Effect of assertive outreach after suicide attempt in the AID (assertive intervention for deliberate self harm) trial: randomised controlled trial Poor description of non-pharmacological interventions: analysis of consecutive sample of randomised trials Group problem-solving skills training for self-harm: randomised controlled trial. An exploratory randomised trial of a simple, brief psychological intervention to reduce subsequent suicidal ideation and behaviour in patients admitted to hospital for self-harm. General hospital admission in the management of parasuicide. A randomised controlled trial. Postcards from the EDge: 5-year outcomes of a randomised controlled trial for hospital-treated self-poisoning. Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study. Intensive follow-up does not decrease the risk of repeat suicide attempts. Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: results of a randomized clinical trial with 2-year follow-up. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Coping Card Usage can Further Reduce Suicide Reattempt in Suicide Attempter Case Management Within 3-Month Intervention. Dynamic wait-listed designs for randomized trials: new designs for prevention of youth suicide Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. The ACCESS study: Zelen randomised controlled trial of a package of care for people presenting to hospital after self-harm. Brief psychological intervention after self-harm: randomised controlled trial from Pakistan. Effect of Systematic Follow-Up by General Practitioners after Deliberate Self-Poisoning: A Randomised Controlled Trial Evaluation of out-patient counselling compared with general practitioner care following overdoses. Interpersonal problem-solving skills training in the treatment of self-poisoning patients. Effect of mobile phone-based psychotherapy in suicide prevention: a randomized controlled trial in Sri Lanka Collaborative assessment and management of suicidality (CAMS): feasibility trial for next‐day appointment services Te Ira Tangata: a Zelen randomised controlled trial of a culturally informed treatment compared to treatment as usual in Māori who present to hospital after self-harm The effect of referral for brief intervention for alcohol misuse on repetition of deliberate self-harm: an exploratory randomized controlled trial. Naturalistic evaluation of suicidal ideation: variability and relation to attempt status. Structured follow-up by general practitioners after deliberate self-poisoning: a randomised controlled trial Manual-assisted cognitive-behaviour therapy (MACT): a randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. An intervention and follow-up study following a suicide attempt in the emergency departments of four general hospitals in Shenyang, China. Behavior therapy vs insight-oriented therapy for repeated suicide attempters. Health care. A model for the management of self-poisoning. Evaluation of a social work service for self-poisoning patients. A Novel Brief Therapy for Patients Who Attempt Suicide: A 24-months Follow-Up Randomized Controlled Study of the Attempted Suicide Short Intervention Program (ASSIP) Intensive in-patient and community intervention versus routine care after attempted suicide. A randomised controlled intervention study. Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide. A controlled trial. The development and implementation of a brief intervention for medically admitted suicide attempt survivors. Randomised controlled trial of brief psychological intervention after deliberate self poisoning. A follow-up program for suicide attempters: evaluation of effectiveness. Preventing repetition of attempted suicide—II. The Amager Project, a randomized controlled trial The management of non-compliance with referral to out-patient after-care among attempted suicide patients: a controlled intervention study. OSTA program: A French follow up intervention program for suicide prevention 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. Cognitive-behavioural intervention for self-harm: randomised controlled trial. The efficacy of an opportunistic cognitive behavioral intervention package (OCB) on substance use and comorbid suicide risk: a multisite randomized controlled trial.
Objective To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts , compared with st and ard treatment . Design R and omised , parallel group , superiority trial with blinded outcome assessment . Setting Outpatient intervention at one location at Copenhagen University Hospital , Denmark . Participants Patients older than 12 years admitted to regional hospitals in Copenhagen with a suicide attempt within the past 14 days . We excluded patients diagnosed with schizophrenia spectrum disorders and patients living in institutions . Intervention Case management through assertive outreach that provided crisis intervention and flexible problem solving . This approach incorporated motivational support and actively assisted patients to scheduled appointments to improve adherence with after-treatment as an add on to st and ard treatment . Main outcome Repeated suicide attempt and death by suicide , recorded in medical records and death register at 1-year follow-up . Results 243 patients were included . During 12 months of follow-up , 20/123 ( 16 % ) patients in the intervention group had been registered in hospital records with subsequent suicide attempt , compared with 13/120 ( 11 % ) in the control group ( odds ratio 1.60 , 95 % confidence interval 0.76 to 3.38 ; P=0.22 ) . By contrast , self reported data on new events showed 11/95 ( 12 % ) in the intervention group versus 13/74 ( 18 % ) in the control group ( 0.61 , 0.26 to 1.46 ; P=0.27 ) . By imputing missing data on the selfreported outcomes , we estimated 15/123 ( 12 % ) events in the intervention group and 23/120 ( 19 % ) in the control group ( 0.69 , 0.34 to 1.43 ; P=0.32 ) . Conclusion Assertive outreach showed no significant effect on subsequent suicide attempt . The difference in rates of events between register data and self reported data could indicate detection bias . Trial registration Clinical Trials.gov NCT00700089 Objectives To evaluate the completeness of descriptions of non-pharmacological interventions in r and omised trials , identify which elements are most frequently missing , and assess whether authors can provide missing details . Design Analysis of consecutive sample of r and omised trials of non-pharmacological interventions . Data sources and study selection All reports of r and omised trials of non-pharmacological interventions published in 2009 in six leading general medical journals ; 133 trial reports , with 137 interventions , met the inclusion criteria . Data collection Using an eight item checklist , two raters assessed the primary full trial report , plus any reference material s , appendices , or websites . Questions about missing details were emailed to corresponding authors , and relevant items were then reassessed . Results Of 137 interventions , only 53 ( 39 % ) were adequately described ; this was increased to 81 ( 59 % ) by using 63 responses from 88 contacted authors . The most frequently missing item was the “ intervention material s ” ( 47 % complete ) , but it also improved the most after author response ( 92 % complete ) . Whereas some authors ( 27/70 ) provided material s or further information , other authors ( 21/70 ) could not ; their reasons included copyright or intellectual property concerns , not having the material s or intervention details , or being unaware of their importance . Although 46 ( 34 % ) trial interventions had further information or material s readily available on a website , many were not mentioned in the report , were not freely accessible , or the URL was no longer functioning . Conclusions Missing essential information about interventions is a frequent , yet remediable , contributor to the worldwide waste in research funding . If trial reports do not have a sufficient description of interventions , other research ers can not build on the findings , and clinicians and patients can not reliably implement useful interventions . Improvement will require action by funders , research ers , and publishers , aided by long term repositories of material s linked to publications BACKGROUND Rates of self-harm are high and have recently increased . This trend and the repetitive nature of self-harm pose a significant challenge to mental health services . AIMS To determine the efficacy of a structured group problem-solving skills training ( PST ) programme as an intervention approach for self-harm in addition to treatment as usual ( TAU ) as offered by mental health services . METHOD A total of 433 participants ( aged 18 - 64 years ) were r and omly assigned to TAU plus PST or TAU alone . Assessment s were carried out at baseline and at 6-week and 6-month follow-up and repeated hospital-treated self-harm was ascertained at 12-month follow-up . RESULTS The treatment groups did not differ in rates of repeated self-harm at 6-week , 6-month and 12-month follow-up . Both treatment groups showed significant improvements in psychological and social functioning at follow-up . Only one measure ( needing and receiving practical help from those closest to them ) showed a positive treatment effect at 6-week ( P = 0.004 ) and 6-month ( P = 0.01 ) follow-up . Repetition was not associated with waiting time in the PST group . CONCLUSIONS This brief intervention for self-harm is no more effective than treatment as usual . Further work is required to establish whether a modified , more intensive programme delivered sooner after the index episode would be effective BACKGROUND Implementation intentions link triggers for self-harm with coping skills and appear to create an automatic tendency to invoke coping responses when faced with a triggering situation . AIMS To test the effectiveness of implementation intentions in reducing suicidal ideation and behaviour in a high-risk group . METHOD Two hundred and twenty-six patients who had self-harmed were r and omised to : ( a ) forming implementation intentions with a ' volitional help sheet ' ; ( b ) self-generating implementation intentions without help ; or ( c ) thinking about triggers and coping , but not forming implementation intentions . We measured self-reported suicidal ideation and behaviour , threats of suicide and likelihood of future suicide attempt at baseline and then again at the 3-month follow-up . RESULTS All suicide-related outcome measures were significantly lower at follow-up among patients forming implementation intentions compared with those in the control condition ( ds>0.35 ) . The volitional help sheet result ed in fewer suicide threats ( d = 0.59 ) and lowered the likelihood of future suicide attempts ( d = 0.29 ) compared with patients who self-generated implementation intentions . CONCLUSIONS Implementation intention-based interventions , particularly when supported by a volitional help sheet , show promise in reducing future suicidal ideation and behaviour Suitably trained junior doctors selected parasuicides with no immediate medical or psychiatric treatment needs on initial assessment in a casualty department . This group was then r and omly allocated to  hospital admission  ( 38 cases ) or discharge home ( 39 cases ) . One week later there were no significant differences between groups on diverse outcome measures , including repetition rate , psychological symptoms , and social functioning . A second follow-up using the same measures at 16 weeks also failed to demonstrate any differences between groups , both of which showed considerable overall improvement . A parasuicide management policy consisting of assessment in a casualty department and selective discharge was appropriate for 15 % of a hospital-referred population . This lends support to recent government recommendations , but caution should be exercised before such a result is generalised BACKGROUND Repetition of hospital-treated self-poisoning and admission to psychiatric hospital are both common in individuals who self-poison . AIMS To evaluate efficacy of postcard intervention after 5 years . METHOD A r and omised controlled trial of individuals who have self-poisoned :  postcard intervention ( eight in 12 months ) plus treatment as usual v. treatment as usual . Our primary outcomes were self-poisoning admissions and psychiatric admissions ( proportions and event rates ) . RESULTS There was no difference between groups for any repeat-episode self-poisoning admission ( intervention group : 24.9 % , 95 % CI 20.6 - 29.5 ; control group : 27.2 % , 95 % CI 22.8 - 31.8 ) but there was a significant reduction in event rates ( incidence risk ratio ( IRR ) = 0.54 , 95 % CI 0.37 - 0.81 ) , saving 306 bed days . There was no difference for any psychiatric admission ( intervention group : 38.1 % , 95 % CI 33.1 - 43.2 ; control group : 35.5 % , 95 % CI 30.8 - 40.5 ) but there was a significant reduction in event rates ( IRR = 0.66 , 95 % CI 0.47 - 0.91 ) , saving 2565 bed days . CONCLUSIONS A postcard intervention halved self-poisoning events and reduced psychiatric admissions by a third after 5 years . Substantial savings occurred in general hospital and psychiatric hospital bed days BACKGROUND We carried out a large r and omized trial of a brief form of cognitive therapy , manual-assisted cognitive behaviour therapy ( MACT ) versus treatment as usual ( TAU ) for deliberate self-harm . METHOD Patients presenting with recurrent deliberate self-harm in five centres were r and omized to either MACT or ( TAU ) and followed up over 1 year .  MACT patients received a booklet based on cognitive behaviour therapy ( CBT ) principles and were offered up to five plus two booster sessions of CBT from a therapist in the first 3 months of the study . Ratings of parasuicide risk , anxiety , depression , social functioning and global function , positive and negative thinking , and quality of life were measured at baseline and after 6 and 12 months . RESULTS Four hundred and eighty patients were r and omized . Sixty per cent of the  MACT group had both the booklet and CBT sessions . There were seven suicides , five in the TAU group . The main outcome measure , the proportion of those repeating deliberate self-harm in the 12 months of the study , showed no significant difference between those treated with MACT ( 39 % ) and treatment as usual ( 46 % ) ( OR 0.78 , 95 % CI 0.53 to 1.14 , P=0.20 ) . CONCLUSION Brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition , but the findings taken in conjunctin with the economic evaluation ( Byford et al. 2003 ) indicate superiority of MACT over TAU in terms of cost and effectiveness combined We carried out a r and omized controlled trial to determine whether an intensive intervention after a suicide attempt could decrease by half the risk of a repeat attempt in the following two years . After initial assessment and r and omization , experimental subjects attended 18 therapy appointments over one year  , including one home visit , and measures to improve attendance .  Control subjects received the usual care . Of 63 experimental subjects , 35 % made a repeat attempt , and so did 30 % of 63 control subjects . The study had a 99 % power to detect the desired decrease of risk ( 30 % to 15 % ) . Clearly , the intervention did not achieve its objective OBJECTIVE The authors evaluated the effectiveness of brief cognitive-behavioral therapy ( CBT ) for the prevention of  suicide attempts in military personnel . METHOD In a r and omized controlled trial , active-duty Army soldiers at Fort Carson , Colo. , who either attempted suicide or experienced suicidal ideation with intent , were r and omly assigned to treatment as usual ( N=76 ) or treatment as usual plus brief CBT ( N=76 ) . Assessment of incidence of suicide attempts during the follow-up period was conducted with the Suicide Attempt Self-Injury Interview . Inclusion criteria were the presence of suicidal ideation with intent to die during the past week and /or a suicide attempt within the past month . Soldiers were excluded if they had a medical or psychiatric condition that would prevent informed consent or participation in outpatient treatment , such as active psychosis or mania . To determine treatment efficacy with regard to incidence and time to suicide attempt , survival curve analyses were conducted . Differences in psychiatric symptoms were evaluated using longitudinal r and om-effects models . RESULTS From baseline to the 24-month follow-up assessment , eight participants in brief CBT ( 13.8 % ) and 18 participants in treatment as usual ( 40.2 % ) made at least one suicide attempt ( hazard ratio=0.38 , 95 % CI=0.16 - 0.87 , number needed to treat=3.88 ) , suggesting that soldiers in brief CBT were approximately 60 % less likely to make a suicide attempt during follow-up than soldiers in treatment as usual . There were no between-group differences in severity of psychiatric symptoms . CONCLUSIONS Brief CBT was effective in preventing follow-up suicide attempts among active-duty military service members with current suicidal ideation and /or a recent suicide attempt Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more This r and omized controlled trial was