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Reducing Suicide: A National Imperative
Intervention efficacy may sometimes depend on the diagnosis of the suicidal individual (e.g., Byford et al., 1999).
Termansen and Bywater (1975) investigated the relative efficacies of no intervention, emergency room assessment alone, emergency room assessment plus as-needed follow-up care at a volunteer crisis center, and emergency room assessment plus a 3-month follow-up by the same mental health worker who conducted the assessment. Over the 3-month follow-up period, they found that the group who received follow-up by the same mental health worker demonstrated lower rates of suicide attempts and higher treatment adherence. Motto and Bostrum (2001) examined the impact of regular follow-up letters to suicidal individuals who refused ongoing treatment after discharge from a hospital. The study randomly assigned those refusing follow-up care or dropping out of follow-up care after hospitalization for severe depression or suicidality to either usual care or to receive regular letters from staff. Results of a survival analysis showed that for the first 2 years, the difference in the survival curves was significant, with the time to suicide longer in the contact vs. no contact group. When evaluated over the full five years the curves were not significantly different. It is important, however, that differences were greatest during the first 2 years, which is when suicides are most likely to occur. This was also when contact with the subjects was most frequent (in year 1). This is the only study to show a significant difference between experimental and usual care conditions for completed suicide.
In a comprehensive intervention, Aoun (1999) (1) instituted a standardized hospital protocol for dealing with cases of deliberate self-harm, (2) employed a suicide intervention counselor who worked with patients from within 48 hours of admission until 6 weeks post-discharge, and (3) provided professional and community education about intervention, risk assessment, and access to service. The experimental group received treatment from the suicide intervention counselor, and the control group received treatment as usual. Patients who received treatment from the suicide intervention counselor had significantly lower rates of hospital readmission for suicide attempts over a 22-month follow-up, as compared to readmission rates among patients who received treatment as usual and patients who were admitted prior to the start date of the intervention. Unfortunately, the findings of this study are limited by non-randomized groups and a variable length of follow-up depending on when the patient entered the study.
Rotheram-Borus, Piacentini, Cantwell, Belin, and Song (2000) provided specialized emergency room care to adolescent females with the goal of enhancing adherence to outpatient therapy. The intervention included a soap opera video regarding suicidality, a family therapy session, and staff training. The control group received standard emergency room