Rate of Repeated Suicide Attempts Decreases With Early Follow-Up

Prevention of repeated suicide attempts was most effective with prompt recontact of patients.

Research published in BMC Psychiatry found that in patients who were referred to an emergency psychiatric unit for attempted suicide, very early follow-up telephone calls effectively reduced successive suicide attempts.

Sophie Exbrayat, from the Department of Emergency Psychiatry, University Hospital, Saint-Étienne, France, and colleagues conducted a single-center, controlled study of 436 patients who were hospitalized for attempted suicide at the Department of Emergency Psychiatry between January and December 2010, and analyzed the effect of follow-up telephone calls at 8, 30, and 60 days during the year after hospitalization.

For their control group, the researchers evaluated records of 823 patients who were admitted to the emergency psychiatry department for attempted suicide the year before and who had not received follow-up telephone calls.

The researchers found that there were significantly fewer repeated suicide attempts among study participants (55/436) compared with control participants (69/387) after the initial index episode (P =.037). A calculation of the rate/ratio showed a drop of 33%.

Of the participants who received follow-up telephone calls, 56% responded to all 3 calls, 32.3% responded to either 1 or 2 calls, and 11.7% did not respond to any of the calls.

“For the 244 patients who responded to all telephone follow-up calls, the OR of recidivism was even lower: 0.50 (95% confidence interval [CI], 0.62 to 0.80),” the authors wrote. Compared with the control group, the relative risk for a successive suicide attempt in the participants who completed all 3 telephone interviews was 0.41 (95% CI, 0.22-0.76).

“The cumulative incidence curve of [successive suicide attempts] seems to indicate that the difference between the 2 groups lies mainly in the first weeks following the suicidal gesture,” the researchers concluded. “Thus, prompt recontact of patients seems most effective.”


The researchers noted that those who attempt suicide are a diverse group, and are therefore not likely to all respond to the same follow-up techniques after intervention.2,3 (For example, postcards seem more effective in women than in men, and follow-up by telephone may be inefficient in groups of patients who have attempted suicide for the first time.)4,5 “Very large studies would be required to evaluate various subgroups of patients and postvention techniques, but implementation of such studies would be limited by the sample sizes required to obtain sufficient power,” the investigators wrote.

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  1. Exbrayat S, Coudrot C, Gourdon X, et al. Effect of telephone follow-up on repeated suicide attempt in patients discharged from an emergency psychiatry department: a controlled study [published online March 20, 2017]. BMC Psychiatry. doi: 10.1186/s12888-017-1258-6
  2. Skegg K. Self-harm. Lancet. 2005;366(9495):1471-1483. doi: 10.1016/S0140-6736(05)67600-3.
  3. Hawton K, Saunders KE. Psychiatric service development and suicide. Lancet. 2009;373(9658):99-100. doi: 10.1016/S0140-6736(08)61871-1.
  4. Carter GL, Clover K, Whyte IM, Dawson AH, D’Este C. Postcards from the Edge project: randomized controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self-poisoning. BMJ. 2005;331:805. doi: 10.1136/bmj.38579.455266.E0
  5. Vaiva G, Walter M, Al Arab AS, Courtet P, Bellivier F, Demarty AL, et al. ALGOS: the development of a randomized controlled trial testing a case management algorithm designed to reduce suicide risk among suicide attempters [published online January 2, 2011]. BMC Psychiatry. doi: 10.1186/1471-244X-11-1