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Archived Comments for: ALGOS: the development of a randomized controlled trial testing a case management algorithm designed to reduce suicide risk among suicide attempters

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  1. Further approaches to evaluating brief contact interventions for suicidal behaviour

    Jayne Cooper, University of Manchester

    1 April 2011

    We read the protocol by Vaiva and colleagues with interest. (1) We have reviewed contact-type interventions for suicidal behaviour and found that they had equivocal results. (2) Further work in this area is clearly necessary and studies like Professor Vaiva’s are to be welcomed. Rather than attempt to replicate existing work, we adopted an alternative approach, using qualitative methodologies to investigate the views of service users and staff regarding contact-based interventions (for example letters, telephone calls or crisis cards) following self-harm (3). We interviewed self-harm patients recently discharged from an emergency department, and clinical and voluntary staff from relevant service areas who took part in a focus group and individual interviews. Analytic themes using methods of constant comparison were identified from transcripts that described the period of time service users felt most at risk and the reasons why specific interventions might be effective. Potential barriers to their implementation both from a service user and service provider prospective were identified.

    Based on this qualitative work, we are currently piloting a 3 stage intervention following self-harm, (4). This involves randomising patients to an intervention group where (in addition to usual treatment) they will receive two phone calls from a clinical researcher soon after hospital attendance, an information leaflet listing local sources of help, and then letters intermittently up to 12 months after recruitment (1, 2, 4, 6, 8 and 12 months), or to a control group, where patients will receive their usual treatment only. We will identify repeat episodes of self-harm but will also assess the feasibility of conducting a large multi-centre randomised trial with particular consideration of recruitment and randomisation procedures. The pilot study will assess the proportion of patients allocated to the treatment group who accept the invitation to join the study and give informed consent. Other outcomes will shed light on the potential efficacy of the intervention and will include the proportion of patients with at least one repeat episode of self-harm resulting in hospital attendance in 12 months.

    Brief contact interventions for suicidal behaviour are potentially very attractive to those planning services because they provide a low cost intervention to individuals who often get very little in the way of treatment. However future studies need to assess whether these interventions are effective.

    1. Guillaume Vaiva, Michel Walter, Abeer S Al Arab, Philippe Courtet, Frank Bellivier, Anne Laure Demarty, Stephane Duhem, Francois Ducrocq, Patrick Goldstein, Christian Libersa. ALGOS: the development of a randomized controlled trial testing a case management algorithm designed to reduce suicide risk among suicide attempters BMC Psychiatry 2011, 11:1
    2. Kapur N, Cooper J, Bennewith O, Gunnell D, Hawton K. Postcards, green cards, and telephone calls – therapeutic contact with individuals following self-harm. Br J Psychiatry 2010; 197: 5-7
    3. Cooper J, Hunter C, Owen-Smith, A, Gunnell D, Donovan, J, Hawton K, & Kapur N, "Well it's like someone at the other end cares about you." A qualitative study exploring the views of users and providers of care of contact based interventions following self-harm. In press Gen Hosp Psych 2011
    4. Link to record in ISRCTN Register:

    Competing interests

    This article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1247). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.