title: Interventions to prevent repeat suicidal behavior in patients admitted to an emergency department for a suicide attempt: a meta-analysis.
abstract: BACKGROUND
  A huge number of patients with self-harm and suicide attempt visit emergency departments (EDs). We systematically reviewed studies and examined the effect of interventions to prevent repeat suicidal behavior in patients admitted to EDs for a suicidal attempt.
  
  
  METHODS
  We searched the databases of MEDLINE, PsychoINFO, CINAHL, and EMBASE through August 2013. Eligible studies were randomized controlled trials assessing the effects on repeat suicidal behavior of interventions initiated in suicidal patients admitted to EDs. Interventions in each trial were classified into groups by consensus. Meta-analyses were performed to determine pooled relative risks (RRs) and 95% confidence intervals (CIs) of repetition of suicide attempt for interventions in each group.
  
  
  RESULTS
  Out of 5390 retrieved articles, 24 trials were included and classified into four groups (11 trials in the Active contact and follow-up, nine in the Psychotherapy, one in the Pharmacotherapy, and three in the Miscellaneous). Active contact and follow-up type interventions were effective in preventing a repeat suicide within 12 months (n=5319; pooled RR=0.83; 95% CI: 0.71 to 0.97). However, the effect at 24 months was not confirmed (n=925; pooled RR=0.98; 95% CI: 0.76-1.22). The effects of the other interventions on preventing a repetition of suicidal behavior remain unclear.
  
  
  CONCLUSIONS
  Caution is needed regarding the heterogeneity of the effects.
  
  
  CONCLUSIONS
  Interventions of active contact and follow-up are recommended to reduce the risk of a repeat suicide attempt at 12 months in patients admitted to EDs with a suicide attempt. However, the long-term effect was not confirmed.
authors.affiliation: Department of Neuropsychiatry, Okayama University Hospital, Japan. Electronic address: masatoshiinagaki@okayama-u.ac.jp.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Inagaki
authors.affiliation: Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kawashima
authors.affiliation: Health Management and Promotion Center, Yokohama City University Graduate School of Medicine, Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Kawanishi
authors.affiliation: Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Yonemoto
authors.affiliation: Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Sugimoto
authors.affiliation: Department of Psychiatry, National Hospital Organization Yokohama Medical Center, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Furuno
authors.affiliation: Department of Psychiatry, Psychiatric Institute, Nara Medical University, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Ikeshita
authors.affiliation: Department of Psychiatry, Faculty of Medicine Fukuoka University, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Eto
authors.affiliation: Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Tachikawa
authors.affiliation: Department of Psychiatry, Yokohama City University School of Medicine, Japan.
authors.forename: Yohko
authors.initials: Y
authors.lastname: Shiraishi
authors.affiliation: Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan.
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Yamada
mesh_terms: D004636:Emergency Service, Hospital; D006801:Humans; D065840:Protective Factors; D016032:Randomized Controlled Trials as Topic; D013405:Suicide / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D000092864:Suicide Prevention
keywords: Emergency department; Meta-analysis; Self-harm; Suicide; Systematic review