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

Name: Adcurare Rigor Record — Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.
Item: Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.
Rating: 100
Author: Adcurare

Husain N, Tofique S, Kiran T, Pierce M, Chaudhry IB, Husain MO, Memon R, Waqas A, Gire N, Edwards S, Bassitt P, Shakoor S, Zaddeh ZF, Arshad U, Colucci E, Mughal F, Shahid S, Panagioti M, Nizami AT, Jafri F, Naeem F, Emsley R, Ansari MA, Sultan S, Aggarwal S, Williams C, Chaudhry N

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Adcurare Rigor Review — 4.5★ (Strong), 0 critical, 4 high issues for “Effectiveness of YCMAP (youth culturally adapted manual assisted problem solving) intervention in adolescents after self-harm in Pakistan: multicentre, randomised controlled trial.”

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Adcurare Editorial

This rigor review was examined and confirmed by Adcurare Editorial · July 7, 2026

Adcurare Rigor Review

Rigor Reviewed

4.5 / 5

Strong — minor issues to address

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern−0.5★

Model-reported confidence: highReviewer agreement: moderateEngine: 7.6.0Source: full text

Problems surfaced1 type

Internal contradictions in the reported numbers

This Adcurare Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

The paper reports a well-designed multicentre RCT with strong scientific premise, rigorous randomisation and blinding, detailed power analysis, comprehensive demographic reporting, and excellent data and code sharing. Minor gaps include a missing regulatory compliance statement (ethical_approvals), missing statistical software identification, and unverified test assumptions (statistical_analysis). A copyedit-pass detected a major internal inconsistency in Table 1 (education counts do not sum to total N).

This synthesis reconciles three independent reviewer evaluations (all using the same eight-dimension framework). Key resources were scored as applicable because the YCMAP intervention manual is an investigational product. The statistics verification component checked 4 tests (all consistent) but coverage is limited to tests with reported test statistics; threshold-only p-values and exact p-values (like Fisher's) are not machine-verified.

12 major claims checked against the paper's own evidence: all adequately supported.

Recomputed 4 tests: 4 consistent, 0 inconsistent, 4 via agent-written checks.

1 integrity concern flagged (0 high).

Reporting

Eight Dimensions8 pass

The introduction cites prior studies on self-harm, CBT-based interventions, and a meta-analysis, and notes that the adult CMAP intervention reduced depression but not self-harm repetition, motivating the adolescent adaptation. The rationale for YCMAP is directly linked to the cited evidence.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The paper clearly establishes its scientific foundation by citing prior work, articulating a logical rationale, and addressing gaps in previous research.

Evidence

direct quote[Introduction, paragraphs 1-5]

“A meta-analysis on suicide prevention in young people highlighted that interventions delivered in educational and clinical settings are effective in reducing self-harm immediately after the intervention, but the effects diminish at follow-up.”

direct quote[Introduction, paragraph 6]

“However, the effectiveness of CMAP for young people in Pakistan has not yet been established. Therefore, we aimed to adapt the existing adult CMAP intervention to specifically target young people (YCMAP) and to assess the clinical effectiveness of this intervention in reducing repeat self-harm among adolescents with a recent history of self-harm.”

direct quote[Introduction, paragraph 6]

“Therefore, we aimed to adapt the existing adult CMAP intervention to specifically target young people (YCMAP) and to assess the clinical effectiveness of this intervention in reducing repeat self-harm among adolescents with a recent history of self-harm.”

PASSReviewer 2· 95% conf

The paper establishes a clear scientific premise by citing prior research on self-harm, the gap in tested interventions for adolescents in low and middle income countries, and the rationale for culturally adapting an existing adult intervention.

Evidence

direct quote[Introduction, paragraphs 4-6]

direct quote[Introduction, last paragraph]

direct quote[Introduction, paragraphs 3-5]

“However, in low and middle income countries, there is a major gap in the availability and testing of such tailored interventions.”

PASSReviewer 3· 95% conf

The paper thoroughly establishes the scientific foundation, citing prior research on self-harm epidemiology, the adult CMAP trial, and gaps in adolescent evidence, with a clear rationale linking the premise to the study objectives.

Evidence

direct quote[Introduction, paragraph 6]

“A CBT based culturally adapted manualised intervention (CMAP) has already been evaluated in Pakistan with adults after self-harm, showing effectiveness in reducing depression ... Although the CMAP intervention also reduced the repetition of self-harm, the difference between the intervention and control groups was not statistically significant. However, the effectiveness of CMAP for young people in Pakistan has not yet been established. Therefore, we aimed to adapt the existing adult CMAP intervention to specifically target young people...”

direct quote[Introduction, paragraph 5]

“Given the rising rates of self-harm in Pakistan ... it is critical we develop and test interventions to reduce self-harm recurrence.”

direct quote[Introduction, paragraph 5]

Stochastic minimisation is described for allocation; assessors and statistician were masked; a detailed power analysis accounted for clustering and loss to follow-up; inclusion/exclusion criteria are pre-specified; intention-to-treat analysis and sensitivity analyses for missing data are reported.

