Cited by 211Suicide and Self-Harm StudiesMental Health Treatment and AccessPsychiatric care and mental health services

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Letters, green cards, telephone calls and postcards: systematic and meta-analytic review of brief contact interventions for reducing self-harm, suicide attempts and suicide.

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Milner, Allison J., Carter, Greg, Pirkis, Jane, Robinson, Jo, Spittal, Matthew J.·2015·British Journal of Psychiatry

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Abstract

BACKGROUND: There is growing interest in brief contact interventions for self-harm and suicide attempt. AIMS: To synthesise the evidence regarding the effectiveness of brief contact interventions for reducing self-harm, suicide attempt and suicide. METHOD: A systematic review and random-effects meta-analyses were conducted of randomised controlled trials using brief contact interventions (telephone contacts; emergency or crisis cards; and postcard or letter contacts). Several sensitivity analyses were conducted to examine study quality and subgroup effects. RESULTS: We found 14 eligible studies overall, of which 12 were amenable to meta-analyses. For any subsequent episode of self-harm or suicide attempt, there was a non-significant reduction in the overall pooled odds ratio (OR) of 0.87 (95% CI 0.74-1.04, P = 0119) for intervention compared with control. The number of repetitions per person was significantly reduced in intervention v. control (incidence rate ratio IRR = 066, 95% CI 0.54-0.80, P<0001). There was no significant reduction in the odds of suicide in intervention compared with control (OR = 0.58, 95% CI 0.24-1.38). CONCLUSIONS: A non-significant positive effect on repeated self-harm, suicide attempt and suicide and a significant effect on the number of episodes of repeated self-harm or suicide attempts per person (based on only three studies) means that brief contact interventions cannot yet be recommended for widespread clinical implementation. We recommend further assessment of possible benefits in well-designed trials in clinical populations.

