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Effect of assertive outreach after suicide attempt in the AID (assertive intervention for deliberate self harm) trial: randomised controlled trial

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4972 (Published 22 August 2012) Cite this as: BMJ 2012;345:e4972
  1. Britt Morthorst, research assistant1,
  2. Jesper Krogh, research assistant1,
  3. Annette Erlangsen, senior researcher12,
  4. Francisco Alberdi, chief psychiatrist1,
  5. Merete Nordentoft, professor1
  1. 1Research Unit, Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark
  2. 2Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
  1. Correspondence to: B Morthorst britt.morthorst{at}regionh.dk
  • Accepted 11 July 2012

Abstract

Objective To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts, compared with standard treatment.

Design Randomised, parallel group, superiority trial with blinded outcome assessment.

Setting Outpatient intervention at one location at Copenhagen University Hospital, Denmark.

Participants 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.

Intervention 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.

Main outcome Repeated suicide attempt and death by suicide, recorded in medical records and death register at 1-year follow-up.

Results 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).

Conclusion 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.

Trial registration ClinicalTrials.gov NCT00700089.

Footnotes

  • We thank all included patients and relatives, intervention staff Agnete Birktoft and Hanne Frandsen, all collaborating partners in intensive units both somatic and psychiatric, Centre of Excellency in Suicide Prevention, social services, external psychiatrists, and psychologists. We thank the investigators Hvid and Wang for their collaboration.

  • Contributors: MN was primary investigator. BM and MN developed the research protocol, designed the study, acquired funding, carried out the intervention, and gathered data. FA was administrative collaborator and consulting physician for the research assistant. FA, AE, and MN were the blinded external evaluation committee. BM and JK constructed the database and conducted the statistical analysis. All authors contributed to writing and revising the manuscript. BM and MN are guarantors.

  • Funding: The study received funding from the Ministry of Health and Internal Affairs, Denmark, the National Board of Social Services, an independent subdivision of The Ministry of Social Affairs and Integration, TrygFonden, and Aase og Ejnar Danielsens Foundation.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: the study received funding from the Ministry of Health and Internal Affairs, Denmark, the National Board of Social Services, an independent subdivision of The Ministry of Social Affairs and Integration, TrygFonden, and Aase og Ejnar Danielsens Foundation; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The trial was approved by the Danish Ethic Committee (journal number KF-01 271146) and by the Danish Data Protection Agency (journal number 2011-41-6398). All participating patients gave written informed consent.

  • Data sharing: No additional data available.

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