A Real-World Effectiveness Study Comparing a Priority Appointment, an Enhanced Contact Intervention, and a Psychotherapeutic Program Following Attempted Suicide

• Published in: The journal of clinical psychiatry Vol. 80; no. 2
• Main Authors: Martínez-Alés, Gonzalo, Angora, Ricardo, Barrigón, María Luisa, Román-Mazuecos, Eva, Jiménez-Sola, Eduardo, Villoria, Lucía, Sánchez-Castro, Pilar, López-Castromán, Jorge, Casado, Isabel, Pacheco, Teresa, Rodríguez-Vega, Beatriz, Navío, Mercedes, Bravo-Ortiz, María Fe, Baca-García, Enrique
• Format: Journal Article
• Language: English
• Published: United States 26-02-2019
• Subjects: Adult; Age Factors; Appointments and Schedules; Female; Humans; Male; Psychotherapy; Recurrence; Risk Factors; Secondary Prevention - methods; Sex Factors; Suicide, Attempted - prevention & control
• ISSN: 1555-2101; 1555-2101
• DOI: 10.4088/JCP.18m12416

To determine the comparative effectiveness of 3 real-practice preventive programs aimed at lowering the relapse risk following a suicide attempt: a single priority appointment with an outpatient psychiatrist, an enhanced contact intervention, and an individual psychotherapy program.
This observational study was conducted in a sample of 1,492 suicide attempters from 3 catchment areas in Madrid, Spain, between 2013 and 2017. Relapse was defined as an emergency department return after a new attempt within a 1-year follow-up. Kaplan-Meier survival functions were obtained by intervention, and Cox proportional hazard regression models were used to estimate unadjusted and adjusted risks of relapse by intervention. Sex- and age-stratified analyses were also conducted. Covariates were age, sex, history of suicide attempts, history of psychiatric disorders, main ICD-10 psychiatric diagnostic groups, medical comorbidities, and family support.
A total of 133 subjects (8.9%) relapsed. The psychotherapy group had a lower presence of known risk factors for suicide attempt. Individual psychotherapy and enhanced contact were more effective than a single priority appointment at reducing suicide reattempt, with a 40% lower relapse risk in adjusted models. Results did not differ after sex and age stratification.
In a naturalistic clinical setting, patients exposed to individual psychotherapy or an enhanced contact intervention had a similar, lower relapse risk than the single priority appointment group.