Effect of assertive outreach after suicide attempt in the AID (assertive intervention for deliberate self harm) trial: randomised controlled trial.
OBJECTIVE
To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts, compared with standard treatment.


METHODS
Randomised, parallel group, superiority trial with blinded outcome assessment.


METHODS
Outpatient intervention at one location at Copenhagen University Hospital, Denmark.


METHODS
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.


BACKGROUND
ClinicalTrials.gov NCT00700089.
Research Unit, Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark. .morthorst@regionh.dk
Britt
B
Morthorst
Jesper
J
Krogh
Annette
A
Erlangsen
Francisco
F
Alberdi
Merete
M
Nordentoft
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D002648:Child; D003419:Crisis Intervention / Q000379:methods*; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012042:Registries; D057566:Self Report; D016037:Single-Blind Method; D013405:Suicide / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult; D000092864:Suicide Prevention