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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

  • Allison J. Milner (a1), Greg Carter (a2), Jane Pirkis (a3), Jo Robinson (a4) and Matthew J. Spittal (a5)...
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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Copyright
Corresponding author
Allison Milner, The McCaughey Centre: VicHealth Centre for the Promotion of Mental Health & Community Wellbeing, Melbourne School of Population Health, University of Melbourne, Level 5, 207 Bouverie Street Melbourne, VIC 3010, Australia. Email: allison.milner@unimelb.edu.au
Footnotes
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The National Health and Medical Research Council Capacity Building Grant in Population Health and Health Services Research (ID: 546248) provided salary support for A.J.M. The funding source had no involvement in the study design; collection, analysis and interpretation of data; the writing of the report; or in the decision to submit the paper for publication.

Declaration of interest

None.

Footnotes
References
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