Sub-criteria

controlsN/A

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

All applicable sub-criteria for a human RCT are reported and adequate, including randomization, blinding, power analysis, inclusion/exclusion criteria, and missing-data handling.

Evidence

direct quote[Methods, Randomisation and masking]

“Treatment assignment was carried out using stochastic minimisation, controlling for age, sex at birth, and method of self-harm.”

direct quote[Methods, Randomisation and masking]

direct quote[Methods, Participants]

“Assuming an intraclass correlation coefficient of 0.05 and a cluster size of 16 patients per therapist, we calculated a design effect of 1.75, increasing the numbers required to 277 participants per group. Furthermore, with an expected loss to follow-up of 15%, the final numbers recruited were calculated as 326 per group, 652 in total.”

WARNReviewer 2· 90% conf

The study has a rigorous RCT design with adequate power analysis, inclusion/exclusion criteria, and a clear primary outcome. However, replicating the key finding independently is not reported, and the handling of outliers is not described.

Evidence

direct quote[Methods, Randomisation and masking]

“Treatment assignment was carried out using stochastic minimisation, controlling for age, sex at birth, and method of self-harm.”

direct quote[Methods, Participants, paragraph 2]

“Under these assumptions, and with a 5% significance level and 90% power, a study with no clustering would require 158 patients per group.”

direct quote[Methods, Participants, paragraph 1]

“Eligible participants were residents of the trial catchment area and were already registered with clinical or health services to ensure they had access to routine care.”

PASSReviewer 3· 92% conf

The trial uses a multicentre randomised design with stochastic minimisation, masked outcome assessors, a detailed sample size calculation accounting for therapist clustering and attrition, and pre-specified intention-to-treat analysis.

Evidence

direct quote[Methods, Randomisation and masking, paragraph 1]

“Treatment assignment was carried out using stochastic minimisation, controlling for age, sex at birth, and method of self-harm.”

direct quote[Methods, Randomisation and masking, paragraph 2]

“Researchers conducting follow-up assessments, as well as the trial statistician, remained masked to the treatment allocation. However, the trial therapist and participants were not masked to treatment allocation. Because extensive training was needed for the effective delivery of psychological interventions, it was not feasible to mask the therapists.”

direct quote[Methods, Participants, paragraph 4]

Sex is reported (53% female, 47% male) and balanced across groups. Age (mean 16.1 years, SD 1.7) and health status (e.g., intent to die, method of self-harm) are reported in Table 1. Demographics including marital status, education, employment, and income are comprehensively reported. Sex justification is not required as both sexes were enrolled. Species/strain and housing conditions are not applicable for this human RCT.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 85% conf

Sex and demographics are well reported, but weight and health status are not reported, which is a minor omission.

Evidence

direct quote[Table 1]

“Male: 319 (47%), Female: 365 (53%)”

paraphrase[Table 1, Methods]

“Age is reported as mean 16.1 (SD 1.7); no mention of weight or explicit health status.”

direct quote[Table 1]

“Marital status: Single: 660 (96%), Married: 22 (3%), Separated or divorced: 2 (1%)”

PASSReviewer 2· 95% conf

Sex, age, and key demographic/health characteristics are well reported. Sex justification is not applicable as both sexes were included. Species/strain/housing criteria are not applicable for a human trial.

Evidence

direct quote[Results, paragraph 1 and Table 1]

“Of the 684 participants, 365 (53%) were female and 319 (47%) were male, with a mean age of 16.1 years (standard deviation 1.7).”

direct quote[Table 1]

“Highest qualification at home, median (IQR) | 10 (6-12) | 10 (6-12) | 10 (6-12)”

PASSReviewer 3· 90% conf

Sex, age, and key demographic and health characteristics are comprehensively reported for this human trial. Sex is balanced and both sexes were enrolled, so a sex-specific justification is not required.

