title: Employing crisis postcards with case management in Kaohsiung, Taiwan: 6-month outcomes of a randomised controlled trial for suicide attempters.
abstract: BACKGROUND
  Suicide attempts constitute a serious clinical problem and have important implications for healthcare resources. The aim of the present study was to evaluate the effectiveness of case management using crisis postcards over a 6-month follow-up period.
  
  
  METHODS
  A randomised controlled trial was conducted in Kaohsiung, Taiwan. Prevention of further suicide attempts was compared between two groups with and without the postcard intervention. The intervention group consisted of 373 participants (139 males, 234 females; age: 39.8 ± 14.0 yrs.). The control group consisted of 388 participants (113 males, 275 females; age: 40.0 ± 16.0 yrs.). A survival analysis was used to test the effectiveness of the crisis postcard intervention for the prevention of suicide reattempts. Per-protocol and intention-to-treat analyses were conducted.
  
  
  RESULTS
  The intention-to-treat analysis indicated that the crisis postcard had no effect (hazard ratio = 0.84; 95% CI = 0.56 - 1.29), whereas the per-protocol analysis showed a strong benefit for the crisis postcard (hazard ratio = 0.39; 95% CI = 0.21 - 0.72).
  
  
  CONCLUSIONS
  Although the results of the present study indicated that the postcard intervention did not reduce subsequent suicide behaviour, our study provides an alteration to the postcard intervention. Further studies need to be conducted to clarify whether this type of intervention can reduce subsequent suicidal behaviour, with a particular focus on reducing the rate of loss to follow-up.
authors.forename: Wei-Jen
authors.initials: WJ
authors.lastname: Chen
authors.forename: Chi-Kung
authors.initials: CK
authors.lastname: Ho
authors.forename: Shi-Sen
authors.initials: SS
authors.lastname: Shyu
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Chen
authors.forename: Guei-Ging
authors.initials: GG
authors.lastname: Lin
authors.forename: Li-Shiu
authors.initials: LS
authors.lastname: Chou
authors.forename: Yun-Ju
authors.initials: YJ
authors.lastname: Fang
authors.forename: Pin-Yang
authors.initials: PY
authors.lastname: Yeh
authors.forename: Tieh-Chi
authors.initials: TC
authors.lastname: Chung
authors.forename: Frank Huang-Chih
authors.initials: FH
authors.lastname: Chou
mesh_terms: D000328:Adult; D019090:Case Management; D003419:Crisis Intervention / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D059020:Suicidal Ideation; D013405:Suicide / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000706:statistics & numerical data; D016019:Survival Analysis; D013624:Taiwan; D013812:Therapeutics; D055815:Young Adult; D000092864:Suicide Prevention