Assertive case management versus enhanced usual care for people with mental health problems who had attempted suicide and were admitted to hospital emergency departments in Japan (ACTION-J): a multicentre, randomised controlled trial

Kawanishi, Chiaki; Aruga, Tohru; Ishizuka, Naoki; Yonemoto, Naohiro; Otsuka, Kotaro; Kamijo, Yoshito; Okubo, Yoshiro; Ikeshita, Katsumi; Sakai, Akio; Miyaoka, Hiroaki; Hitomi, Yoshie; Iwakuma, Akihiro; Kinoshita, Toshihiko; Akiyoshi, Jotaro; Horikawa, Naoshi; Hirotsune, Hideto; Eto, Nobuaki; Iwata, Nakao; Kohno, Mototsugu; Iwanami, Akira; Mimura, Masaru; Asada, Takashi; Hirayasu, Yoshio

doi:10.1016/s2215-0366(14)70259-7

Cited by 79 publications

(120 citation statements)

References 25 publications

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“…For information on the effectiveness of the remaining interventions not covered in this report the reader is instead referred to our review in the Cochrane Library. 13 A total of 29 trials were therefore included in the present review (Figure 1; Supplementary Document SD3), comprising 18 trials of cognitive behavioural-based psychotherapy (CBT), [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] three trials of dialectical behaviour therapy (DBT), [36][37][38] and four trials each of case management [39][40][41][42] and postcards. [43][44][45][46] (Insert Figure 1 about here)…”

Section: Resultsmentioning

confidence: 99%

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Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis

Hawton

Witt

Salisbury

et al. 2016

The Lancet Psychiatry

186

161

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Section: Resultsmentioning

confidence: 99%

“…The effectiveness of case management was compared to TAU 39,40,42 or enhanced usual care 41 in four independent trials. There was no evidence of a significant treatment effect for case management by the post-treatment assessment (OR 0·78, 95% CI 0·47 to 1·30; N=1,608; Figure 6).…”

Section: Case Management Versus Treatment As Usual or Enhanced Usual mentioning

confidence: 99%

Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis

Hawton

Witt

Salisbury

et al. 2016

The Lancet Psychiatry

186

161

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“…Although there is growing evidence for the effectiveness of long-term psychological therapies to reduce self-harm (usually in outpatient psychiatric care), 3 few interventions have been developed specifically for acute settings. Apart from assertive case management, 4 no brief psychological interventions based in emergency departments have been shown to be effective for those who present to emergency departments or acute services after a suicide attempt 3, 5, 6, 7, 8, 9. The aim of the present study, therefore, is to test the efficacy of an innovative brief low-intensity psychological intervention, the volitional help sheet (VHS), given in hospital within 24 h of a suicide attempt, to reduce future self-harm.…”

Section: Introductionmentioning

confidence: 99%

A brief psychological intervention to reduce repetition of self-harm in patients admitted to hospital following a suicide attempt: a randomised controlled trial

O’Connor

Ferguson

Scott

et al. 2017

The Lancet Psychiatry

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SummaryBackgroundWe investigated whether a volitional helpsheet (VHS), a brief psychological intervention, could reduce repeat self-harm in the 6 months following a suicide attempt.MethodsWe did a prospective, single-site, randomised controlled trial. Patients admitted to a hospital in Edinburgh, UK, after a suicide attempt were deemed eligible for the study if they were over the age of 16 years, had a self-reported history of self-harm, were fluent in English, were medically fit to interview, and were not participating in other research studies within the hospital. Eligible patients were randomly assigned (1:1), via web-based randomisation, to receive either VHS plus usual treatment (intervention group) or only treatment as usual (control group). Randomisation was stratified by sex and self-reported past self-harm history. The Information Services Division of the National Health Service (NHS-ISD) staff and those extracting data from medical notes were masked to the study group the participant was allocated to. Clinical staff working within the hospital were also masked to participants' randomisation status. There were three primary outcomes: the proportion of paticipants who re-presented to hospital with self-harm during the 6-month follow-up period; the number of times a participant re-presented to hospital with self-harm during the 6-month follow-up period; and cost-effectiveness of the VHS as measured by estimated incremental cost per self-harm event averted. Primary outcomes were analysed in all randomised patients. Follow-up data collection was extracted from the Information Services Division of the NHS and from patient medical records. The trial is registered with International Standard Randomised Controlled Trial Number Registry, number ISRCTN99488269.FindingsBetween May 9, 2012, and Feb 24, 2014, we assessed 1308 people for eligibility. Of these, 259 patients were randomly assigned to the intervention group and 259 to the control group. We obtained complete follow-up data on 512 (99%) of 518 patients (five participants were lost to follow-up in the intervention group and one in the control group). 11 patients assigned to the intervention group did not complete the VHS in hospital. Overall, the intervention did not affect the number of people who re-presented with self-harm (67 [26%] of 254 patients in the intervention group vs 71 [28%] of 258 patients in the control group, odds ratio [OR] 0·90, 95% CI 0·58–1·39, p=0·63). The intervention had no effect on the number of re-presentations per patient (mean 0·67 [SD 2·55] re-presentations for the intervention group vs 0·85 [2·79] for the control group, incident rate ratio [IRR] 1·65, 95% CI 0·74–3·67, p=0·21). Mean total costs per person for NHS hospital services in the VHS intervention group over the 6 months were £513 versus £561 in the control group but this difference was not significant (95% CI–£353 to £257, p=0·76). Three patients died by suicide in the 6 months following their index suicide attempt (one in the intervention group and two in the control ...

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“…Forty studies were further excluded because of identical or overlapping patient samples. A total of 115 studies reporting 167 samples were included in the meta‐analysis (SM 2, Table of Included Studies, and SM 3 Data used in meta‐analysis). The samples included 46 samples of females, 46 samples of males and 75 samples of both sexes.…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis of suicide rates among people discharged from non‐psychiatric settings after presentation with suicidal thoughts or behaviours

Wang

Swaraj

Chung

et al. 2019

Acta Psychiatr Scand

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analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours.Objective: To quantify the suicide rate among people discharged from nonpsychiatric settings after presentations with suicidal thoughts or behaviours. Method: Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. Results: A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I 2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). Conclusions: People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades. Summations• The pooled suicide rate among patients with suicidal thoughts or behaviours following discharge from a non-psychiatric setting was 483 per 100 000 person-years (95% CI 445-520).• Suicide rates were lower among samples of younger people (<25 years of age) and among more recently published studies, but were higher in the first year after discharge, among older people (>55 years of age), and men.• All patients presenting to emergency departments and general hospitals with suicidal thoughts or behaviours warrant a careful assessment and individualized treatment planning. Considerations• High between-study heterogeneity limits the extent to which the results can be regarded as generalizable.• The meta-analysis could not examine a range of clinical factors that might contribute to variation in suicide rates.• Few studies from low-and middle-income countries could be included.

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Assertive case management versus enhanced usual care for people with mental health problems who had attempted suicide and were admitted to hospital emergency departments in Japan (ACTION-J): a multicentre, randomised controlled trial

Cited by 79 publications

References 25 publications

Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis

Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis

A brief psychological intervention to reduce repetition of self-harm in patients admitted to hospital following a suicide attempt: a randomised controlled trial

Meta‐analysis of suicide rates among people discharged from non‐psychiatric settings after presentation with suicidal thoughts or behaviours

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