Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: randomised controlled study

Abstract

Objective To determine the effects over one year of contacting patients by telephone one month or three months after being discharged from an emergency department for deliberate self poisoning compared with usual treatment. Design Multicentre, randomised controlled trial. Setting 13 emergency departments in the north of France. Participants 605 people discharged from an emergency department after attempted suicide by deliberate self poisoning. Intervention The intervention consisted of contacting patients by telephone at one month or three months after discharge from an emergency department for attempted suicide to evaluate the success of recommended treatment or to adjust treatment. Control patients received treatment as usual, in most cases referral back to their general practitioner. Main outcome measures The primary outcome measures were proportion of participants who reattempted suicide, number of deaths by suicide, and losses to follow-up at 13 months' follow-up. Secondary outcome measures were types and number of contacts with health care. Results On an intention to treat basis, the three groups did not differ significantly for further suicide attempts, deaths by suicide, or losses to follow-up: contact at one month (intervention 23% (34/147) v controls 30% (93/312), difference 7%, 95% confidence interval − 2% to 15%), three months (25% (36/146) v 30%, difference 5%, − 4% to 14%). Participants contacted at one month were less likely at follow-up to report having reattempted suicide (12% v 22% in control group, difference 10%, 2% to 18%). Conclusion Contacting people by telephone one month after being discharged from an emergency department for deliberate self poisoning may help reduce the number of reattempted suicides over one year.

Effectiveness of a telephone management programme for patients discharged from an emergency department after a suicide attempt: Controlled study in a Spanish population

“…Finally, this is an manageable, cost-effective and easily reproducible programme, unlike other effective programmes that are based on intensive interventions or carried out in experimental conditions (183;190). As in our study, Fleischmann et al pointed out the importance of regular contact to reduce the risk of further suicide attempt and suicide completion (183). The effectiveness of such interventions may be due to the fact that telephone management allows the listener to be aware of the needs or doubts of the patient on repeated occasions and is able to regularly assess suicidal thoughts, as well as to encourage adherence to usual treatment.…”

“…Simillarly, Vaiva and colleagues observed that subjects who received telephone contact 1 month following their suicide attempts presented significantly fewer suicide attempts than those who received no contact (183). However, a subsequent interevention (telephone contact three months post attempt) did not reduce the number of subsequent suicide attempts when compared with no-contact.…”

Suicide Prevention Resource Center

“…A randomized controlled study of 605 adults age 18 to 65 discharged from 13 emergency departments following a suicide attempt by drug overdose/poisoning, showed that those contacted by telephone one month after being discharged were 45% less likely to repeat a suicide attempt during the year following the index attempt than those who did not receive the telephone contact (Vaiva et al, 2007). In another study, researchers sent post cards to a group of 394 individuals randomized to the intervention group at intervals of 1, 2, 3,4,6,8,10, and 12 months after a suicide attempt.…”

Letter to the Editor: Suicidal ideation and research ethics committees: a reply

“…While we agree that the evidence the editorial was based on is limited somewhat by the outcome that the studies were measuring, we feel it is important that the decisions ethics committee reach are evidence based. If the available evidence does not support an association between asking questions about suicide and suicidality, then any limitations placed on a proposed research project should be justified, particularly as the general direction of travel seems to be that asking questions is more likely to reduce suicidality than increase it (see for example: Cedereke et al 2002;Vaiva et al 2006;Biddle et al 2013). We are not saying that such a situation can never be found, but that a good case needs to be made if restrictions are put in place.…”