psychosocial and pharmacological treatment of patients following deliberate self-harm: the methodological issues involved in evaluating effectiveness.

Development of effective treatments for patients following deliberate self-harm (self-poisoning or self-injury) is a very important element in suicide prevention. The randomized controlled trial (RCT) is the mainstay of evaluation of treatments. In a systematic review of the literature, the effectiveness of treatments based on RCTs was examined and the quality of the RCTs was assessed. Twenty trials were identified, and where possible, these were grouped on the basis of similarities among the types of treatment. In this paper, we examine the methodological aspects of the trials and consider what may be learned that will assist in the design of future studies in this field. The methodological quality of the trials was reasonable, but most trials included too few participants to detect clinically important differences in rates of repeated self-harm. In planning future trials, the following major issues should be addressed: investigators should perform power calculations to determine the number of subjects necessary to detect clinically important effects, provide information on method of randomization and interventions, use standard measures of outcome, and focus on homogeneous subgroups of patients. Improving the methodology of future studies in this field will be essential if sound evidence is to be obtained which can inform effective service provision for deliberate self-harm patients.     

THE TREATMENT OF WOMEN WITHIN THE CRIMINAL JUSTICE SYSTEM: AN INQUIRY INTO THE SOCIAL IMPACT OF THE WOMEN'S RIGHTS MOVEMENT

Two studies considered the possible impact of the feminist movement upon criminal justice decisions relating to women. One body of data confirmed a trend away from indiscriminate leniency in the punishment of female criminals during the women's movement. Courtroom and parole board decisions determining length of imprisonment showed an improving alignment of punishment and criminal circumstances for women and men. The second set of data disclosed that an increased seriousness was accorded to the crime of rape as feminism became more influential. Rape, as a violation of the woman's right to bodily self-determination, was punished more harshly during the period of greater feminist influence, a fact that was not true of other male violent crimes. The women's movement appears to have brought about a more realistic balance of female and male responsibilities before the law as well as a greater respect for women's sexual rights.