Taku Furuno1, Makiko Nakagawa2, Kosuke Hino2, Tomoki Yamada3, Yoshitaka Kawashima4, Yutaka Matsuoka5, Osamu Shirakawa6, Naoki Ishizuka7, Naohiro Yonemoto8, Chiaki Kawanishi9, Yoshio Hirayasu10. 1. Department of Psychiatry, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama 245-8575, Japan; Department of Psychiatry, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. Electronic address: takfuruno@hotmail.com. 2. Psychiatric Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. 3. Department of Psychiatry, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; Itsuki Clinic, 2-1-10, Tomioka-nishi, Kanazawa-ku, Yokohama 236-0052, Japan. 4. Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashimachi, Kodarira, Tokyo 187-8533, Japan. 5. Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, 5-1-1, Tsukiji, Chuou-ku, Tokyo 104-0045, Japan. 6. Department of Neuropsychiatry, Kinki University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama 589-8511, Japan. 7. Department of Clinical Trial Planning and Management, Clinical Research Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan. 8. Department of Biostatistics, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. 9. Department of Neuropsychiatry, Sapporo Medical University Graduate School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan. 10. Department of Psychiatry, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Abstract
BACKGROUND: Self-harm is an important risk factor for subsequent suicide and repetition of self-harm, and a common cause of emergency department presentations. However, there still remains limited evidence on intervention in emergency department settings for individuals who self-harm. METHODS: This multicentre, randomised controlled trial was conducted at 17 general hospitals in Japan. In total, 914 adult patients admitted to emergency departments for a suicide attempt and had a DSM-IV-TR axis I disorder were randomly assigned to two groups, to receive either assertive case management (intervention) or enhanced usual care (control). Assertive case management was introduced by the case manager during emergency department admissions for suicide attempts, and continued after discharge. Interventions were provided until the end of the study period (for at least 18 months and up to 5 years). RESULTS: The number of overall self-harm episodes per person-year was significantly lower in the intervention group (adjusted incidence risk ratio (IRR) 0.88, 95%CI 0.80-0.96, p=0.0031). Subgroup analysis showed a greater reduction of overall self-harm episodes among patients with no previous suicide attempt at baseline (adjusted IRR 0.73, 95% CI 0.53-0.98, p=0.037). LIMITATIONS: Patients younger than 20 years and patients who self-harmed but were not admitted to an emergency department were excluded. CONCLUSIONS: The present study showed that assertive case management following emergency admission for a suicide attempt reduced the incident rate of repeat overall self-harm.
RCT Entities:
BACKGROUND: Self-harm is an important risk factor for subsequent suicide and repetition of self-harm, and a common cause of emergency department presentations. However, there still remains limited evidence on intervention in emergency department settings for individuals who self-harm. METHODS: This multicentre, randomised controlled trial was conducted at 17 general hospitals in Japan. In total, 914 adult patients admitted to emergency departments for a suicide attempt and had a DSM-IV-TR axis I disorder were randomly assigned to two groups, to receive either assertive case management (intervention) or enhanced usual care (control). Assertive case management was introduced by the case manager during emergency department admissions for suicide attempts, and continued after discharge. Interventions were provided until the end of the study period (for at least 18 months and up to 5 years). RESULTS: The number of overall self-harm episodes per person-year was significantly lower in the intervention group (adjusted incidence risk ratio (IRR) 0.88, 95%CI 0.80-0.96, p=0.0031). Subgroup analysis showed a greater reduction of overall self-harm episodes among patients with no previous suicide attempt at baseline (adjusted IRR 0.73, 95% CI 0.53-0.98, p=0.037). LIMITATIONS: Patients younger than 20 years and patients who self-harmed but were not admitted to an emergency department were excluded. CONCLUSIONS: The present study showed that assertive case management following emergency admission for a suicide attempt reduced the incident rate of repeat overall self-harm.
Authors: Katrina G Witt; Sarah E Hetrick; Gowri Rajaram; Philip Hazell; Tatiana L Taylor Salisbury; Ellen Townsend; Keith Hawton Journal: Cochrane Database Syst Rev Date: 2021-04-22
Authors: Ole Jakob Storebø; Jutta M Stoffers-Winterling; Birgit A Völlm; Mickey T Kongerslev; Jessica T Mattivi; Mie S Jørgensen; Erlend Faltinsen; Adnan Todorovac; Christian P Sales; Henriette E Callesen; Klaus Lieb; Erik Simonsen Journal: Cochrane Database Syst Rev Date: 2020-05-04
Authors: Christopher M Doran; Lisa Wittenhagen; Edward Heffernan; Carla Meurk Journal: Int J Environ Res Public Health Date: 2021-06-23 Impact factor: 3.390