title: Effect of Systematic Follow-Up by General Practitioners after Deliberate Self-Poisoning: A Randomised Controlled Trial.
abstract: OBJECTIVE
  To assess whether systematic follow-up by general practitioners (GPs) of cases of deliberate self-poisoning (DSP) by their patients decreases psychiatric symptoms and suicidal behaviour compared with current practice.
  
  
  METHODS
  Randomised clinical trial with two parallel groups.
  
  
  METHODS
  General practices in Oslo and the eastern part of Akershus County.
  
  
  METHODS
  Patients aged 18-75 years admitted to hospital for DSP. We excluded patients diagnosed with psychoses, without a known GP, those not able to complete a questionnaire, and patients admitted to psychiatric in-patient care or other institutions where their GP could not follow them immediately after discharge.
  
  
  METHODS
  The GPs received a written guideline, contacted the patients and scheduled a consultation within one week after discharge, and then provided regular consultations for six months. We randomised the patients to either intervention (n = 78) or treatment as usual (n = 98).
  
  
  METHODS
  Primary outcome measure was the Beck Scale for Suicide Ideation (SSI). Secondary outcomes were Beck Depression Inventory (BDI) and Beck Hopelessness Scale (BHS), self-reported further self-harm and treatment for DSP in a general hospital or an emergency medical agency (EMA). We assessed patients on entry to the trial and at three and six months. We collected data from interviews, self-report questionnaires, and hospital and EMA medical records.
  
  
  RESULTS
  There were no significant differences between the groups in SSI, BDI, or BHS mean scores or change from baseline to three or six months. During follow-up, self-reported DSP was 39.5% in the intervention group vs. 15.8% in controls (P = 0.009). Readmissions to general hospitals were similar (13% in both groups (P = 0.963), while DSP episodes treated at EMAs were 17% in the intervention group and 7% in the control group (P = 0.103).
  
  
  CONCLUSIONS
  Structured follow-up by GPs after an episode of DSP had no significant effect on suicide ideation, depression or hopelessness. There was no significant difference in repeated episodes of DSP in hospitals or EMAs. However, the total number of incidents of deliberate self-harm reported by the patients was significantly higher in the intervention group.
  
  
  BACKGROUND
  Trial registration ClinicalTrials.gov Identifier: NCT01342809.
authors.affiliation: Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.|Regional Centre of Violence, Traumatic Stress and Suicide Prevention Eastern Norway, Oslo, Norway.
authors.forename: Tine K
authors.initials: TK
authors.lastname: Grimholt
authors.affiliation: Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Dag
authors.initials: D
authors.lastname: Jacobsen
authors.affiliation: Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Ole Rikard
authors.initials: OR
authors.lastname: Haavet
authors.affiliation: Department of Biostatistics, Oslo University Hospital, Oslo, Norway.
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.affiliation: Psychiatric Consultation Team, Akershus University Hospital, Akershus,Norway.
authors.forename: Trond
authors.initials: T
authors.lastname: Jorgensen
authors.affiliation: Regional Centre of Violence, Traumatic Stress and Suicide Prevention Eastern Norway, Oslo, Norway.|Diakonhjemmet Hospital, Oslo,Norway.
authors.forename: Astrid Berge
authors.initials: AB
authors.lastname: Norheim
authors.affiliation: Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.|Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Oivind
authors.initials: O
authors.lastname: Ekeberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D003863:Depression / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D058005:General Practitioners; D065026:Hope; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011041:Poisoning / Q000523:psychology* / Q000628:therapy; D016728:Self-Injurious Behavior / Q000523:psychology* / Q000628:therapy; D059020:Suicidal Ideation; D055815:Young Adult