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Original research
Design of a brief psychological intervention for youth who self-harm: a formative study in India
  1. Shilpa Aggarwal1,2,
  2. George Patton3,4,
  3. Michael Berk5,6,
  4. Vikram Patel7
  1. 1 Faculty of Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
  2. 2 Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
  3. 3 Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  4. 4 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  5. 5 Orygen (Centre for Youth Mental Health), Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
  6. 6 Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
  7. 7 Harvard T H Chan School of Public Health, Global Health and Social Medicine, Boston, Massachusetts, USA
  1. Correspondence to Dr Shilpa Aggarwal, Public Health Foundation of India, New Delhi, Delhi, India 110017; shilpazq{at}


Background There is an urgent need for context-specific research leading to development of scalable interventions to address self-harm and suicide in low and middle-income countries (LMICs).

Objective The current study was conducted to determine the contents of a psychological intervention to reduce recurrence of self-harm and improve functioning in youth who self-harm in India and finalise its delivery mechanisms.

Methods A systematic, sequential approach was used to integrate available scientific evidence, expert service providers’ knowledge and experience, and service users’ lived experiences in the codesigning and development of a psychological intervention. The steps included: identifying prioritised outcomes for youth who self-harm as well as a selection of feasible and acceptable elements from self-harm interventions that have been trialled in LMICs, intervention development workshops with mental health professionals and youth to finalise elements, a review of relevant treatment manuals to decide on the treatment framework, and finalising the treatment structure and schedule in the second round of intervention development workshops.

Findings We developed ATMAN treatment with three key elements; problem solving, emotion regulation and social network strengthening skills. The delivery schedule emphasises on the engagement elements, and allows for involvement of other stakeholders such as family members when acceptable to the clients.

Conclusion and clinical implications ATMAN treatment could prove to be especially effective in reducing self-harm recurrence in youth in India due to its brief schedule, elements that have been selected in collaboration with the service users and its potential to be scaled up for delivery by non-specialist treatment providers.

  • suicide & self-harm

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  • Contributors SA was involved in conceptualising and designing the study, analysis and drafting the manuscript. GP was involved in designing the study, analysis and drafting the manuscript. MB and VP were involved in guiding the study design, analysis and drafting the manuscript.

  • Funding This work was supported by the Wellcome Trust-India Alliance Research Fellowship awarded to the first author (grant number IA/CPHE/16/1/502664).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was reviewed and approved by two ethics committees: Institutional Ethics Committee of Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai (IEC/684118) and Institutional Ethics Committee of Public Health Foundation of India, Gurgaon, Haryana (IEC-366/17).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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