Skip to main content
Research Trends

An Intervention and Follow-Up Study Following a Suicide Attempt in the Emergency Departments of Four General Hospitals in Shenyang, China

Published Online:https://doi.org/10.1027/0227-5910/a000181

Background: Studies on the effects of interventions in patients who have attempted suicide in China have not reported so far. Aims: To describe the basic situation surrounding the interventions and follow-up of patients who have attempted suicide and to determine whether the interventions would be effective in reducing repeat suicide attempts. Method: 239 patients who had attempted suicide were evaluated in the emergency departments of four general hospitals. They were randomized into three groups: cognitive therapy group, telephone intervention group, and control group. Postintervention the participants were evaluated at 3, 6, and 12 months separately by the following measurements: a detailed structured questionnaire, Beck Suicide Ideation Scale (SIS), Hamilton Rating Scale for Depression (HAMD), and a quality-of-life scale. Results: After 12 months, the cumulative dropout rate was 69.5% (n = 57) for the cognitive therapy group, 55.0% (n = 44) for the telephone intervention group, and 64.9% (n = 50) for the control group. One patient (1.2%) in the cognitive therapy group, one patient (1.3%) in the telephone intervention group, and five patients (6.5%) in the control group made at least one subsequent suicide attempt. The rates of repeated attempted suicide among the three groups were not significantly different (χ² = 5.077, p = .08). Five patients (6.1%) received cognitive therapy, and 60 patients (75.0%) received telephone intervention. There were no differences regarding the score of HAMD, a quality-of-life scale, and the rates of subsequent suicide attempt and suicide ideation among the three groups at follow-up. Conclusions: The dropout rates were higher than those reported in developed countries. Most participants in the cognitive therapy group refused to receive cognitive therapy so that the effect of cognitive therapy for these patients cannot be evaluated. The participants in the telephone intervention group had good compliance, but the effect of telephone intervention could not be confirmed, so that more studies are needed in the future. Consequently, interventions cannot be evaluated accurately in their preventing suicide attempts for patients who have attempted suicide in China at present.

References

  • Beck, A. T. , Kovacs, M. , & Weissman, A. (1979). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47, 343–352. First citation in articleCrossref MedlineGoogle Scholar

  • Berk, M. S. , Henriques, G. R. , Warman, D. M. , Brown, G. K. , Beck, A. T. (2004). A cognitive therapy intervention for suicide attempters: An overview of the treatment and case examples. Cognitive and Behavioral Practice, 11, 265–277. First citation in articleCrossrefGoogle Scholar

  • Brown, G. K. , Beck, A. T. , Steer, R. A. , Grisham, J. R. (2000). Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 68, 371–377. First citation in articleCrossref MedlineGoogle Scholar

  • Brown, G. K. , Have, T. T. , Henriques, G. R. , Xie, S. X. , Hollander, J. E. , Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. The Journal of the American Medical Association, 294, 563–570. First citation in articleCrossref MedlineGoogle Scholar

  • Brown, G. K. , Henriques, G. R. , Ratto, C. , Beck, A. T. (2002). Cognitive therapy treatment manual for suicide attempters. Philadelphia, PA: University of Pennsylvania Press. First citation in articleGoogle Scholar

  • Cedereke, M. , Monti, K. , & Ojehagen, A. (2002). Telephone contact with patients in the year after a suicide attempt: Does it affect treatment attendance and outcome? A randomized controlled study. European Psychiatry, 17, 82–91. First citation in articleCrossref MedlineGoogle Scholar

  • Conner, K. R. , Phillips, M. R. , Meldrum, S. C. (2007). Predictors of low-intent and high-intent suicide attempts in rural China. American Journal of Public Health, 97, 1842–1846. First citation in articleCrossref MedlineGoogle Scholar

  • Conner, K. R. , Phillips, M. R. , Meldrum, S. , Knox, K. L. , Zhang, Y. P. , Yang, G. H. (2005). Low-planned suicides in China. Psychological Medicine, 35, 1197–1204. First citation in articleCrossref MedlineGoogle Scholar

  • Fawcett, J. , Scheftner, W. A. , Fogg, L. , Clark, D. C. , Young, M. A. , Hedeker, D. , Gibbons, R. (1990). Time-related predictors of suicide in major affective disorder. American Journal of Psychiatry, 147, 1189–1194. First citation in articleCrossref MedlineGoogle Scholar

  • First, M. B. , Spitzer, R. L. , Gibbon, M. (2002). Structured clinical interview for DSM-IV-TR axis I disorders. New York, NY: Biometrics Research Department, New York State Psychiatric Institute. First citation in articleGoogle Scholar

  • Guthrie, E. , Kapur, N. , Mackway-Jones, K. , Chew-Graham, C. , Moorey, J. , Mendel, E. , ... Tomenson, B. (2001). Randomized controlled trial of brief psychological intervention after deliberate self-poisoning. British Medical Journal, 323, 1–5. First citation in articleCrossref MedlineGoogle Scholar

  • Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62. First citation in articleCrossref MedlineGoogle Scholar

  • Henriques, G. R. , Beck, A. T. , Brown, G. K. (2003). Cognitive therapy for adolescent and young adult suicide attempters. Behavioral Sciences and the Law, 46, 1258–1268. First citation in articleGoogle Scholar

  • Kessler, R. C. , Borges, G. , & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56, 617–625. First citation in articleCrossref MedlineGoogle Scholar

  • Krug, E. G. , Mercy, J. A. , Dahlberg, L. L. , Zwi, A. B. (2002). The first world report on violence and health. The Lancet, 5, 1083–1088. First citation in articleCrossrefGoogle Scholar

