Effectiveness of ATMAN psychological intervention in reducing self-harm in young people in India: a mixed method case series.

Abstract

There is a scarcity of psychological interventions for self-harm in young people, either developed or adapted for use in low and middle-income countries (LMICs). ATMAN is a psychological intervention developed in India for youth with three key modules: problem-solving, emotion regulation and social network strengthening skills in addition to crisis management. ATMAN was delivered in 27 youth with a history of self-harm (14-24 years old) sequentially by a specialist and it a non-specialist counsellor. Out of 27, 18 youth who started the ATMAN intervention completed it, and 13 completed the 10-month follow-up. There was a significant reduction in post-intervention scores on Beck's Scale for Suicidal Ideation (BSI) (mean difference [confidence interval]: 14.1 [17.2, 10.9]) and Patient Health Questionnaire (PHQ-9) (9.6 [12.8, 6.4]) from the baseline scores, irrespective of who delivered the intervention (non-specialist vs. specialist). The difference remained significant at the 10-month follow-up (BSI: 17.0 [20.5, 13.6] and PHQ-9: 10.5 [14.5, 6.6]). Themes such as improved understanding of self-harm acting as a deterrent, using ATMAN strategies to deal with daily life distress, and the importance of addressing stigma in self-harm emerged during the qualitative interviews. Although requiring further evaluation, ATMAN shows promise as a scalable intervention that can be used in LMICs to reduce the burden of suicide in young people.