Table 1.
Summary of participants, interventions, follow up period, size of trial, and quality of concealment of allocation
| Study | Details of participants | Interventions | No randomised (No lost to follow up or excluded) | Follow up period | Quality of concealment of allocation* |
|---|---|---|---|---|---|
| Problem solving therapy v standard aftercare | |||||
| Gibbons et al (UK, 1978)30 | Patients over 17 years who presented to A&E department after deliberate self poisoning; repeaters (⩾1 attempt) and first timers; 71% female | Experimental (n=200): crisis orientated, time limited, task centred social work at home (problem solving intervention). Control (n=200): routine service—54% GP referral, 33% psychiatric referral, 13% other referral | 400 | 12 months | 3 |
| Hawton et al (UK, 1987)31 | Patients over 16 years admitted to general hospital for self poisoning; 31% repeaters; 66% female | Experimental (n=41): outpatient problem orientated therapy by non-medical clinicians. Control (n=39): GP care (for example, individual support, marital therapy) after advice from clinician | 80 | 12 months | 3 |
| Salkovskis et al (UK, 1990)32 | Patients aged 16-65 years (mean 27.5) referred by duty psychiatrist after antidepressant self poisoning assessed in A&E department; all repeaters with high risk of further repetition; 50% female | Experimental (n=12): domicillary cognitive behavioural problem solving treatment. Control (n=8): treatment as usual (GP care) | 20 | 12 months | 3 |
| McLeavey et al (Ireland, 1994)33 | Patients aged 15-45 years (mean 24.4) admitted to A&E department after self poisoning; 35.6% repeaters; 74% female | Experimental (n=19): interpersonal problem solving skills training.34 Control (n=20): brief problem solving therapy35 | 39 | 12 months | 1 |
| Intensive care plus outreach v standard care | |||||
| Chowdhury et al (UK, 1973)36 | Patients (all repeaters) admitted to general hospital after deliberate self harm; 57% female | Experimental (n=71): special aftercare—regular outpatient appointments; patients also seen without appointments; home visits to patients who missed appointments; emergency 24 hour telephone access. Control (n=84): normal aftercare—outpatient appointment with psychiatrist and/or social worker; non-attenders not pursued | 155 | 6 months | 1 |
| Welu (USA, 1977)37 | Suicide attempters over 16 years brought to A&E department; 60% repeaters; % female not given | Experimental (n=63): special outreach programme—community mental health team contacted patient immediately after discharge; home visit arranged; weekly/twice weekly contact with therapist. Control (n=57): routine care—appointment for evaluation at the community mental health centre next day at request of treating physician | 120 (1) | 4 months | 1 |
| Hawton et al (UK, 1981)38 | Patients ⩾16 years (mean 25.3) admitted to general hospital after deliberate self poisoning; 32% repeaters; 70% female | Experimental (n=48): domicillary therapy (brief problem orientated) as often as therapist thought necessary; open telephone access to general hospital service. Control (n=48): outpatient therapy once a week in outpatient clinic in general hospital | 96 | 12 months | 3 |
| Allard et al (Canada, 1992)39 | Patients seen in A&E department for suicide attempt; 50% repeaters; 55% female | Experimental (n=76): intensive intervention—schedule of visits was arranged including at least one home visit; therapy provided when needed; reminders (telephone or written) and home visits made if appointments missed. Control (n=74): treatment by another staff team in the same hospital | 150 (24) | 12 months | 3 |
| Van Heeringen et al (Belgium, 1995)40 | Patients ⩾15 years treated in A&E department after suicide attempt; 30% repeaters; 43% female | Experimental (n=258): special care—home visits by nurse to patients who did not keep outpatient appointments, reasons for not attending discussed and patient encouraged to attend. Control (n=258): outpatient appointments only; non-compliant patients not visited | 516 (125) | 12 months | 3 |
| Van der Sande et al (Netherlands, 1997)41 | Patients ⩾16 years (mean 36.3) admitted to hospital after suicide attempt; 73% repeaters; 66% female | Experimental (n=140): brief psychiatric unit admission, encouraging patients to contact unit on discharge; outpatient therapy plus 24 hour emergency access to unit. Control (n=134): usual care—25% admitted to hospital, 65% outpatient referral | 274 | 12 months | 3 |
