A randomised clinical trial was carried out in suicide attempters to assess clinical efficacy of an intensive psychosocial intervention compared with treatment as usual.

Two hundred and seventy-four suicide attempters presenting for medical treatment were randomly assigned to either intensive psychosocial treatment or ‘care as usual’. Intensive psychosocial treatment consisted of brief admission to a special crisis-intervention unit and problem-solving aftercare. ‘Care as usual’ included any form of treatment the assessing clinicians thought appropriate. Psychological well-being was evaluated by the SCL–90 and the Hopelessness Scale at 3, 6 and 12 months following entry in the study.

No differences in outcome were found. The probability of repeat suicide attempts in the 12-month follow-up was 0.17 for patients in the experimental group and 0.15 for the control group. There were no differences in ratings on the SCL–90 and the Hopelessness Scale. Patients in the experimental group attended significantly more out-patient treatment sessions.

General implementation of an intensive in-patient and community intervention programme for suicide attempters does not seem justified.

Attempted suicide rates are much higher in the UK than in the Netherlands. We have compared the characteristics of suicide attempters referred to general hospitals in Oxford and Utrecht.

We compared the characteristics of referrals for attempted suicide to a general hospital in Oxford and one in Utrecht, for the years 1988 and 1989.

Most of the attempters in Oxford were young whereas attempters in Utrecht were older; this age difference was particularly marked in females. Utrecht attempters appeared more often to have socio-economic problems and to suffer from psychiatric and personality disorders (except substance abuse), even when account was taken of the age differences of the two populations.

There is some evidence for different thresholds for attempted suicide in the UK and the Netherlands, although other social explanations for the difference in attempted suicide rates are feasible and require further study.