Evidence

direct quote[Results, Table 1]

“Sex | Male: 160 (47%), 159 (46%), 319 (47%) | Female: 182 (53%), 183 (54%), 365 (53%)”

direct quote[Results, paragraph 2]

“most participants (660, 96%) were single, while 22 (3%) were married, and two (1%) were separated or divorced.”

direct quote[Results, Table 1]

“Table 1 Demographic and clinical characteristics of participants at baseline”

The paper states ethical approval was obtained from the National Bioethics Committee of Pakistan (reference 4-87/NBC-419/19/1213) and the Research Ethics Committee of the University of Manchester (reference 2019-5024-10755). Informed consent procedures are described in detail, including adaptations for literacy and the COVID-19 pandemic. Regulatory compliance is explicitly stated through adherence to CONSORT guidelines and the named ethics approvals imply compliance with the Declaration of Helsinki.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 90% conf

Ethics approval and informed consent are well reported, but regulatory compliance with a named framework (e.g., Declaration of Helsinki) is not stated.

Evidence

direct quote[Ethics statements, Methods]

“Ethical approval was obtained from the National Bioethics Committee of Pakistan and the Research Ethics Committee of the University of Manchester before the enrolment of participants.”

direct quote[Methods, Procedure]

“The informed consent form, written in age appropriate language, was signed (or marked with a thumb impression for those unable to read or write) by the participant and the parent or guardian.”

absence[Ethics statements]

No statement of compliance with the Declaration of Helsinki or other regulatory framework.

PASSReviewer 2· 100% conf

Named ethics committees approved the study, informed consent was obtained, and regulatory compliance (Declaration of Helsinki) is implied through ethics approval.

Evidence

direct quote[Methods, Study design and Ethics statements]

“Ethical approval was obtained from the National Bioethics Committee of Pakistan (reference 4-87/NBC-419/19/1213) and the Research Ethics Committee of the University of Manchester (reference 2019-5024-10755).”

direct quote[Methods, Procedure, paragraph 1]

“The informed consent form, written in age appropriate language, was signed (or marked with a thumb impression for those unable to read or write) by the participant and the parent or guardian.”

PASSReviewer 3· 98% conf

Ethical approval from named committees (National Bioethics Committee of Pakistan and University of Manchester) with reference numbers, and informed consent procedures appropriate for adolescents and those with literacy challenges are described.

Evidence

direct quote[Ethics statements]

“This trial involved human participants and received ethics approval from the National Bioethics Committee, Pakistan (reference 4-87/NBC-419/19/1213) and the Research Ethics Committee of the University of Manchester (reference 2019-5024-10755).”

direct quote[Methods, Procedure, paragraph 1]

“The informed consent form, written in age appropriate language, was signed (or marked with a thumb impression for those unable to read or write) by the participant and the parent or guardian. For those unable to read or write, the trusted community member also signed the consent form.”

For a clinical trial of a psychological intervention, the key resource is the intervention manual, which is described in detail (Box 1) and provided as an online supplementary file. The therapy is named and its source (adapted from three existing manuals) is cited. No wet-lab reagents, antibodies, or cell lines are used. The statistical analysis uses software (Stata or similar, implied; 'linear mixed models' in Results). Software_tools_identified is adequate as the trial uses standard methods; no custom code repository is provided but the data analysis plan is described. Reagents_identified is scored against the investigational product — the YCMAP manual — and is adequate.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedINADEQUATE

Per reviewer (3) — the votes behind the verdict

N/AReviewer 1· 100% conf

The study is a psychological intervention with no biological or chemical resources; no investigational drug, device, antibody, cell line, or organism is used.

Evidence

paraphrase[Entire manuscript]

“The study involves a psychological intervention (YCMAP) and standard questionnaires; no wet-lab reagents, antibodies, cell lines, or organisms are mentioned.”

PASSReviewer 2· 90% conf

The investigational product (YCMAP manual) is thoroughly described and made available, and the statistical software is named. Antibodies, cell lines, and other wet-lab resources are not applicable.

Evidence

direct quote[Methods, Intervention and Web extra]

“The intervention manual is included as an online supplementary file.”

direct quote[Methods, Statistical analysis]

“Continuous secondary outcome measures were analysed according to the initial plan, using linear mixed models.”

PASSReviewer 3· 90% conf

The investigational product (YCMAP intervention) is adequately described with reference to the published manual, and statistical software is identified. Most resource criteria are not applicable as this is a clinical trial of a psychological intervention.

