Discussion
suicidal ideation, self-harm
The CMAP trial is one of the few trials which evaluated a CBT-based culturally adapted psychological intervention to reduce self-harm and clinical outcomes known to be predictive of suicide and the first trial of its kind in any low- and middle-income country (LMIC). This trial showed that the repetition rate of self-harm was low for both groups at 12 months, although the number in the intervention arm was lower (Consistent with our findings, a previous trial investigating the effectiveness of Volitional Help Sheets also did not report any statistically significant differences both in terms of repetition (67 intervention vs 71 TAU) and suicide rate (one in intervention vs two in TAU) [The majority of the participants in the trial reported that they had serious intent to die. In a recent report, of those who presented to hospitals with suicidal ideation, the risk of self-harm within 12 months was 10% and 18% within 5 years [Suicide theories such as Interpersonal–Psychological Theory of Suicide [The nature of the stressors that trigger self-harm behaviours may be difficult to change, but the coping strategies to deal with stressors are dynamic and amenable to change. Therefore, strengthening coping resources can be a helpful strategy to reduce self-harm behaviours [Mental health interventions may not only reduce suicidal behaviours but may also contribute in improving QoL [