Abstract
BackgroundBrief contact interventions (BCIs) might be reliable suicide prevention strategies. BCI efficacy trials, however, gave equivocal results. AlgoS trial is a composite BCI that yielded inconclusive results when analyzed with Intention-To-Treat strategy. In order to elicit intervention strengths and weaknesses, post-hoc analyses of AlgoS data were performed.MethodsAlgoS was a randomized controlled trial conducted in 23 French hospitals. Suicide attempters were randomly assigned to either the intervention group (AlgoS) or the control group (Treatment as usual TAU). In the AlgoS arm, first-time suicide attempters received crisis cards; non first-time suicide attempters received a phone call, and post-cards if the call could not be completed, or if the participant was in crisis and/or non-compliant with the post-discharge treatment. An As Treated strategy, accounting for the actual intervention received, was combined with subgroup analyses.Results1,040 patients were recruited and randomized into two groups of N = 520, from which 53 withdrew participation; 15 were excluded after inclusion/exclusion criteria reassessment. AlgoS first attempters were less likely to reiterate suicide attempt (SA) than their TAU counterparts at 6 and 13–14 months (RR [95% CI]: 0.46 [0.25–0.85] and 0.50 [0.31–0.81] respectively). AlgoS non-first attempters had similar SA rates as their TAU counterparts at 6 and 13–14 months (RR [95% CI]: 0.84 [0.57–1.25] and 1.00 [0.73–1.37] respectively). SA rates were dissimilar within the AlgoS non-first attempter group.ConclusionsThis new set of analysis suggests that crisis cards could be efficacious to prevent new SA attempts among first-time attempters, while phone calls were probably not significantly efficacious among multi-attempters. Importantly, phone calls were informative of new SA risk, thus a key component of future interventions.
Highlights
With a toll nearing one million per year, suicide is the 17th leading cause of death worldwide, and the 10th cause of death for adults 18–40 years old [1,2]
suicide attempts (SAs) rates were dissimilar within the AlgoS non-first attempter group. This new set of analysis suggests that crisis cards could be efficacious to prevent new SA attempts among first-time attempters, while phone calls were probably not significantly efficacious among multi-attempters
Given the literature accumulated at that time, it assumed that the crisis card would be most efficient for first attempters, whereas multiple attempters would rather need a phone call
Summary
With a toll nearing one million per year, suicide is the 17th leading cause of death worldwide, and the 10th cause of death for adults 18–40 years old [1,2]. Suicide prevention is considered a global public-health priority, and large-scale multimodal programs are deemed the most efficient strategy to adopt [1]. Brief Contact Interventions (BCIs) in the immediate aftermath of suicide attempts (SAs) were identified as relevant pieces to integrate into such programs [3]. As shown by 3 recently published meta-analyses, results of efficacy trials of BCI are equivocal, . Focusing on ED-based preventive interventions, Inagaki et al found active contact and follow-up actions to significantly reduce the risk of suicide reattempt at 12 month (combined RR = 0.83, 95% CI: 0.71–0.98), but the effect was not maintained at 24 months (RR = 0.97, 95% CI: 0.76–1.22) [2]. Brief contact interventions (BCIs) might be reliable suicide prevention strategies. AlgoS trial is a composite BCI that yielded inconclusive results when analyzed with Intention-To-Treat strategy. In order to elicit intervention strengths and weaknesses, post-hoc analyses of AlgoS data were performed.
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