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Objective To determine whether brief intervention and contact is effective in reducing subsequent suicide mortality among suicide attempters in low and middle-income countries.
Methods Suicide attempters (n = 1867) identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, China) participated, from January 2002 to October 2005, in a randomized controlled trial to receive either treatment as usual, or treatment as usual plus brief intervention and contact (BIC), which included patient education and follow-up. Overall, 91% completed the study. The primary study outcome measurement was death from suicide at 18-month follow-up.
Findings Significantly fewer deaths from suicide occurred in the BIC than in the treatment-as-usual group (0.2% versus 2.2%, respectively; χ = 13.83, P < 0.001).
Conclusion This low-cost brief intervention may be an important part of suicide prevention programmes for underresourced low- and middle-income countries.
Bulletin of the World Health Organization 2008;86:703-709.
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Introduction
Suicide is a preventable cause of death. After about two centuries of research in suicide prevention, the effectiveness of a number of interventions has been demonstrated and various risk factors have been placed in perspective. Thus, "it is no longer acceptable to state blandly that there is no convincing evidence for the effectiveness of suicide prevention measures" and, even more importantly, "... the unacceptable rate of suicide worldwide can be reduced."1
WHO estimated that 877 000 deaths were due to suicide in the year 2002,2 the majority of which (85%) occurred in low- and middle-income countries.3 Attempted suicide can be up to 40 times more frequent than completed suicide.4,5 Many of those who attempt suicide require medical attention and they are at high risk for completed suicide.6-8 Self-inflicted injuries represented 1.4% of the global burden of disease in 20022 and are expected to increase to 2.4% by 2020. As suicide is among the top three causes of death in the population aged 15-34 years,9 there is a massive loss to societies of young people in their productive years of life....