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Suicide, Attempted | Effectiveness of a Case Management Algorithm: ALGOS After a Suicide Attempt

Suicide, Attempted research study

What is the primary objective of this study?

The suicidal behaviors are phenomena eminently multifactorial. It is thus always difficult to define univocal strategies of prevention of suicide repetition, during the emergency stay, i.e. almost in general population. One find 23 clinical trials in this topic in the past 25 years, and 18 are negative. The majority of the positive trials have the concern of being dissociated from an assumption of responsibility of care strictly speaking, to adopt a position \"méta\", nearer to the concept of \"case management\": how to remain in contact with the suicide attempter, without forcing it in this every day life, replacing a possible proposing, but assumption of responsibility resources reliable and quickly accessible in the event of at risk situation? Each one of these studies tests devices which seem more appropriate to such or such characteristic of this population, by retaining only simple criteria like the sex, the number of former suicide attempts, the proposal or not for an assumption of responsibility of care, the observance or not with the plan of care. Thus, it would seem interesting to combine these approaches in an algorithm entitled \"ALGOS\". Main aim: To test the effectiveness of this algorithm of case management, named \"ALGOS\", in reducing the number of death by suicide, in terms of reduction of suicide re-attempts and the number of loss of contact patients in the ALGOS group during 6 months period, compared to a control group of suicide attempters treated as usual (i.e. primarily transmitted to the attending physician). Secondary objectives: To evaluate, according to the method validated by Beecham in 1992, direct medico-economic impact in the year which follows the introduction of algorithm ALGOS. Reduction of the other suicidal behaviors in 6 months (reduction in the full number of suicidal repetitions in each group, evolution of the score of suicidal ideation, etc…). To evaluate the effect of the algorithm, at the 13th month. To study the possible differences within the time in terms of suicidal repetitions in the 2 groups. To propose different profiles of answers according to psychopathology, the number of suicide attempts, suicidal character, the sex,… Methodology: Comparative simple blind prospective multicentric controlled study

Who is eligible to participate?

Inclusion Criteria: - Surviving to a suicide attempt (SA) directly leaving the Emergency unit or have been hospitalized less than 7 days Exclusion Criteria: - recidivists who made 4 SA and more in the 3 past years

Which medical condition, disease, disorder, syndrome, illness, or injury is researched?

Suicide, Attempted

Study Interventions

Interventions can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available or noninvasive approaches such as surveys, education, and interviews.

Behavioral:ALGOS algorithm of case managementIf the subject survives one 1st SA (first attempter): he leaves the center where he was included with a "chart resource" (crisis card) which contains addresses of the Web sites of associations of prevention of the suicide, as well as an accessible phone number 24/24h. If the subject is not a first attempter : he will be recontacted on the telephone between the 10th and the 21st day following the SA. If the subject is not contacted or little observing in the plan of care, it will receive a series of postcards then regularly, with 4 recoveries: to 2, 3, 4 and 5 months after the attempt.

Study Arms

Research studies and clinical trials typically have two or more research arms. An arm is a group of people who receive the same treatment in the study.

ALGOS groupAlgorithm of case management over the 6 months following the suicidal gesture (systematic telephone contact, postcards and crisis card)

Control groupTreatment as usual (referral back to the general practitioner)

Study Status

Completed

Start Date: February 2010

Completed Date: July 2014

Phase: N/A

Type: Interventional

Design:

Primary Outcome: Number of suicide re-attempters

Secondary Outcome: Number of deaths per suicide

Study sponsors, principal investigator, and references

Principal Investigator: Guillauma VAIVA

Lead Sponsor: University Hospital, Lille

Collaborator:

More information:https://clinicaltrials.gov/show/NCT01123174

Vaiva G, Vaiva G, Ducrocq F, Meyer P, Mathieu D, Philippe A, Libersa C, Goudemand M. Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: randomised controlled study. BMJ. 2006 May 27;332(7552):1241-5.

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