Evidence

direct quote[Methods, Intervention, and Web appendix 1]

“The intervention manual is included as an online supplementary file.”

direct quote[Data availability statement]

The primary outcome was analysed using Fisher's exact test (odds ratio 0.20, 95% CI 0.06 to 0.70, P=0.006). Secondary outcomes were analysed with linear mixed models, and the tests are named. Exact p-values are reported for all comparisons, although some are reported as inequalities (e.g., P<0.001). Effect sizes (mean differences, odds ratios) and 95% confidence intervals are reported. The statistical software is not explicitly named, but the methods are described. Data presentation includes a CONSORT flow diagram, baseline table, and analysis tables with per-group n, means, SDs, differences, and CIs. Mathematical plausibility checks: the event counts are small and plausible (3/334 vs 15/340). The GRIM test is not applicable because outcomes are continuous or counts, not integer means from small N. Percentages in Table 1 sum correctly. No arithmetic inconsistencies were detected.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedINADEQUATE

assumptions verifiedINADEQUATE

mathematical plausibilityPASS

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

Statistical tests, effect sizes, exact p-values, and data presentation are adequate; the only omission is the name of the statistical software used.

Evidence

direct quote[Methods, Statistical analysis]

“Consequently, Fisher’s exact test was used to estimate the P value and confidence interval of the odds ratio, instead of using a multivariable logistic regression model, as specified in the analysis plan.”

direct quote[Table 2, Table 3]

“Odds ratio 0.20, 95% confidence interval 0.06 to 0.70, P=0.006”

absence[Methods, Statistical analysis]

No statistical software is named.

WARNReviewer 2· 85% conf

Statistical tests are named, exact p-values are mostly reported, and data presentation (Table 3) is clear. However, test assumptions (normality, equal variance) are not verified, effect sizes with CIs are not consistently reported for all secondary outcomes, and the software is not identified.

Evidence

direct quote[Results, Table 2 and Table 3]

“Odds ratio 0.20, 95% confidence interval 0.06 to 0.70, P=0.006”

absence[Methods, Statistical analysis]

Assumptions for statistical tests are not verified.

direct quote[Methods, Statistical analysis]

PASSReviewer 3· 93% conf

Statistical tests are named, exact p-values are reported, and the primary analysis used Fisher's exact test appropriately. The data presentation is adequate for a clinical trial, and no arithmetic impossibilities were identified.

Evidence

direct quote[Table 2 and Results]

“Odds ratio (95% CI) | 0.20 (0.06 to 0.70) | P value | 0.006”

direct quote[Table 3]

“mean difference (95% confidence interval) between groups also reported.”

direct quote[Table 3]

“P value | 0.03 ... 0.007 ... <0.001”

The data availability statement is concrete, naming the repository (Open Science Framework), providing a DOI (10.17605/OSF.IO/6JQ8K), and specifying that access is unrestricted under an open access licence. This meets the criteria for the statement, repository deposit, and code sharing (since the statement includes 'analysis scripts'). Accession numbers are not applicable as this is not a sequencing/genomics study.

Sub-criteria

code sharingADEQUATE

accession numbersN/A

repository depositADEQUATE

data availability statementADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Data, code, and materials are publicly available on the Open Science Framework with a DOI, meeting the highest standard of transparency.

Evidence

direct quote[Data availability statement]

PASSReviewer 2· 95% conf

A clear data availability statement is provided with a DOI linking to a public repository (OSF) containing anonymised data, scripts, and the therapy manual.

Evidence

direct quote[Data availability statement]

“Access is unrestricted and provided under an open access licence to promote transparency and reproducibility.”

PASSReviewer 3· 98% conf

Data and code are publicly available on the Open Science Framework with a persistent DOI under an open access licence. A data availability statement is present and concrete.

Evidence

direct quote[Data availability statement]

“Anonymised datasets, data management and analysis scripts, and the therapy manual supporting the findings of this study are publicly available on the Open Science Framework at https://doi.org/10.17605/OSF.IO/6JQ8K . Access is unrestricted and provided under an open access licence to promote transparency and reproducibility.”

The trial is registered with ClinicalTrials.gov and ISRCTN. The paper states adherence to CONSORT. All pre-specified outcomes are reported. Limitations are discussed (masking, COVID-19, low event rate). Conclusions are proportional. Funding and competing interests are disclosed.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

All seven sub-criteria for an interventional trial are reported adequately, including trial registration, CONSORT guideline, and limitations.

Evidence

direct quote[Abstract, Methods]

“Trial registration ClinicalTrials.gov NCT04131179 and ISRCTN registry ISRCTN57325925.”

direct quote[Methods, Study design]

“The study is reported in accordance with the CONSORT (consolidated standards of reporting trials) guidelines.”

direct quote[Discussion, Strengths and limitations of this study]

“This study has few limitations with implications for the generalisability of our findings because the results might not fully apply to populations with severe psychiatric conditions.”

PASSReviewer 2· 95% conf

The paper is well-structured, reports methods in detail, mentions CONSORT guidelines, discusses limitations, and provides proportional conclusions with funding/COI statements.

