title: Effectiveness of a telephone management programme for patients discharged from an emergency department after a suicide attempt: controlled study in a Spanish population.
abstract: OBJECTIVE
  To determine the effectiveness over one year of a specific telephone management programme on patients discharged from an emergency department (ED) after a suicide attempt. We hypothesized that the programme will reduce the percentage of patients re-attempting suicide and delay the time between attempts.
  
  
  METHODS
  A multicentre, case-control, population-based study. The effect of the 1-year intervention on the main outcome measures was evaluated with respect to a 1-year baseline period and a control group.
  
  
  METHODS
  Two hospitals with distinct catchment areas in Catalonia (Spain).
  
  
  METHODS
  A total of 991 patients discharged from the ED of either hospital after a suicide attempt during the baseline year and the intervention year.
  
  
  METHODS
  The intervention was carried out on patients discharged from the ED for attempted suicide (Sabadell). It consisted of a systematic, one-year telephone follow-up programme: after 1 week, thereafter at 1, 3, 6, 9 and 12-month intervals, to assess the risk of suicide and increasing adherence to treatment. The population in the control group (Terrassa) received treatment as usual after discharge, without additional telephone management.
  
  
  METHODS
  Time elapsed between initial suicide attempt and subsequent one, and changes in the annual rate of patients who reattempted suicide in the year of the intervention and the preceding one.
  
  
  RESULTS
  The telephone management programme delayed suicide reattempts in the intervention group compared to the baseline year (mean time in days to first reattempt, year 2008=346.47, sd=4.65; mean time in days to first reattempt, year 2007=316.46, sd=7.18; P<0.0005; χ²=12.1, df=1) and compared to the control population during the same period (mean time in days to first reattempt, treatment period=346.47, sd=4.65; mean time in days to first reattempt, pre-treatment period=300.36, sd=10.67; P<0.0005; χ²=16.8, df=1). The intervention reduced the rate of patients who reattempted suicide in the experimental population compared to the previous year (Intervention 6% (16/296) v Baseline 14% (39/285) difference 8%, 95% confidence interval 2% to 12%) and to the control population (Intervention 6% (16/296) v Control 14% (31/218) difference 8%, -13% to -2%)
  
  
  CONCLUSIONS
  One of the main obstacles was the difficulty to contact all patients within the established deadlines. Another limitation of our study was that patients under the age of 18 underwent an intensive intervention in the day hospital, although their number was very small (13/319 in 2008) and did not significantly influence the results. But the main limitation of our study was that it was performed within the EAAD project. This project includes a comprehensive multilevel intervention practically in the same experimental area and aimed at an early diagnosis and treatment of depression, which is the main psychiatric disorder associated with suicide. Moreover, longer-term studies should be encouraged to determine whether such interventions really reduce suicide
  
  
  CONCLUSIONS
  A telephone management programme for patients discharged from an ED after a suicide attempted would be a useful strategy in delaying further suicide attempts and in reducing the rate of reattempts, which is known as the highest risk factor for suicide completion.
authors.affiliation: Department of Mental Health, Corporació Sanitària Parc Taulí de Sabadell (Barcelona), Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Campus d'Excel·lència Internacional, Bellaterra 08193, Spain. acebria@tauli.cat
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Cebrià
authors.forename: Isabel
authors.initials: I
authors.lastname: Parra
authors.forename: Montserrat
authors.initials: M
authors.lastname: Pàmias
authors.forename: Anna
authors.initials: A
authors.lastname: Escayola
authors.forename: Gemma
authors.initials: G
authors.lastname: García-Parés
authors.forename: Joaquim
authors.initials: J
authors.lastname: Puntí
authors.forename: Andrés
authors.initials: A
authors.lastname: Laredo
authors.forename: Vicenç
authors.initials: V
authors.lastname: Vallès
authors.forename: Myriam
authors.initials: M
authors.lastname: Cavero
authors.forename: Joan Carles
authors.initials: JC
authors.lastname: Oliva
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hegerl
authors.forename: Victor
authors.initials: V
authors.lastname: Pérez-Solà
authors.forename: Diego J
authors.initials: DJ
authors.lastname: Palao
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000150:complications / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D012306:Risk; D055502:Secondary Prevention; D013030:Spain; D013406:Suicide, Attempted / Q000517:prevention & control*; D013689:Telephone; D055815:Young Adult