Research Unit, Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
BMJ. 2012 Aug 22;345:e4972. doi: 10.1136/bmj.e4972.
To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts, compared with standard treatment.
Randomised, parallel group, superiority trial with blinded outcome assessment.
Outpatient intervention at one location at Copenhagen University Hospital, Denmark.
Patients older than 12 years admitted to regional hospitals in Copenhagen with a suicide attempt within the past 14 days. We excluded patients diagnosed with schizophrenia spectrum disorders and patients living in institutions.
Case management through assertive outreach that provided crisis intervention and flexible problem solving. This approach incorporated motivational support and actively assisted patients to scheduled appointments to improve adherence with after-treatment as an add on to standard treatment.
Repeated suicide attempt and death by suicide, recorded in medical records and death register at 1-year follow-up.
243 patients were included. During 12 months of follow-up, 20/123 (16%) patients in the intervention group had been registered in hospital records with subsequent suicide attempt, compared with 13/120 (11%) in the control group (odds ratio 1.60, 95% confidence interval 0.76 to 3.38; P=0.22). By contrast, self reported data on new events showed 11/95 (12%) in the intervention group versus 13/74 (18%) in the control group (0.61, 0.26 to 1.46; P=0.27). By imputing missing data on the selfreported outcomes, we estimated 15/123 (12%) events in the intervention group and 23/120 (19%) in the control group (0.69, 0.34 to 1.43; P=0.32).
Assertive outreach showed no significant effect on subsequent suicide attempt. The difference in rates of events between register data and self reported data could indicate detection bias.
ClinicalTrials.gov NCT00700089.
评估在自杀未遂后进行积极外展干预是否可以降低随后自杀行为的频率，与标准治疗相比。
随机、平行组、优效性试验，采用盲法结局评估。
丹麦哥本哈根大学医院的一个门诊点。
年龄大于 12 岁，在过去 14 天内因自杀未遂而被区域医院收治的患者。我们排除了诊断为精神分裂症谱系障碍的患者和居住在机构中的患者。
通过积极外展进行病例管理，提供危机干预和灵活的问题解决。这种方法结合了动机支持，并积极帮助患者预约，以改善对治疗后的依从性，作为标准治疗的附加治疗。
在 1 年随访时，通过医疗记录和死亡登记记录到的重复自杀尝试和自杀死亡。
共纳入 243 名患者。在 12 个月的随访期间，干预组中有 20/123（16%）名患者在医院记录中被登记有随后的自杀尝试，而对照组中有 13/120（11%）名患者（比值比 1.60，95%置信区间 0.76 至 3.38；P=0.22）。相比之下，通过自我报告的数据显示，干预组中有 11/95（12%）名患者发生新事件，而对照组中有 13/74（18%）名患者（0.61，0.26 至 1.46；P=0.27）。通过对自我报告结局的缺失数据进行推断，我们估计干预组中有 15/123（12%）名患者和对照组中有 23/120（19%）名患者发生事件（0.69，0.34 至 1.43；P=0.32）。
积极外展对随后的自杀尝试没有显著影响。登记数据和自我报告数据之间事件发生率的差异可能表明存在检测偏差。
ClinicalTrials.gov NCT00700089。
