Effects of Community-Based Caring Contact in Reducing Thwarted Belongingness Among Postdischarge Young Adults With Self-Harm: Randomized Controlled Trial.

BACKGROUND: For patients with self-harm behaviors, the urge to hurt themselves persists after hospital discharge, leading to costly readmissions and even death. Hence, postdischarge intervention programs that reduce self-harm behavior among patients should be part of a cogent community mental health care policy. OBJECTIVE: We aimed to determine whether a combination of a self-help mobile app and volunteer support could complement treatment as usual (TAU) to reduce the risk of suicide among these patients. METHODS: We conducted a pragmatic randomized controlled trial on discharged patients aged between 18 and 45 years with self-harm episodes/suicide attempts, all of whom were recruited from 4 hospital emergency departments in Hong Kong. Participants were randomly assigned to one of three groups: (1) mobile app + TAU ("apps"), (2) mobile app + volunteer support + TAU ("volunteers"), or (3) TAU only as the control group ("TAU"). They were asked to submit a mobile app-based questionnaire during 4 measurement time points at monthly intervals. RESULTS: A total of 40 participants were recruited. Blending volunteer care with a preprogrammed mobile app was found to be effective in improving service compliance. Drawing upon the interpersonal-psychological theory of suicide, our findings suggested that a reduction in perceived burdensomeness and thwarted belongingness through community-based caring contact are linked to improvement in hopelessness, albeit a transient one, and suicide risk. CONCLUSIONS: A combination of volunteer care with a self-help mobile app as a strategy for strengthening the continuity of care can be cautiously implemented for discharged patients at risk of self-harm during the transition from the hospital to a community setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT03081078; https://clinicaltrials.gov/study/NCT03081078.

An evaluation of the long-term sustainability of suicide prevention programs in an offshore Island.

INTRODUCTION: In 2002, a suicide prevention program for visitors was implemented in Cheung Chau, an offshore island with 21,000 residents and many visitors. This research revisited the intervention and evaluated its long-term effectiveness. Insights are provided into implementing a sustainable intervention. METHODS: Suicide death records (2007-2017) of Cheung Chau residents and visitors were retrieved. Information related to suicide method and sociodemographic characteristics of people who died by suicide were explored. Bivariate analyses were conducted to examine differences between visitors and residents; visitors and residents who died in Cheung Chau; and residents who died in or outside Cheung Chau. RESULTS: After post-implementation period, suicide rate for visitors and residents increased. Visitors were generally younger than the residents with a different distribution of type of housing. Most of the visitors killed themselves by charcoal burning, and nearly half of the residents used hanging. CONCLUSION: Long-term evaluation and monitoring of suicide prevention programs and sustained efforts are crucial to ensure program success. The prevention program in Cheung Chau was initially effective, but its long-term effects wore off. Both the mental health needs of visitors and residents should be addressed. Refinement of the current program and sustainable efforts are required for ensuring long-term success.

Short- and long-term effects of a community-based suicide prevention program: A Hong Kong experience.

BACKGROUND: A multidisciplinary, multilayer, community-based suicide prevention program (2008-2012) was implemented in the Eastern District, Hong Kong. This article documents the program and reports on short- and longer-term program evaluation. METHODS: Characteristics and rates of self-harm/suicidal behaviors and suicide deaths by age group and gender in the Eastern District before, during, and after the intervention were calculated and compared with the rest of Hong Kong, using Kruskal-Wallis and chi-squared tests, and Jonckheere-Terpstra and Cochran-Mantel-Haenszel tests for trend analyses. RESULTS: The program impacts varied by age and gender subgroups. Suicide rates in the Eastern District were lower compared to the rest of Hong Kong during the intervention period. They slowly rebounded after the intervention ceased; nevertheless, they remained lower than the rest of Hong Kong until 2016. The rates of self-harm continuously dropped and remained lower than the rest of Hong Kong. During the intervention period in the Eastern District, the age of people who died by suicide increased; more deaths occurred from jumping and fewer by charcoal burning. CONCLUSIONS: The program coincided with the lowered self-harm and suicide rates after the implementation. Some of the strategies need to be rebooted or routinely and continuously implemented to ensure the sustainability.