Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries
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OBJECTIVE: To determine whether brief intervention and contact is effective in reducing subsequent suicide mortality among suicide attempters in low and middle-income countries. METHODS: Suicide attempters (n = 1867) identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, China) participated, from January 2002 to October 2005, in a randomized controlled trial to receive either treatment as usual, or treatment as usual plus brief intervention and contact (BIC), which included patient education and follow-up. Overall, 91% completed the study. The primary study outcome measurement was death from suicide at 18-month follow-up. FINDINGS: Significantly fewer deaths from suicide occurred in the BIC than in the treatment-as-usual group (0.2% versus 2.2%, respectively; chi2 = 13.83, P < 0.001). CONCLUSION: This low-cost brief intervention may be an important part of suicide prevention programmes for underresourced low- and middle-income countries.
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Cites
The world report on violence and health
Krug, E. G., Mercy, J. A., Dahlberg, L. L., & Zwi, A. B. (2002) · The Lancet · doi:10.1016/s0140-6736(02)11133-0 · Cited by 9,110 · see citing works
Suicide Prevention Strategies: A Systematic Review
Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., Hegerl, U., Lonnqvist, J., Malone, K., Marusic, A., et al. (2005) · JAMA · doi:10.1001/jama.294.16.2064 · Cited by 2,852 · see citing works
Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research
(1994) · doi:10.17226/2139 · Cited by 2,073 · see citing works
Brief interventions for alcohol problems: a review
BIEN, T. H., MILLER, W. R., & TONIGAN, J. S. (1993) · Addiction · doi:10.1111/j.1360-0443.1993.tb00820.x · Cited by 1,577 · see citing works
Cognitive Therapy for the Prevention of Suicide Attempts: A Randomized Controlled Trial
Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005) · JAMA · doi:10.1001/jama.294.5.563 · Cited by 1,045 · see citing works
A randomized controlled trial of postcrisis suicide prevention.
Motto, J. A., & Bostrom, A. G. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.6.828 · Cited by 517 · see citing works
De Leo, D., Buono, M. D., & Dwyer, J. (2002) · British Journal of Psychiatry · doi:10.1192/bjp.181.3.226 · Cited by 246 · see citing works
Flagged first, then by citations
Research works printed but not linked: 18
- Schmidtke A, Bille-Brahe U, De Leo D, Kerkhof A, Bjerke T, Crepet P, et al. 4. Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO multicentre study on parasuicide. Acta Psychiatr Scand 1996;93:327-38. PMID:8792901 doi:10.1111/j.1600-0447.1996. tb10656.x Hultén · DOI
- A, Wasserman D, Hawton K, Jiang GX, Salander-Renberg E, Schmidtke A, et al. Recommended care for young people (15-19 years) after suicide attempts in certain European countries. Eur Child Adolesc Psychiatry 2000;9:100-8. PMID:10926059 doi:10.1007/PL00010707 Gunnell · DOI
- D, Frankel S. Prevention of suicide: aspirations and evidence. BMJ 1994;308:1227-33. PMID:8080520
- HL, Fick G, Love EJ. Suicide following an inpatient hospitalization for a suicide attempt: a Canadian follow-up study. Soc Psychiatry Psychiatr Epidemiol 1998;33:543-51. PMID:9803822 doi:10.1007/s001270050092 Bennewith · DOI
- O, Stocks N, Gunnell D, Peters TJ, Evans MO, Sharp DJ. General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomized controlled trial. BMJ 2002;324:1254-7. PMID:12028981 doi:10.1136/bmj.324.7348.1254 The · DOI
- AL. National strategies for the reduction and prevention of suicide. Crisis 2005;26:1-3. PMID:15762077 Bertolote
- JM. Suicide prevention: at what level does it work? World Psychiatry 2004;3:147-51. PMID:16633479
- K, Arensman E, Townsend E, Bremner S, Feldman E, Goldney R, et al. Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ 1998;317:441-7. PMID:9703526
- U, Wittmann L, Schnyder U, Michel K. Psychological and psychosocial interventions after attempted suicide. An overview of treatment studies. Crisis 2004;25:108-17. PMID:15387237 Beautrais
- AL. Suicides and serious suicide attempts: Two populations or one? Psychol Med 2001;31:837-45. PMID:11459381 doi:10.1017/ S0033291701003889 Motto · DOI
- JA. Suicide prevention for high-risk persons who refuse treatment. Suicide Life Threat Behav 1976;6:223-30. PMID:1023455 Motto
- JA, Heilbron DC, Juster RP, Bostrom AG. Communication as a suicide prevention program. In: Soubrier JP, Vedrienne J, eds. Depression and suicide. Paris: Pergamon; 1981. pp.143-166. Motto
- Leo D, Carollo G, Dello Buono M. Lower suicide rates associated with a tele-help/tele-check service for the elderly at home. Am J Psychiatry 1995; 152:632-4. PMID:7694919