  • Leaf, P. J. , Livingston, M. M. , Tischler, G. L. , Weissman, M. M. , Holzer, C. E. 3rd , Myers, J. K. (1985). Contact with health professionals for the treatment of psychiatric and emotional problems. Medical Care, 23, 1322–1337. First citation in articleCrossref MedlineGoogle Scholar

  • Li, X. Y. , Yang, R. S. , Zhang, C. (2001). A case-control study of the risk factors in attempted suicide. Chinese Journal of Epidemiology, 22, 281–283. First citation in articleGoogle Scholar

  • Linehan, M. M. , Comtois, K. A. , Murray, A. M. , Brown, M. Z. , Gallop, R. J. , Heard, H. L. , Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766. First citation in articleCrossref MedlineGoogle Scholar

  • Mann, J. , Apter, A. , & Bertolote, J. (2005). Suicide prevention strategies: A systematic review. The Journal of the American Medical Association, 294, 2064–2074. First citation in articleCrossref MedlineGoogle Scholar

  • McLeavey, B. C. , Daly, R. J. , Ludgate, J. W. , Murray, C. M. (1994). Interpersonal problem solving skills training in the treatment of self-poisoning patients. Suicide and Life-Threatening Behavior, 24, 382–394. First citation in articleMedlineGoogle Scholar

  • Mishara, B. L. , Chagnon, F. , Daigle, M. , Balan, B. , Raymond, S. , Marcoux, I. , ... Berman, A. (2007). Which helper behaviors and intervention styles are related to better short-term outcomes in telephone crisis intervention? Results from a silent monitoring study of calls to the U. S. 1-800-SUICIDE Network. Suicide and Life-Threatening Behavior, 37, 308–321. First citation in articleCrossref MedlineGoogle Scholar

  • Nordstrom, P. , Asberg, M. , Aberg-Wistedt, A. , Nordin, C. (1995). Attempted suicide predicts suicide risk in mood disorders. Acta Psychiatria Scandinavica, 92, 345–350. First citation in articleCrossref MedlineGoogle Scholar

  • Pasieczny, N. , & Connor, J. (2011). The effectiveness of dialectical behavior therapy in routine public mental health settings: An Australian controlled trial. Behavior Research and Therapy, 49, 4–10. First citation in articleCrossref MedlineGoogle Scholar

  • Pearson, V. , Liu, M. (2002). Ling’s death. An ethnography of a Chinese woman’s suicide. Suicide and Life-Threatening Behavior, 32, 347–358. First citation in articleCrossref MedlineGoogle Scholar

  • Phillips, M. R. (1998). The transformation of China’s mental health services. China Journal, 39, 1–36. First citation in articleCrossrefGoogle Scholar

  • Phillips, M. R. , Li, X. Y. , & Zhang, Y. P. (2002). Suicide rates in China 1995–99. The Lancet, 359, 835–840. First citation in articleCrossref MedlineGoogle Scholar

  • Phillips, M. R. , Yang, G. H. , Zhang, Y. P. , Wang, L. J. , Ji, H. Y. , Zhou, M. G. (2002). Risk factors for suicide in China: A national case-control psychological autopsy study. The Lancet, 360, 1728–1736. First citation in articleCrossref MedlineGoogle Scholar

  • Prichard, C. (1996). Suicide in the People’s Republic of China categorized by age and gender: Evidence of the influence of culture on suicide. Acta Psychiatria Scandinavica, 93, 362–367. First citation in articleCrossref MedlineGoogle Scholar

  • Rathus, J. H. , & Miller, A. L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behavior, 32, 146–157. First citation in articleCrossref MedlineGoogle Scholar

  • Salkovskis, P. M. , Atha, C. , & Storer, D. (1990). Cognitive behavioral problem solving in the treatment of patients who repeatedly attempt suicide: A controlled trial. The British Journal of Psychiatry, 157, 871–876. First citation in articleCrossref MedlineGoogle Scholar

  • Shi, Q. C. , Zhang, J. M. , Xu, F. Z. , Phillips, M. R. , Xu, Y. , Fu, Y. L. , ... Yu, M. (2005). Epidemiological survey of mental illnesses in the people aged 15 and older in Zhejiang Province, China. Zhonghua Yu Fang Yi Xue Za Zhi, 39, 229–236. First citation in articleMedlineGoogle Scholar

  • Vaiva, G. , Ducrocq, F. , Meyer, P. , Mathieu, D. , Philippe, A. , Libersa, C. , Goudemand, M. (2006). Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: Randomized controlled study. British Medical Journal, 332, 1241–1245. First citation in articleCrossref MedlineGoogle Scholar

  • Williams, J. B. (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry, 45, 742–747. First citation in articleCrossref MedlineGoogle Scholar

  • Yang, G. H. , Phillips, M. R. , Zhou, M. G. , Wang, L. J. , Zhang, Y. P. , Xu, D. (2005). Understanding the unique characteristics of suicide in China: National psychological autopsy study. Biomedical and Environmental Sciences, 18, 379–389. First citation in articleMedlineGoogle Scholar

  • Yip, P. S. , Liu, K. Y. , Hu, J. , & Song, X. M. (2005). Suicide rates in China during a decade of rapid social changes. Social Psychiatry and Psychiatric Epidemiology, 40, 792–798. First citation in articleCrossref MedlineGoogle Scholar

  • Zhang, Y. P. , Li, X. Y. , & Wang, L. J. (2004). National case-control study of suicide and accidental death. Chinese Mental Health Journal, 18, 861–864. First citation in articleGoogle Scholar

  • Zhou, R. Y. , Zhang, Y. H. , Peng, B. (1997). Comparison of three diagnostic criteria for the diagnosis of schizophrenia and mood disorders. Chinese Journal of Psychiatry, 30, 45–49. First citation in articleGoogle Scholar