Factors influencing the effectiveness of case management interventions for suicide attempters in a psychiatric hospital.

Aim: Preventing suicide reattempts is important; however, few evidence-based treatments are available. In Japan, the ACTION-J study helped implement case management for suicide attempters in general hospitals and reduced suicide reattempts over a period of up to 6 months. Therefore, the current study aimed to evaluate the effectiveness of case management, modeled after the ACTION-J study, when applied in psychiatric hospitals, and examined the factors influencing suicide reattempts to propose more effective methods of support.

Methods: We conducted a 1-year follow-up study on suicide reattempts after discharge among participants who received case management interventions. Baseline characteristics were extracted, and Cox regression analysis was used to identify the factors influencing suicide reattempts.

Results: Of the 205 participants, 47 (22.9%) reattempted suicide during the observation period. Univariate analysis revealed that the factors significantly associated with suicide reattempts included younger age, adjustment disorder, dissociative disorder, history of previous suicide attempts, and the use of drug overdose as the method of the current attempt. Multivariate analysis showed that dissociative disorders were significant independent factors for suicide attempts.

Conclusions: Factors influencing suicide reattempts among participants in the case management intervention included younger age, adjustment disorder, dissociative disorder, history of previous suicide attempts, and overdose as the method of attempt. In addition to a history of previous suicide attempts and overdoses, which were previously reported, dissociative disorder was observed to strongly influence suicide reattempts, even after case management. Therefore, additional psychotherapeutic strategies, particularly for individuals with dissociative disorders or frequent suicide attempts, may be necessary.