- TF, Higgins-Biddle JC. Alcohol screening and brief intervention: dissemination strategies for medical practice and public health. Addiction 2000;95:677-86. PMID:10885042 doi:10.1046/j.1360- 0443.2000.9556773.x Babor · DOI
- HJ. Efficacy of different strategies of after-care for patients who have attempted suicide. J R Soc Med 1989;82:643-8. PMID:2556579 Bertolote
- JM, Fleischmann A, De Leo D, Bolhari J, Botega N, De Silva D, et al. Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey. Psychol Med 2005;35:1457-65. PMID:16164769 doi:10.1017/S0033291705005404 Fleischmann · DOI
- A, Bertolote JM, De Leo D, Botega N, Phillips M, Sisask M, et al. Characteristics of attempted suicides seen in emergency-care settings of general hospitals in eight low-and middle-income countries. Psychol Med 2005;35:1467-74. PMID:16164770 doi:10.1017/S0033291705005416 Multisite · DOI
- -Wasserman D. Suicidal communication of persons attempting suicide and responses of significant others. Acta Psychiatr Scand 1986;73:481-99. PMID:3751655 doi:10.1111/j.1600-0447.1986.tb02715.x Wasserman D. 32. Suicide: an unnecessary death. London: Dunitz; 2001. · DOI
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Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010) · Psychological Review · doi:10.1037/a0018697 · Cited by 5,292 · see citing works
Suicide prevention strategies revisited: 10-year systematic review
Zalsman, G., Hawton, K., Wasserman, D., van Heeringen, K., Arensman, E., Sarchiapone, M., Carli, V., Höschl, C., Barzilay, R., Balazs, J., et al. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30030-x · Cited by 1,765 · see citing works
Suicide mortality and coronavirus disease 2019—a perfect storm?
Reger, M. A., Stanley, I. H., & Joiner, T. E. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.1060 · Cited by 1,026 · see citing works
School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial
Wasserman, D., Hoven, C. W., Wasserman, C., Wall, M., Eisenberg, R., Hadlaczky, G., Kelleher, I., Sarchiapone, M., Apter, A., Balazs, J., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(14)61213-7 · Cited by 781 · see citing works
Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., Chaudhury, S. R., Bush, A. L., & Green, K. L. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.1776 · Cited by 648 · see citing works
van Ginneken, N., Tharyan, P., Lewin, S., Rao, G. N., Meera, S., Pian, J., Chandrashekar, S., & Patel, V. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009149.pub2 · Cited by 575 · see citing works
Simon, G. E., Rutter, C. M., Peterson, D., Oliver, M., Whiteside, U., Operskalski, B., & Ludman, E. J. (2013) · Psychiatric Services · doi:10.1176/appi.ps.201200587 · Cited by 575 · see citing works
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Mann, J. J., Michel, C. A., & Auerbach, R. P. (2021) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.20060864 · Cited by 577 · see citing works
Suicide Prevention in an Emergency Department Population: The ED-SAFE Study
Miller, I. W., Camargo, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., Manton, A. P., Espinola, J. A., Jones, R., Hasegawa, K., et al. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.0678 · Cited by 418 · see citing works
Suicide and Suicidal Attempts in the United States: Costs and Policy Implications
Shepard, D. S., Gurewich, D., Lwin, A. K., Reed, G. A., & Silverman, M. M. (2016) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12225 · Cited by 413 · see citing works
Suicide following self-harm: Findings from the Multicentre Study of self-harm in England, 2000–2012
Hawton, K., Bergen, H., Cooper, J., Turnbull, P., Waters, K., Ness, J., & Kapur, N. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.12.062 · Cited by 393 · see citing works
A systematic review of social factors and suicidal behavior in older adulthood
Fässberg, M. M., Orden, K. A. V., Duberstein, P., Erlangsen, A., Lapierre, S., Bodner, E., Canetto, S. S., Leo, D. D., Szanto, K., & Waern, M. (2012) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph9030722 · Cited by 342 · see citing works
Suicide Attempt in Young People: A Signal for Long-term Health Care and Social Needs
Goldman-Mellor, S. J., Caspi, A., Harrington, H., Hogan, S., Nada-Raja, S., Poulton, R., & Moffitt, T. E. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.2803 · Cited by 310 · see citing works
Suicide risk assessment and intervention in people with mental illness
Bolton, J. M., Gunnell, D., & Turecki, G. (2015) · BMJ · doi:10.1136/bmj.h4978 · Cited by 294 · see citing works
Gysin-Maillart, A., Schwab, S., Soravia, L., Megert, M., & Michel, K. (2016) · PLOS Medicine · doi:10.1371/journal.pmed.1001968 · Cited by 293 · see citing works
“Exceptions are the treatment studies by Fleischmann et al. [12], Brown et al. [11], and, most recently, Rudd et al. [13] reporting significant risk reductions over 18, and 24 months.”
