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Effectiveness of a nationwide aftercare program for suicide attempters

Published online by Cambridge University Press:  23 October 2012

Y.-J. Pan ,
W.-H. Chang ,
M.-B. Lee ,
C.-H. Chen ,
S.-C. Liao  and
E. D. Caine
Y.-J. Pan
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK Department of Psychiatry, Far Eastern Memorial Hospital, Taiwan
W.-H. Chang
Affiliation:
Taiwan Suicide Prevention Center, Department of Health, Taiwan
M.-B. Lee*
Affiliation:
Taiwan Suicide Prevention Center, Department of Health, Taiwan Departments of Psychiatry and Social Medicine, National Taiwan University Hospital and College of Medicine, Taiwan
C.-H. Chen
Affiliation:
Institute of Statistical Science, Academia Sinica and Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taiwan
S.-C. Liao
Affiliation:
Taiwan Suicide Prevention Center, Department of Health, Taiwan Department of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan
E. D. Caine
Affiliation:
Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY and VA VISN 2 Center of Excellence for Preventing Suicide, Canandaigua, NY, USA
*
*Address for correspondence: M.-B. Lee, M.D., Departments of Psychiatry and Social Medicine, National Taiwan University Hospital and College of Medicine, No. 7, Chung San South Road, Taipei 100, Taiwan. (Email: [email protected])
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Abstract

Background

The effectiveness of large-scale interventions to prevent suicide among persons who previously attempted suicide remains to be determined. The National Suicide Surveillance System (NSSS), launched in Taiwan in 2006, is a structured nationwide intervention program for people who survived their suicide attempts. This naturalistic study examined its effectiveness using data from the first 3 years of its operation.

Method

Effectiveness of the NSSS aftercare services was examined using a logistic/proportional odds mixture model, with eventual suicide as the outcome of interest. As well, we examined time until death for those who died and factors associated with eventual suicide.

Results

Receipt of aftercare services was associated with reduced risk for subsequent suicide; for service recipients who eventually killed themselves, there was a prolonged duration between the index and fatal attempts. Elderly attempters were particularly prone to a shorter duration between the index and fatal attempts. Male gender, the lethality potential of the index attempt, and a history of having had a mental disorder also were associated with higher risk.

Conclusions

The structured aftercare program of the NSSS appears to decrease suicides and to delay time to death for those who remained susceptible to suicide.

Keywords

Aftercarelethal methodsstructured interventionssuicidesuicide attempts
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 7 , July 2013 , pp. 1447 - 1454
Copyright
Copyright © Cambridge University Press 2012 

