ALGOS: the development of a randomized controlled trial testing a case management algorithm designed to reduce suicide risk among suicide attempters

Abstract

BackgroundSuicide attempts (SA) constitute a serious clinical problem. People who attempt suicide are at high risk of further repetition. However, no interventions have been shown to be effective in reducing repetition in this group of patients.Methods/DesignMulticentre randomized controlled trial.We examine the effectiveness of «ALGOS algorithm»: an intervention based in a decisional tree of contact type which aims at reducing the incidence of repeated suicide attempt during 6 months. This algorithm of case management comprises the two strategies of intervention that showed a significant reduction in the number of SA repeaters: systematic telephone contact (ineffective in first-attempters) and «Crisis card» (effective only in first-attempters). Participants who are lost from contact and those refusing healthcare, can then benefit from «short letters» or «postcards».DiscussionALGOS algorithm is easily reproducible and inexpensive intervention that will supply the guidelines for assessment and management of a population sometimes in difficulties with healthcare compliance. Furthermore, it will target some of these subgroups of patients by providing specific interventions for optimizing the benefits of case management strategy.Trial RegistrationThe study was registered with the ClinicalTrials.gov Registry; number: NCT01123174.

Effectiveness of a telephone management programme for patients discharged from an emergency department after a suicide attempt: Controlled study in a Spanish population

“…Furthermore, regular telephone contact allow an earlier detection of increased risk of suicide repetition and to take appropriate measures to prevent suicide completion, rather than a single telephone contact. In this line, the Vaiva et al project suggests the ALGOS algorithm that includes the strategy of sending short letters to certain patients in order to improve the "connectedness" (191). However, with a single telephone call it seems unlikely that the rate of further suicide attempts can be reduced by 12% in 13 months, as obtained in their previous study (165).…”

“…This is of particular interest given that over 40% of patients who completed suicides received psychiatric attention for self-harm in the emergency departments during the previous year (191).…”

A Cross-National Tool for Assessing and Studying Suicidal Behaviors

“…Members of our group have experience in multicenter randomized controlled trials using interventions such as phone calls to reduce the incidence of repeated suicide attempts (Vaiva et al, 2006;Vaiva et al, 2011).…”

A multicentre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England

“…In many ways this was a composite of interventions to date, 146 and similar to a planned intervention in France. 158 With respect to the main aim of our study, we found that carrying out a pilot randomised trial of our intervention was challenging but feasible.…”