Effect of assertive outreach after suicide attempt in the AID (assertive intervention for deliberate self harm) trial: randomised controlled trial

BMJ. 2012 Aug 22;345:e4972. doi: 10.1136/bmj.e4972.

Abstract

Objective: To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts, compared with standard treatment.

Design: Randomised, parallel group, superiority trial with blinded outcome assessment.

Setting: Outpatient intervention at one location at Copenhagen University Hospital, Denmark.

Participants: Patients older than 12 years admitted to regional hospitals in Copenhagen with a suicide attempt within the past 14 days. We excluded patients diagnosed with schizophrenia spectrum disorders and patients living in institutions.

Intervention: Case management through assertive outreach that provided crisis intervention and flexible problem solving. This approach incorporated motivational support and actively assisted patients to scheduled appointments to improve adherence with after-treatment as an add on to standard treatment.

Main outcome: Repeated suicide attempt and death by suicide, recorded in medical records and death register at 1-year follow-up.

Results: 243 patients were included. During 12 months of follow-up, 20/123 (16%) patients in the intervention group had been registered in hospital records with subsequent suicide attempt, compared with 13/120 (11%) in the control group (odds ratio 1.60, 95% confidence interval 0.76 to 3.38; P=0.22). By contrast, self reported data on new events showed 11/95 (12%) in the intervention group versus 13/74 (18%) in the control group (0.61, 0.26 to 1.46; P=0.27). By imputing missing data on the selfreported outcomes, we estimated 15/123 (12%) events in the intervention group and 23/120 (19%) in the control group (0.69, 0.34 to 1.43; P=0.32).

Conclusion: Assertive outreach showed no significant effect on subsequent suicide attempt. The difference in rates of events between register data and self reported data could indicate detection bias.

Trial registration: ClinicalTrials.gov NCT00700089.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Case Management*
  • Child
  • Crisis Intervention / methods*
  • Denmark
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Registries
  • Self Report
  • Single-Blind Method
  • Suicide / prevention & control
  • Suicide / statistics & numerical data
  • Suicide, Attempted / prevention & control*
  • Suicide, Attempted / statistics & numerical data
  • Treatment Outcome
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT00700089