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Robinson, J., Bailey, E., Witt, K., Stefanac, N., Milner, A., Currier, D., Pirkis, J., Condron, P., & Hetrick, S. (2018) · EClinicalMedicine · doi:10.1016/j.eclinm.2018.10.004 · Cited by 242 · see citing works
Suicide risk assessment in clinical practice: pragmatic guidelines for imperfect assessments
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Luxton, D. D., June, J. D., & Comtois, K. A. (2013) · Crisis · doi:10.1027/0227-5910/a000158 · Cited by 218 · see citing works
Milner, A. J., Carter, G., Pirkis, J., Robinson, J., & Spittal, M. J. (2015) · British Journal of Psychiatry · doi:10.1192/bjp.bp.114.147819 · Cited by 211 · see citing works
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Parra-Uribe, I., Blasco-Fontecilla, H., Garcia-Parés, G., Martínez-Naval, L., Valero-Coppin, O., Cebrià-Meca, A., Oquendo, M. A., & Palao-Vidal, D. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1317-z · Cited by 195 · see citing works
Carter, G., Page, A., Large, M., Hetrick, S., Milner, A. J., Bendit, N., Walton, C., Draper, B., Hazell, P., Fortune, S., et al. (2016) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867416661039 · Cited by 167 · see citing works
Treatment engagement: a neglected aspect in the psychiatric care of suicidal patients.
Lizardi, D., & Stanley, B. (2010) · Psychiatric Services · doi:10.1176/ps.2010.61.12.1183 · Cited by 161 · see citing works
Comtois, K. A., Kerbrat, A. H., DeCou, C. R., Atkins, D. C., Majeres, J. J., Baker, J. C., & Ries, R. K. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.4530 · Cited by 144 · see citing works
Inagaki, M., Kawashima, Y., Kawanishi, C., Yonemoto, N., Sugimoto, T., Furuno, T., Ikeshita, K., Eto, N., Tachikawa, H., Shiraishi, Y., et al. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.12.048 · Cited by 137 · see citing works
Erlangsen, A., Lind, B. D., Stuart, E. A., Qin, P., Stenager, E., Larsen, K. J., Wang, A. G., Hvid, M., Nielsen, A. C., Pedersen, C. M., et al. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)00083-2 · Cited by 116 · see citing works
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DeVylder, J. E., Ryan, T. C., Cwik, M., Wilson, M. E., Jay, S., Nestadt, P. S., Goldstein, M., & Wilcox, H. C. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.14070 · Cited by 109 · see citing works
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“Finally, an international study in several low- and middle-income countries utilized an hour-long informational video at the emergency department coupled with 9 follow-up phone calls and found decreased suicides after 18 months postdischarge compared with treatment as usual.(157) No differences in repeat suicide attem…”
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Effectiveness of brief psychological interventions for suicidal presentations: a systematic review
McCabe, R., Garside, R., Backhouse, A., & Xanthopoulou, P. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1663-5 · Cited by 102 · see citing works
Inagaki, M., Kawashima, Y., Yonemoto, N., & Yamada, M. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2017-7 · Cited by 95 · see citing works
Campo, J. V., Geist, R., & Kolko, D. J. (2018) · The Canadian Journal of Psychiatry · doi:10.1177/0706743717751668 · Cited by 86 · see citing works
Davidson, C. L., Babson, K. A., Bonn‐Miller, M. O., Souter, T., & Vannoy, S. (2013) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12014 · Cited by 71 · see citing works
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Ghanbari, B., Malakouti, S. K., Nojomi, M., Alavi, K., & Khaleghparast, S. (2015) · Global Journal of Health Science · doi:10.5539/gjhs.v8n5p145 · Cited by 55 · see citing works
Postcards, green cards and telephone calls: Therapeutic contact with individuals following self-harm
Kapur, N., Cooper, J., Bennewith, O., Gunnell, D., & Hawton, K. (2010) · British Journal of Psychiatry · doi:10.1192/bjp.bp.109.072496 · Cited by 55 · see citing works
Luxton, D. D., Thomas, E. K., Chipps, J., Relova, R. M., Brown, D., McLay, R., Lee, T. T., Nakama, H., & Smolenski, D. J. (2014) · Contemporary Clinical Trials · doi:10.1016/j.cct.2014.01.007 · Cited by 52 · see citing works
Youth suicide prevention: does access to care matter?
