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Human Contact and Suicide Prevention

Despite the high rate of suicide in the developed world, no randomized controlled trial has yet identified an intervention that reduces suicide rates. Researchers in this study examined the effect of regular mail contact on subsequent suicide rates in 3005 high-risk patients who had been hospitalized for depression or suicide. The 843 patients who were not engaged in treatment 30 days after discharge were randomized to receive mail contact or no contact; 223 patients were lost to follow-up, and 1939 had agreed to further treatment.

Contact patients received personalized letters every month for 4 months, bimonthly for 8 months, and then every 3 months for 4 years. Few patients (3 percent) requested that the letters stop; 25 percent responded appreciatively. Suicide rates, confirmed by coroners' reports, death certificates, and family reports, were significantly lower in contacted patients during the first 2 years than in the other groups and were approximately twice as high in uncontacted patients, higher still in treated patients, and highest in patients lost to follow-up. After 2 years, the effect of mail contact gradually wore off. Groups showed no differences in nonsuicidal deaths.

Comment: This striking finding, strengthened by the large sample size and long follow-up, shows that the simple expression of concern is therapeutic. The effect is believable because it corresponded to the time of most intensive contact and gradually waned thereafter. This intervention is simple, cost-effective and -- because it targets patients who refuse more formal and validated treatments -- ethical. Higher suicide rates in treated patients may indicate that they were more severely ill and therefore more motivated to seek treatment. The finding of the worst outcomes in patients lost to follow-up is consistent with results from studies showing poor prognosis in such individuals; unknown factors (e.g., substance abuse, impulsive geographic moves, aversion to treatment) may increase their risk of suicide.

— P Roy-Byrne

Published in Journal Watch Psychiatry July 11, 2001

Citation(s):

Motto JA and Bostrom AG. A randomized controlled trial of postcrisis suicide prevention. Psychiatr Serv 2001 Jun 52 828-833.

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