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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.
Open accessAbstract
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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“National suicide prevention best practices recommend that individuals identified as being at risk of suicide receive treatment specifically directed to reduce their risk of suicide and services to ensure they remain engaged in mental health care.6”
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“In contrast to other resource intensive suicide-specific interventions that require a mental health specialist, follow-up interventions are typically brief (6-12 sessions), low cost, nondemand interventions that can be conducted by anyone and occur according to a structured schedule over a designated period (e.g., 1 year).77,78”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [77]
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Feasibility of a Supportive Text Messaging Intervention in Northwest Alaska
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“A meta-analytic review (Milner et al., 2015) of brief contact interventions, including telephone calls, postcards, and letters, found a reduction in repeated episodes of self-harm, suicide attempts, and suicide.”
BackgroundCaughlan, C., Kakuska, A. G., Manthei, J., Martinez, A., DiBianco, L., & Rushing, S. C. (2024) · Health Promotion Practice · doi:10.1177/15248399241275610 · Cited by 2
“Milner et al. (2015) conducted a meta-analysis of 12 randomized control trials utilizing a brief CC intervention that included telephone calls, short letters, crisis cards, and postcards to individuals presenting suicidality.”
Milner, A. J., & Carter, G. L. (2016) · Wiley eBooks · doi:10.1002/9781118903223.ch26 · Cited by 2
Research Priorities in Suicide Prevention: Final Report
Reifels, L., Ftanou, M., Krysinska, K. E., Machlin, A., Robinson, J. D., & Pirkis, J. (2017) · Minerva Access (University of Melbourne) · Cited by 1
Randomised controlled trial of a brief theory-based online intervention to reduce self-harm
Keyworth, C., Leather, J. Z., Quinlivan, L. M., O’Connor, R. C., & Armitage, C. J. (2025) · BJPsych Open · doi:10.1192/bjo.2025.2 · Cited by 1
Janssen, W. C., Snijders, T. C., Gerritse, F. L., & van Veen, S. M. P. (2025) · BJPsych International · doi:10.1192/bji.2025.10051 · Cited by 1
McGill, K., Bhullar, N., Carrandi, A., Batterham, P. J., Wayland, S., & Maple, M. J. (2025) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.70043 · Cited by 1
Caring contact SMS text messages following suicidal behaviour
Ng, L. L., Diamond, D., Lozano, C. D. S., & Ang, M. (2025) · Australasian Psychiatry · doi:10.1177/10398562251382455 · Cited by 1
Bullock, H. L., Waddell, K., & Lavis, J. N. (2016) · MacSphere (McMaster University) · Cited by 1
Rusé, J., Clenet, A., Vaïva, G., Debien, C., Arbus, C., & Salles, J. (2023) · BMC Psychiatry · doi:10.1186/s12888-022-04503-z · Cited by 1
“Their effectiveness has been studied extensively in recent years [21], with meta-analyses showing that they reduce the number of suicide attempts per individual [22] and also prevent suicide reattempts at 12 months [23].”
