title: A randomized controlled trial of postcrisis suicide prevention.
abstract: OBJECTIVE
  This study tested the hypothesis that professionals' maintenance of long-term contact with persons who are at risk of suicide can exert a suicide-prevention influence. This influence was hypothesized to result from the development of a feeling of connectedness and to be most pertinent to high-risk individuals who refuse to remain in the health care system.
  
  
  METHODS
  A total of 3,005 persons hospitalized because of a depressive or suicidal state, populations known to be at risk of subsequent suicide, were contacted 30 days after discharge about follow-up treatment. A total of 843 patients who had refused ongoing care were randomly divided into two groups; persons in one group were contacted by letter at least four times a year for five years. The other group-the control group-received no further contact. A follow-up procedure identified patients who died during the five-year contact period and during the subsequent ten years. Suicide rates in the contact and no-contact groups were compared.
  
  
  RESULTS
  Patients in the contact group had a lower suicide rate in all five years of the study. Formal survival analyses revealed a significantly lower rate in the contact group (p=.04) for the first two years; differences in the rates gradually diminished, and by year 14 no differences between groups were observed.
  
  
  CONCLUSIONS
  A systematic program of contact with persons who are at risk of suicide and who refuse to remain in the health care system appears to exert a significant preventive influence for at least two years. Diminution of the frequency of contact and discontinuation of contact appear to reduce and eventually eliminate this preventive influence.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, School of Medicine, CA 94143, USA. jerrymotto@aol.com
authors.forename: J A
authors.initials: JA
authors.lastname: Motto
authors.forename: A G
authors.initials: AG
authors.lastname: Bostrom
mesh_terms: D000328:Adult; D000359:Aftercare; D002140:California; D003866:Depressive Disorder / Q000150:complications / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D011177:Postal Service; D018709:Statistics, Nonparametric; D013405:Suicide / Q000706:statistics & numerical data; D016019:Survival Analysis; D015996:Survival Rate; D016312:Treatment Refusal; D000092864:Suicide Prevention