One Year Intervention And Follow-up Study Of Suicide Attempt In The Emergency Departments Of General Hospitals In Shenyang

BackgroundSuicide is a significant public health problem in the world. Every year, almost one million people die from suicide, at least ten million people attempt suicide, a "global" mortality rate of 16 per 100,000, or one death every 40 seconds. Suicide is among the three leading causes of death among those aged 15-44 years in some countries, and the second leading cause of death in the 10-24 years age group. Instead, better insight into individuals' measures against suicide, who unsuccessfully attempted suicide, should improve our understanding, because an unsuccessful attempt is a high-risk factor for subsequent suicide,30-60% of suicides has a history of unsuccessful attempts and 10%-14% suicide attempters die in the end. Previous studies indicated that serious suicide attempters and suicide victim are two overlapping populations, and share common characteristics. To prevent repeated suicide attempts is one of the most significant measures to reduce completed suicide behaviors. Some randomized controlled trials from Europe and United State have reported the interventions that effectively prevented repetition of suicide attempts. In China, a number of characteristics which are associated with occurrence of suicide attempt have been identified, including low rates of mental disorders, higher lethality of self-harm acts, low intent suicide attempts and acute stress. There have been several recent researches of intervention that may be considered effective in reducing suicide attempters in rural area of China. The research of Beijing Hui Long Guan Hospital demonstrate that is effective to suicide prevention by visiting the suicide attempters in regular contact by the local cadre and country doctor. But few reports about interventions designed to prevent suicide attempts have been evaluated in urban China. The aim of the present study is to investigate whether interventions in addition to treatment delivered as usual, compared to no such intervention after a suicide attempt, has any impact on repetition of suicidal behavior, HAMA score and life quality. Then we investigate whether different interventions (cognitive psychotherapy vs family and social support) have different influence at one year follow-up.ObjectiveTo determine whether the interventions to patients after a suicide attempt in the emergency departments of general hospitals would be more effective to reduce the repeated suicide attempt.Methods239 patients who had attempted suicide and were evaluated by DSM-IV-TR Axis I Disorders (SCID-I/P) at the emergency departments of 4 general hospitals from June 2007 to January 2008 were randomized to the cognitive therapy group or the family and social support group or the control group. Participants were assessed at 3-month, 6-month, and 12-month respectively and followed up for one year. The primary study outcome measurement was repetition rate of suicide attempt, HAMD score, Quality of life Scale and Suicide intent scale. A double blind method was used in the assessment and intervention.Results1. Follow-up rateAt the 3-month follow-up,172(72.0%) patients were reached.116(48.5%) and 88(36.8%) subjects were followed up at the 6-month and 12-month.2. Repetition rate of suicide attemptIn the cognitive therapy group five patients (6.2%) had repeated suicide attempts and in the family and social support group one patient (1.3%) had repeated suicide attempt at the 6-month follow-up. A patient of the family and social support group died at the 6-month follow-up. In control group four patients (5.8%) had repeated suicide attempts at the 6-month follow-up and five patients (6.2%) had repeated suicide attempts at the 12-month follow-up.3. Compliance of interventions featuresIn the cognitive therapy group five patients (6.2%) received cognitive therapy and two patients completely comply. In the family and social support group sixty patients (76.9%) received intervention and forty-nine patients completely comply. The compliance of interventions between the cognitive therapy group and the family and social support group was significantly different.4. Outcome measuresThe difference of depression measured by HAMD score and the difference the quality of life score were significantly marked from baseline to 3-month assessment in any groups (P<.0001). The change of HAMD score and the quality of life score between the three assessment point was not significantly different in any groups (Kruskal-Wallis Test:â‘ HAMD:P<0.001;â‘¡The quality of life score:P<0.001)5. Suicide ideationThere were no significant differences among three groups based on rates of suicide ideation between the three assessment points (cognitive psychotherapy group:P< 0.001; the family and social support group P<0.001; control group:P<0.001).6. Psychiatric treatments4% patients of the cognitive therapy group,5.6% patients of the family and social support group and no patients of the control group received the psychiatric treatments at the 12-month follow-up. There were no significant differences among the three groups. ConclusionThe intervention of family and social support and of cognitive therapy can reduce the repeated suicide attempt. The compliance of interventions between the cognitive therapy group and the family and social support group was significantly different. The results of patients in intervention groups were not statistically different with that of patients in the control group. Few patients can receive the psychiatric treatments and the intervention of suicide attempts can not change the prevalence of psychiatric treatments.