| Treatment Compared | Study, Year | Population | Age Range (Yrs) | Intervention and Control Groups | Followup Period (After Enrollment) | Number (%) of Participants with DSH during Followup | Odds Ratio (95% CI) |
|---|---|---|---|---|---|---|---|
| Problem-solving Therapy vs Standard Aftercare | Gibbons, et al., 197837 | Southampton, UK
Self-poisoning patients with no immediate suicide risk and no formal psychiatric diagnosis |
> 17 | Intervention: Home-based crisis-oriented problem-solving therapy by social workers over 3 mos Control: Standard aftercare |
12 mos | Intervention: 27/200 (13.5)
Control: 29/200 (14.5) |
0.92 (0.52-1.62) |
| Hawton, et al., 198738 | Oxford, UK
Deliberate self-poisoning patients who were not in psychiatric care, did not require treatment for alcohol or drug addiction, and did not need inpatient psychiatric care |
> 16 | Intervention: Outpatient therapy by non-medical clinicians for < 8
sessions
Control: Standard aftercare |
12 mos | Intervention: 3/41 (7.3)
Control: 6/39 (15.4) |
0.43 (0.10-1.87) | |
| Salkovskis, et al., 199039 | Leeds, UK
Non-psychotic patients referred by psychiatrist after admission to an emergency department after antidepressant self-poisoning; > 4 on Buglass and Hawton Risk of Repetition Scale or > 2 previous attempts |
16-65 | Intervention: Home-based therapy by community psychiatric nurse for 5 sessions
Control: Standard aftercare |
12 mos | Intervention: 3/12 (25.0)
Control: 4/8 (50.0) |
0.33 (0.05-2.24) | |
| McLeavey, et al., 199440 | Cork, Ireland
Non-psychotic, non-suicidal patients without cognitive impairment and not needing psychiatric inpatient care who were admitted to an emergency department for self-poisoning |
15-45 | Intervention: Interpersonal problem-solving skills training by trained therapists
for approximately 5 sessions
Control: Brief problem-solving therapy |
12 mos | Intervention: 2/19 (10.5)
Control: 5/20 (25.0) |
0.35 (0.06-2.09) | |
| Evans, et al., 199941 | London, UK
Patients with self-harm episode in previous 12 mos with a personality disturbance but no alcohol or drug dependence or schizophrenia who were admitted to Paddington, Westminster or Chelsea, Westminister, emergency department |
16-50 | Intervention: Manual-assisted cognitive-behavioral therapy by trained therapists
for 2-6 sessions
Control: Standard psychiatric treatment |
6 mos | Intervention: 10/18 (55.6)
Control: 10/14 (71.4) |
OR not calculated | |
| Overall | 0.70 (0.45-1.11) | ||||||
| Intensive Care Plus Outreach vs Standard Care | Chowdhury, et al., 197342 | Edinburgh, UK
Patients with a previous DSH episode admitted for DSH to a general hospital; included patients with psychiatric disturbance, alcohol dependence, and drug addiction |
> 16 | Intervention: Enhanced aftercare with aggressive outreach and followup
Control: Standard aftercare |
6 mos | Intervention: 17/71 (23.9)
Control: 19/84 (22.6) |
1.08 (0.51-2.27) |
| Welu, 197743 | Pittsburgh, PA
Patients admitted to an emergency department for DSH |
> 16 | Intervention: Special outreach program with weekly or bi-weekly contact with
trained mental health professionals for 4 mos
Control: Standard aftercare |
4 mos | Intervention: 3/62 (4.8)
Control: 9/57 (15.8) |
0.27 (0.07-1.06) | |
| Hawton, et al., 198144 | Oxford, UK
Patients not receiving current psychiatric care or treatment for alcohol or drug addiction admitted to a general hospital after DSH |
> 15 | Intervention: Home-based therapy as often as therapist felt necessary for
< 3 mos by mental health professionals
Control: Weekly outpatient therapy |
12 mos | Intervention: 5/48 (10.4)
Control: 7/48 (14.6) |
0.68 (0.20-2.32) | |
| Allard, et al., 199245 | Montreal, Canada
Non-sociopathic patients with a recent suicide attempt who presented to hospital for another suicide attempt |
NR | Intervention: Enhanced aftercare with aggressive outreach and followup by mental
health professionals for 12 mos
Control: Standard aftercare |
12 mos | Intervention: 22/63 (34.9) Control: 19/63 (30.2) |
1.24 (0.59-2.62) | |
| Van Heeringen, et al., 199546 | Ghent, Belgium
Patients treated in an emergency department after a suicide attempt |
> 15 | Intervention: Enhanced aftercare with aggressive outreach and followup by mental
health professionals for unspecified period
Control: Standard aftercare |
12 mos | Intervention: 21/196 (10.7)
Control: 34/195 (17.4) |
0.57 (0.32-1.02) | |
| van der Sande, et al., 199747 | Utrecht, the Netherlands
Patients without drug or alcohol addiction and obvious psychiatric comorbidity admitted to the hospital after a suicide attempt |
> 16 | Intervention: Brief psychiatric admission with outpatient therapy by mental
