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Postcards from the EDge: 24-month outcomes of a randomised controlled trial for hospital-treated self-poisoning

  • Gregory L. Carter (a1), Kerrie Clover (a2), Ian M. Whyte (a3), Andrew H. Dawson (a4) and Catherine D'Este (a5)...

Abstract

Background

Repetition of self-poisoning is common.

Aims

To report the 24-month outcomes of a non-obligatory postcard intervention (plus treatment as usual) compared with treatment as usual.

Method

In a randomised-controlled trial (Zelen design) conducted in Newcastle, Australia, eight postcards were sent to participants over a 12-month period. The principal outcomes were the proportion of participants with one or more repeat episodes of self-poisoning and the number of repeat episodes per person.

Results

No significant reduction was observed in the proportion of people repeating self-poisoning in the intervention group (21.2%, 95% CI 17.0–25.3) compared with the control group (22.8%, 95% CI 18.7–27.0; χ 2=0.32, d.f. = 1, P= 0.57); the difference between groups was −1.7% (95% CI −7.5 to 4.2). There was a significant reduction in the rate of repetition, with an incidence risk ratio of 0.49 (95% CI 0.33–0.73).

Conclusions

A postcard intervention maintained the halving of the rate of repetition of hospital-treated self-poisoning events over a 2-year period, although it did not significantly reduce the proportion of individuals who repeated self-poisoning.

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Copyright

Corresponding author

Dr Gregory Carter, Department of Consultation–Liaison Psychiatry, Locked Bag 7, Hunter Region Mail Centre, NSW 2310, Australia. Tel: + 612 4921 1283; fax: + 612 4921 1870; email: Gregory.Carter@newcastle.edu.au

Footnotes

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Declaration of interest

None.

Footnotes

References

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Bateman, A. & Fonagy, P. (1999) Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. American Journal of Psychiatry, 156, 15631569.
Bateman, A. & Fonagy, P. (2001) Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. American Journal of Psychiatry, 158, 3642.
Brown, G. K., Ten Have, T., Henriques, G. R., et al (2005) Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA, 294, 563570.
Buckley, N. A., Whyte, I. M., Dawson, A. H., et al (1999) Preformatted admission charts for poisoning admissions facilitate clinical assessment and research. Annals of Emergency Medicine, 34, 476482.
Carter, G., Clover, K. & Fryer, J. (1999) Deliberate self-harm: can we move the goal posts closer? eBMJ, http://www.bmj.com/cgi/eletters/317/7156/44
Carter, G. L., Clover, K., Whyte, I. M., et al (2005) Postcards from the EDge project: randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning. BMJ, 331, 805807.
Crawford, M. J. & Kumar, P. (2007) Intervention following deliberate self-harm: enough evidence to act? Evidence-Based Mental Health, 10, 3739.
Crawford, M. J., Thomas, O., Khan, N., et al (2007) Psychosocial interventions following self-harm: systematic review of their efficacy in preventing suicide. British Journal of Psychiatry, 190, 1117.
Evans, M. O., Morgan, H. G., Hayward, A., et al (1999) Crisis telephone consultation for deliberate self-harm patients: effects on repetition. British Journal of Psychiatry, 175, 2327.
Evans, J., Evans, M., Morgan, H. G., et al (2005) Crisis card following self-harm: 12-month follow-up of a randomised controlled trial. British Journal of Psychiatry, 187, 186187.
Gunnell, D., Bennewith, O., Peters, T. J., et al (2005) The epidemiology and management of self-harm amongst adults in England. Journal of Public Health, 27, 6773.
Guthrie, E., Kapur, N., Mackway-Jones, K., et al (2001) Randomised controlled trial of brief psychological intervention after deliberate self poisoning. BMJ, 323, 135138.
House, A., Owens, D. & Patchett, L. (1998) Deliberate self-harm. Effective Health Care, 4, 112.
Linehan, M. M., Armstrong, H. E., Suarez, A., et al (1991) Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 10601064.
Linehan, M. M., Comtois, K. A., Murray, A. M., et al (2006) Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757766.
McGrath, J. (1989) A survey of deliberate self-poisoning. Medical Journal of Australia, 150, 317322.
Morgan, H. G., Jones, E. M. & Owen, J. H. (1993) Secondary prevention of non-fatal deliberate self-harm. The green card study. British Journal of Psychiatry, 163, 111112.
Motto, J. A. (1976) Suicide prevention for high-risk persons who refuse treatment. Suicide and Life-Threatening Behavior, 6, 223230.
Motto, J. A. & Bostrom, A. G. (2001) A randomized controlled trial of postcrisis suicide prevention. Psychiatric Services, 52, 828833.
Owens, D., Horrocks, J. & House, A. (2002) Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry, 181, 193199.
Reith, D. M., Whyte, I. M., Carter, G. L., et al (2004) Risk factors for suicide and other deaths following hospital treated self-poisoning in Australia. Australian and New Zealand Journal of Psychiatry, 38, 520525.
Tyrer, P., Thompson, S., Schmidt, U., et al (2003) Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study. Psychological Medicine, 33, 969976.
Vaiva, G., Ducrocq, F., Meyer, P., et al (2006) Effect of telephone contacton further suicide attempts in patients discharged from an emergency department: randomised controlled study. BMJ, 332, 12411245.
Whyte, I. M., Dawson, A. H., Buckley, N. A., et al (1997) A model for the management of self-poisoning. Medical Journal of Australia, 167, 142146.
Whyte, I. M., Buckley, N. A. & Dawson, A. H. (2002) Data collection in clinical toxicology: are there too many variables? Journal of Toxicology – Clinical Toxicology, 40, 223230.
Zelen, M. (1979) A new design for randomized clinical trials. New England Journal of Medicine, 300, 12421245.
Zelen, M. (1990) Randomized consent designs for clinical trials: an update. Statistics in Medicine, 9, 645656.
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Postcards from the EDge: 24-month outcomes of a randomised controlled trial for hospital-treated self-poisoning

