Preventing Suicide with Post-Discharge Follow-ups

The time period following discharge from inpatient psychiatry and emergency department (ED) treatment is one of heightened risk for repeat suicide attempts for patients. Evidence reported in the literature shows that follow-up contacts might reduce suicide risk, although there has not been a comprehensive and critical review of the evidence to date.  A new study published in Crisis: The Journal of Crisis Intervention and Suicide Prevention evaluates evidence for the effectiveness of suicide prevention interventions that involve follow-up contacts with patients. The study used published empirical studies of follow-up interventions with suicidal behaviors (suicide, attempts, and ideation) as outcomes were searched. Study populations were inpatient psychiatric or ED patients being discharged to home. Contact modalities included phone, postal letter, postcards, in-person, and technology-based methods (e-mail and texting). Results showed that eight original studies, two follow-up studies, and one secondary analysis study met inclusion criteria. Five studies showed a statistically significant reduction in suicidal behavior. Four studies showed mixed results with trends toward a preventative effect and two studies did not show a preventative effect. The authors concluded that repeated follow-up contacts appear to reduce suicidal behavior. More research is needed, however, especially randomized controlled trials, to determine what specific factors might make follow-up contact modalities or methods more effective than others.

For the abstract.

Comments

[aek]

Is anyone looking at why previous suicide attempt(s) is the leading risk factor for suicide, and why the majority of people who attempt have recent healthcare provider contact?

What about the inpatient experience is actually therapeutic? The principles of psychiatric ward management are direct holdovers from prison ward management (containment, control, coercion). It's dehumanizing, distressing and not conducive for building self-esteem, self confidence, self efficacy and reduction of psychologic distress. The usual experience is to suffer "leers, jeers and sneers" from hospital staff/first responders - at the best, indifference, but a loss of civil rights, labeling, stigma and quality of life degradation as a result of having been swept up in the mental health system. Isn't it likely that the chief lesson learned is that there not only is no help, but that one is egregiously dehumanized and punished for having sought or received treatment as usual?

What effective treatment is there for directly addressing the causative distressors of suicidality?

DBT addresses impulsiveness, but not suicidality. Suicide/crisis hotlines even directly state that they do not offer help for suicidality. The purpose of those is to serve as a suicide deterrant by slowing down impulsive behavior.

Until causative stressors of suicidality are directly treated in an effective and sustained manner, I expect suicide rates to remain unchanged.