Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial

Article


Husain, N., Tofique, S., Kiran, T., Pierce, M., Chaudhry, I., Husain, M., Memon, R., Waqas, A., Gire, N., Edwards, S., Bassitt, P., Shakoor, S., Zaddeh, Z., Arshad, U., Colucci, E., Mughal, F., Shahid, S., Panagioti, M., Nizami, A.T., Jafri, F., Naeem, F., Emsley, R., Ansari, M.A., Sultan, S., Aggarwal, S., Williams, C. and Chaudhry, N. 2025. Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial. British Medical Journal (The BMJ). 390. https://doi.org/10.1136/bmj-2024-083272
TypeArticle
TitleEffectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial
AuthorsHusain, N., Tofique, S., Kiran, T., Pierce, M., Chaudhry, I., Husain, M., Memon, R., Waqas, A., Gire, N., Edwards, S., Bassitt, P., Shakoor, S., Zaddeh, Z., Arshad, U., Colucci, E., Mughal, F., Shahid, S., Panagioti, M., Nizami, A.T., Jafri, F., Naeem, F., Emsley, R., Ansari, M.A., Sultan, S., Aggarwal, S., Williams, C. and Chaudhry, N.
Abstract

Objective
To evaluate the clinical effectiveness of the YCMAP intervention (Youth Culturally Adapted Manual Assisted Problem Solving) for adolescents after self-harm in Pakistan.

Design
Multicentre, randomised controlled trial that compared YCMAP with enhanced treatment as usual.

Settings
General practices, emergency departments, medical wards of participating hospitals, and community centres across Karachi, Hyderabad, Lahore, Multan, and Rawalpindi.

Participants
Adolescents with a recent history of self-harm identified at participating health centres by treating physicians between 5 November 2019 and 31 August 2021.

Intervention
The YCMAP group received up to 10 treatment sessions over three months; the intervention was based on the principles of cognitive behaviour therapy.

Main outcome measure
The primary outcome was the repetition of self-harm at 12 months after randomisation. Secondary outcomes were distress, hopelessness, suicidal ideation, and health related quality of life at three, six, nine, and 12 months after randomisation. Participants’ satisfaction with the services was assessed at three and 12 months after randomisation.

Results
This trial was conducted between November 2019 and February 2023 and included 684 adolescents randomised to YCMAP (n=342) or enhanced treatment as usual (n=342). The YCMAP group had a significantly lower risk of self-harm repetition than the enhanced treatment as usual group at 12 months after randomisation (odds ratio 0.20, 95% confidence interval 0.06 to 0.70, P=0.006). YCMAP participants showed a statistically significant reduction in distress, hopelessness, and suicidal ideation at three months, but these differences were not statistically significant at 12 months. YCMAP participants also reported significantly better quality of life and satisfaction with services at three months, with these effects sustained at all follow-up points.

Conclusion
The YCMAP intervention was shown to be beneficial in self-harm prevention among adolescents. Further research and replication of findings in diverse settings are recommended to strengthen the evidence base for this public health intervention.

Trial registration
ClinicalTrials.gov NCT04131179 and ISRCTN registry ISRCTN57325925.

Sustainable Development Goals3 Good health and well-being
Middlesex University ThemeHealth & Wellbeing
PublisherBMJ Publishing Group
JournalBritish Medical Journal (The BMJ)
ISSN0959-8138
Electronic1756-1833
Publication dates
Online12 Sep 2025
Print12 Sep 2025
Publication process dates
Accepted13 Aug 2025
Deposited22 Sep 2025
Output statusPublished
Publisher's version
License
File Access Level
Open
Copyright Statement

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.

Digital Object Identifier (DOI)https://doi.org/10.1136/bmj-2024-083272
PubMed ID40940081
PubMed Central IDPMC12426884
Scopus EID2-s2.0-105015894680
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