title: Postcards in Persia: randomised controlled trial to reduce suicidal behaviours 12 months after hospital-treated self-poisoning.
abstract: BACKGROUND
  Hospital-treated self-poisoning is common, with limited effective  interventions for reducing subsequent suicidal behaviour.
  
  
  OBJECTIVE
  To test the efficacy of a postcard intervention to reduce suicidal  behaviour.
  
  
  METHODS
  Randomised controlled trial of individuals who self-poisoned (n =  2300), the intervention consisted of nine postcards sent over 12 months versus  usual treatment. Outcomes assessed at 12 months (n = 2113) were  suicidal ideation, suicide attempts and self-cutting (proportion and event  rates).
  
  
  RESULTS
  There was a significant reduction in any suicidal ideation (relative risk  reduction (RRR) = 0.31, 95% CI 0.22-0.38), any suicide attempt (RRR =  0.42, 95% CI 0.11-0.63) and number of attempts (incidence rate ratios  (IRR) = 0.64, 95% CI 0.42-0.97). There was no significant reduction in  any self-cutting (RRR = 0.14, 95% CI -0.29 to 0.42) or self-cutting  events (IRR = 1.03 95% CI 0.76-1.39).
  
  
  CONCLUSIONS
  A postcard intervention reduced suicidal ideation and suicide attempts in a  non-Western population. Sustained, brief contact by mail may reduce suicidal  ideation and suicide attempts in individuals who self-poison.
authors.affiliation: Department of Internal Medicine, Division of Clinical Toxicology, Faculty of Medicine, Shahid Beheshti University MC, Tehran, Iran. Hassanian@sbmu.ac.ir
authors.forename: Hossein
authors.initials: H
authors.lastname: Hassanian-Moghaddam
authors.forename: Saeedeh
authors.initials: S
authors.lastname: Sarjami
authors.forename: Ali-Asghar
authors.initials: AA
authors.lastname: Kolahi
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Carter
mesh_terms: D000293:Adolescent; D000359:Aftercare / Q000379:methods; D015709:Correspondence as Topic; D005260:Female; D006760:Hospitalization; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D019071:Persia; D011041:Poisoning / Q000523:psychology / Q000628:therapy*; D055502:Secondary Prevention; D016728:Self-Injurious Behavior / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology; D013997:Time Factors; D055815:Young Adult