design ed to evaluate the effectiveness of using  crisis coping cards ( n = 32 )  in the case management of suicide prevention compared with case management without the use of coping cards ( n = 32 ) over a 3-month intervention period . The generalized estimating equation was used to examine the interaction effect between treatments and time on suicide risk , depression , anxiety , and hopelessness . Results indicated that subsequent suicidal behaviors , severity of suicide risk , depression , anxiety , and hopelessness were reduced more in the coping card intervention group compared to the case management only group . Moreover , for the survival curves of time to suicide reattempt , the coping card group showed a significantly longer time to reattempt than the case management only group at 2-month and 3-month intervention periods Background The traditional wait-listed design , where half are r and omly assigned to receive the intervention early and half are r and omly assigned to receive it later , is often acceptable to communities who would not be comfortable with a notreatment group . As such this traditional wait-listed design provides an excellent opportunity to evaluate short-term impact of an intervention . We introduce a new class of wait-listed design s for conducting r and omized experiments where all subjects receive the intervention , and the timing of the intervention is r and omly assigned . We use the term “ dynamic wait-listed design s ” to describe this new class . Purpose This paper examines a new class of statistical design s where r and om assignment to intervention condition occurs at multiple times in a trial . As an extension of a traditional wait-listed design , this dynamic design allows all subjects to receive the intervention at a r and om time . Motivated by our search for increased statistical power in an ongoing school-based trial that is testing a program of gatekeeper training to identify suicidal youth and refer them to treatment , this new design class is especially useful when the primary outcome is a count or rate of occurrence , such as suicidal behavior , whose rate can fluctuate over time due to uncontrolled factors . Methods Statistical power is computed for various dynamic wait-listed design s under conditions where the underlying rate of occurrence is allowed to vary non systematic ally . We also present as an example a large ongoing trial to evaluate a gatekeeper training suicide prevention program in 32 schools which we initially began as a classic r and omized wait-listed design . The primary outcome of interest in this study is the count of the number of children who are identified by the school system as having suicidal thoughts or behaviors  who are then vali date d as being suicidal by mental health professionals in the community . Results A general result shows that dynamic wait-listed design s always have higher statistical power over a traditional wait-listed design . This power increase can be substantial . Efficiency gains of 33 % are easy to obtain for situations where the intervention has a small effect and the variation in rate across time is quite high . When the rate variation for an outcome is very low or the intervention effect is large , efficiency gains approach 100 % . A small increase in the number of times where r and om assignment occurs from 2 – for the st and ard wait-listed design , to say 4 – can provide a large reduction in variance . Efficiency gains can also be high when converting st and ard wait-listed design to a dynamic one half-way into the study . Limitations As with all wait-listed design s , dynamic wait-listed design s can only be used to evaluate short-term impact . Since all subjects eventually receive the intervention , no comparison can be made after the end of the r and om assignment period . The statistical power benefits are primarily limited to outcomes that can be treated as count or time to event data . Conclusions A dynamic design r and omly assigns units – either individuals or groups – to start the intervention at varying times during the course of the study . This design is useful in testing interventions that screen for new or existing cases , as well as testing the scalability of interventions as they are disseminated or exp and ed system wide . They can improve on the traditional wait-listed design both in terms of statistical power and robustness in the presence of exogenous factors . This paper demonstrates that such design s yield smaller st and ard errors and can achieve higher statistical power than that of a st and ard wait-listed design . Just as important , dynamic design s can also help reduce the logistical challenges of implementing an intervention on a wide scale . When the intervention requires that significant training re sources be allocated throughout the study , the dynamic waitlisted design is likely to increase the rate of training and lead to a higher level of program implementation CONTEXT Suicide attempts constitute a major risk factor for completed suicide , yet few interventions specifically design ed to prevent suicide attempts have been evaluated . OBJECTIVE To determine the effectiveness of a 10-session cognitive therapy intervention design ed to prevent repeat suicide attempts in adults who recently attempted suicide . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial of adults ( N = 120 ) who attempted suicide and were evaluated at a hospital emergency department within 48 hours of the attempt . Potential participants ( N = 350 ) were consecutively recruited from October 1999 to September 2002 ; 66 refused to participate and 164 were ineligible . Participants were followed up for 18 months . INTERVENTION Cognitive therapy or enhanced usual care with tracking and referral services . MAIN OUTCOME MEASURES Incidence of repeat suicide attempts and number of days until a repeat suicide attempt . Suicide ideation ( dichotomized ) , hopelessness , and depression severity at 1 , 3 , 6 , 12 , and 18 months . RESULTS From baseline to the 18-month assessment , 13 participants ( 24.1 % ) in the cognitive therapy group and 23 participants ( 41.6 % ) in the usual care group made at least 1 subsequent suicide attempt ( asymptotic z score , 1.97 ; P = .049 ) . Using the Kaplan-Meier method , the estimated 18-month reattempt-free probability in the cognitive therapy group was 0.76 ( 95 % confidence interval [ CI ] , 0.62 - 0.85 ) and in the usual care group was 0.58 ( 95 % CI , 0.44 - 0.70 ) . Participants in the cognitive therapy group had a significantly lower reattempt rate ( Wald chi2(1 ) = 3.9 ; P = .049 ) and were 50 % less likely to reattempt suicide than participants in the usual care group ( hazard ratio , 0.51 ; 95 % CI , 0.26 - 0.997 ) . The severity of self-reported depression was significantly lower for the cognitive therapy group than for the usual care group at 6 months ( P= .02 ) , 12 months ( P = .009 ) , and 18 months ( P = .046 ) . The cognitive therapy group reported significantly less hopelessness than the usual care group at 6 months ( P = .045 ) . There were no significant differences between groups based on rates of suicide ideation at any assessment point . CONCLUSION Cognitive therapy was effective in preventing suicide attempts for adults who recently attempted suicide BACKGROUND The problem of people presenting to hospitals with self-harm is important because such presentations are common , there is a clear link to suicide and a high premature mortality . However , the best treatment for this population is unclear . AIMS To see whether a package of measures , that included regular postcards and problem-solving therapy , improved outcomes at 1 year compared with usual care in people who presented to hospital with self-harm ( the ACCESS study : trial registration Australian and New Zeal and Clinical Trials Registry ACTRN12609000641291 ) . METHOD The design of the study was a Zelen r and omised controlled trial . The primary outcome was re-presentation to hospital with self-harm within 12 months of the index episode . RESULTS There were no significant differences in the primary outcome and most of the secondary outcomes between the two groups . About half the people offered problem-solving therapy did not receive it , for various reasons . CONCLUSIONS The package as offered had little effect on the proportion of people re-presenting to hospital with self-harm . The dose of problem-solving therapy may have been too small to have an effect and there was a difficulty engaging participants in active treatment BACKGROUND Self-harm is a major risk factor for completed suicide . AIMS To determine