AID-trial:A Randomized Clinical Trial Comparing the Effect on Repeated Self-harm of Assertive Intervention and Standard Treatment After Deliberate Self-harm

SPECIFIC AIMS/HYPOTHESES

The aim of this study is to investigate if assertive outreach incorporating hands-on guidance and motivational support of compliance with follow-up treatment after suicide attempts is able to reduce the frequency of non-fatal and fatal suicide acts.

BACKGROUND AND SIGNIFICANCE

Suicidal behavior is associated with considerable risk of subsequent self-harm, including completed suicide. Owens et al. (Owens, Horrocks, & House 2002a) conducted a systematic review of fatal and non-fatal repetition of self-harm. Owens found that the median one-year repetition rate was 16 percent non-fatal and two percent fatal. Results from the epidemiological European Multicentre Study (WHO/EURO) also shows a repetition rate between 12 and 30 percent within the first year, making suicide attempts a very important high-risk factor (Cedereke, Monti, & Ojehagen 2002;Schmidtke et al. 1996).

Unfortunately there are still very few randomized controlled trials with evidence based recommendations for suicide prevention. The studies conducted are often flawed due to selection bias or lack statistical power (Crawford et al. 2007;Hawton et al. 1998b;van der et al. 1997). A systematic review of randomised clinical trials of psychosocial and pharmacological interventions for persons who have attempted suicide revealed that until now, no intervention has proven effective in reducing suicide rate or repetition rate (Hawton et al. 1999). The authors identified non-significant trends toward reduced repetition of deliberate self-harm for problem-solving therapy compared with standard aftercare, for provision of an emergency contact card in addition to standard care compared with standard aftercare alone, and for intensive aftercare plus outreach compared with standard aftercare. In one relatively large study in this group, which evaluated community follow-up of patients who did not attend outpatient appointments, there was a near significant difference in repetition of deliberate self-harm of 10.7 percent compared with 17.4 percent (0.57; 0.32 to 1.02), (Van Heeringen et al. 1995).