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“A meta-analysis found that postdischarge brief contact interventions, such as letters, postcards, crisis cards, and telephone calls, were associated with a significant reduction in the number of repeat episodes per participant, although nonsignificant reductions were observed in the number of patients with any repeat…”
Background
Suicide Risk Among Adults With Mental Health Emergency Department Visits With and Without Suicidal Symptoms
Olfson, M., Gao, Y. N., Xie, M., Cullen, S. W., & Marcus, S. C. (2021) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.20m13833 · Cited by 34
Suicide prevention: Towards integrative, innovative and individualized brief contact interventions
Berrouiguet, S., Courtet, P., Larsen, M. E., Walter, M., & Vaïva, G. (2017) · European Psychiatry · doi:10.1016/j.eurpsy.2017.09.006 · Cited by 33
Effectiveness of a French Program to Prevent Suicide Reattempt (VigilanS)
Plancke, L., Amariei, A., Danel, T., Debien, C., Duhem, S., Notredame, C.-É., Wathelet, M., & Vaïva, G. (2020) · Archives of Suicide Research · doi:10.1080/13811118.2020.1735596 · Cited by 36
“…the protection mechanisms suggested by the authors of the articles he had done the meta-analysis: social support, suicide prevention literacy and alternative learning behaviors are the three mechanisms found, most often in the introduction or discussion of articles (Milner et al., 2015, 2016).”
Background
Differences in the Effectiveness of Psychosocial Interventions for Suicidal Ideation and Behaviour in Women and Men: A Systematic Review of Randomised Controlled Trials
Krysinska, K. E., Batterham, P. J., & Christensen, H. M. (2016) · Archives of Suicide Research · doi:10.1080/13811118.2016.1162246 · Cited by 33
Overcoming Challenges to Evidence‐Based Policy Development in a Large, Integrated Delivery System
Frakt, A. B., Prentice, J. C., Pizer, S. D., Elwy, A. R., Garrido, M. M., Kilbourne, A. M., & Atkins, D. (2018) · Health Services Research · doi:10.1111/1475-6773.12986 · Cited by 33
Employing a sequential multiple assignment randomized trial (SMART) to evaluate the impact of brief risk and protective factor prevention interventions for American Indian Youth Suicide
The Celebrating Life Team, O’Keefe, V. M., Haroz, E. E., Goklish, N. A., Ivanich, J., Cwik, M. F., & Barlow, A. (2019) · BMC Public Health · doi:10.1186/s12889-019-7996-2 · Cited by 29
Combining green cards, telephone calls and postcards into an intervention algorithm to reduce suicide reattempt (AlgoS): P-hoc analyses of an inconclusive randomized controlled trial
Messiah, A., Notredame, C.-É., Demarty, A.-L., Duhem, S., Vaïva, G., & on behalf of AlgoS investigators (2019) · PLoS ONE · doi:10.1371/journal.pone.0210778 · Cited by 29
Ethical and Practical Considerations in the Use of a Predictive Model to Trigger Suicide Prevention Interventions in Healthcare Settings
Tucker, R. P., Tackett, M. J., Glickman, D. R., & Reger, M. A. (2018) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12431 · Cited by 28
A systematic review of suicide risk management strategies in primary care settings
Thangada, M. S., & Kasoju, R. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1440738 · Cited by 26
Caring E‐mails for Military and Veteran Suicide Prevention: A Randomized Controlled Trial
Luxton, D. D., Smolenski, D. J., Reger, M. A., Relova, R. M., & Skopp, N. A. (2019) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12589 · Cited by 29
Predictors and incidence rate of suicide re-attempt among suicide attempters: A prospective study
Esmaeili, E. D., Farahbakhsh, M., Sarbazi, E., Khodamoradi, F., Fam, S. G., & Azizi, H. (2021) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2021.102999 · Cited by 27
Preventing repetition of attempted suicide—III. The Amager Project, 5-year follow-up of a randomized controlled trial
Lahoz, T., Hvid, M., & Wang, A. (2016) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2016.1180711 · Cited by 24
“This is also shown in a recent systematic review and random-effects meta-analysis of 12 randomized controlled trials using brief contact interventions such as telephone contacts, emergency crisis cards, postcards or letters, which showed positive results in reducing the frequency of individuals repeating suicide attem…”
Background
Developing a Hypothetical Model for Suicide Progression in Older Adults With Universal, Selective, and Indicated Prevention Strategies
Sakashita, T., & Oyama, H. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00161 · Cited by 29
“Hospital-based studies of indicated prevention interventions, including follow-up care after suicide attempts (37, 54), suggest these interventions were also not integrated with other prevention strategies.”
Background
SMS SOS: a randomized controlled trial to reduce self-harm and suicide attempts using SMS text messaging
Stevens, G. J., Hammond, T. E., Brownhill, S., Anand, M., de la Riva, A., Hawkins, J., Chapman, T., Baldacchino, R., Micallef, J.-A., Andepalli, J., et al. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2104-9 · Cited by 24
Veteran Preferences for the Caring Contacts Suicide Prevention Intervention
Reger, M. A., Gebhardt, H. M., Lee, J. M., Ammerman, B. A., Tucker, R. P., Matarazzo, B. B., Wood, A. E., & Ruskin, D. (2018) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12528 · Cited by 23
SAFETEL: a pilot randomised controlled trial to assess the feasibility and acceptability of a safety planning and telephone follow-up intervention to reduce suicidal behaviour
O’Connor, R. C., Smillie, S., McClelland, H., Lundy, J.-M., Stewart, C., Syrett, S., Gavigan, M., McConnachie, A., Stanley, B., Smith, M. J., et al. (2022) · Pilot and Feasibility Studies · doi:10.1186/s40814-022-01081-5 · Cited by 23
Engagement in physical activity, suicidal thoughts and suicide attempts among older people in five developing countries
Bishwajit, G., Wang, R., Tang, S., & Yaya, S. (2019) · PeerJ · doi:10.7717/peerj.7108 · Cited by 25
“Interventions, such as cognitive behavioral therapy and some antidepressants, have indeed been recognized as helpful in reducing risks of ST/SA; nevertheless, many require relatively intensive resources and are confined to a limited scale of population with poor viability in many contexts (Milner et al., 2015).”
Background
A Pilot Study of an Intervention to Prevent Suicide After Psychiatric Hospitalization
Riblet, N. B. V., Shiner, B. R., Schnurr, P. P., BRUCE, M. L., Wasserman, D., Cornelius, S. L., Scott, R. C., & Watts, B. V. (2019) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001061 · Cited by 21
“The study of Fleischmann et al. randomized 1699 patients to the World Health Organization Brief Intervention and Contact Program (WHO BIC) versus treatment as usual, and evaluated a more intense intervention that others included in the Milner et al. (2015) review.”
BackgroundMethod
Sex and age trends in Australia's suicide rate over the last decade: Something is still seriously wrong with men in middle and late life
Burns, R. A. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.08.036 · Cited by 22
Changes in the number of suicide re-attempts in a French region since the inception of VigilanS, a regionwide program combining brief contact interventions (BCI)
