Telephone-based outreach and interventions for persons with suicide attempts – A randomized controlled trial

ABSTRACT Background: Suicidal ideation and a history of suicide attempts (SAs) are risk factors for future suicide. Telephone outreaches as treatment augmentation strategies could address these risks. Aim: To compare the efficacy of manualized addon telephone-based psychosocial interventions (TBPIs) with telephone contacts (TCs) during follow-up on suicidal ideation in individuals with a recent SA. Methods: Using a parallel-group, rater-blind, two-arm, randomized controlled trial design at two general hospital settings, we recruited 390 individuals with recent SA. We excluded recent psychosis, substance dependence, and medically unstable conditions. The TBPI group (N = 194) received three sessions of manualized psychosocial intervention with reminders for treatment adherence. The TC group (n = 196) received three telephone reminders for treatment adherence. Both the outreaches were at weekly intervals. Primary outcomes were changes in Beck’s Scale for Suicide Ideation and rates of repeat suicidal behaviors at 6 months. Results: Using intent to treat analysis at trial completion, TBPI (N = 194, χ 2 = 44.19, W = 0.14, P < 0.001) and TC (N = 196, χ 2 = 20.26, W = 0.07 , P < 0.001) significantly reduced suicidal ideation at 6 months. There were no significant differences between TBPI and TC on suicidal ideation (δ = -0.031(CI = -0.091-0.030), P < 0.323) nor on rates of repeat suicidal behaviors (TBPI, N = 3 [1.5%]; TC N = 5 [2.6%], χ =2.24, P < 0.329). Exploratory analyses revealed significantly reduced suicidal ideation in those who received TBPI irrespective of whether psychiatric disorders were present. Those who received TC and were without psychiatric disorder did not show significantly reduced suicidal ideation. Conclusions: Telephone outreaches - during follow-up - are potential treatment augmentation strategies in individuals at risk of suicide in Indian hospital settings.