the efficacy of a brief psychological intervention - culturally adapted manual-assisted problem-solving training ( C-MAP ) - delivered following an episode of self-harm compared with treatment as usual ( TAU ) . METHOD The study was a r and omised controlled assessor-masked clinical trial ( trial registration : Clinical Trials.gov NCT01308151 ) . All patients admitted after an episode of self-harm during the previous 7 days to the participating medical units of three university hospitals in Karachi , Pakistan , were included in the study . A total of 250 patients were screened and 221 were r and omly allocated to C-MAP plus treatment as usual ( TAU ) or to TAU alone . All patients were assessed at baseline , at 3 months ( end of intervention ) and at 6 months after baseline . The primary outcome measure was reduction in suicidal ideation at 3 months . The secondary outcome measures included hopelessness , depression , coping re sources and healthcare utilisation . RESULTS A total of 108 patients were r and omised to the C-MAP  group and 113 to the TAU group . Patients in the C-MAP group showed statistically significant improvement on the Beck Scale for Suicide Ideation and Beck Hopelessness Inventory , which was sustained at 3 months after the completion of C-MAP . There was also a significant reduction in symptoms of depression compared with patients receiving TAU . CONCLUSIONS The positive outcomes of this brief psychological intervention in patients attempting self-harm are promising and suggest that C-MAP may have a role in suicide prevention Objective To assess whether systematic follow-up by general practitioners ( GPs ) of cases of deliberate self-poisoning ( DSP ) by their patients decreases psychiatric symptoms and suicidal behaviour compared with current practice . Design R and omised clinical trial with two parallel groups . Setting General practice s in Oslo and the eastern part of Akershus County . Participants Patients aged 18–75 years admitted to hospital for DSP . We excluded patients diagnosed with psychoses , without a known GP , those not able to complete a question naire , and patients admitted to psychiatric in-patient care or other institutions where their GP could not follow them immediately after discharge . Intervention The GPs received a written guideline , contacted the patients and scheduled a consultation within one week after discharge , and then provided regular consultations for six months . We r and omised the patients to either intervention ( n = 78 ) or treatment as usual ( n = 98 ) . Main Outcome Measures Primary outcome measure was the Beck Scale for Suicide Ideation ( SSI ) . Secondary outcomes were Beck Depression Inventory ( BDI ) and Beck Hopelessness Scale ( BHS ) , self-reported further self-harm and treatment for DSP in a general hospital or an emergency medical agency ( EMA ) . We assessed patients on entry to the trial and at three and six months . We collected data from interviews , self-report question naires , and hospital and EMA medical records . Results There were no significant differences between the groups in SSI , BDI , or BHS mean scores or change from baseline to three or six months . During follow-up , self-reported DSP was 39.5 % in the intervention group vs. 15.8 % in controls ( P = 0.009 ) . Readmissions to general hospitals were similar ( 13 % in both groups ( P = 0.963 ) , while DSP episodes treated at EMAs were 17 % in the intervention group and 7 % in the control group ( P = 0.103 ) . Conclusion Structured follow-up by GPs after an episode of DSP had no significant effect on suicide ideation , depression or hopelessness . There was no significant difference in repeated episodes of DSP in hospitals or EMAs . However , the total number of incidents of deliberate self-harm reported by the patients was significantly higher in the intervention group . Trial registration Trial registration Clinical Trials.gov Identifier : In a r and omized prospect i ve treatment study , 80 overdose patients ( not requiring intensive psychiatric intervention ) received either brief out-patient counselling or were returned to the care of their general practitioners with advice on management . There was little difference in outcome between the two groups . However , two sub-groups of patients benefited more from out-patient counselling than from general practitioner care , these were : ( a ) women , and ( b ) patients with dyadic problems . Counselling following overdoses should be focused on groups of patients such as these who are most likely to benefit from it . Further work is needed to identify treatment approaches that will help other groups who take overdoses , especially men The present study evaluated the effectiveness of  interpersonal problem-solving skills training ( IPSST ) for the treatment of self-poisoning patients . Thirty-nine self-poisoning patients were assigned r and omly either to IPSST or to a control treatment condition ( a brief problem-oriented approach ) . Both conditions were equally effective in reducing the number of presenting problems and in reducing hopelessness levels . However , the IPSST condition was significantly more effective than the control condition as determined by other outcome measures ( measures of interpersonal cognitive problem solving , self-rated personal problem-solving ability , perceived ability to cope with ongoing problems , and self-perception ) . Follow-up studies showed maintenance of IPSST treatment gains at 6 months and a greater reduction of repetition of self-poisoning in the IPSST group at 1 year posttreatment We conducted a r and omized controlled trial to test whether a Brief Mobile Treatment ( BMT ) intervention could improve outcomes relative to usual care among suicide attempters . The intervention included training in problem solving therapy , meditation , a brief intervention to increase social support as well as advice on alcohol and other drugs , and mobile phone follow-up . The effect of the intervention was measured in terms of a reduction in suicidal ideation , depression and self-harm at Baseline , six and 12 months . A wait-list control group received usual care .  A total of 68 participants was recruited from a Sri Lankan hospital following a suicide attempt . Participants who received the intervention were found to achieve significant improvements in reducing suicidal ideation and depression than those receiving usual care . The BMT group also experienced a significant improvement of social support when compared to the control group . However , the BMT group did not demonstrate a significant effect in reducing actual self-harm and most substance use , and differential effects on alcohol use were restricted to men . Although the present study was limited in revealing which component of the intervention was more effective in preventing suicide , it showed its efficacy in reducing suicide as a whole Background : Despite the ubiquity of suicidality in behavioral health setting s , empirically supported interventions for suicidality are surprisingly rare . Given the importance of resolving suicidality and therapists ' anxieties about treating suicidal patients , there is a clear need for innovative services and clinical approaches . The purpose of the current study was an attempt to address some of these needs by examining the feasibility and use of a new intervention called the “ Collaborative Assessment and Management of Suicidality ” ( CAMS ) within a “ Next‐Day Appointment ” ( NDA ) outpatient treatment setting . Methods : As part of a larger feasibility study , n = 32 suicidal patients were r and omly assigned to CAMS care versus Enhanced Care as Usual ( E‐CAU )  in an outpatient crisis intervention setting attached to a safety net hospital . Intent to treat suicidal patients were seen and assessed before , during , and after treatment ( with follow‐up assessment s conducted at 2 , 4 , 6 , and 12 months ) . Results : The feasibility of using CAMS in the NDA setting was clear ; both groups appeared to initially benefit from their respective treatments in terms of decreased suicidal ideation and overall symptom distress . Although patients rated both treatments favorably , the CAMS group had significantly higher satisfaction and better treatment retention than E‐CAU . At 12 months post‐treatment , CAMS patients showed significantly better and sustained reductions in suicidal ideation , overall symptom distress , and increased hope in comparison to E‐CAU patients . Conclusions : CAMS was both feasible in this NDA setting and effective in treating suicidal ideation , distress , and hopelessness ( particularly at 12 months followup ) . Depression and Anxiety , 2011 . © 2011 Wiley Periodicals , Purpose Indigenous people have high rates of suicide and self-harm compared to other population groups . Aim The aim of this trial was to see if a package of interventions delivered in a culturally appropriate way improved outcomes at one year in Maori who presented with intentional self-harm to emergency departments . Methods Participants were Maori who presented with intentional self-harm to emergency departments in New Zeal and . The study design was a double consent Zelen r and omised controlled trial . The intervention included regular postcards , problem solving therapy , patient support , risk management , improved access to primary care and cultural assessment in addition to usual care . The control group received usual care . The main outcome measure was the self-rated change in scores on the Beck Hopelessness Scale at one year . Results 182 people were r and omized to the intervention group 95 of whom consented to take part in the study . 