Djembi, L. F., Vaïva, G., Debien, C., Duhem, S., Demarty, A.-L., Koudou, Y. A., & Messiah, A. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-2443-6 · Cited by 21
The Potential Impact of Adjunct Digital Tools and Technology to Help Distressed and Suicidal Men: An Integrative Review
Balcombe, L., & Leo, D. D. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.796371 · Cited by 24
Brief contact interventions to reduce suicide among discharged patients with mental health disorders—A meta‐analysis of RCTs
Tay, J. L., & Li, Z. (2022) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12903 · Cited by 21
Predicting Lifetime Suicide Attempts in a Community Sample of Adolescents Using Machine Learning Algorithms
Jankowsky, K., Steger, D., & Schroeders, U. (2023) · Assessment · doi:10.1177/10731911231167490 · Cited by 28
“However, it has been meta-analytically shown that brief-contact interventions only slightly reduced the overall number of repeated self-harm incidents per person and not the odds of death by suicide (Milner et al., 2015).”
Background
Taking care of suicidal patients with new technologies and reaching-out means in the post-discharge period
Falcone, G., Nardella, A., Lamis, D. A., Erbuto, D., Girardi, P., & Pompili, M. (2017) · World Journal of Psychiatry · doi:10.5498/wjp.v7.i3.163 · Cited by 20
Un exemple de système de veille post-hospitalière des suicidants : VigilanS
Jardon, V., Debien, C., Duhem, S., Morgiève, M., Ducrocq, F., & Vaïva, G. (2018) · L Encéphale · doi:10.1016/j.encep.2018.09.009 · Cited by 20
Brief Cognitive-Behavioral Therapy for Suicidal Inpatients
Diefenbach, G. J., Rudd, M. D., Merling, L. F., Davies, C. D., Katz, B. W., & Tolin, D. F. (2020) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2020.09.010 · Cited by 22
Interventions of choice for the prevention and treatment of suicidal behaviours: An umbrella review
Sufrate‐Sorzano, T., Santolalla‐Arnedo, I., Garrote‐Cámara, M. E., Nalda, B. A., Cotelo‐Sáenz, R., Pastells‐Peiró, R., Bellon, F., Blanco‐Blanco, J., Juárez‐Vela, R., & Molina‐Luque, F. (2023) · Nursing Open · doi:10.1002/nop2.1820 · Cited by 19
“…Lai et al. (2014) Lapierre (2011) Larsen et al. (2016) Macedo et al. (2014) Meerwijk et al. (2016) Melia et al. (2020) MéndezBustos et al. (2019) Milner et al. (2015) Milner et al. (2014) Okolie et al. (2017) Riblet et al. (2017) Robinson et al. (2016) Tighe et al. (2018) Winter et al.…”
BackgroundMethodInfluential
Untitled work
Teismann (2019) · doi:10.1159/000493887 · Cited by 18
Brief Interventions for Self-injurious Thoughts and Behaviors in Young People: A Systematic Review
Dobias, M. L., Chen, S., Fox, K. R., & Schleider, J. L. (2023) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-023-00424-9 · Cited by 25
Developing a post-discharge suicide prevention intervention for children and young people: a qualitative study of integrating the lived-experience of young people, their carers, and mental health clinicians
Watling, D. P., Preece, M. H. W., Hawgood, J. L., Bloomfield, S., & Kõlves, K. (2022) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-022-00460-3 · Cited by 18
A Systematic Review of Training Interventions for Emergency Department Providers and Psychosocial Interventions delivered by Emergency Department Providers for Patients who self-harm
Zarska, A., Barnicot, K., Lavelle, M., Dorey, T., & McCabe, R. (2022) · Archives of Suicide Research · doi:10.1080/13811118.2022.2071660 · Cited by 17
“However, past research found follow-up contacts alone to be ineffective: two meta-analyses concluded the evidence was not sufficiently strong for it to be recommended (Hawton et al., 2016; Milner et al., 2015).”
Background
Interventions for attempted suicide
Menon, V., & Vijayakumar, L. (2022) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000807 · Cited by 17
“Interestingly, limited evidence (from three trials) suggested a significant reduction in repeat event rates (reattempts or repeat self-harm) [22].”
Background
Suicide reattempt in a population-wide brief contact intervention to prevent suicide attempts: The VigilanS program, France
Djembi, L. F., Debien, C., Demarty, A.-L., Vaïva, G., & Messiah, A. (2021) · European Psychiatry · doi:10.1192/j.eurpsy.2021.2221 · Cited by 17
“These monitoring programs are commonly referred to as "Brief Contact Interventions " (BCIs) [19, 20].”
BackgroundMethodResultInfluential
Development of the Veterans Crisis Line Caring Letters Suicide Prevention Intervention
Reger, M. A., Lauver, M., Manchester, C., Abraham, T. H., Landes, S. J., Garrido, M. M., Griffin, C., Woods, J. A., Strombotne, K. L., & Hughes, G. (2022) · Health Services Research · doi:10.1111/1475-6773.13985 · Cited by 16
Prevention of Suicidal Behavior with Telemedicine in Patients with a Recent Suicide Attempt: Is a 6‐month Intervention Long Enough?
Gabilondo, A., Aristegi, E., González-Pinto, A. M., Zurimendi, J. M., del Pino, M. M., Roca, R., Zorrilla, E. P., & Iruín, Á. (2019) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12576 · Cited by 14
Suicide Prevention Interventions and Their Linkages in Multilayered Approaches for Older Adults: A Review and Comparison
Sakashita, T., & Oyama, H. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.842193 · Cited by 15
“However, this follow-up care has often not been designed to be integrated with other prevention strategies (40, 42), which might limit its benefits.”
Background
An Emergency Department‐Initiated Intervention to Lower Relapse Risk after Attempted Suicide
Martínez‐Alés, G., Jiménez‐Sola, E., Román‐Mazuecos, E., Sánchez-Castro, P., de Dios, C., Vega, B. R., & Bravo‐Ortiz, M. F. (2019) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12542 · Cited by 15
Psychiatric intervention and repeated admission to emergency centres due to drug overdose
Kanehara, A., Yamana, H., Yasunaga, H., Matsui, H., Ando, S., Okamura, T., Kumakura, Y., Fushimi, K., & Kasai, K. (2015) · BJPsych Open · doi:10.1192/bjpo.bp.115.002204 · Cited by 13
MEDIACONNEX: a multicenter randomised trial based on short message service to reduce suicide attempt recurrence in adolescents
Ligier, F., Kabuth, B., & Guillemin, F. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0965-8 · Cited by 12
“These different care modalities have diverse results depending on the sex or personality of the patient [21].”
Background
A pilot study of a text message and online brief contact intervention following self-harm or a suicide attempt: A mixed methods evaluation
Josifovski, N., Shand, F., Morley, K. C., Chia, J., Henshaw, R. C., Petrie, K., Reda, B., Li, E., Theobald, A., Onie, S., et al. (2022) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2022.03.002 · Cited by 12
Community-based screening intervention for depression affects suicide rates among middle-aged Japanese adults
Oyama, H., & Sakashita, T. (2017) · Psychological Medicine · doi:10.1017/s0033291717000204 · Cited by 12
“Recent reviews of brief contact interventions for reducing suicide risk have found that letter-based correspondence with people at risk of suicide who were less likely to adhere to treatment had a preventive influence (Luxton et al. 2013; Milner et al. 2015).”
BackgroundInfluential

