Effect of assertive case management intervention on suicide attempters with comorbid Axis I and II psychiatric diagnoses: secondary analysis of a randomised controlled trial

Abstract

Background: Most suicide attempters suffer from psychiatric disorders, which are often comorbid with personality disorders. The effects of intervention on patients who have attempted suicide with comorbid Axis I and II diagnoses have not been fully elucidated. We evaluated whether assertive case management can reduce the repetition of suicidal behaviours in patients who had attempted suicide with comorbid Axis I and II diagnoses. Methods: This study was a secondary analysis of a randomised controlled trial investigating whether assertive case management could reduce the repetition of suicide attempts, compared with enhanced usual care. Subjects were divided into those who had comorbid Axis I and II diagnoses (Axis I + II group), and those who had an Axis I diagnosis without Axis II comorbidity (Axis I group). Outcome measures were compared between patients receiving a case management intervention and patients receiving enhanced usual care, as allocated. The primary outcome measure was the incidence proportion of the first episode of recurrent suicidal behaviour at 6 months after randomisation. We calculated risk ratios (RR) with 95% confidence intervals (CI) at 6 months and 12 months after randomisation of patients in the Axis I and Axis I + II groups. Results: Of 914 enrolled patients, 120 (13.1%) were in the Axis I + II group, and 794 (86.9%) were in the Axis I group. Assertive case management was significantly effective for the Axis I group on the primary outcome at 6 months (risk ratio [RR] 0.51, 95% confidence intervals [CI] 0.31 to 0.84). The RR of the Axis I + II group was 0.44 (95% CI 0.14 to 1.40). Conclusions: Assertive case management not only had an effect on patients who had attempted suicide with only Axis I disorders but may also have a similar effect on patients with comorbid Axis I and II disorders.

Suicide Prevention Program for Adolescents and Young Adults Aged 12-26 Years: An Initiative to Address Unmet Needs and Save Lives

“…Prior studies in hospitals and community-based settings focusing on implementing strategies for suicide prevention have shown promising results with reduction in suicide attempts in the intervention group [7][8][9]. Our results corroborate with prior findings and further strengthen the consensus that individuals with high risk for suicide need proper care coordination with strong support from families and mental health professionals to address their needs and overall well-being.…”

Suicide prevention in Japan: Government and community measures, and high‐risk interventions

“…Furuno et al (2018) found that assertive case management reduced the number of overall self‐harm episodes (adjusted incidence risk ratio [IRR] 0.88, 95%; CI, 0.80‐0.96; P = .0031). Norimoto et al (2020) also showed that this case management was effective in patients with comorbid DSM‐IV Axis I, that is, all psychological diagnostic categories except intellectual disability and personality disorder, and Axis II diagnoses, that is, personality disorders and intellectual disability, as well as only Axis I diagnoses (risk ratio of Axis I + Axis II: 0.44, 95%; CI 0.14‐1.40). In summary, the ACTION‐J study provided strong evidence for the effective prevention of recurrent suicide attempts.…”

Implementations of an evidence‐based assertive case management intervention for suicide attempters: Post‐ACTION‐J Study (PACS)

“…The ACTION‐J Study showed that a 6‐month assertive case management intervention effectively prevented suicide reattempts over 6 months by those with a history of attempts 7–9 . Subsequent secondary analyses of ACTION‐J data also revealed that assertive case management helped prevent suicide reattempts among patients with comorbid DSM‐IV‐TR Axis I and II disorders 11 and those with a history of self‐poisoning, 12 and reduced the overall incidence of self‐harm 13 . The secondary analysis also elucidated the importance of visits to a psychiatrist a short time before the first suicide attempt in men and in women with substance‐related disorder, previous suicide attempts, and drug overdose in the first suicide attempt as predictive factors for future suicide reattempts 14 …”