183 people were r and omized to the control group 72 of whom consented to take part in the study . For those who consented comparing the intervention group with the control group there was a statistically significant greater change in hopelessness scores at 3 months ( difference −1.7 95 % CI −3.4 to −0.01 , p = 0.05 ) but not at one year ( difference −1.6 95 % CI −3.4 to 0.3 , p = 0.11 ) . Maori who consented and received the intervention were also significantly less likely to present to hospital for non-self-harm reasons in the year after the index episode ( 44.2 vs. 61.1 % , p = 0.03 ) . Those participants r and omised to the intervention were less likely to re-present with self-harm at 3 months ( 10.4 vs. 18 % , p = 0.04 ) but not at 12 months compared to the control group . Conclusions In Maori who presented to hospital with intentional self-harm a culturally informed intervention had an effect on hopelessness and re-presentation with self-harm in the short term but not at 12 months . There was a significant decrease in hospital presentations for non-self harm over the next year . Trial registration Australian and New Zeal and Clinical Trials Registry ACTRN12609000952246 BACKGROUND Referral for brief intervention among people who misuse alcohol is reported to be effective but its impact among those who present to services following deliberate self-harm ( DSH ) has not been examined . METHOD Consecutive patients who presented to an Emergency Department ( ED ) following an episode of DSH were screened for alcohol misuse . Those found to be misusing alcohol were r and omly assigned to brief intervention plus a health information leaflet or to a health information leaflet alone . The primary outcome was whether the patient reattended an ED following a further episode of DSH during the subsequent 6 months . Secondary outcomes were alcohol consumption , mental health and satisfaction with care measured 3 and 6 months after r and omization . RESULTS One hundred and three people took part in the study . Follow-up data on our primary outcome were obtained for all subjects and on 63 % for secondary outcomes . Half those referred for brief intervention received it . Repetition of DSH was strongly associated with baseline alcohol consumption , but not influenced by treatment allocation . There was a non-significant trend towards the number of units of alcohol consumed per drinking day being lower among those r and omized to brief intervention . CONCLUSIONS Referral for brief intervention for alcohol misuse following an episode of DSH may not influence the likelihood of repetition of self-harm . Longer-term interventions may be needed to help people who deliberately harm themselves and have evidence of concurrent alcohol misuse Suicidal ideation has been thought to have a relatively stable course across weeks and months . However , daily changes in levels of ideation have not been adequately examined despite the importance of potential variability clinical ly and conceptually . For example , it has been suggested that variability in suicidal ideation may become less closely tied to variability in other mood symptoms ( e.g. , depression , hopelessness ) among individuals with multiple suicide attempts . The present report had two related goals : ( 1 ) to prospect ively evaluate suicidal ideation and related mood symptoms , and ( 2 ) to determine whether suicide attempt status predicted a decreased association between ideation and other mood symptoms . Non- clinical participants ( N=108 ) with varying levels of suicidal ideation and number of previous suicide attempts completed the  beck hopelessness scale ( BHS ) , beck depression inventory ( BDI ) , and suicide probability scale ( SPS )  every day for 4 weeks . Findings suggested considerable variability in suicidal ideation , especially for multiple attempters . Multiple attempt status predicted a decreased association between suicidal ideation and depression , although the results were only marginally significant . These findings have implication s for conceptual models of suicide risk as well as assessment and treatment of suicidal individuals Background General Practitioners ( GPs ) play an important role in the follow-up of patients after deliberate self-poisoning ( DSP ) . The aim was to examine whether structured follow-up by GPs increased the content of , adherence to , and satisfaction with treatment after discharge from emergency departments . Methods This was a multicentre , r and omised trial with blinded assignment . Five emergency departments and general practice s in the catchment area participated . 202 patients discharged from emergency departments after DSP were assigned . The intervention was structured follow-up by the GP over a 6-month period with a minimum of five consultations , accompanied by written guidelines for the GPs with suggestions for motivating patients to follow treatment , assessing personal problems and suicidal ideation , and availability in the case of suicidal crisis . Outcome measures were data retrieved from the Register for the control and payment of reimbursements to health service providers ( KUHR ) and by question naires mailed to patients and GPs . After 3 and 6 months , the frequency and content of GP contact , and adherence to GP consultations and treatment in general were registered . Satisfaction with general treatment received and with the GP was measured by the EUROPEP scale . Results Patients in the intervention group received significantly more consultations than the control group ( mean 6.7 vs. 4.5 ( p = 0.004 ) ) . The intervention group was significantly more satisfied with the time their GP took to listen to their personal problems ( 93.1 % vs. 59.4 % ( p = 0.002 ) ) and with the fact that the GP included them in medical decisions ( 87.5 % vs. 54 . 8 % ( p = 0.009 ) ) . The intervention group was significantly more satisfied with the treatment in general than the control group ( 79 % vs. 51 % ( p = 0.026 ) ) . Conclusions Guidelines and structured , enhanced follow-up by the GP after the discharge of the DSP patient increased the number of consultations and satisfaction with aftercare in general practice . Consistently with previous research , there is still a need for interventional studies .Trial registration Clinical Trials.gov Identifier : NCT01342809 . Registered 18 April 2011 BACKGROUND The treatment of deliberate self-harm ( parasuicide ) remains limited in efficacy . Despite a range of psychosocial , educational and pharmacological interventions only one approach , dialectical behaviour therapy , a form of cognitive-behaviour therapy ( CBT ) , has been shown to reduce repeat episodes , but this is lengthy and intensive and difficult to extrapolate to busy clinical practice . We investigated the effectiveness of a new manual-based treatment varying from bibliotherapy ( six self-help booklets ) alone to six sessions of cognitive therapy linked to the booklets , which contained elements of dialectical behaviour therapy . METHODS Thirty-four patients , aged between 16 and 50 , seen after an episode of deliberate self-harm , with personality disturbance within the flamboyant cluster and a previous parasuicide episode within the past 12 months , were r and omly assigned to treatment  with manual-assisted cognitive-behaviour therapy ( MACT N = 18 ) or treatment as usual ( TAU N = 16 ) . Assessment of clinical symptoms and social function were made at baseline and repeated by an independent assessor masked to treatment allocation at 6 months . The number and rate of all parasuicide attempts , time to