Longer Interventions Associated With Lower Risk for Relapse After a Suicide Attempt

Woman during a psychotherapy session
An enhanced care program featuring scheduled in-person psychiatric visits for up to 12 months lowered the risk for relapse after a suicide attempt by 44% vs a single priority appointment within a week of an attempt.

Adults who received psychotherapy and frequent outpatient follow-up visits after attempted suicide for up to 12 months were at lower risk for another suicide attempt, according to observational study results published in the Journal of Clinical Psychiatry.

The study included 1492 individuals who attempted suicide and entered one of three suicide risk intervention programs provided by hospitals in Madrid, Spain, between 2013 and 2017. Investigators evaluated the effectiveness of the programs on decreasing the risk of another attempted suicide by comparing the 3 interventions:

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  • Usual care (n=788): An appointment with a psychiatrist at a community mental healthcare center within 7 days of hospital discharge, which is the routine intervention in Madrid for patients who have made a suicide attempt.
  • Psychotherapy (n=523): Usual care plus 2 months of weekly 30-minute individual therapy sessions focusing on problem-solving and stress reduction and reminder calls if a patient failed to attend a session.
  • Enhanced contact (n=181): An appointment 3 days after hospital discharge; 6 to 12 months of frequent outpatient visits (depending on patients’ mental health severity) with a devoted psychiatrist trained in suicide prevention; and follow-up calls regarding both routine and emergency treatment and offering general support at months 1, 6, and 12.

After one year, 8.9% of the participants experienced a relapse, defined as being treated again at the reference hospital due to another suicide attempt. Overall, the psychotherapy and enhanced contact interventions were more effective than usual care in reducing the odds of another suicide attempt, with a 40% lower relapse risk when adjusting for sex, concurrent alcohol or drug abuse, personal history of suicide attempts, and presence of a mood or personality disorder diagnosis.

Although much of the evidence concerning suicide prevention strategies comes from randomized controlled trials, the researchers pointed to a growing need for a “real-world approach.” “Nonetheless,” they concluded, “the question of (whether) psychotherapy adds value to contact maintenance for suicidal prevention remains partially unanswered.”


Martínez-Alés G, Angora R, Barrigón M, et al. A real-world effectiveness study comparing a priority appointment, and enhanced contact intervention, and a psychotherapeutic program following attempted suicide. J Clin Psychiatry. 2019;80(2).