scholarly journals Two‐day assertive‐case‐management educational program for medical personnel to prevent suicide attempts: A multicenter pre–post observational study

2020 ◽  
Vol 74 (6) ◽  
pp. 362-370
Author(s):  
Yoshitaka Kawashima ◽  
Naohiro Yonemoto ◽  
Chiaki Kawanishi ◽  
Kotaro Otsuka ◽  
Masaru Mimura ◽  
...  
Keyword(s):  
Observational Study ◽  
Case Management ◽  
Educational Program ◽  
Suicide Attempts ◽  
Medical Personnel ◽  
Assertive Case Management

scholarly journals 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

2020 ◽  
Author(s):  
Masami Inui-Yukawa ◽  
Hitoshi Miyaoka ◽  
Kenji Yamamoto ◽  
Yoshito Kamijo ◽  
Michiko Takai ◽  
...  
Keyword(s):  
Case Management ◽  
Suicide Attempts ◽  
Intervention Group ◽  
Secondary Analysis ◽  
Control Group ◽  
Management Intervention ◽  
Group Assignment ◽  
Case Management Intervention ◽  
Self Harm ◽  
Assertive Case Management

Abstract 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).

scholarly journals Effectiveness of a Flexible and Continuous Case Management Program for Suicide Attempters

2020 ◽  
Vol 17 (7) ◽  
pp. 2599
Author(s):  
Min-Hyuk Kim ◽  
Jinhee Lee ◽  
Hyunjean Noh ◽  
Jin-Pyo Hong ◽  
Hyun Kim ◽  
...  
Keyword(s):  
Case Management ◽  
Teaching Hospital ◽  
Suicide Attempts ◽  
Management Program ◽  
Continuous Case ◽  
Case Management Program ◽  
Suicide Attempters ◽  
Flexible Approach ◽  
Risk Of Death ◽  
Management Group

The purpose of this study was to investigate the effect of continuous case management with a flexible approach on the prevention of suicide by suicide reattempt in a real clinical setting. The subjects in this study were 526 suicide attempters who visited emergency rooms in a teaching hospital in South Korea. Subjects were provided a continuous case management program with a flexible approach according to the severity of their suicide risk and needs. During the entire observation period (from 182 days to 855 days, mean = 572 ± 254), 18 patients (3.7%) died by suicide reattempt: Eight patients (2.27%) in the case management group and 10 patients (7.35%) in the no-case management group. The Cox regression analysis showed that the case management group had a 75% lower risk of death from suicide attempts than the no-case management group (HR = 0.34, 95% CI = 0.13–0.87). This result was shown to be more robust after adjusting for confounding factors such as gender, age, psychiatric treatment, suicide attempts, and family history of suicide (adjusted HR = 0.27, 95% CI = 0.09–0.83). This study was conducted in a single teaching hospital and not a randomized controlled one. A flexible and continuous case management program for suicide attempters is effective for preventing death by suicide reattempts.

The Ethics of Referral and Intervention with Non-Life Threatening Suicide Attempts by Overdose of Medication and Ingestion of Harmful Substances

1996 ◽  
Vol 33 (3) ◽  
pp. 179-191 ◽  
Author(s):  
Barbara Fitchette
Keyword(s):  
Suicide Attempt ◽  
Suicide Attempts ◽  
Ethical Issues ◽  
Medical Personnel ◽  
Medical Intervention ◽  
Information Centre ◽  
Medical Interventions ◽  
Life Threatening ◽  
Industrial Cleaning ◽  
Made In

Most suicide attempts by ingestion of substances (including medication overdoses, drinking household or industrial cleaning products, etc.) are not lethal. In fact, many are never reported and there is no medical intervention—the attempter may simply feel “bad” for a while and not seek medical help. In many instances, a minimal intervention may be useful (such as inducing vomiting), although a lethal or harmful outcome is unlikely. In Canada, all major cities have a Poison Information Centre to provide advice concerning cases of potential accidental or intentional poisoning. This article presents data from calls to a Poison Information Centre where callers requested information concerning the dangers and lethality, after they had ingested substances which they thought could be harmful in a possible suicide attempt. We compare information given and referrals made in the case of poisoning in which there was danger of harmful consequences with reactions to cases where the type and quantity of substance ingested was assessed as having no danger for potentially harming the person. In many instances, persons who do not need medical intervention are referred to an emergency room because the possible “overdose” was considered to be a suicide attempt. We discuss the views of key informants (medical personnel, medical/legal experts, front-line suicide prevention workers, a “chronic” suicide attempter) and conclude by discussing the possible benefits and harm from such referrals and, particularly, the ethical issues involved in referring for medical treatment an individual who does not need medical interventions and whose suicide attempt was not potentially harmful.

scholarly journals 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)

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e020517 ◽  
Author(s):  
Chiaki Kawanishi ◽  
Takao Ishii ◽  
Naohiro Yonemoto ◽  
Mitsuhiko Yamada ◽  
Hirokazu Tachikawa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Case Management ◽  
Emergency Departments ◽  
Suicide Attempters ◽  
Management Intervention ◽  
Social Risks ◽  
Case Management Intervention ◽  
Fidelity Assessment ◽  
Medical Fees ◽  
Assertive Case Management

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.

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