Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 Feb 1;14(2):e0210778.
doi: 10.1371/journal.pone.0210778. eCollection 2019.

Combining green cards, telephone calls and postcards into an intervention algorithm to reduce suicide reattempt (AlgoS): P-hoc analyses of an inconclusive randomized controlled trial

Antoine Messiah  1 , Charles-Edouard Notredame  2   3 , Anne-Laure Demarty  4   5 , Stéphane Duhem  4   5 , Guillaume Vaiva  1   2   5 ; AlgoS investigators
Affiliations
Randomized Controlled Trial

Combining green cards, telephone calls and postcards into an intervention algorithm to reduce suicide reattempt (AlgoS): P-hoc analyses of an inconclusive randomized controlled trial

Antoine Messiah et al. PLoS One. .

Abstract

Background: Brief contact interventions (BCIs) might be reliable suicide prevention strategies. BCI efficacy trials, however, gave equivocal results. AlgoS trial is a composite BCI that yielded inconclusive results when analyzed with Intention-To-Treat strategy. In order to elicit intervention strengths and weaknesses, post-hoc analyses of AlgoS data were performed.

Methods: AlgoS was a randomized controlled trial conducted in 23 French hospitals. Suicide attempters were randomly assigned to either the intervention group (AlgoS) or the control group (Treatment as usual TAU). In the AlgoS arm, first-time suicide attempters received crisis cards; non first-time suicide attempters received a phone call, and post-cards if the call could not be completed, or if the participant was in crisis and/or non-compliant with the post-discharge treatment. An As Treated strategy, accounting for the actual intervention received, was combined with subgroup analyses.

Results: 1,040 patients were recruited and randomized into two groups of N = 520, from which 53 withdrew participation; 15 were excluded after inclusion/exclusion criteria reassessment. AlgoS first attempters were less likely to reiterate suicide attempt (SA) than their TAU counterparts at 6 and 13-14 months (RR [95% CI]: 0.46 [0.25-0.85] and 0.50 [0.31-0.81] respectively). AlgoS non-first attempters had similar SA rates as their TAU counterparts at 6 and 13-14 months (RR [95% CI]: 0.84 [0.57-1.25] and 1.00 [0.73-1.37] respectively). SA rates were dissimilar within the AlgoS non-first attempter group.

Conclusions: This new set of analysis suggests that crisis cards could be efficacious to prevent new SA attempts among first-time attempters, while phone calls were probably not significantly efficacious among multi-attempters. Importantly, phone calls were informative of new SA risk, thus a key component of future interventions.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flowchart.
Fig 2
Fig 2. Analysis groups for the As Treated strategy.
Number of participants (N) are those at baseline. N at 6-months and 13–14 months analysis are in Table 3.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. World Health Organization; WHO | Suicide data [Internet]. WHO; 2016. [cited 2016 Dec 12]. Available from: http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/
    1. Inagaki M, Kawashima Y, Kawanishi C, Yonemoto N, Sugimoto T, Furuno T, et al. Interventions to prevent repeat suicidal behavior in patients admitted to an emergency department for a suicide attempt: a meta-analysis. J Affect Disord. 2015;175:66–78. 10.1016/j.jad.2014.12.048 - DOI - PubMed
    1. Riblet NBV, Shiner B, Young-Xu Y, Watts BV. Strategies to prevent death by suicide: meta-analysis of randomised controlled trials. Br J Psychiatry. 2017;210(6):396–402. 10.1192/bjp.bp.116.187799 - DOI - PubMed
    1. Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Hazell P, et al. Psychosocial interventions for self-harm in adults In: Cochrane Database of Systematic Reviews [Internet]. John Wiley & Sons, Ltd; 2016. [cited 2016 Dec 21]. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD012189/full - DOI - PMC - PubMed
    1. Finkelstein Y, Macdonald EM, Hollands S, Sivilotti MLA, Hutson JR, Mamdani MM, et al. Risk of Suicide Following Deliberate Self-poisoning. JAMA Psychiatry. 2015;72(6):570–5. 10.1001/jamapsychiatry.2014.3188 - DOI - PubMed

Publication types

Grants and funding

This study received a Hospital Clinical Research Grant (PHRC 2009-1902) from the French Health Ministry. None of the funding sources had any involvement in the study design, the collection, analysis or interpretation of data, the writing of the report or the decision to submit the paper for publication.