next episode and costs of care were also determined . RESULTS Thirty-two patients ( 18 MACT ; 14 TAU ) were seen at follow-up and 10 patients in each group ( 56 % MACT and 71 % TAU ) had a suicidal act during the 6 months . The rate of suicidal acts per month was lower with MACT ( median 0.17/month MACT ; 0.37/month TAU ; P = 0.11 ) and self-rated depressive symptoms also improved ( P = 0.03 ) . The treatment involved a mean of 2.7 sessions and the observed average cost of care was 46 % less with MACT ( P = 0.22 ) . CONCLUSIONS Although limited by the small sample , the results of this pilot study suggest that this new form of cognitive-behaviour therapy is promising in its efficacy and feasible in clinical practice BACKGROUND Studies on the effects of interventions in patients who have attempted suicide in China have not reported so far . AIMS To describe the basic situation surrounding the interventions and follow-up of patients who have attempted suicide and to determine whether the interventions would be effective in reducing repeat suicide attempts . METHOD 239 patients who had attempted suicide were evaluated in the emergency departments of four general hospitals . They were r and omized into three groups : cognitive therapy group , telephone intervention group , and control group . Postintervention the participants were evaluated at 3 , 6 , and 12 months separately by the following measurements : a detailed structured question naire , Beck Suicide Ideation Scale ( SIS ) , Hamilton Rating Scale for Depression ( HAMD ) , and a quality -of-life scale . RESULTS After 12 months , the cumulative dropout rate was 69.5 % ( n = 57 ) for the cognitive therapy group , 55.0 % ( n = 44 ) for the telephone intervention group , and 64.9 % ( n = 50 ) for the control group . One patient ( 1.2 % ) in the cognitive therapy group , one patient ( 1.3 % ) in the telephone intervention group , and five patients ( 6.5 % ) in the control group made at least one subsequent suicide attempt . The rates of repeated attempted suicide among the three groups were not significantly different ( χ² = 5.077 , p = .08 ) . Five patients ( 6.1 % ) received cognitive therapy , and 60 patients ( 75.0 % ) received telephone intervention . There were no differences regarding the score of HAMD , a quality -of-life scale , and the rates of subsequent suicide attempt and suicide ideation among the three groups at follow-up . CONCLUSIONS The dropout rates were higher than those reported in developed countries . Most participants in the cognitive therapy group refused to receive cognitive therapy so that the effect of cognitive therapy for these patients can not be evaluated . The participants in the telephone intervention group had good compliance , but the effect of telephone intervention could not be confirmed , so that more studies are needed in the future . Consequently , interventions can not be evaluated accurately in their preventing suicide attempts for patients who have attempted suicide in China at present A behavior therapy package was compared with insight-oriented therapy in a clinical trial for repeated suicide attempters .  Self-report measures of depression , anxiety , and assertiveness were obtained before and after ten days of inpatient treatment and at follow-up intervals for nine moths . Interviews with patients during a two-year follow-up period elicited frequency of suicidal attempts and ideation . Results indicated the superiority of the behavior therapy package , with the structured , brief hospitalization and assertive follow-up likely contributing to the main effects OBJECTIVE To describe the development and activity of a multidisciplinary service to manage self-poisoning . DESIGN Descriptive , comparative study with prospect i ve data collection . SETTING Regional toxicology treatment centre in the Hunter area of New South Wales ( NSW ) with primary and secondary referral service to 385,000 people and tertiary referral service to a further 100,000 . PATIENTS All patients ( 1987 - 1995 ) with poisoning or envenomation presenting to the Hunter Area Toxicology Service ( HATS ) . MAIN OUTCOME MEASURES Average length of stay for HATS compared with national and NSW hospitals ; mortality data for HATS compared with NSW . RESULTS Average length of stay for HATS was 0.53 - 1.22 days shorter than for all Australian hospitals , potentially saving 518 bed-days , valued at $ 468,000 per year . Average length of stay was 0.94 - 3.39 days shorter than for all NSW hospitals , saving 1470 bed-days at $ 1.4 million per year . Inpatient mortality ( 0.2 % ; 95 % confidence interval , 0.0 - 1.1 ) was not significantly different from NSW ( 0.5 % ; 95 % CI , 0.2 - 0.8 ) . St and ardised mortality ratios showed no greater all-cause suicide mortality . CONCLUSIONS In our central ised model for managing self-poisoning , all toxicology patients in an area health service are diverted to one hospital , where all patients with deliberate self-poisoning are admitted under the one multidisciplinary team , and all receive psychiatric assessment . This model has substantially reduced bed stay , with considerable savings to the Hunter Area Health Service manifested as an increase in beds available for other purpose Four hundred patients aged at least 17 who came to Casualty in one year after deliberately poisoning themselves were r and omly assigned between an Experimental social work service ( task-centered casework ) and a Control ( routine ) follow-up service .  139 patients were excluded from the trial , most of whom were already in continuing psychiatric treatment . After one year there was no difference in the proportions of E and C patients who repeated self-poisoning ( about 14 per cent ) , but significantly more of the excluded group had repeated ( 36 per cent ) . A r and om half of the trial patients were re-interviewed four months after admission . Both E and C groups had improved to a significant extent on measures of depressed mood and of social problems . E patients showed more change in social problems and were more satisfied with the service they had received Background Attempted suicide is the main risk factor for suicide and repeated suicide attempts . However , the evidence for follow-up treatments reducing suicidal behavior in these patients is limited . The objective of the present study was to evaluate the efficacy of the Attempted Suicide Short Intervention Program ( ASSIP ) in reducing suicidal behavior .  ASSIP is a novel brief therapy based on a patient-centered model of suicidal behavior , with an emphasis on early therapeutic alliance . Methods and Findings Patients who had recently attempted suicide were r and omly allocated to treatment as usual ( n = 60 ) or treatment as usual plus ASSIP ( n = 60 ) .  ASSIP participants received three therapy sessions followed by regular contact through personalized letters over 24 months . Participants considered to be at high risk of suicide were included , 63 % were diagnosed with an affective disorder , and 50 % had a history of prior suicide attempts . Clinical exclusion criteria were habitual self-harm , serious cognitive impairment , and psychotic disorder . Study participants completed a set of psychosocial and clinical question naires every 6 months over a 24-month follow-up period . The study represents a real-world clinical setting at an outpatient clinic of a university hospital of psychiatry . The primary outcome measure was repeat suicide attempts during the 24-month follow-up period . Secondary outcome measures were suicidal ideation , depression , and health-care utilization . Furthermore , effects of prior suicide attempts , depression at baseline , diagnosis , and therapeutic alliance on outcome were investigated . During the 24-month follow-up period , five repeat suicide attempts were recorded in the ASSIP group and 41 attempts in the control group . The rates of participants reattempting suicide at least once were 8.3 % ( n = 5 ) and 26.7 % ( n = 16 ) . ASSIP was associated with an approximately 80 % reduced risk of participants making at least one repeat suicide attempt ( Wald χ2 1 = 13.1 , 95 % CI 12.4–13.7 , p < 0.001 ) . ASSIP participants spent 72 % fewer days in the hospital during follow-up ( ASSIP : 29 d ; control group : 105 d ; W = 94.5 , p = 0.038 ) . Higher scores of patient-rated therapeutic alliance in the ASSIP group were associated with a lower rate of repeat suicide attempts . Prior suicide attempts , depression , and a diagnosis of personality disorder at baseline did not significantly affect outcome . Participants with a diagnosis of borderline personality disorder ( n = 