Abstract
The purpose of this study was to investigate the effect of continuous case management with a flexible approach on the prevention of suicide by suicide reattempt in a real clinical setting. The subjects in this study were 526 suicide attempters who visited emergency rooms in a teaching hospital in South Korea. Subjects were provided a continuous case management program with a flexible approach according to the severity of their suicide risk and needs. During the entire observation period (from 182 days to 855 days, mean = 572 ± 254), 18 patients (3.7%) died by suicide reattempt: Eight patients (2.27%) in the case management group and 10 patients (7.35%) in the no-case management group. The Cox regression analysis showed that the case management group had a 75% lower risk of death from suicide attempts than the no-case management group (HR = 0.34, 95% CI = 0.13–0.87). This result was shown to be more robust after adjusting for confounding factors such as gender, age, psychiatric treatment, suicide attempts, and family history of suicide (adjusted HR = 0.27, 95% CI = 0.09–0.83). This study was conducted in a single teaching hospital and not a randomized controlled one. A flexible and continuous case management program for suicide attempters is effective for preventing death by suicide reattempts.
Highlights
Suicide is a complex major public health issue and accounts for an estimated 11.4 suicides per100,000 people that occur per year, resulting in 804,000 deaths worldwide every year [1]
Seventy-two percent (353/489) of all suicide attempters participated in the case management program
By the end of the observation period (31 December, 2012), 199 people (56.7%) among the cases remained in the case management program (24 people were referred to another mental health center because they moved to another city, 113 people refused to receive the program)
Summary
Suicide is a complex major public health issue and accounts for an estimated 11.4 suicides per100,000 people that occur per year, resulting in 804,000 deaths worldwide every year [1]. Suicide is a complex major public health issue and accounts for an estimated 11.4 suicides per. The suicide rate in Korea is the highest among the Organization for Economic Co-Operation and Development (OECD) member countries with 29.1 deaths per 100,000 people, which is approximately 2.3 times higher than the OECD average of 12.5 deaths per 100,000 people [2]. Strategies to prevent suicide include common prevention for the general population (education on suicide, publicity, access control in lethal methods of suicide), selective prevention for people vulnerable to suicide (people with mental illnesses, etc.), and intensive prevention for high-risk groups such as people with mental illnesses known to be associated with suicide or those who have already attempted suicide [3,4]. Suicide attempters even once have 66 times higher likelihood of dying by suicide within a year of the. Res. Public Health 2020, 17, 2599; doi:10.3390/ijerph17072599 www.mdpi.com/journal/ijerph
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