Intensive supportive ambulatory aftercare may increase adherence to treatment and decrease depressive symptoms in patients after a suicide attempt - 19/08/20

Doi : 10.1016/j.fjpsy.2020.05.001

Héloïse Delavenne ^a, Frederico Duarte Garcia ^a, Nathalie Giraudeau ^b, Sandrine Louchart ^c, Lynda Zarrou ^d, Humberto Correa ^a, Florence Thibaut ^e,^⁎
^a Department of Mental Health, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil and INCT de Medicina Molecular e Programa de Pós-graduação em Medicina Molecular da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
^b Department of Psychiatry, Saintonge Hospital, Saintes, France
^c Department of Geriatrics and Memory assessment centre, Rainier III Centre, Monaco
^d Paris, France
^e University Hospital Cochin (Tarnier), University of Paris, INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France

^⁎Corresponding author at: Department of Psychiatry and Addictive Disorders, Hôpital Tarnier, 89, rue d’Assas, 75006 Paris, France.Department of Psychiatry and Addictive Disorders, Hôpital Tarnier89, rue d’AssasParis75006France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 19 August 2020
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Highlights

•	Patients present a high risk for relapse during the post-discharge period of a suicide attempt.
•	Individualized, proactive, intensive psychosocial follow-up (IPC) provided by a psychiatric team, assuring continuity of care maintaining substantial personalized contacts after discharge, could significantly reduce the levels of depressive symptoms in suicide attempters patients after discharge.
•	IPC seems to improve compliance with treatment and slightly decrease the number of repeat SA.

Le texte complet de cet article est disponible en PDF.

Summary

Objectives

Patients who survive a suicide attempt present an increased risk of relapse during the three months after discharge from a hospital, referred to herein as the post-discharge period. Developing and assessing the efficacy and safety of methods that reduce the risk of relapse in the post-discharge period is critical for professionals in the field of suicide prevention. This study aimed to compare the efficacy of a new Intensive Psychosocial Care (IPC) program after discharge for a suicide attempt with a Standard Care Program (SCP) in non-hospitalized patients.

Methods

We conducted a open-label prospective trial to compare the outcome of patients who have attempted suicide for a duration of 6 months according to whether they were included in care program group IPC or SCP after discharge from the emergency department.

Results

Using the Beck Depression Inventory short-form (BDI-SF), the IPC program was significantly associated with both a decrease of the total score of the scale at 6th month, and a trend towards a decline in the time lag between discharge and the improvement of depressive symptoms. When compared to SPC, patients receiving the IPC had also a lower drop-out rate (31% versus 43% in the 6th month) and a higher adherence to treatment until the 3rd month (56% versus 41.7%). Median time to reattempt was 83.7 [95%CI: 45.8–121.7] days for IPC as compared to 75.6 [95%CI: 38.8–112.4] days for SCP, respectively.

Conclusions

Personalized follow-up with close contacts by the same caregivers as those who initially assessed the patient in the emergency room improved adherence to care and reduced depressive symptoms more intensely and faster after a suicide attempt.

Le texte complet de cet article est disponible en PDF.

Keywords : Suicide, Attempted-suicide, Self-injurious behavior, Suicidal ideation, Depressive disorder, Prevention, Ambulatory care, Social support