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Psychiatric telephone contact following emergency department discharge reduces suicide re-attempts in people originally admitted for attempted suicide
  1. Gregory K Brown, PhD,
  2. Shannon Wiltsey Stirman, PhD
  1. University of Pennsylvania, Philadelphia, PA, USA

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OpenUrlAbstract/FREE Full Text

Q Does telephone contact at 1 or 3 months after discharge from an emergency department reduce further suicide attempts or death by suicide in people originally admitted for attempted suicide by self-poisoning?

METHODS

Embedded ImageDesign:

Randomised controlled trial.

Embedded ImageAllocation:

Concealed.

Embedded ImageBlinding:

Single blind (assessors blinded)

Embedded ImageFollow up period:

Twelve months.

Embedded ImageSetting:

Thirteen emergency departments (EDs), France; time frame not reported.

Embedded ImagePatients:

605 adults (18–65 years) discharged from ED following attempted suicide by drug overdose/poisoning. Exclusion criteria: homeless people; people addicted to illegal drugs.

Embedded ImageIntervention:

Telephone contact at 1 or 3 months following ED discharge, or no telephone contact. Calls were made by psychiatrists with at least 5 years’ experience in managing suicidal crises and consisted of psychological support (empathy, reassurance, explanation and suggestion), treatment review and promotion of treatment compliance.

Embedded ImageOutcomes:

Proportion of people reattempting suicide; number of deaths by suicide; losses to follow up; numbers of contacts with healthcare.

Embedded ImagePatient follow up:

70% (or 100% with intention to treat analysis)

MAIN RESULTS

There were no significant differences in any outcome (or in numbers of adverse outcomes) between any groups on an intention-to-treat analysis. There was, however, a reduction in suicide attempt rate in the 1 month telephone contact group compared with control group at follow up (proportion of people reattempting suicide: 12% (13/107) with 1 month contact v 22% (62/280) with no contact; p = 0.03). The number of GP contacts during follow up was also greater in the 1 month telephone contact group (number of GP contacts made by participants to discuss suicide: 87% (82/107) with 1 month contact v 73% (73/280) with non-contact; p = 0.004).

CONCLUSIONS

Telephone contact 1 month following discharge from an ED reduces suicide reattempt compared with no telephone contact in people orignially admitted for attempted suicide by self-poisoning.

NOTES

The inability to establish telephone contact with 27% of those allocated to the 1 month contact group may explain why a significant difference between the 1 month intervention and control groups was not found by an intention-to-treat analysis.

Commentary

Suicide is a major public health problem. One approach to suicide prevention is to identify those individuals who are most likely to make a suicide attempt and engage them in psychiatric treatment. Suicide attempters who are evaluated in the hospital setting are typically offered a referral or follow up appointment upon discharge. However, studies have indicated that the majority of these patients who are offered referrals do not attend outpatient treatment.1,3 Vaiva et al addressed this problem by offering telephone contact after discharge from the emergency department. Their telephone intervention was brief, simple to implement and cost effective. They found that patients who were contacted by a psychiatrist were significantly less likely to reattempt suicide.

Mental health outreach services are essential for the prevention of suicide attempts, especially in the first month following discharge from the hospital when patients are most likely to reattempt. In our practice, we have observed that patients who attempt suicide lead chaotic lifestyles and often feel indifferent or hopeless about mental health treatment. The standard model of outpatient treatment that assumes that the patient is motivated and able to attend treatment regularly is insufficient for this population. We found cognitive therapy was helpful for teaching problem-solving skills and was effective in preventing repeat attempts.4 However, we have learned that persistent outreach services such as those interventions recommended by Vaiva et al are required to engage suicide attempters in treatment and offer them some hope.

References

Footnotes

  • For correspondence: Guillaume Vaiva, University Hospital of Lille, School of Medicine, Lille, France; gvaiva{at}chru-lille.fr

  • Source of funding: Regional Hospitalisation Agency.