| Emergency card v standard aftercare | |||||
| Morgan et al (UK, 1993)21 | Mean age 30 years; patients admitted after first episode of deliberate self harm; % female not given | Experimental (n=101): standard care plus green card (emergency card indicating that doctor was available and how to contact them). Control (n=111): standard care—for example, referral back to primary healthcare team, psychiatric inpatient admission | 112 | 12 months | 3 |
| Cotgrove et al (UK, 1995)22 | Patients aged 12.2-16.7 years (mean 14.9) admitted after deliberate self harm; % repeaters not given; 85% female | Experimental (n=47): standard care plus green card (emergency card)—green card acted as passport to readmission into paediatric ward in local hospital. Control (n=58): standard follow up treatment from clinic or child psychiatry department | 105 | 12 months | 1 |
| Dialectical behaviour therapy v standard aftercare | |||||
| Linehan et al (USA, 1991)27 | Patients aged 18-45 years who had self harmed within 8 weeks before entering study; all female; all multiple repeaters of self harm | Experimental (n=32): dialectical behaviour therapy (individual and group work) for 1 year; telephone access to therapist. Control (n=31): treatment as usual; 73% individual psychotherapy | 63 (24) | 12 months | 3 |
| Inpatient behaviour therapy v inpatient insight orientated therapy | |||||
| Liberman and Eckman (USA, 1981)42 | Patients (mean (range) age 29.7 (18-47) years) all repeaters; patients referred by psychiatric emergency service or hospital A&E department after deliberate self harm; 67% female | Experimental (n=12): inpatient treatment with behaviour therapy. Control (n=12): inpatient treatment with insight orientated therapy; both groups received individual and group therapy plus aftercare at community mental health centre or with private therapist | 24 | 24 months | 2 |
| Same therapist (continuity of care) v different therapist (change of care) | |||||
| Torhorst et al (Germany, 1987)28 | Patients referred to toxological department of Technical University Munich after deliberate self poisoning; 48% repeaters; 62% female | Experimental (n=68): continuity of care—therapy with same therapist who assessed patient in hospital after attempt. Control (n=73): change of care—therapy with different therapist than seen at hospital assessment | 141 (8) | 12 months | 2 |
| General hospital admission v discharge | |||||
| Waterhouse and Platt (UK, 1990)43 | Patients ⩾16 years (mean 30.3) admitted to A&E department for deliberate self harm; 36% repeaters; 63% female | Experimental (n=38): general hospital admission. Control (n=39): discharge from hospital; on discharge both groups advised to contact GP if they needed further help | 77 | 16 weeks | 3 |
| Flupenthixol v placebo | |||||
| Montgomery et al (UK, 1979)26 | Patients aged 18-68 years (mean 35.3) admitted after suicidal act; all repeaters; 70% female | Experimental (n=18): 20 mg intramuscular flupenthixol deconate for 6 months. Control (n=19): placebo for 6 months | 37 (7) | 6 months | 3 |
| Antidepressants v placebo | |||||
| Hirsch et al (UK, 1982)16 R Draper, S Hirsch (personal communication) | Patients aged 16-65 years admitted after deliberate self poisoning; % repeaters and % female not given | Experimental (n=76): antidepressants—either 30-60 mg mianserin for 6 weeks or 75-150 mg nomifensine for 6 weeks. Control (n=38): placebo for 6 weeks | 114 | 12 weeks | 3 |
| Montgomery et al (UK, 1983)44 | Patients with personality disorders (mean age 35.7 years) admitted to medical ward after deliberate self harm; all repeaters; 66% female | Experimental (n=17): mianserin 30 mg for 6 months. Control (n=21): placebo | 38 | 6 months | 3 |
| Long term therapy v short term therapy | |||||
| Torhorst et al (Germany, 1988)45 | All patients repeaters who had deliberately self poisoned; % female not given | Experimental (n=40): long term therapy—one therapy session a month for 12 months. Control (n=40): short term therapy—12 weekly therapy sessions for 3 months; all participants had brief crisis intervention (3 days) in hospital | 80 | 12 months | 2 |
*
1=poorest quality; 3=best quality.