Authors: Milner, A. J., Carter, G., Pirkis, J., Robinson, J., & Spittal, M. J.
Affiliations: The University of Melbourne (AU)
ORCID: Milner, Allison J.
Pirkis, Jane
Robinson, Jo
Spittal, Matthew J.
Venue: British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 2015-03
Volume: 206
Issue: 3
Pages: 184-190
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/bjp.bp.114.147819
OpenAlex: W2123846655
Cited by: 211
References: 47
Citations by year: 2026: 6 · 2025: 15 · 2024: 17 · 2023: 19 · 2022: 21 · 2021: 24 · 2020: 17 · 2019: 21 · 2018: 21 · 2017: 22 · 2016: 21 · 2015: 6
FWCI: 3.35
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified, 1038 d)
Locations: The British Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Minerva Access (University of Melbourne) (submittedVersion)
Figshare (submittedVersion, cc-by)
NOVA (University of Newcastle Australia) (submittedVersion)
Funders: Medical Research Council
National Health and Medical Research Council (546248)
Topics: Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords: self-harm, suicide attempts, suicide prevention, telephone-delivered intervention, postcards, intervention effectiveness
MeSH terms: Suicide Prevention, Humans, Postal Service, Psychotherapy, Brief, Suicide, Attempted, Telephone, Self-Injurious Behavior

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Letters, green cards, telephone calls and postcards: systematic and meta-analytic review of brief contact interventions for reducing self-harm, suicide attempts and suicide.

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