Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan.
BMC Public Health. 2009 Sep 26;9:364. doi: 10.1186/1471-2458-9-364.
A previous suicide attempt is a potent risk factor for suicide later on. Crisis intervention, psychiatric and psychosocial evaluation at emergency medical facilities, and follow-up care for suicide attempters are considered important components for suicide prevention. The Japanese Multimodal Intervention Trials for Suicide Prevention (J-MISP) includes a randomized, controlled, multicenter trial of post-suicide attempt case management for the prevention of further attempts (ACTION-J) to address the continuing increase in suicides in Japan. The primary aim of ACTION-J is to examine the effectiveness of an extensive intervention for suicide attempters in prevention of recurrent suicidal behavior, as compared with standard intervention. This paper describes the rationale and protocol of the ACTION-J trial.
METHODS/DESIGN: In this clinical trial, case management intervention will be provided at 19 emergency medical facilities in Japan. After crisis intervention including psychiatric evaluation, psychosocial assessment, and psychological education, subjects will be randomly assigned to either a group receiving continuous case management or a control group receiving standard care. Suicidal ideation, depressive symptoms, and general health condition will be evaluated as secondary measures. The intervention was initiated in July 2006. By December, 2009, 842 subjects will be randomized. Subject follow-up will continue for 1.5 to 5 years.
Suicide is a complex phenomenon that encompasses multiple factors. Case management by multi-sector collaboration is needed. ACTION-J may provide valuable information on suicide attempters and may develop effective case management to reduce future risk for suicide attempters.
UMIN Clinical Trials Registry number, UMIN000000444. ClinicalTrials.gov number, NCT00736918.
既往自杀未遂是日后自杀的一个强有力的危险因素。在急诊医疗设施中进行危机干预、精神科和心理社会评估，以及对自杀未遂者进行随访护理，被认为是预防自杀的重要组成部分。日本多模式预防自杀干预试验（J-MISP）包括一项针对自杀未遂后病例管理的随机、对照、多中心试验（ACTION-J），旨在预防日本自杀人数的持续增加。ACTION-J 的主要目的是检验广泛的自杀未遂者干预措施在预防复发性自杀行为方面的有效性，与标准干预相比。本文描述了 ACTION-J 试验的原理和方案。
方法/设计：在这项临床试验中，病例管理干预将在日本的 19 家急诊医疗设施中进行。在包括精神科评估、心理社会评估和心理教育在内的危机干预后，将对受试者进行随机分组，分别接受连续病例管理或标准护理。自杀意念、抑郁症状和一般健康状况将作为次要措施进行评估。干预于 2006 年 7 月开始。截至 2009 年 12 月，将有 842 名受试者被随机分组。对受试者的随访将持续 1.5 至 5 年。
自杀是一种复杂的现象，涉及多个因素。需要多部门合作进行病例管理。ACTION-J 可能为自杀未遂者提供有价值的信息，并可能开发出有效的病例管理方法，以降低自杀未遂者的未来风险。
UMIN 临床试验注册编号，UMIN000000444。ClinicalTrials.gov 编号，NCT00736918。
