Original Article
An Emergency Department-Initiated Intervention to Lower Relapse Risk after Attempted Suicide
Gonzalo Martínez-Alés MD, MSc,
Eduardo Jiménez-Sola MD,
Eva Román-Mazuecos MD,
María Pilar Sánchez-Castro MD,
Consuelo de Dios MD, PhD,
Beatriz Rodríguez-Vega MD, PhD,
María Fe Bravo-Ortiz MD, PhD,
Corresponding Author
Gonzalo Martínez-Alés MD, MSc
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Universidad Autónoma de Madrid School of Medicine, Madrid, Spain
Address correspondence to Gonzalo Martínez-Alés, La Paz University Hospital; Paseo de la Castellana, 261, 28046 Madrid, Spain; E-mail: [email protected]Search for more papers by this authorEduardo Jiménez-Sola MD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Search for more papers by this authorEva Román-Mazuecos MD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Search for more papers by this authorMaría Pilar Sánchez-Castro MD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Search for more papers by this authorConsuelo de Dios MD, PhD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Universidad Autónoma de Madrid School of Medicine, Madrid, Spain
Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
Search for more papers by this authorBeatriz Rodríguez-Vega MD, PhD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Universidad Autónoma de Madrid School of Medicine, Madrid, Spain
Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
Search for more papers by this authorMaría Fe Bravo-Ortiz MD, PhD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Universidad Autónoma de Madrid School of Medicine, Madrid, Spain
Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
Search for more papers by this authorGonzalo Martínez-Alés MD, MSc,
Eduardo Jiménez-Sola MD,
Eva Román-Mazuecos MD,
María Pilar Sánchez-Castro MD,
Consuelo de Dios MD, PhD,
Beatriz Rodríguez-Vega MD, PhD,
María Fe Bravo-Ortiz MD, PhD,
Corresponding Author
Gonzalo Martínez-Alés MD, MSc
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Universidad Autónoma de Madrid School of Medicine, Madrid, Spain
Address correspondence to Gonzalo Martínez-Alés, La Paz University Hospital; Paseo de la Castellana, 261, 28046 Madrid, Spain; E-mail: [email protected]Search for more papers by this authorEduardo Jiménez-Sola MD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Search for more papers by this authorEva Román-Mazuecos MD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Search for more papers by this authorMaría Pilar Sánchez-Castro MD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Search for more papers by this authorConsuelo de Dios MD, PhD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Universidad Autónoma de Madrid School of Medicine, Madrid, Spain
Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
Search for more papers by this authorBeatriz Rodríguez-Vega MD, PhD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Universidad Autónoma de Madrid School of Medicine, Madrid, Spain
Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
Search for more papers by this authorMaría Fe Bravo-Ortiz MD, PhD
Department of Psychiatry, La Paz University Hospital, Madrid, Spain
Universidad Autónoma de Madrid School of Medicine, Madrid, Spain
Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
Search for more papers by this authorThe authors want to thank their fellow clinicians for their careful dedication to patients and their essential contribution with data collection, as well as Teresa López-Cuadrado for her help with the study design. This article received no financial support.
The study protocol complies with the Declaration of Helsinki for Human Rights and has the approval of the Hospital Universitario La Paz's Ethical and Clinical Research Committee.
The data sets generated and analyzed during the current study are not publicly available, because restrictions apply to data from public general hospitals in the Community of Madrid. However, the corresponding author can ask for the Ethic's Committee permission for partial share under reasonable request.
Abstract
Objective
According to randomized trials, contact after a suicide attempt lowers relapse risk. However, effectiveness studies based on real clinical data can provide additional external validity.
Method
We conducted an observational study to determine if an emergency department (ED)-initiated intervention for suicide attempt risk reduction, consisting on scheduling a single added appointment within 7 days after discharge following a suicide attempt, can reduce the risk of relapse. The study included 1,775 patients who had been treated at a general hospital ED due to a suicide attempt. The principal outcome measure was ED return after a new attempt. We obtained Kaplan-Meier survival functions and used Cox proportional hazard regression models to estimate unadjusted and adjusted risks of relapse by treatment phase. Covariates included: age, gender, history of suicide attempts, history of psychiatric disorders, concurrent alcohol/drug abuse, number of attempts during follow-up, admission as an inpatient and family support.
Results
A total of 497 (22.5%) attempts were followed by a relapse. Subjects exposed to the studied intervention had a lower risk of relapse after a suicide attempt, with a 24% adjusted risk reduction estimate.
Conclusion
Our real-world results suggest that an additional early appointment, scheduled before discharging suicide attempters, reduces suicide reattempt risk.
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