Campo, J. V. (2009) · Current Opinion in Pediatrics · doi:10.1097/mop.0b013e32833069bd · Cited by 52 · see citing works
Chesin, M. S., Stanley, B., Haigh, E. A. P., Chaudhury, S. R., Pontoski, K., Knox, K. L., & Brown, G. K. (2017) · Archives of Suicide Research · doi:10.1080/13811118.2016.1164642 · Cited by 50 · see citing works
Dimeff, L. A., Jobes, D. A., Chalker, S. A., Piehl, B. M., Duvivier, L. L., Lok, B. C., Zalake, M. S., Chung, J., & Koerner, K. (2020) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2018.05.005 · Cited by 49 · see citing works
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Brown, G. K., & Green, K. L. (2014) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2014.06.006 · Cited by 39 · see citing works
Rengasamy, M., & Sparks, G. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201800421 · Cited by 36 · see citing works
Richardson, J. S., Mark, T. L., & McKeon, R. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300196 · Cited by 30 · see citing works
Clinical risk factors among youth at high risk for suicide in South Africa and Guyana
Thornton, V. J., Asanbe, C. B., & Denton, E. D. (2019) · Depression and Anxiety · doi:10.1002/da.22889 · Cited by 29 · see citing works
Motivational interviewing to address suicidal ideation: A randomized controlled trial in veterans
Britton, P. C., Conner, K. R., Chapman, B. P., & Maisto, S. A. (2020) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12581 · Cited by 28 · see citing works
Brenner, L. A., Capaldi, V., Constans, J., Dobscha, S., Fuller, M., Matarazzo, B., McGraw, K., Richter, K., Sall, J., Smolenski, D., et al. (2025) · Annals of Internal Medicine · doi:10.7326/annals-24-01938 · Cited by 22 · see citing works
Evidence-based youth suicide prevention and intervention in pediatric primary care settings.
Ruch, D. A., Hughes, J. L., Bridge, J. A., & Fontanella, C. A. (2024) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2024.07.017 · Cited by 10 · see citing works
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Chang, N. A., Jager‐Hyman, S., Brown, G. K., Cunningham, A., & Stanley, B. (2016) · The International Handbook of Suicide Prevention · doi:10.1002/9781118903223.ch23 · Cited by 4 · see citing works
- Authors
- Fleischmann, A.
- Affiliations
- World Health Organization (CH)
- Corresponding author
- Fleischmann, Alexandra
- Venue
- Bulletin of the World Health Organization
- Publisher
- WHO Press
- Published
- 2008-09-01
- Volume
- 86
- Issue
- 9
- Pages
- 703-709
- ISSN
- 0042-9686 (ISSN-L)
- PMC
- PMC2649494
- OpenAlex
- W2123527596
- Cited by
- 470
- References
- 8
- Citations by year
- 2026: 14 · 2025: 16 · 2024: 15 · 2023: 29 · 2022: 32 · 2021: 38 · 2020: 29 · 2019: 43 · 2018: 25 · 2017: 23 · 2016: 38 · 2015: 39 · 2014: 23 · 2013: 25 · 2012: 21
- FWCI
- 21.56
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Bulletin of the World Health Organization (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Griffith Research Online (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- suicide attempters, suicide prevention, suicide mortality, follow-up care, patient education, low- and middle-income countries, emergency department, cross-cultural comparison
- MeSH terms
- Adult, Mental Disorders, Brazil, China, Female, Humans, India, Iran, Male, Professional-Patient Relations, Social Support, Sri Lanka, Suicide, Attempted, Young Adult
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