  • Gregory L. Carter (a1), Kerrie Clover (a2), Ian M. Whyte (a3), Andrew H. Dawson (a4) and Catherine D'Este (a5)...
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eLetters

Post Cards from the EDge: Replication concerns

Dr. Mukesh Kripalani, Specialist Registrar
30 January 2008

We read with great interest the recently published randomised controlled trial for hospital treated -self poisoning which was conducted in Newcastle, Australia. Given the results of the study, we would like to replicate a similar trial in our clinical setting of liaison psychiatry based in UK.

But prior to proceeding, we would like to clarify certain points which were not clear from the study. This study was primarily targeted forpatients who had presented with self poisoning and other forms of self harm were excluded.It was unclear about the proportion of patients who had a diagnosis of mental illness, co-morbid alcohol misuse and also had support from secondary mental health services, as this could have an impact too on repetition rates.

Moreover could we clarify the proportion of both males and females who had used other self-harming techniques in the past? This is because quite a high proportion of our patients use both forms of self-poisoning and cutting. We would also like to point out those patients with a lack offamily support present more often to us. Hence we believe that the controland the intervention group should have been matched for it.

We would like to know the amount of work generated by people responding to receiving the post-cards in order to estimate the additionalworkload potentially created.

Bed-occupancy criteria need further clarification. Does each episode of self-poisoning lead directly to a certain number of days the patients needs to be in hospital? There are a number of variables which have an impact on that statistic including severity of overdose, accommodation, crisis teams etc to name a few.

We believe the outcome of a qualitative survey would be more beneficial to understand which bit of the entire package of intervention put in place has actually made a difference to the patient. We would welcome its findings whole-heartedly.

Authors:Dr. Mukesh Kripalani, SpR; Dr. Sagarika Nag, Staff Grade; Lyn Williams, Nurse Consultant; Dr. Amanda Gash, Consultant Liaison Psychiatrist

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Conflict of interest: All work for the Liaison Psychiatry team.

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