PICO: Treatment as Usual Vs Treatment as Usual plus BIC

Question: Among the adult suicide attempters (Population) in the emergency department, does the use of usual treatment (Intervention), compared with usual treatment plus brief intervention and contact (Comparison), reduce the suicide rate (Outcome)?

Findings:

Alexandra, Fleischmann., José, Bertolote., Danuta, Wasserman., Diego, De Leo., Jafar, Bolhari., Neury, J Botega., Damani, De Silva., Michael, Phillips., Lakshmi, Vijayakumar., Airi, Värnik., Lourens, Schlebusch., & Huong, Tran Thi Thanh.Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bulletin of the World Health Organization; Sep2008, Vol. 86 Issue 9, p703-709, 7p,

Summary:

The main objective of this randomized controlled trial was to examine whether brief intervention and contact (BIC) + usual treatment was more effective than the usual treatment (TAU) alone in reducing subsequent suicide mortality among suicide attempters in low and middle-level countries. This randomized controlled trial was conducted in five countries and it involved 1867 suicide attempters. The participants were all adults and were drawn from the emergency departments with help of the medical staff. The participants were randomly assigned to each intervention group (BIC: n= 922) and TAU: n= 945). Those who were assigned to the treatment as usual (TAU) group did not receive any follow up treatment for 18 months after they were discharged. On the other hand, besides receiving the usual treatment those in BIC group received follow up treatment. The follow up treatment in this case included a 1-hour individual information session and nine follow up contacts after discharge. The nine follow up visits were conducted by a person with clinical experience and were spread within the 18months period (at 1, 2, 4, 7 and 11 week(s), and 4, 6, 12 and 18 months). During the follow visits, members of the BIC were taught about the suicidal behaviors, risks and protective factors, basic epidemiology and alternatives to committing suicides. In addition, during these visits, whenever the interviewer realized that the patient needed intensive care, appropriate referral was made. 91% of 1867 completed the study.

According to Fleischmann, Bertolote, Wasserman, De Leo, Bolhari, Botega, De Silva, Phillips, Vijayakumar, Värnik, Schlebusch and Tran Thi, (2008) the primary study outcome measurement during the 18-months period was the number of suicide deaths. During the 18months period, 2 members in the BIC group (those who received usual treatment + follow up visit) died compared to 18 in the TAU group (those who received usual treatment only). This translates to a death rate of 0.2% in the BIC group and a death rate 2.2% in the treatment-as-usual (TAU) group. These results indicate that besides the normal treatment, giving suicide attempters brief intervention and contact (BIC) after discharge has a positive influence on prevention of suicide deaths up-to 18months after discharge from emergency departments. According to Fleischmann, Bertolote, Wasserman, De Leo, Bolhari, Botega, De Silva, Phillips, Vijayakumar, Värnik, Schlebusch and Tran Thi, (2008) the BIC acts as a temporary social support network and helps the suicide to find ways of solving suicidal crises. In addition, BIC gives the suicide attempters a feeling of being appreciated and a realization that someone out there cares for them. This is why patients who were given BIC after discharge were less likely to commit suicide compared to patients who were given just the usual treatment.

The outcomes of this study suggests that nurses should ensure that an adult suicide attempter should be given follow up care+ the usual treatment in order to significantly reduce the suicide rate after the patient is discharged. The two cases are related in that the participants in the study were all adults and suicide attempters and were all drawn from the emergency departments. Similarly, in the PICO question, the patient is an adult suicide attempter in the emergency department. Going by the outcomes of this study, giving this patient brief intervention and contact for 18months will achieve a more reduced suicide rate than giving him the usual treatment without brief intervention and contact.

References

Fleischmann, A., Bertolote, J., Wasserman, D., De Leo, D., Bolhari, J., Botega, N., De Silva, D., Phillips, M., Vijayakumar, L., Värnik, A., Schlebusch, L. & Tran Thi, H. (2008). Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bulletin of the World Health Organization, 86, 9, 703-709