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Self-harm and suicidal behaviour are common reasons for emergency department presentation. Those who present with self-harm have an elevated risk of further suicidal behaviour and death.
To examine whether a postcard intervention reduces self-harm re-presentations in individuals presenting to the emergency department.
Randomised controlled trial conducted in Christchurch, New Zealand. The intervention consisted of six postcards mailed during the 12 months following an index emergency department attendance for self-harm. Outcome measures were the proportion of participants re-presenting with self-harm and the number of re-presentations for self-harm in the 12 months following the initial presentation.
After adjustment for prior self-harm, there were no significant differences between the control and intervention groups in the proportion of participants re-presenting with self-harm or in the total number of re-presentations for self-harm.
The postcard intervention did not reduce further self-harm. Together with previous results this finding suggests that the postcard intervention may be effective only for selected subgroups.
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Manjeet S Bhatia, Professor and Head
03 August 2010
Postcard intervention for repeat self-harm
Manjeet S Bhatia, Anurag Jhanjee,Department of Psychiatry,U.C.M.S & G.T.B Hospital, Unversity of Delhi, Delhi-110095, India.
In July’s issue of the journal, Annette Beautrais and colleagues (1) reported a randomized controlled trial highlighting the role of postcards in intervention of self-harm cases. Some of important aspects have been appropriately highlighted. However, there are many points which need detailed elaboration. Some of the limitations were as follows:
1.The study included mainly the patients with self-poisoning (nature& type of substance not mentioned; the underlying psychiatric status of the patient was not mentioned.2.The study did not control many important confounding factors viz. age, gender, educational status, ethnicity, treatment details, rationale of sending the postcards less frequently as compared to Carter et al (2) and the details of other modes of self-harm has not been elaborated.3.There are many other variables which are related to treatment settings,therapists, patients, gender, method & lethality of self-harm etc. which needs elaboration.4.As mentioned as ‘Background characteristics’, the details are not provided.5.The study did not include all the visits and the reasons of reluctance of staff to recruit subjects not given. These reasons may be important in planning any similar study in future.6.In such a study, it is important to differentiate suicide ideators, planners, attempters and completers (3). 7.Postcards play an important role in following up and interventions in high risk psychiatric patients (4).
Declaration of Interest: None
References1.Beautrais AL, Gibb SL, Faulkner A, Fergusson DM, Mulder RT. Postcard interventions for repeat self-harm: randomized controlled trial. Br J Psychiatry 2010; 197: 55-60.2.Carte GL, Clover K,. Whyte IM, Dawson AH, D’Este C. Postcards from the Edge: 24-months outcomes of a randomized controlled trial for hospital-treated self-poisoning, Br J Psychiatry 2007; 191:548-53.3.Bhatia MS, Aggarwal NK, Aggarwal BB. Psychosocial profiles of suicide ideators, attempters and completers in India. Int J Soc Psychiatry 2000; 46: 155-63.4.Leo DD, Hawgood J, Ide N, Andersen K, Klieve H. Post-Discharge Care in Psychiatric Patients at High Risk of Suicide.WHO Collaborating Centre on Research and Training in Suicide Prevention. Brisbane, Griffith University, 2008. ... More
Conflict of interest: None Declared
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