Effectiveness of Assertive Case Management for Patients with Suicidal Intent Admitted to Emergency Departments Following Attempted Suicide by Self-Poisoning: A Secondary Analysis of the ACTION-J Study

Background: Self-poisoning is commonly observed in individuals as a component of suicide attempts and self-harm. The effectiveness of interventions for self-poisoning is unclear. The objective of this study was to examine the effectiveness of assertive case management intervention in preventing suicidal behaviour in self-poisoning patients.Methods: We conducted a secondary analysis of data from the ACTION-J study. Participants were self-poisoning patients with clear suicidal intent who were admitted to emergency departments and who had a primary psychiatric diagnosis (as per DSM-IV-TR axis 1). Patients were randomly assigned either to assertive case management (intervention group) or enhanced usual care (control group). The primary outcome measure was the incidence of a first recurrent suicidal attempt within 6 months after group assignment.Results: There were 297 self-poisoning patients in the intervention group and 295 in the control group. The primary outcome was significantly lower in the intervention group than in the control group (risk ratio [RR]: 0.473, 95% confidence interval [CI]: 0.284 to 0.788). The incidence of a first recurrent suicidal attempt within 1 and 3 months after group assignment was also significantly lower in the intervention group, as was the number of overall self-harm episodes over the entire study period (incidence rate ratio [IRR]: 0.711, 95% CI: 0.582 to 0.866). Furthermore, the number of non-suicidal self-harm episodes and suicide attempts was significantly lower in the intervention group than in the control group.Conclusion: Assertive case management is effective when promptly introduced in a hospital setting as an intervention following a suicide attempt, particularly for self-poisoning patients.Trial Registration: This study is registered at ClinicalTrials.gov (NCT00736918) and UMIN-CTR (C000000444).

Protocol for a prospective multicentre registry cohort study on suicide attempters given the assertive case management intervention after admission to an emergency department in Japan: post-ACTION-J Study (PACS)

IntroductionSuicide attempt is the most important risk factor for later suicide. A randomised-controlled, multicentre trial of postsuicide attempt case management for the prevention of further suicide attempts in Japan, named ACTION-J, has established effective interventions for prevention of suicide reattempts. The ACTION-J assertive case management intervention programme was adopted by the Japanese Ministry of Health, Labour and Welfare in 2016, when medical fees were revised. This nationwide programme is provided to patients who attempt suicide and who are admitted to emergency departments in Japan.The aim of the present study is to examine the current implementation status of the ACTION-J programme. The present study also aims to clarify which patients’ and hospitals’ factors affect the implementation of the programme.Methods and analysisThis is a prospective, multicentre, patient registry cohort study. Participants will be suicide attempters admitted to the emergency departments of medical facilities with both psychiatry and emergency departments. The assertive case management programme will be delivered to participants by a case manager for up to 24 weeks, based on psychiatric diagnoses, social risks and patient needs. The core feature of the programme is to encourage patients to participate in psychiatric treatment.The primary outcome will be the proportion of patients still participating in the case management intervention at 24 weeks after registration. The secondary outcomes will include measures of the fidelity of the case management intervention. The fidelity will be evaluated using a fidelity assessment manual developed by the study group.Ethics and disseminationThis observational study has been approved by the ethics board of Sapporo Medical University. Enrolment began in October 2016 and will continue until December 2018. Dissemination plans include presentations at scientific conferences and scientific publications.Trial registrationUMIN000024474.

Preventing Self-harm and Reducing Suicidal Ideation Through an Expedited Regular Supportive Psychotherapy and assertive Case Management – Protocol for a Three-arm Partial Randomised Controlled Trial

aimTo conduct a three-arm partial randomised controlled trail to evaluate the effectiveness of expedited regular supportive psychotherapy and assertive case management for patients presenting with suicidal ideation or self-harm to the emergency department (ED).Hypothesiswe expect expedited regular supportive psychotherapy plus assertive case management will reduce the suicidality and/or suicidal behaviour in patients by at least 20% at 4 weeks compared to patients receiving only assertive case management or routine care and these differences will be sustained at 6 months.MethodsThis will be a longitudinal, prospective, three-arm controlled single-rater-blinded partial randomized clinical trial with a recruitment period of 12 months and an observation period of 6 months for each participant. Patients in the intervention group will receive regular face-to-face or over the phone brief supportive psychotherapy during weekdays following presentation to the ED with suicidal ideation or self-harm until patients are actively enrolled in regular community mental health services with active case management by the therapist. Patients in the control and the assertive outreach arms will each receive the usual follow-up services offered routinely to regular patients and assertive outreach patients respectively who present to the ED with suicidal ideation or self-harm.ResultsRecruitment will commence in February 2016 and we expect the results of the study to be available by September 2017.ConclusionIf our hypothesis is proved correct, our intervention will be a new model for caring for patients with self-harm and suicidal ideation and is expected to reduce suicide rates.Disclosure of interestThe authors have not supplied their declaration of competing interest.