20 ) had more previous suicide attempts and a higher number of reattempts . Key study limitations were missing data and dropout rates . Although both were generally low , they increased during follow-up . At 24 months , the group difference in dropout rate was significant : ASSIP , 7 % ( n = 4 ) ; control , 22 % ( n = 13 ) . A further limitation is that we do not have detailed information of the co-active follow-up treatment apart from participant self-reports every 6 months on the setting and the duration of the co-active treatment . Conclusions ASSIP , a manual-based brief therapy for patients who have recently attempted suicide , administered in addition to the usual clinical treatment , was efficacious in reducing suicidal behavior in a real-world clinical setting . ASSIP fulfills the need for an easy-to-administer low-cost intervention . Large pragmatic trials will be needed to conclusively establish the efficacy of ASSIP and replicate our findings in other clinical setting s. Trial registration Clinical Trials.gov BACKGROUND A r and omised clinical trial was carried out in suicide attempters to assess clinical efficacy of an intensive psychosocial intervention compared with treatment as usual . METHOD Two hundred and seventy-four suicide attempters presenting for medical treatment were r and omly assigned to either intensive psychosocial treatment or ' care as usual ' . Intensive psychosocial treatment consisted of brief admission to a special crisis-intervention unit and problem-solving aftercare . ' Care as usual ' included any form of treatment the assessing clinicians thought appropriate . Psychological well-being was evaluated by the SCL-90 and the Hopelessness Scale at 3 , 6 and 12 months following entry in the study . RESULTS No differences in outcome were found . The probability of repeat suicide attempts in the 12-month follow-up was 0.17 for patients in the experimental group and 0.15 for the control group . There were no differences in ratings on the SCL-90 and the Hopelessness Scale . Patients in the experimental group attended significantly more out-patient treatment sessions . CONCLUSIONS General implementation of an intensive in-patient and community intervention programme for suicide attempters does not seem justified In a controlled trial , 20 patients at high risk of repeated suicide attempts were r and omly allocated to either cognitive-behavioural problem solving or a ' treatment-as-usual ' control condition . The group practising problem solving improved significantly more than controls on ratings of depression , hopelessness , suicidal ideation and target problems at the end of treatment and at follow-up of up to one year , and there was evidence of an effect on the rates of repetition over the six months after treatment OBJECTIVE The current study endeavored to establish the feasibility and acceptability of a brief intervention for medically admitted suicide attempt survivors . METHOD Fifty patients admitted to a Level 1 trauma center were recruited following a suicide attempt . The first 10 patients provided information on what constituted usual care , which in turn informed the creation of the intervention manual and research design . The next 10 patients informed refinement of the intervention and research procedures . The final 30 patients were r and omized in a pre-post research design to receive the teachable moment brief intervention plus usual care or usual care only . Patients were assessed prior to r and omization and 1 month later by blinded research assistants . Outcomes included patient satisfaction , readiness to change problematic behaviors , reasons for living , and suicidal ideation . RESULTS Patients rated the brief intervention as " good " to " great " on all items related to client satisfaction . Significant group × time interactions were observed for readiness to change ( β=9.02 , S.D.=3.73 , P=.02 ) and reasons for living ( β=29.60 , S.D.=10.22 , P=.004 ) , suggesting greater improvement for those patients who received the brief intervention . CONCLUSIONS Patients admitted to an acute inpatient medical setting may benefit from a brief intervention that complements usual care by focusing specifically on the functional aspects of the suicide attempt in a collaborative , patient-centered manner Abstract Objectives : To determine the effects of a brief psychological intervention ( brief psychodynamic interpersonal therapy ) for patients after deliberate self poisoning compared with usual treatment . To compare the impact of the active intervention and usual treatment on patients ' satisfaction with care . Design : R and omised controlled trial . Participants : 119 adults who had deliberately poisoned themselves and presented to the emergency department of a teaching hospital . Setting : Community based study . Intervention : Four sessions of therapy delivered in the patient 's home . Control patients received “ treatment as usual , ” which in most cases consisted of referral back to their general practitioner . Outcome measures : Severity of suicidal ideation six months after treatment as assessed by the Beck scale for suicidal ideation . Secondary outcome measures at six month follow up included depressive symptoms as measured by the Beck depression inventory , patient satisfaction with treatment , and self reported subsequent attempts at self harm . Results : Participants r and omised to the intervention had a significantly greater reduction in suicidal ideation at six month follow up compared with those in the control group ( reduction in the mean ( SD ) Beck scale 8.0 v 1.5 ) . They were more satisfied with their treatment and were less likely to report repeated attempts to harm themselves at follow up ( proportion repeating 9 % v 28 % in control group ; difference 19 % , 95 % confidence interval 9 % to 30 % , P=0.009 ) . Conclusion : Brief psychodynamic interpersonal therapy may be a valuable treatment after people have deliberately tried to poison themselves . What is already known on this topic Deliberate self poisoning is one of the commonest reasons for admission to hospital in the United Kingdom and up to 15 % of patients who poison themselves eventually kill themselves There are no interventions of proved efficacy for these patients Most episodes of self poisoning are precipitated by some form of interpersonal problem What this study adds Compared with usual treatment four sessions of psychodynamic interpersonal therapy reduced suicidal ideation and self reported attempts at self harm The intervention also improved patients ' satisfaction with Suicide attempters are a high-risk group in relation to ultimately completing suicide and are usually " treated and released " with little or no follow-up care . A 4-month follow-up outreach program for suicide attempters seen in the emergency room was developed with an emphasis on continuity and quantity of " treatment " received . Suicide attempters were r and omly assigned to the " follow-up outreach " or " normal " treatment programs . Measures for the evaluation of effectiveness were ( a ) incidence of suicide reattempts and purposive accidents and ( b ) prevalence of drug misuse and excessive use of alcohol . The experimental group showed a statistically significant reduction in suicide reattempts and excessive use of alcohol , while the reduction of drug abuse , although not statistically significant , did conform to a trend indicating improvement . Purposive accidents occured at a relatively equal rate among both groups Repetition after attempted suicide is high but only few effect studies have been carried out . The Baerum Model from Norway offers practical and affordable intervention for those not being offered psychiatric treatment . During a period from 2005–2007 , all attempted suicide patients except those with major psychiatric diagnoses ( schizophrenia , bipolar disorder , severe/psychotic depression ) , were offered participation . The intervention group received the OPAC programme ( outreach , problem solving , adherence , continuity ) and the control group received treatment as usual ( TAU ) . The intervention period was 6 months . After this intervention period , all patients were followed passively for an extra 6 months . The design was an intent-to-treat one . The outcomes were : 1 ) repetition of attempted suicide or suicide , and 2 ) total number of suicidal acts .  