BackgroundAssessment and Management of Suicidal Risk
Melvin, G. A., Oquendo, M. A., Stanley, B., & Posner, K. (2023) · Springer eBooks · doi:10.1007/978-3-030-42825-9_67-1 · Cited by 1
Irigoyen-Otiñano, M., Llorca-Bofí, V., López-Peña, P., Gabilondo, A., Cano‐Escalera, G., Roca, R., Zorrilla, E. P., & González-Pinto, A. M. (2025) · The European Journal of Psychiatry · doi:10.1016/j.ejpsy.2025.100311 · Cited by 1
Effective treatments for suicidal youth
Brent, D. A. (2021) · doi:10.1093/med/9780198834441.003.0069 · Cited by 1
Improving the Efficiency and Scalability of Cognitive Behavioral Therapies
Dobias, M., Schleider, J. L., & Ollendick, T. H. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00075-3 · Cited by 2
Jankowsky, K., Steger, D., & Schroeders, U. (2022) · doi:10.31234/osf.io/sa37x · Cited by 1
Brief interventions and contacts after suicide attempt: A meta-analysis.Preprint
Homan, S., Ritzinger, A. T., Michel, S., Bertram, A.-M., Marciniak, M. A., Rühlmann, C., Pethő, A., Kirchhofer, L., Homan, P., Olbrich, S., et al. (2023) · PsyArXiv (OSF Preprints) · doi:10.31234/osf.io/s2dja · Cited by 1
Adams, A. N., Lyons, C. L., & O’Brien, M. (2016) · Oxford University Press eBooks · doi:10.1093/med/9780190250843.003.0014
Best Practice Following Hospital Presentation for Self-Harm: A Rapid Literature Review
Robinson, S. S., Donaldson, A., Witt, K., & Bailey, E. (2016) · Monash University Research Portal (Monash University)
Vance, M. M. (2019) · Journal of International Crisis and Risk Communication Research
Prevention of suicide following psychiatric hospitalization
Riblet, N. B. V., & Shiner, B. R. (2021) · doi:10.1093/med/9780198834441.003.0061
Psychiatric Issues in the Critically Poisoned Patient
Rasimas, J. J., & Carter, G. L. (2017) · Springer eBooks · doi:10.1007/978-3-319-17900-1_44
Droit et intelligence artificielle en psychiatrie
Mazeau, L., & Berrouiguet, S. (2021) · Éthique Publique · doi:10.4000/ethiquepublique.6571
Comendador, L., Jiménez‐Villamizar, M. P., Sanabria‐Mazo, J. P., Canedo, C. M., Cebrià, A. I., Sanz, A., & Palao, D. J. (2022) · doi:10.31234/osf.io/f2dy8
Les dispositifs d’aide à distance : lignes de force de la prévention du suicide en France
Notredame, C.-É., Jorioz, R., Mannoni, C., Wathelet, M., Grandgenèvre, P., Debien, C., Pauwels, N., Ducrocq, F., Leaune, É., Morgiève, M., et al. (2022) · La Presse Médicale Formation · doi:10.1016/j.lpmfor.2022.07.010
Saúde mental e bem-estar Vol. 1
(2023) · Seven Editora eBooks · doi:10.56238/saudementalebemest
Funderburk, J. S., Shepardson, R. L., Possemato, K., Johnson, E. M., Roelk, B. L., Louer-Thompson, E., Martin, J. L., & Wray, L. O. (2024) · Psychiatric Services · doi:10.1176/appi.ps.20230157
Kartal, D., Jaeger, T., Lamblin, M., Richards, H., Witt, K., Occhipinti, J., Mihalopoulos, C., Chatterton, M. L., Chanen, A. M., McGorry, P. D., et al. (2024) · Research Square · doi:10.21203/rs.3.rs-4285258/v1
Comendador, L., Jiménez‐Villamizar, M. P., Losilla, J.-M., Sanabria‐Mazo, J. P., Canedo, C. M., Sanz, A., Cebrià, A.-I., & Palao, D. J. (2024) · medRxiv · doi:10.1101/2024.05.21.24306868
Baldaçara, L., Périco, C. D. A.-M., Pinto, F. I., Grüdtner, R. R., Calfat, E. L. D. B., da Rocha, G. A., Porto, D. M., Leite, V. D. S., Robis, K. P., Fidalgo, T. M., et al. (2024) · Debates em Psiquiatria · doi:10.25118/2763-9037.2024.v14.1262
Baldaçara, L., Périco, C. D. A.-M., Pinto, F. I., Grüdtner, R. R., Calfat, E. L. D. B., da Rocha, G. A., Porto, D. M., Leite, V. D. S., Robis, K. P., Fidalgo, T. M., et al. (2024) · Debates em Psiquiatria · doi:10.25118/2763-9037.2024.v14.1263
Assessment and Management of Suicidal Risk
Melvin, G. A., Oquendo, M. A., Stanley, B., & Posner, K. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_67
Chalancon, B., Leaune, É., Vacher, A., Vernet, T., Vieux, M., Lau-Taï, P., Bislimi, K., & Poulet, E. (2025) · L Encéphale · doi:10.1016/j.encep.2024.11.018
Metadata
- Authors
- Milner, A. J., Carter, G., Pirkis, J., Robinson, J., & Spittal, M. J.
- Affiliations
- The University of Melbourne (AU)
- 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
- 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
- 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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