Skip to main content
×
×
Home

Postcard intervention for repeat self-harm: randomised controlled trial

  • Annette L. Beautrais (a1), Sheree J. Gibb (a2), Alan Faulkner (a3), David M. Fergusson (a2) and Roger T. Mulder (a2)...
Abstract
Background

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.

Aims

To examine whether a postcard intervention reduces self-harm re-presentations in individuals presenting to the emergency department.

Method

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.

Results

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.

Conclusions

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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Postcard intervention for repeat self-harm: randomised controlled trial
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Postcard intervention for repeat self-harm: randomised controlled trial
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Postcard intervention for repeat self-harm: randomised controlled trial
      Available formats
      ×
Copyright
Corresponding author
Annette L. Beautrais, PhD, Yale University School of Medicine, Department of Emergency Medicine, 464 Congress Avenue, Suite 260, New Haven, CT, 06519, USA. Email: Annette.Beautrais@yale.edu
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
1 Larkin, GL, Beautrais, AL. The epidemiology of emergency department visits for suicide attempts in the South Pacific: New Zealand, 1997–2006. Ann Emerg Med 2008; 51: 554–5.
2 Larkin, GL, Smith, RP, Beautrais, AL. Trends in US emergency department visits for suicide attempts, 1992–2000. Crisis 2008; 29: 7380.
3 Hawton, K, Fagg, J, Simkin, S, Bale, E, Bond, A. Trends in deliberate self-harm in Oxford, 1985–1995. Implications for clinical service and the prevention of suicide. Br J Psychiatry 1997; 171: 556–60.
4 Gibb, SJ, Beautrais, AL. Epidemiology of attempted suicide in Canterbury 1993–2002. N Z Med J 2004; 1205: 19.
5 Crandall, C, Fullerton-Gleason, L, Aguero, R, LaValley, J. Subsequent suicide mortality among emergency department patients seen for suicidal behavior. Acad Emerg Med 2006; 13: 435–42.
6 Gairin, I, House, A, Owens, D. Attendance at the accident and emergency department in the year before suicide: retrospective study. Br J Psychiatry 2003; 183: 2833.
7 Owens, D, Horrocks, J, House, A. Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry 2002; 181: 193–9.
8 De Leo, D, Dello Buono, MD, Dwyer, J. Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in Northern Italy. Br J Psychiatry 2002; 181: 226–9.
9 Vaiva, G, Vaiva, G, Ducrocq, F, Meyer, P, Mathieu, D, Philippe, A, et al. Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: randomised controlled study. BMJ 2006; 332: 1241–5.
10 Brown, GK, Ten Have, T, Henriques, GR, Xie, SX, Hollander, JE, Beck, AT. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA 2005; 294: 563–70.
11 Guthrie, E, Kapur, N, Mackway-Jones, K, Chew-Graham, C, Moorey, J, Mendel, E, et al. Randomised controlled trial of brief psychological intervention after deliberate self poisoning. BMJ 2001; 323: 135.
12 Motto, JA. Suicide prevention for high-risk persons who refuse treatment. Suicide Life Threat Behav 1976; 6: 223–30.
13 Motto, JA, Bostrom, AG. A randomized controlled trial of postcrisis suicide prevention. Psychiatr Serv 2001; 52: 828–33.
14 Carter, GL, Clover, K, Whyte, IM, Dawson, AH, D'Este, C. Postcards from the EDge: 24-month outcomes of a randomised controlled trial for hospital-treated self-poisoning. Br J Psychiatry 2007; 191: 548–53.
15 Carter, GL, Clover, K, Whyte, IM, Dawson, AH, D'Este, C. Postcards from the EDge project: randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning, BMJ 2005; 331: 805.
16 Fleming, TR, Harrington, DP, O'Brien, PC. Designs for group sequential tests. Control Clin Trials 1984, 5: 348–61.
17 Lee, J. Covariance adjustment of rates based on the multiple logistic regression model. J Chronic Dis 1981; 34: 415–26.
18 Hall, DJ, O'Brien, F, Stark, C, Pelosi, A, Smith, H. Thirteen-year follow-up of deliberate self-harm, using linked data. Br J Psychiatry 1998; 172: 239–42.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Postcard intervention for repeat self-harm: randomised controlled trial

  • Annette L. Beautrais (a1), Sheree J. Gibb (a2), Alan Faulkner (a3), David M. Fergusson (a2) and Roger T. Mulder (a2)...
Submit a response

eLetters

Postcard intervention for repeat self-harm

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

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *