Low cost intervention reduces suicide rate in poorer countries, study shows

BMJ 2008; 337 doi: (Published 02 September 2008) Cite this as: BMJ 2008;337:a1524
  1. Susan Mayor
  1. 1London

    A brief, low cost intervention followed by contact reduces the number of deaths from suicide among people who have attempted suicide in low and middle income countries, an international study shows.

    From January 2002 to October 2005 the study followed up 1867 people who had attempted suicide identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites: Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Iran; and Yuncheng, China.

    The participants were randomised to receive either treatment as usual or to the standard treatment together with a one hour, individual information session as close as possible to the time of discharge from hospital and nine follow-up contacts, by phone or in the form of visits from a person with clinical experience (Bulletin of the World Health Organization 2008;86:703-9, doi:10.2471/BLT.07.046995). Whenever an interviewer realised that a patient needed more intensive treatment the patient was referred for more intensive treatment if this was available. Overall, 91% of the participants completed the study.

    The results showed fewer deaths from suicide at 18 months’ follow up in the intervention group than in the usual treatment group (0.2% versus 2.2%; χ2= 13.83, P<0.001).

    “People who make attempts at suicide often end up in emergency rooms,” explained the lead author, Alexandra Fleischmann, from the Department of Mental Health and Substance Abuse at the World Health Organization, Geneva. “But in low to middle income countries, if there are no complications, patients are discharged after being treated for their injuries with no referral to mental health services.

    “By providing the patient with information and following up with telephone calls, further attempts can be prevented and lives can be saved.”

    The study says that most (85%) of the 877 000 deaths from suicide in 2002 occurred in low and middle income countries. The authors note that self inflicted injuries represented 1.4% of the global burden of disease in 2002 and that this figure was expected to rise to 2.4% by 2020.

    “As suicide is among the top three causes of death in the population aged 15-34 years, there is a massive loss to societies of young people in their productive years of life,” they wrote.


    Cite this as: BMJ 2008;337:a1524

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