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References

Bertolote, JM (2004). Suicide prevention: at what level does it work? World Psychiatry 3, 147–151.Google ScholarPubMed
Chan, SS, Chiu, HF, Chen, EY, Chan, WS, Wong, PW, Chan, CL, Law, YW, Yip, PS (2009). Population-attributable risk of suicide conferred by Axis I psychiatric diagnoses in a Hong Kong Chinese population. Psychiatric Services 60, 1135–1138.CrossRefGoogle Scholar
Chang, SS, Gunnell, D, Wheeler, BW, Yip, P, Sterne, JA (2010). The evolution of the epidemic of charcoal-burning suicide in Taiwan: a spatial and temporal analysis. PLoS Medicine 7, e1000212.CrossRefGoogle ScholarPubMed
Chiang, HC, Chen, HS, Tai, CW, Lee, MB (2006). National suicide surveillance system: experience in Taiwan. IEEE Healthcom, 8th International Conference on e-Health Networking, Application and Services, New Delhi, India, pp. 160–164.Google Scholar
Chiang, HC, Liao, SC, Lee, MB (2008). National suicide surveillance/aftercare system: challenges and debates in Taiwan. 41st American Association Suicidology (AAS) Annual Conference: Advancing Suicidology: Embracing Diversity in Research and Practice, Boston, MA.Google Scholar
Cooper, J, Kapur, N, Webb, R, Lawlor, M, Guthrie, E, Mackway-Jones, K, Appleby, L (2005). Suicide after deliberate self-harm: a 4-year cohort study. American Journal of Psychiatry 162, 297–303.CrossRefGoogle ScholarPubMed
Crawford, MJ, Kumar, P (2007). Intervention following deliberate self-harm: enough evidence to act? Evidence-Based Mental Health 10, 37–39.CrossRefGoogle ScholarPubMed
Elnour, AA, Harrison, J (2008). Lethality of suicide methods. Injury Prevention 14, 39–45.CrossRefGoogle ScholarPubMed
Fleischmann, A, Bertolote, JM, Wasserman, D, De Leo, D, Bolhari, J, Botega, NJ, De Silva, D, Phillips, M, Vijayakumar, L, Varnik, A, Schlebusch, L, Thanh, HT (2008). Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bulletin of the World Health Organization 86, 703–709.CrossRefGoogle ScholarPubMed
Gibb, SJ, Beautrais, AL, Fergusson, DM (2005). Mortality and further suicidal behaviour after an index suicide attempt: a 10-year study. Australian and New Zealand Journal of Psychiatry 39, 95–100.CrossRefGoogle Scholar
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205–228.CrossRefGoogle ScholarPubMed
Hawton, K, Zahl, D, Weatherall, R (2003). Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry 182, 537–542.CrossRefGoogle ScholarPubMed
Hawton, KKE, Townsend, E, Arensman, E, Gunnell, D, Hazell, P, House, A, van Heeringen, K (1999). Psychosocial and pharmacological treatments for deliberate self-harm. Cochrane Database of Systematic Reviews 1999, Issue 4, Art. No. CD001764.CrossRefGoogle Scholar
Isometsa, ET, Lonnqvist, JK (1998). Suicide attempts preceding completed suicide. British Journal of Psychiatry 173, 531–535.CrossRefGoogle ScholarPubMed
Kraemer, HC (2003). Current concepts of risk in psychiatric disorders. Current Opinion in Psychiatry 16, 421–430.CrossRefGoogle Scholar
Kuk, AYC, Chen, CH (1992). A mixture model combining logistic regression with proportional hazards regression. Biometrika 79, 531–541.CrossRefGoogle Scholar
Kuo, CJ, Conwell, Y, Yu, Q, Chiu, CH, Chen, YY, Tsai, SY, Chen, CC (2008). Suicide by charcoal burning in Taiwan: implications for means substitution by a case-linkage study. Social Psychiatry and Psychiatric Epidemiology 43, 286–290.CrossRefGoogle ScholarPubMed
Liao, SC, Chen, WJ, Lee, MB, Yang, MJ, Lai, TJ, Liu, CY, Lung, FW, Lin, CY, Chen, CC (2012). Low prevalence of major depressive disorder in Taiwanese adults: possible explanations and implications. Psychological Medicine 42, 1227–1237.CrossRefGoogle ScholarPubMed
Liao, SC, Lee, MB, Chen, WJ, Yang, MJ, Lu, RB, Chen, CC (2006). Prevalence and correlates of suicide ideation, plan, and attempt in Taiwan communities: preliminary report from National Psychiatric Morbidity Survey. 12th Meeting of the Pacific Rim College of Psychiatrist Scientific 2006, Taipei, Taiwan.Google Scholar
Liao, SC, Lee, MB, Chiang, HC (2008). The structured interventions for suicide attempters [in Chinese]. Formosan Journal of Medicine 12, 713–721.Google Scholar
Lu, W, Ying, Z (2004). On semiparametric transformation cure models. Biometrika 91, 331–343.CrossRefGoogle Scholar
Luoma, JB, Martin, CE, Pearson, JL (2002). Contact with mental health and primary care providers before suicide: a review of the evidence. American Journal of Psychiatry 159, 909–916.CrossRefGoogle ScholarPubMed
Mrazek, PJ, Haggerty, RJ (1994). Reducing Risks from Mental Disorders: Frontiers for Preventive Intervention Research. National Academy Press: Washington, DC.Google Scholar
Ostamo, A, Lonnqvist, J (2001). Excess mortality of suicide attempters. Social Psychiatry and Psychiatric Epidemiology 36, 29–35.CrossRefGoogle ScholarPubMed
Tidemalm, D, Langstrom, N, Lichtenstein, P, Runeson, B (2008). Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long-term follow-up. British Medical Journal 337, a2205.CrossRefGoogle ScholarPubMed
Weisman, AD, Worden, JW (1972). Risk-rescue rating in suicide assessment. Archives of General Psychiatry 26, 553–560.CrossRefGoogle ScholarPubMed
Yip, PS, Law, CK, Fu, KW, Law, YW, Wong, PW, Xu, Y (2010). Restricting the means of suicide by charcoal burning. British Journal of Psychiatry 196, 241–242.CrossRefGoogle ScholarPubMed
Zahl, DL, Hawton, K (2004). Repetition of deliberate self-harm and subsequent suicide risk: long-term follow-up study of 11,583 patients. British Journal of Psychiatry 185, 70–75.CrossRefGoogle Scholar