health professionals and 24 hr hospital access for unspecified period
Control: Standard aftercare |
12 mos | Intervention: 24/140 (17.1)
Control: 20/134 (14.9) |
1.18 (0.62-2.25) | |
| Overall | 0.83 (0.61-1.14) | ||||||
| Emergency Care vs Standard Aftercare | Morgan, et al., 199348 | Bristol, UK
Patients admitted to the hospital after first DSH episode |
Mean age, 30 | Intervention: Standard care plus card indicating 24-hr access to mental health
professional for 12 mos
Control: Standard aftercare |
12 mos | Intervention: 5/101 (5.0)
Control: 12/111 (10.8) |
0.43 (0.15-1.27) |
| Dialectical Behavior Therapy vs Standard Aftercare | Linehan, et al., 199149 | Seattle, WA
Female patients with borderline personality disorder and >2 suicide attempts in last 5 yrs, current suicide attempt within past 8 wks |
18-45 | Intervention: Dialectical behavioral therapy (individual and group) with mental
health professional for 1 yr
Control: Standard aftercare |
12 mos | Intervention: 5/19 (26.3)
Control: 12/20 (60.0) |
0.24 (0.06-0.93) |
| Inpatient Behavior Therapy vs Inpatient Insight-Oriented Therapy | Liberman and Eckman, 198150 | Los Angeles, CA
Patients with > 1 suicide attempt who were not psychotic or addicted to alcohol or drugs and were referred by psychiatrist after admission to emergency department for DSH |
18-47 | Intervention: Inpatient psychiatric treatment with behavior therapy for 10 days
Control: Inpatient psychiatric treatment with insight-oriented therapy for 10 days |
12 mos | Intervention: 2/12 (16.7)
Control: 3/12 (25.0) |
0.60 (0.08-4.45) |
| Same Therapist (Continuity of Care) vs Different Therapist (Change of Care) | Torhorst, et al., 198751 | Munich, Germany
Non-psychotic patients hospitalized after a self-poisoning suicide attempt |
NR | Intervention: Outpatient appointment with same therapist as seen in hospital for
3-mo treatment
Control: Outpatient appointment with different therapist than seen in hospital for 3-mo treatment |
12 mos | Intervention: 12/68 (17.6)
Control: 4/73 (5.5) |
3.70 (1.13-12.09) |
| General Hospital Admission vs Discharge | Waterhouse and Platt, 199052 | York, UK
Patients without current medical or psychiatric treatment needs admitted to an emergency department for DSH |
> 16 | Intervention: General hospital admission for about 1 day
Control: Discharge from hospital |
4 mos | Intervention: 3/38 (7.9)
Control: 4/39 (10.3) |
0.75 (0.16-3.60) |
| Flupenthixol (Antipsychotic) vs Placebo | Montgomery, et al., 197953 | Maidstone, UK
Patients with >2 DSH episodes without overt depression or schizophrenia admitted to a general hospital after a suicide attempt |
18-68 | Intervention: Monthly intramuscular administration for 6 mos
Control: Monthly placebo administration |
6 mos | Intervention: 3/14 (21.4)
Control: 12/16 (75.0) |
0.09 (0.02-0.50) |
| Antidepressants vs Placebo | Hirsch, et al., 198254 | London, UK
Patients with a GHQ score > 20 and not on antidepressant or antipsychotic medication and were admitted to a hospital after deliberate self-poisoning |
16-65 | Intervention: Mianserin or nomifensine therapy for 6 wks
Control: Placebo |
3 mos | Intervention: 16/76 (21.1)
Control: 5/38 (13.2) |
1.76 (0.59-5.24) |
| Montgomery, et al., 198355 | London, UK
Patients with personality disorder and no depression or schizophrenia with previous DSH, admitted after DSH |
Mean age, 35.7 | Intervention: Mianserin therapy for 6 mos
Control: Placebo |
6 mos | Intervention: 8/17 (47.1)
Control: 12/21 (57.1) |
0.67 (0.18-2.41) | |
| Verkes, et al., 199856 | Leiden, Rotterdam, the Netherlands
Patients with repeated DSH without current diagnosis of major depression who were admitted to emergency departments of university hospitals |
> 18 | Intervention: Paroxetine plus psychotherapy (therapy and therapist not described)
for 12 mos
Control: Placebo plus psychotherapy |
12 mos | Intervention: 15/46 (32.6)
Control: 21/45 (46.7) |
0.70 (no CI, P= 0.12) | |
| Overall | 0.83 (0.47-1.48) | ||||||
| Long-term Therapy vs Short-term Therapy | Torhorst, et al., 198857 | Munich, Germany
Patients with repeat DSH without psychosis, current psychiatric treatment, or drug addiction admitted for deliberate self-poisoning episode |
NR | Intervention: 1 session per month by a mental health professional for 12 mos
Control: 12 weekly therapy sessions by a mental health professional over 3 mos |
12 mos | Intervention: 9/40 (22.5)
Control: 9/40 (22.5) |
1.0 (0.35-2.86) |
Note: CI, confidence interval; DSH, deliberate self-harm; GHQ, Generalized Health Questionnaire; NR, not reported; OR, odds ratio. a Adapted from Hawton, et al., 2001.18 |
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