Evaluación de un Programa Intensivode Prevención de Reintento de Suicidio (PIPRS) en un Área de Salud de 430.000 personas / Evaluation of an Intensive-Reattempt-Prevention Programme based on problem solving therapy in a catchment area of 430.000 people in Madrid, Spain

Introducción. La prevención del suicidio es objetivo prioritario en salud mental. Tener un antecedente de intento de suicidio se considera factor de alto riesgo para la repetición. Este estudio persigue evaluar la efectividad de un programa de prevención de reintentos de suicidio en un área sanitaria de 430.000 habitantes. Metodología. Se realizó un estudio de seguimiento de 12 meses con todas (871) las personas que entre el 1 de enero de 2013 y el 31 de diciembre de 2015 habían realizado intentos de suicidio y solicitaron atención en salud mental del área. De estas, 292 recibieron tratamiento en un Programa Intensivo de Prevención de Reintentos de Suicidio (PIPRS) mediante terapia breve de solución de problemas y enfoque de gestión de caso y se compararon con 357 pacientes que recibieron tratamiento convencional (Treatment as usual, TAU). Resultados. Repitieron intento de suicidio el 9,0% en el PIPRS frente al 23,3% del TAU (Prueba exacta de Fisher p<0,001) y un NNT=7, IC 95% (5-11). El análisis multivariante de Regresión de Cox mostró que el grupo que recibió TAU tenía una HR= 2,68, IC 95% (1,65-4,35) respecto al grupo PIPRS. La ventaja del PIPRS se mantuvo al controlar por las características no homogéneas de los grupos. Conclusiones. La aplicación de un programa de prevención mediante psicoterapia breve y enfoque de gestión de caso, tras un intento de suicidio, reduce y retrasa en el tiempo la repetición de intentos durante el año siguiente. Destaca un esfuerzo clínico (NNT=7) muy rentable.(AU)

Background. Suicide prevention is a primary goal of mental health care and a past history of suicide attempts is considered a high-risk factor for subsequent attempts. This study aims to evaluate the effectiveness of an intensive suicide-reattempt-prevention program (ISRPP) in a health catchment area of 430.000 inhabitants. Methods. A 12-month follow-up study was conducted with all individuals who, between 1 January 2013 and 31 December 2015, had attempted suicide and sought mental health care in the area. Out of a total of 871 patients treated, 292 received treatment as part of ISRPP using short-term problem-solving therapy and a case management approach. Results were compared to those of 357 patients who received treatment as usual (TAU). Results. Attempted suicide was repeated by 9,0% in the ISRPP group, compared to 23,3% in the TAU (Fisher’s exact test p<0,001). The number needed to treat (NNT) was=7; 95% CI 95% (5-11). A multivariate Cox regression analysis showed that the TAU group had a hazard ratio (HR)=2,68; 95% CI (1,65-4,35) compared to the ISRPP group. The advantage of ISRPP was maintained when controlling for the non-homogeneous characteristics of the groups. Conclusions. Applied after a suicide attempt, an intensive prevention programme based on brief cognitive behavioural therapy (CBT) and case management reduces and delays repeat suicide attempts at one-year follow-up. The clinical effort is remarkable (NNT=7).(AU)

Cost-effectiveness of a Contact Intervention and a Psychotherapeutic Program for Post-discharge Suicide Prevention.

OBJECTIVE: To determine the cost-effectiveness of 2 strategies for post-discharge suicide prevention, an Enhanced Contact intervention based on repeated in-person and telephone contacts, and an individual 2-month long problem-solving Psychotherapy program, in comparison to facilitated access to outpatient care following a suicide attempt. METHODS: We conducted a cost-effectiveness analysis based on a decision tree between January and December 2019. Comparative effectiveness estimates were obtained from an observational study conducted between 2013 and 2017 in Madrid, Spain. Electronic health care records documented resource use (including extra-hospital emergency care, mortality, inpatient admission, and disability leave). Direct cost data were derived from Madrid's official list of public health care prices. Indirect cost data were derived from Spain's National Institute of Statistics. RESULTS: Both augmentation strategies were more cost-effective than a single priority outpatient appointment considering reasonable thresholds of willingness to pay. Under the base-case scenario, Enhanced Contact and Psychotherapy incurred, respectively, €2,340 and 6,260 per averted attempt, compared to a single priority appointment. Deterministic and probabilistic sensitivity analyses showed both augmentation strategies to remain cost-effective under several scenarios. Enhanced Contact was slightly cost minimizing in comparison to Psychotherapy (base-case scenario: €-196 per averted attempt). CONCLUSIONS: Two post-discharge suicide prevention strategies based on Enhanced Contact and Psychotherapy were cost-effective in comparison to a single priority appointment. Increasing contacts between suicide attempters and mental health-care providers was slightly cost minimizing compared to psychotherapy.

A Real-World Effectiveness Study Comparing a Priority Appointment, an Enhanced Contact Intervention, and a Psychotherapeutic Program Following Attempted Suicide.

OBJECTIVE: To determine the comparative effectiveness of 3 real-practice preventive programs aimed at lowering the relapse risk following a suicide attempt: a single priority appointment with an outpatient psychiatrist, an enhanced contact intervention, and an individual psychotherapy program. METHODS: This observational study was conducted in a sample of 1,492 suicide attempters from 3 catchment areas in Madrid, Spain, between 2013 and 2017. Relapse was defined as an emergency department return after a new attempt within a 1-year follow-up. Kaplan-Meier survival functions were obtained by intervention, and Cox proportional hazard regression models were used to estimate unadjusted and adjusted risks of relapse by intervention. Sex- and age-stratified analyses were also conducted. Covariates were age, sex, history of suicide attempts, history of psychiatric disorders, main ICD-10 psychiatric diagnostic groups, medical comorbidities, and family support. RESULTS: A total of 133 subjects (8.9%) relapsed. The psychotherapy group had a lower presence of known risk factors for suicide attempt. Individual psychotherapy and enhanced contact were more effective than a single priority appointment at reducing suicide reattempt, with a 40% lower relapse risk in adjusted models. Results did not differ after sex and age stratification. CONCLUSIONS: In a naturalistic clinical setting, patients exposed to individual psychotherapy or an enhanced contact intervention had a similar, lower relapse risk than the single priority appointment group.