Drop out rates ranged from 21 to 53 Commentary No follow up plan was provided

Drop out rates ranged from 21 to 53 commentary no

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Drop-out rates ranged from 21% to 53%. Commentary No follow-up plan was provided to 55% of the ED patients studied. Consequently, the intervention was the follow-up plan for many. Groups ranged from 45 to 18 patients. Source Canada. Allard B et al. Suicide Life Threat Behav 1992;22:303–14. Design RCT. Both groups given written instructions to make clinic appointment within one week of discharge. 150 patients with 76 experimental subjects and 74 in the comparison group; each followed for 24 months. Question Will a follow-up, outpatient treatment program, begun after ED or inpatient discharge, decrease the number of suicide attempts? Target Population ED patients with indisputable suicide attempt; 22% admitted; 30 years average age; > 40% personality disorders; ≥ 55% unemployed. Intervention Explicit discharge plan followed by one month of weekly visits and eight monthly visits thereafter; one home visit; all others office visits; reminders. Selected Outcomes No differences found. Only 21 patients in the experimental group received the complete intervention. Losses to follow-up of 15%–17%. The experimental group had the highest reattempt rate (35%). Commentary Certain groups of challenged patients may not come for office visits.
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Continuity of Care for Suicide Prevention and Research 86 Source England. Morgan HG et al. Br J Psychiatry 1993;163:111–12. Design RCT. Usual care. 212 patients with 101 in the experimental group and 111 in the control group; each followed for 12 months. Question Will the use of a crisis card combined with on-demand access to psychiatry residents reduce the rate of suicide threats and/or attempts? Target Population ED patients that made their first suicide attempt; all admitted; about 30 years average age; most had depressive disorder. Intervention At discharge given a “green card” (i.e., a “crisis card”) describing how to contact resident at any time; written reminder sent to home and to primary care doctor; rehospitalization was an option. Selected Outcomes Follow-up data obtained after one year showed a significant reduction (4.95% versus 13.51%, P ≤ 0.05) in the combination of actual or seriously threatened self-harm behaviors in the experimental group. Only 15 intervention patients contacted resident. Commentary This is the only randomized controlled trial found regarding the safety- planning aspects of “crisis cards.” This form of protection appears to have real merits. Source Netherlands. van der Sande R et al. Br J Psychiatry 1997;171:35–41. Design RCT. Comparison to usual care. 274 patients with 140 in the experimental group and 134 in the usual care group; each followed for 12 months. Question Will an approach using (1) inpatient crisis intervention, (2) on-demand readmission, and (3) problem-solving outpatient treatment affect rates of repeat suicide attempts? The investigators labeled this “continuity of care and problem-solving treatment.” Target Population Suicide attempters, excluding self-mutilation or chronic substance use, ages 15 and older presenting to an ED; about 85% overdosed; about half
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