Repetition of suicide attempts: data from emergency care settings in five culturally different low- and middle-income countries participating in the WHO SUPRE-MISS Study.
BACKGROUND
Attempted suicide is a strong risk factor for subsequent suicidal behaviors. Innovative strategies to deal with people who have attempted suicide are needed, particularly in resource-poor settings.


OBJECTIVE
To evaluate a brief educational intervention and periodic follow-up contacts (BIC) for suicide attempters in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, People's Republic of China) as part of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS).


METHODS
Among the 1,867 suicide attempters enrolled in the emergency departments of the participating sites, 922 (49.4%) were randomly assigned to a brief intervention and contact (BIC) group and 945 (50.6%) to a treatment as usual (TAU) group. Repeated suicide attempts over the 18 months following the index attempt - the secondary outcome measure presented in this paper - were identified by follow-up calls or visits. Subsequent completed suicide - the primary outcome measure - has been reported in a previous paper.


RESULTS
Overall, the proportion of subjects with repeated suicide attempts was similar in the BIC and TAU groups (7.6% vs. 7.5%, chi(2) = 0.013; p = .909), but there were differences in rates across the five sites.


CONCLUSIONS
This study from five low- and middle-income countries does not confirm the effectiveness of brief educational intervention and follow-up contacts for suicide attempters in reducing subsequent repetition of suicide attempts up to 18 months after discharge from emergency departments.
Bertolote
José M
JM
Botucatu Medical School - UNESP, Botucatu, Brazil.
Fleischmann
Alexandra
A
De Leo
Diego
D
Phillips
Michael R
MR
Botega
Neury J
NJ
Vijayakumar
Lakshmi
L
De Silva
Damani
D
Schlebusch
Lourens
L
Nguyen
Van Tuong
VT
Sisask
Merike
M
Bolhari
Jafar
J
Wasserman
Danuta
D
D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D019049:Developed Countries / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007492:Iran / Q000453:epidemiology; D008297:Male; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D055502:Secondary Prevention; D013188:Sri Lanka / Q000453:epidemiology; D013406:Suicide, Attempted / Q000191:economics / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult