Thirteen emergency departments in the north of France recruited patients over a six month period, during the day but not at weekends. Overall, 605 patients were included. The mean age of participants did not differ from that of non-participants. The sex ratio of participants was three men for every seven women compared with four men for every six women for non-participants (P = 0.0001, χ2 = 47, df = 1).
Overall, 70% of participants in both of the intervention groups were successfully contacted by telephone. Compared with the contacted participants, fewer of the non-contactable ones were depressed (35% (31/89) v 48% (98/204); P = 0.05, χ2 = 3.8, df = 1) or had a somatisation disorder (13% (n = 11) v 24% (n = 49); P = 0.03, χ2 = 4.8, df = 1). No difference was found for age, sex, personal factors, number of previous suicide attempts, or severity of psychopathological disorders.
At the end of the 13 month follow-up period we assessed all the included participants, regardless of whether their assigned telephone intervention had taken place. Fifty seven were lost to follow-up (9%). These were more often men (38% (22/57) v 27% (147/545); P = 0.07), had arrived at the emergency department on their own (59% (n = 34) v 42% (n = 229); P = 0.01), were more likely to be drunk (53% (n = 30) v 40% (n = 218); P = 0.05), and had fewer social phobias (2% (n = 1) v 13% (n = 71); P = 0.02).
Six participants died: two among the intervention groups (one a possible suicide from a road traffic incident and the other cancer), two in the control group (both by suicide), and two who were lost to follow-up (one from suicide and one from an ischaemic vascular attack).
The randomised groups did not differ for personal characteristics, psychopathological assessments, previous suicide attempts, or ongoing treatment in the emergency departments ().
Baseline characteristics of participants assigned to telephone contact at one month or three months after attempted suicide or to usual treatment (controls). Values are numbers (percentages) unless stated otherwise
Effect of contact by telephone
On an intention to treat basis, the three groups did not differ significantly for proportion with an adverse outcome (P = 0.25, ): contact at one month (one death (cancer), 23% (34/147) v 30% (93/312) in control group, difference 7%, 95% confidence interval - 2% to 15%); contact at three months (one death from suicide, 5% (36/146) v 30% in control group, difference 5%, - 4% to 14%); comparison between contact at one month and contact at three months (23% v 25%, difference 2%, - 11% to 8%).
Results of intention to treat analysis in participants assigned to telephone contact one month or three months after attempted suicide or to usual treatment (controls). Values are numbers (percentages) unless stated otherwise
The number of participants contacted at one month who reattempted suicide was significantly lower than that of controls (12% (13/107) v 22% (62/280); χ2 = 4.7, df = 1, P = 0.03, difference 10%, 95% confidence interval 2% to 18%). This difference was seen over the first six months after telephone contact. No deaths from suicide occurred in this group.
For participants contacted at three months, the number who attempted further suicide was not significantly lower than that of controls (17% (16/95) v 22%; P = 0.27, difference 5%, - 4% to 14%).
Attendance for treatment
Participants in the interventions groups talked about their attempted suicide with their general practitioner more often than the controls ().
Use of healthcare resources during 13 months' follow-up in participants contacted by telephone one month or three months after attempted suicide
Of the 107 participants contacted at one month, 72 were ordinary calls (lasting 5-10 minutes), 22 concerned crisis intervention (15-45 minutes), and 13 detected participants at high risk of suicide. Seven of the 72 participants who seemed alright at the time of contact attempted suicide during the following year. Of the 22 participants who required crisis intervention, five attempted suicide within a year. Thirteen participants were sent to the emergency department; 10 were considered by the psychiatrist as being at risk and eight of these were admitted to hospital. Only one of these 13 patients reattempted suicide, six months later.