Employing crisis postcards with case management in Kaohsiung, Taiwan: 6-month outcomes of a randomised controlled trial for suicide attempters

Wei-Jen Chen,Shi-Sen Shyu,Pin-Yang Yeh,Li-Shiu Chou,Tieh-Chi Chung,Frank Huang-Chih Chou,Guei-Ging Lin,Yun-Ju Fang,Chi-Kung Ho,Cheng-Chung Chen

doi:10.1186/1471-244x-13-191

Abstract

BackgroundSuicide attempts constitute a serious clinical problem and have important implications for healthcare resources. The aim of the present study was to evaluate the effectiveness of case management using crisis postcards over a 6-month follow-up period.MethodA randomised controlled trial was conducted in Kaohsiung, Taiwan. Prevention of further suicide attempts was compared between two groups with and without the postcard intervention. The intervention group consisted of 373 participants (139 males, 234 females; age: 39.8 ± 14.0 yrs.). The control group consisted of 388 participants (113 males, 275 females; age: 40.0 ± 16.0 yrs.). A survival analysis was used to test the effectiveness of the crisis postcard intervention for the prevention of suicide reattempts. Per-protocol and intention-to-treat analyses were conducted.ResultsThe intention-to-treat analysis indicated that the crisis postcard had no effect (hazard ratio = 0.84; 95% CI = 0.56 – 1.29), whereas the per-protocol analysis showed a strong benefit for the crisis postcard (hazard ratio = 0.39; 95% CI = 0.21 – 0.72).ConclusionAlthough the results of the present study indicated that the postcard intervention did not reduce subsequent suicide behaviour, our study provides an alteration to the postcard intervention. Further studies need to be conducted to clarify whether this type of intervention can reduce subsequent suicidal behaviour, with a particular focus on reducing the rate of loss to follow-up.

Highlights

Suicide attempts constitute a serious clinical problem and have important implications for healthcare resources
The intention-to-treat analysis indicated that the crisis postcard had no effect, whereas the per-protocol analysis showed a strong benefit for the crisis postcard
Conclusion: the results of the present study indicated that the postcard intervention did not reduce subsequent suicide behaviour, our study provides an alteration to the postcard intervention

Summary

Introduction

Suicide attempts constitute a serious clinical problem and have important implications for healthcare resources. Suicide is a global challenge and a major public health problem worldwide. Suicide accounts for almost 1 million deaths annually, and an estimated 10 million suicide attempts occur every year [1]. 32% of all deaths due to suicide occur in the Western Pacific region [2]. This disproportionately high rate of suicide is geographically constrained to 37 countries and an estimated. The suicide rate in this region is approximately 19.3 per 100,000 individuals [3]. In Kaohsiung City, Taiwan’s second largest metropolitan city, suicide has become a major public health issue, a fact that is reflected in a relatively high suicide rate, which reached 18.4 deaths for every 100,000 people in 2010

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