Comparative Effectiveness of Psychological Interventions in Youth with Deliberate Self-harm: The Role of Anxiety, Depression, and Coping Skills

Background: Deliberate self-harm among youth is an increasing public health concern, often linked to impaired coping, problem-solving deficits, and emotional dysregulation. This study evaluated the comparative effectiveness of Problem-Solving Skills Training, Coping Skills Training, and Dialectical Behaviour Therapy (DBT) in improving psychological outcomes among youth with self-harm behaviour. Methods: A cross-sectional study was conducted at a tertiary care hospital in Eastern India between September 2023 and December 2024. A total of 225 participants (97 males and 128 females) aged 15-29 years, with at least one deliberate self-harm episode in the previous year, were randomly assigned to one of the three intervention groups. Standardized tools assessed problem-solving ability, coping skills, anxiety, and depression pre- and post-interventions. Data were analysed using t-tests, one-way Analysis Of Variance (ANOVA), and effect size calculations. Results: All interventions produced significant improvements in problem-solving and coping, as well as reductions in depression and anxiety (p < 0.001). DBT showed the most significant decrease in anxiety scores (mean difference = 10.20), with a substantial group difference in anxiety reduction (F(2,222) = 3.585, p = 0.029), with dialectical behaviour therapy outperforming problem-solving skills training. Large within-group effect sizes were observed across interventions. Discussion: While DBT yielded the highest anxiety reduction, both problemsolving and coping skills training also produced clinically meaningful benefits. These findings highlight the potential of structured interventions as scalable alternatives in the absence of DBT-trained professionals. Conclusion: These results support the effectiveness of structured psychological treatments, particularly dialectical behaviour therapy, in reducing emotional distress and enhancing coping behaviours.