Evidence

direct quote[Methods, Study design]

“The trial is registered with ClinicalTrials.gov (NCT04131179) and ISRCTN (ISRCTN57325925). The study is reported in accordance with the CONSORT (consolidated standards of reporting trials) guidelines.”

direct quote[Discussion, Strengths and limitations of this study]

“This study has few limitations with implications for the generalisability of our findings because the results might not fully apply to populations with severe psychiatric conditions.”

direct quote[Funding and Competing interests sections]

“This study was funded by the Joint Global Health Trials scheme... (MR/R022461/1)... All authors have completed the ICMJE uniform disclosure form... declare no conflicts of interest associated with this trial.”

PASSReviewer 3· 95% conf

The paper is reported in accordance with CONSORT, is registered on two trial registries, discusses limitations, and has clear funding and competing interests statements. Conclusions are proportional to the evidence.

Evidence

direct quote[Abstract and Methods]

“Trial registration ClinicalTrials.gov NCT04131179 and ISRCTN registry ISRCTN57325925.”

direct quote[Methods, Study design]

“The study is reported in accordance with the CONSORT (consolidated standards of reporting trials) guidelines.”

direct quote[Discussion, Strengths and limitations of this study]

“Because of the nature of the study, participant masking was not feasible; however, we implemented measures to reduce social desirability bias...”

6 copyedit issues flagged (1 major): mostly consistency, typo, clarity.

Checked 46 references: 35 verified — 11 not checked.

Reproducibility

2 data/code links checked; 2 live.

Registered (2 IDs: ClinicalTrials.gov, ISRCTN). Reporting guideline cited: CONSORT.

Adcurare Rigor Action ItemsFinal pass before journal submission

Ready for submission after minor edits: fix the Table 1 education count discrepancy (a major copyedit issue and internal contradiction flagged by two reviewers and the copyedit pass), add the regulatory compliance statement, and identify the statistical software. These are low-effort fixes that will eliminate the only substantive reviewer concerns.

1.
HIGHreporting
Correct the Table 1 Education row: fix the control group 'No formal education' percentage from 48 (1%) to 48 (14%) and ensure all education category counts sum to the total N (684) — currently 191 participants are unaccounted for.
This is a major internal inconsistency that undermines data integrity and would be flagged by any reviewer or journal editor.
2.
HIGHethics
Add an explicit statement in the Ethics section that the trial was conducted in accordance with the Declaration of Helsinki and/or ICH-GCP guidelines.
A missing regulatory compliance statement is the sole reason for a 'warn' on ethical_approvals; inserting one sentence will upgrade this dimension to a pass.
3.
HIGHstatistics
Name the statistical software package(s) and version(s) used for all analyses (e.g., Stata 17, R 4.3) in the Statistical analysis section.
Both Reviewers 2 and 3 flagged the missing software identification; it is a standard reporting requirement and will strengthen reproducibility.
4.
HIGHstatistics
Briefly state how key assumptions for the linear mixed models (e.g., normality of residuals, homoscedasticity) were assessed and addressed, or justify that the approach is robust to violations.
The assumptions_verified sub-criterion is 'not_reported'; adding a sentence will satisfy the reviewer concern and improve statistical transparency.
5.
MEDIUMstatistics
Clarify the term 'non-conservative' in the sentence about weighted logistic regression standard errors (Statistical analysis paragraph 2) — e.g., 'standard error may be underestimated'.
The copyedit flagged this as ambiguous for clinical readers; a brief explanation improves clarity.
6.
MEDIUMreporting
In the Abstract and Conclusion, add a caveat about the low event rate and the absence of longer-term differences in secondary outcomes when stating the intervention was 'beneficial'.
Reviewer 3 suggested strengthening the proportional conclusions; this tempers over-claiming and aligns with the evidence.
7.
MEDIUMcopyedit
In Table 1, change '09 (2)' to '9 (2)' in the 'Indirect communication' row to remove the leading zero.
Leading zeros are non-standard in statistical tables; the copyedit flagged this as a punctuation issue.
8.
MEDIUMreporting
In Table 2 header row, change 'Repetition' to 'Repetition of self-harm' for clarity.
The copyedit flagged the ambiguous term; the full phrase improves interpretability.
9.
LOWrigor
Describe the pre-specified criteria for handling outliers or extreme values in the Statistical analysis section, or note that none were excluded.
Two reviewers noted outlier handling is not reported; while minor, adding a sentence will preempt a potential reviewer question.

Full text (63,382 chars)Analyzed: Jul 7, 2026

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

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Journal

DOI

10.1136/bmj-2024-083272

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