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Close contact did not reduce suicide risk for adolescents and adults

An intervention program that promoted keeping close contact with young people after they had attempted suicide did not lower the risks of a subsequent attempt, according to study results published in the British Medical Journal.

Globally, the number of suicide attempts was estimated by the World Health Organization to be 10 to 40 times higher than that of fatal episodes.

“Patients with suicidal behavior have been characterized as difficult to engage in after-treatment,” the researchers wrote. “Various trials of interventions offering help after contact with emergency rooms have focused on treatment accessibility and adherence to after-treatment, to optimize the treatment chain for both adults and adolescents.”

Britt Morthorst, a research assistant at the Mental Health Centre in Copenhagen, and colleagues conducted a randomized trial to test the effectiveness of a close-contact intervention involving 243 patients, aged older than 12 years, who had attempted suicide within the past 14 days. Patients were assigned either to standard treatment or assertive intervention for deliberate self-harm (AID).

Standard treatment (n=120) was adapted to the patient’s individual needs, and compliance with treatment recommendations typically was left to the discretion of the patient. AID (n=123) consisted of eight to 20 flexible outreach consultations by specially-trained nurses who kept close contact for up to 6 months in addition to standard treatment.

In the 12 months of follow-up, 16% of patients in the AID group had attempted suicide, compared with 11% of those in the control group (OR=1.60; 95% CI, 0.76-3.38; P=0.22). One patient died by suicide in the AID group, and no patients died by suicide in the control group. Post-hoc analysis combining medical records and self-reported data showed that the frequency of repeated attempts was 17% for the AID group and 18% for the control group (OR=0.97; 95% CI, 0.50-1.89; P=0.93). This figure corresponds with rates found in previous international studies.

“Unfortunately, the conclusion must be that neither standard treatment nor additional assertive outreach is good enough,” Morthorst said in a press release. “My suggestion is that we try to get hold of young people at risk before they attempt suicide the first time.”

Disclosure: The study was supported by the Danish Ministry of Health and Internal Affairs, the National Board of Social Services in Denmark, TrygFonden and Aase og Ejnar Danielsens Foundation.