A total of 200 patients were offered participation , 67 refused . Of the 133 participants , 69 were r and omized to the OPAC programme and 64 to the ( non-intervention ) control group . Four in each group dropped out after initial participation . There was a significant lower proportion who repeated a suicide attempt the intervention group ( proportion 8.7 % ) than in the control group ( proportion 21.9 % ) and the number of repetitive acts was also significant lower ( eight repetitions in the intervention group vs. 22 in the control group ) . In conclusion , our findings suggest a protective effect of the OPAC programme on the proportion who repeated a suicide attempt and on the total number of repetitions during the follow-up The failure to comply with referral for out-patient after-care is a well-documented problem among attempted suicide patients . The present study aim ed at the investigation of an experimental referral procedure by means of a r and omized controlled study . Non-compliant patients in the experimental group were visited in their homes by a community nurse in order to assess reasons for non-compliance and to motivate patients to comply with referral . One year after their suicide attempt patients were visited in their homes in order to assess repetition of suicidal behaviour . Uni- and multi-variate analyses showed a significant beneficial effect of the experimental procedure on compliance with referral . A near-significant effect of the experimental procedure on the rate of repetition of suicidal behaviour was found Attempted suicide is a strong risk factor for subsequent suicidal behavior . In recent years , a particular interest has been given to follow-up interventions as a potential effective strategy in preventing recurrent suicidal behavior . We developed a follow-up intervention program called OSTA ( organization of a suitable monitoring for suicide attempters ) aim ed at addressing this issue and tested its effectiveness in a 1-year r and omized controlled trial . Individuals who attempted suicide and were admitted to the emergency department ( ED ) of Bicêtre Hospital ( n=320 ) were r and omly allocated to receive either the OSTA program or a control treatment . On an intention to treat basis , the proportion of patients who reattempted suicide did not differ significantly between the interventional group ( IG ) 14.5 % ( 22/152 ) and the control group ( CG ) 14 % ( 21/150 ) . There were also no significant differences , between the two arms , in the number of suicide attempts . Although no significant difference has been found between the OSTA program and the control treatment concerning the rate of suicide reattempts , we believe that further studies should be conducted to test the effectiveness of more st and ardized follow-up studies in suicide prevention BACKGROUND Non-fatal suicide attempt is the most important risk factor for later suicide . Emergency department visits for attempted suicide are increasingly recognised as opportunities for intervention . However , no strong evidence exists that any intervention is effective at preventing repeated suicide attempts . We aim ed to investigate whether assertive case management can reduce repetition of suicide attempts in people with mental health problems who had attempted suicide and were admitted to emergency departments . METHODS In this multicentre , r and omised controlled trial in 17 hospital emergency departments in Japan , we r and omly assigned people aged 20 years and older with mental health problems who had attempted suicide to receive either assertive case management ( based on psychiatric diagnoses , social risks , and needs of the patients ) or enhanced usual care ( control ) , using an internet-based r and omisation system . Interventions were provided until the end of the follow-up period ( ie , at least 18 months and up to 5 years ) . Outcome assessors were masked to group allocation , but patients and case managers who provided the interventions were not . The primary outcome was the incidence of first recurrent suicidal behaviour ( attempted suicide or completed suicide ) ; secondary outcomes included completed suicide and all-cause mortality . This study is registered at Clinical Trials.gov ( NCT00736918 ) and UMIN-CTR ( C000000444 ) . FINDINGS Between July 1 , 2006 , and Dec 31 , 2009 , 914 eligible participants were r and omly assigned , 460 to the assertive case management group and 456 to the enhanced usual care group . We noted no significant difference in incidence of first recurrent suicidal behaviour between the assertive case management group and the enhanced usual care group over the full study period ( log-rank p=0·258 ) . Because the proportional hazards assumption did not hold , we did ad-hoc analyses for cumulative incidence of the primary outcome at months 1 , 3 , 6 , 12 , and 18 after r and omisation , adjusting for multiplicity with the Bonferroni method . Assertive case management significantly reduced the incidence of first recurrent suicidal behaviour up to the 6-month timepoint ( 6-month risk ratio 0·50 , 95 % CI 0·32 - 0·80 ; p=0·003 ) , but not at the later timepoints . Prespecified subgroup analyses showed that the intervention had a greater effect in women ( up to 18 months ) , and in participants younger than 40 years and those with a history of previous suicide attempts ( up to 6 months ) . We did not identify any differences between the intervention and control groups for completed suicide ( 27 [ 6 % ] of 460 vs 30 [ 7 % ] of 454 , log-rank p=0·660 ) or all-cause mortality ( 46 [ 10 % ] of 460 vs 42 [ 9 % ] of 454 , log-rank p=0·698 ) . INTERPRETATION Our results suggest that assertive case management is feasible in real-world clinical setting s. Although it was not effective at reducing the incidence of repetition of suicide attempts in the long term , the results of our ad-hoc analyses suggested that it was effective for up to 6 months . This finding should be investigated in future research . FUNDING The Ministry of Health , Labour , and Welfare of Japan BACKGROUND Self-harm by young people is occurring with increasing frequency . Conventional in-patient and out-patient treatment has yet to be proved efficacious . AIMS To investigate the efficacy of a short cognitive-behavioural therapy intervention with 90 adolescents and adults who had recently engaged in self-harm . METHOD Participants ( aged 15 - 35 years ) were r and omly assigned to treatment as usual plus the intervention , or treatment as usual only . Assessment s were completed at baseline and at 3 months , 6 months and 9 months follow-up . RESULTS Patients who received cognitive-behavioural therapy in addition to treatment as usual were found to have significantly greater reductions in self-harm , suicidal cognitions and symptoms of depression and anxiety , and significantly greater improvements in self-esteem and problem-solving ability , compared with the control group . CONCLUSIONS These findings extend the evidence that a time-limited cognitive-behavioural intervention is effective for patients with recurrent and chronic self-harm OBJECTIVE People with substance use disorders who present with suicidal behavior are at high risk of subsequent suicide . There are few effective treatments specifically tailored for this population that diminish this risk . We aim ed to assess the impact of an opportunistic cognitive behavioral intervention package ( OCB ) among adult out patients with a substance use and comorbid suicide risk . METHOD A r and omized controlled trial was conducted across 2 sites in which 185 patients presenting with suicide risk and concurrent substance use received either OCB ( 8 sessions plus group therapy ) or treatment as usual ( TAU ) over a 6-month period . Primary outcomes were suicidal behavior ( suicide attempts , suicidal intent and presence of suicide ideation ) and level of drug and alcohol consumption . Secondary outcomes were changes in psychological measures of suicide ideation , depression , anxiety , and self-efficacy . RESULTS There were no completed suicides , and only 2 participants reported suicide attempts at follow-up . Suicide ideation , alcohol consumption , and cannabis use fell over time but no significant Treatment × Time differences were found . There were also no differences between OCB and TAU over time on psychological measures of depression , anxiety , or self-efficacy . Suicide ideation at 6-month follow-up was predicted by cannabis use and higher scores on the Brief Psychiatric Rating Scale at baseline . CONCLUSIONS The opportunistic cognitive behavioral intervention package did not appear to be beneficial in reducing suicide ideation , drug and alcohol consumption , or depression relative to treatment as usual
OBJECTIVE To examine the efficacy of psychological and psychosocial interventions for reductions in repeated self-harm .