Interviews After Suicide Attempts Show There’s No “One Size Fits All” to Care

Even before the pandemic, suicide had become a public health concern. According to CDC data, suicide was the 10thleading cause of death in the United States in 2018, with the 48,344 deaths more than doubling the number of homicides. Suicide is also the second-leading cause of death among those ages 10 to 34, and the fourth-leading cause among those 35 to 54.

Research shows that an attempt at suicide increases the risk of a completed suicide, even if patients do not employ more dangerous methods. Amid the rising death toll, public health experts are investigating interventions that can begin with patients after they leave the emergency room. But less is known about the success of these interventions from the patient’s perspective.

A new PLOS One study from authors at the Lausanne University Hospital in Switzerland shows why prevention can be so difficult—interviews with patients who had attempted suicide showed the same intervention yielded vastly different reactions. The latest results follow publication of the original study, which measured the value of adding nurse practitioner check-in calls for a three-month period and a family intervention. Some patients refused the intervention, and others who accepted it refused the follow-up calls discussed in the most recent study, which authors said highlight the challenge of working with patients.

Respondents reported a range of reactions: Some thought the check-in calls from a nurse practitioner were very helpful, while others thought they came too often. Others were upset when the calls ceased. The authors wrote that some participants “deplored that too much attention was being paid to the suicide attempt, referring for instance to the fact that this act could be considered as a ‘personal choice.’”

“Multiple post-suicide attempt interventions have been studied but they followed almost always a ‘one size fits all’ approach, namely same intervention for everyone,” the authors wrote. “Our results seem to indicate, rather, that intervention needs are specific to individuals.”

Much of the paper features patients’ own voices, including this statement that sums up the authors’ call for personalized care after a suicide attempt: “It is a necessity but the call shouldn’t be too frequent; there should be an agreement with the person on how many times a week and at what schedule.”

Other patients blanched at the number of people involved in their care, especially if they were already being seen by a psychiatrist. Said one, “My doctor was already calling me and watching how I was doing, so it [the phone calls included in the intervention] kind of oppressed me actually.”

A second part of the original intervention, coming up with a joint crisis plan, brought mixed reviews. Many respondents said the timing of the planning process—while still in emergency care—occurred when patients admitted they were too aggressive for the process to be useful.

But the idea of establishing a relationship with a case manager, the person charged with developing the plan, had merit for some.

Patients who are being treated after a suicide attempt might be offered the chance to customize their aftercare, the authors said. Quality of encounters matter, and for some, a face-to-face follow-up may be preferable to phone calls.

“Our results seem therefore to speak for such a ‘one-on-one’ intervention,” they wrote. “Indeed, such an approach could take into account how patients understand their suicide attempt and how they plan to recover from it … by avoiding overcare when patients prefer to rely on other resources.”