A randomized controlled multicenter trial of post-suicide attempt case management for the prevention of further attempts in Japan (ACTION-J).
BACKGROUND
A previous suicide attempt is a potent risk factor for suicide later on. Crisis intervention, psychiatric and psychosocial evaluation at emergency medical facilities, and follow-up care for suicide attempters are considered important components for suicide prevention. The Japanese Multimodal Intervention Trials for Suicide Prevention (J-MISP) includes a randomized, controlled, multicenter trial of post-suicide attempt case management for the prevention of further attempts (ACTION-J) to address the continuing increase in suicides in Japan. The primary aim of ACTION-J is to examine the effectiveness of an extensive intervention for suicide attempters in prevention of recurrent suicidal behavior, as compared with standard intervention. This paper describes the rationale and protocol of the ACTION-J trial.


METHODS
In this clinical trial, case management intervention will be provided at 19 emergency medical facilities in Japan. After crisis intervention including psychiatric evaluation, psychosocial assessment, and psychological education, subjects will be randomly assigned to either a group receiving continuous case management or a control group receiving standard care. Suicidal ideation, depressive symptoms, and general health condition will be evaluated as secondary measures. The intervention was initiated in July 2006. By December, 2009, 842 subjects will be randomized. Subject follow-up will continue for 1.5 to 5 years.


CONCLUSIONS
Suicide is a complex phenomenon that encompasses multiple factors. Case management by multi-sector collaboration is needed. ACTION-J may provide valuable information on suicide attempters and may develop effective case management to reduce future risk for suicide attempters.


BACKGROUND
UMIN Clinical Trials Registry number, UMIN000000444. ClinicalTrials.gov number, NCT00736918.
Hirayasu
Yoshio
Y
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan. hirayasu@yokohama-cu.ac.jp
Kawanishi
Chiaki
C
Yonemoto
Naohiro
N
Ishizuka
Naoki
N
Okubo
Yoshiro
Y
Sakai
Akio
A
Kishimoto
Toshifumi
T
Miyaoka
Hitoshi
H
Otsuka
Kotaro
K
Kamijo
Yoshito
Y
Matsuoka
Yutaka
Y
Aruga
Toru
T
D000328:Adult; D000359:Aftercare; D001071:Appointments and Schedules; D019090:Case Management; D003625:Data Collection; D005260:Female; D006760:Hospitalization; D006801:Humans; D007564:Japan; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000379:methods*; D019145:Rehabilitation Nursing; D035842:Research Subjects; D055502:Secondary Prevention; D013406:Suicide, Attempted / Q000523:psychology*