ASSIP vs. Crisis Counseling for Preventing Suicide Re-attempts: Outcome Predictor Analysis of a Randomized Clinical Trial Data

Abstract

Objective

Knowledge of the effectiveness and limits of the suitability of brief interventions in suicide prevention is greatly needed. We investigated subgroup differences and predictors for suicide re-attempts within a clinical trial population recruited for a brief intervention to prevent re-attempts.

Methods

Consenting adult patients receiving treatment for a suicide attempt in Helsinki City general hospital emergency rooms in 2016–2017 (n = 239) were randomly allocated to (a) the Attempted Suicide Short Intervention Program (ASSIP) or (b) Crisis Counseling (CC). Participants also received their usual treatment. Information on primary outcome repeat attempts and secondary outcomes was collected via telephone and from medical and psychiatric records for 2 years. As proportions of re-attempts did not differ significantly between ASSIP and CC (29.2 vs. 35.2%), patients were pooled and predictors for suicide re-attempts were analyzed using Kaplan–Meier and logistic regression analyses.

Results

Re-attempts were predicted by participants’ younger age (OR 0.965 [0.933–0.998]), previous suicide attempts (OR 2.437 [1.106–5.370]), psychiatric hospitalization in the year preceding baseline (OR 3.256 [1.422–7.458]), and clinical diagnosis of a personality disorder (OR 4.244 [1.923–9.370]), especially borderline personality disorder (OR 5.922 [2.558–13.709]).

Conclusions

Within a population of suicide attempters consenting to a brief intervention trial, the risk of re-attempt was strongly predicted by subjects’ young age, history of previous attempts, psychiatric hospitalizations, and personality disorder, particularly borderline personality disorder. The composition of treated populations with regard to these characteristics may strongly influence the observed success of brief interventions. Their potential as moderators of treatment effectiveness and as indicators of the utility of brief interventions warrants further investigation.

HIGHLIGHTS

• During the 2-year follow-up, 32% of trial participants reattempted suicide.

• Rates of reattempts varied and were strongly predicted by clinical subgroup.

• Subgroup composition may strongly influence brief interventions’ observed outcome.

Keywords:

• ASSIP
• intervention studies
• outcome
• suicide attempt

CLINICAL TRIAL REGISTRATION

ISRCTN13464512.

ETHICAL APPROVAL

The trial protocol was reviewed and approved by the ethical committee of the Helsinki and Uusimaa Hospital District (HUS), approval number 95/13/03/03/2016, and granted research permits from both the City of Helsinki and the Helsinki and Uusimaa Hospital District. All the participating patients gave written informed consent. The study was conducted in accordance with the Declaration of Helsinki guidelines.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

DATA AVAILABILITY STATEMENT

Due to limitations imposed by the Finnish data protection legislation, research permits, and content of consent provided by the participating patients, data of this study will not be publicly available.

Additional information

Funding

This trial was conducted as part of the crisis services of MIELI Mental Health, Finland, and the study treatments and follow-up were provided without external funding. The researchers received small grants from the Helsinki and Uusimaa Hospital District for purposes of data management, analysis, and writing.

Notes on contributors

Petri Arvilommi

Petri Arvilommi, Selma Gaily-Luoma, and Erkki Isometsä, Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Jukka Valkonen

Jukka Valkonen and Outi Ruishalme, MIELI Mental Health Finland, Helsinki, Finland.

Lars Lindholm

Lars Lindholm, Department of Psychiatry, South Ostrobothnia Hospital District, Seinäjoki, Finland.

Selma Gaily-Luoma

Petri Arvilommi, Selma Gaily-Luoma, and Erkki Isometsä, Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Kirsi Suominen

Kirsi Suominen, Helsinki City Department of Social Services and Health Care, Psychiatric and Substance Abuse Services, Helsinki, Finland.

Anja Gysin-Maillart

Anja Gysin-Maillart, Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland and University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland.

Outi Ruishalme

Jukka Valkonen and Outi Ruishalme, MIELI Mental Health Finland, Helsinki, Finland.

Erkki Isometsä

Petri Arvilommi, Selma Gaily-Luoma, and Erkki Isometsä, Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.