Table 1.
Studies on continuity of care of suicide attempters or individuals at-risk of suicidal behavior.
| Country | Intervention in population having committed a suicide attempt | Results |
|---|---|---|
| Australia12 | 12 contacts (postal cards every month) after hospital discharge. Young aged 15-24 | RCT, n=778. SA ns; SA in intervention group 57/378, 15.1% (95%CI 11.5% to 18.7%) vs in control group 68/394, 17.3% (13.5% to 21.0%). However, in unadjusted analysis the number of repetitions was significantly reduced [IRR=0.55 (0.35 to 0.87)] |
| Taiwan16 | 6-12 contacts (phone calls during 3-6 month, 2/month). Frequency of contacts change following assessment of risk (BSRS, Pierce RS, SAD PERSONS S): high (psychiatrist), moderate (1-2 contacts/week), low (2 contacts/month), no risk (stop contacts) | No RCT, n= 44,364 received aftercare (854 died by suicide) S*. Interventions decreased subsequent suicides for attempters (with initial willingness for aftercare OR=0.36, 95%CI 0.26-0.51; without initial willingness for aftercare: OR=0.78, 95%CI 0.62-0.97). In addition, aftercare was shown to prolong duration to eventual death. |
| Spain14 | 7 contacts (phone call at 1 week, 1, 3, 6, 9, 12 months) to assess risk and increase adherence to treatment | RCT, n=991. SA*, Delayed SA*. Mean time in days to first reattempt=346.47 for intervention vs 316.46 in the control group. |
| Iran15 | 8-9 contacts (postal cards, 1, 2, 3, 4, 6, 8, 10, 12 months + birthday) to assess risk and increase adherence to treatment | RCT, n=2300. SA*, SI*. Reeducation of SI (relative risk reduction (RRR)=0.31, 95%CI 0.22-0.38), SA (RRR=0.42, 95%CI 0.11-0.63) in the intervention group compared to control group. |
| New Zealand11 | 6 contacts (postal cards over 12 months) after hospital discharge | RCT, n=327. SA ns. No significant differences between the control and intervention groups in the proportion of participants re-presenting with self-harm or in the total number of re-presentations for self-harm. |
| Brazil, India, Sri Lanka, Iran, China8,19 | 1 hour education session (epidemiology, risk and protecting factors, help solutions, human and phone resources) + 9 contacts (phone call or visit at 1, 2, 4, 7, 11 weeks/4, 6, 12, 18 months) | RCT, n=1867. S* SA ns. Significant reeducation of suicides in the intervention group (BIC, 0.2% vs TAU, 2.2%, chi2=13.83, P<0.001). No change in SA - similar in the BIC and TAU groups (7.6% vs. 7.5%, chi2=0.013; P=0.909), but differences in rates across the five sites. |
| France17 | 3 contacts (phone call at 1, 3, 13 months) after hospital discharge | RCT, n= 605. 1 mo. SA* 3 mo. SA ns. The number of participants contacted at one month who reattempted suicide was significantly lower than that of controls [12% (13/107) vs 22% (62/280); chi2=4.7, df=1, P=0.03]. No differences in the follow-up at 3 months. |
| Australia13 | 8 contacts (postal cards at 1, 2, 3, 4, 6, 8, 10, 12 months) after hospital discharge | RCT, n=772. SA*. Significant reduction in the rate of SA repetition, with incidence risk ratio of 0.49 (95%CI 0.33-0.73) |
| Sweden18 | 2 contacts (phone calls at 1, 5 months after 1st SA) + support to initiate or go on the treatment | RCT, n=216. SA ns. Randomized groups did not differ in repetition of SA during follow-up or in improvement in GSI (SCL-90), GAF and SSI, but individuals with no initial treatment the intervention group improved more in certain psychological symptom dimensions (SCL-90). |
| Italy6,7 | 2 contacts / week for assessment of the needs and to provide emotional support in the elderly + Alarm system to call for help (tele-help/tele-check service) | No RCT. S*. Short-term: Only one death by suicide in the elderly subjects connected to Tele-Help/Tele-Check vs expected number of 7.44 for the general population. Long-term: Significantly fewer suicide deaths (n=6) occurred among elderly service users [standardized mortality ratio (SMR) 28.8%] than expected (n=20.86; chi2=10.58, d.f.=1, P<0.001) |
| USA9,10 | 4 contacts (letters during 5 years) after hospital discharge and refusal to be treated. Follow-up up to 15 years after SA | RCT, n=843. S*. Short term (3 years) and long term (5 and 15 years): Intervention group shows the lowest rate of suicide (P=0.04) in the first five years. Then, the difference with the control group diminishes and disappears after 14 years. |
*Significant reduction; ns, non-significant; SA, suicide attempt; SI, suicidal ideation; S, Suicide; RCT: Randomised Control Trial.