Suicide Prevention Algorithm in the French Overseas Territories (APSOM)

Assessment of Preventive Efficacy of an Algorithm Taking Place After Suicide Attempts Among Attempters Admitted to Hospital in the French Overseas Territories

In France, suicide behaviours are a major public health concern that triggered the creation in 2013 of a National Observatory of Suicide. In continental France, the "Algos" protocol was found to be effective for the prevention of suicide attempts reiterations. This protocol is based on a procedure that keeps telephone and postal contacts with the suicide attempter and allows, via an algorithm, to assess the risk of suicide attempt recurrence, in order to intervene if necessary. Nevertheless, Algos does not involve primary care health practitioners, who could add a substantial additional efficacy, especially if they intervene downstream and in supplement to Algos. In addition, this kind of protocol has never been evaluated in the French overseas territories.

Study Overview

• Status: Completed
• Conditions: Suicide Attempt
• Intervention / Treatment: Other: APSOM vs Control

Detailed Description

Since (1) Algos was never implemented in the French overseas departments (FOD) and does not involve primary care practitioners (PCP), (2) the additional effect of PCP involvement over and beyond Algos alone in unknown, and (3) little research on suicide behaviours has been conducted in the FOD, this proposal has the following main aim: to assess the effectiveness and the efficacy of the intervention, in supplement and downstream to Algos, of a healthcare professional, on the recurrence of suicide attempts in the FOD; the healthcare professional will be the patient's general practitioner, whenever possible.

• Study Type: Interventional
• Enrollment (Actual): 259
• Phase: Not Applicable

Contacts and Locations

Study Locations

• French Guiana
  • Cayenne, French Guiana, 97306
    • CH de Cayenne
  • Saint-Laurent du Maroni, French Guiana, 97393
    • CH Ouest Guyanais
• Guadeloupe
  • Les Abymes, Guadeloupe, 97189
    • CHU de Pointe à Pitre
  • Saint-claude, Guadeloupe, 97120
    • CH de Monteran
• Martinique
  • Fort-de-France, Martinique, 97261
    • CHU Martinique
• Réunion
  • Saint-Benoit, Réunion, 97470
    • Etablissement Psychiatrique de Santé Mentale
  • Saint-Paul, Réunion, 97863
    • Centre d'Accueil Psychiatrique Ouest-Centre
  • Saint-Pierre, Réunion, 97448
    • Centre d'Accueil d'Urgences Médico-Psychologique
  • Saint-denis, Réunion, 97405
    • Centre d'Accueil Psychiatrique Nord

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (ADULT, OLDER_ADULT, CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Man or woman over 16 years of age
• Leaving the hospital within 15 days of the suicide attempt
• Giving (him/herself or his/her legal representative)an oral consent to participate in the study
• Having healthcare insurance
• Reachable by phone, with possibility of confidential conversation, and by mail
• Resident of Guadeloupe, French Guyana, Martinique, or Reunion Island
• Able to understand and speak French

Exclusion Criteria:

• Homeless person
• Disabled adult, person under judicial/court protection, legally incompetent adult
• Participant unable to understand the study protocol, its risks and side effects, or declining to participate

Study Plan

How is the study designed?

Design Details

• Primary Purpose: PREVENTION
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Control; Phone contact with patient will be made by a professional psychologist within 21 days of hospital discharge. If contact cannot be made after 9 attempts, post-cards will be sent monthly at M2, M3, M4 and M5, asking the participant to establish contact with the designated psychologist. The phone call will determine whether or not the participant is in a state of suicidal crisis. If yes, steps will be taken to attend the crisis within 24 hours.	Other: APSOM vs Control; In complement to actions described in the control arm, the patient's general practitioner (GP) and the patient him/herself will be contacted within 21 days of hospital discharge in order to organize an appointment between them two; this consultation is expected to take place between day 22 and day 45 after hospital discharge. If the patient does not have a GP, a health-care professional (HCP) will be provided. .GP (or HCP) will also be contacted at 6 and 13 months.
OTHER: APSOM; In complement to actions described in the control arm, the patient's general practitioner (GP) and the patient him/herself will be contacted within 21 days of hospital discharge in order to organize an appointment between them two; this consultation is expected to take place between day 22 and day 45 after hospital discharge. If the patient does not have a GP, a health-care professional (HCP) will be provided. .GP (or HCP) will also be contacted at 6 and 13 months.	Other: APSOM vs Control; In complement to actions described in the control arm, the patient's general practitioner (GP) and the patient him/herself will be contacted within 21 days of hospital discharge in order to organize an appointment between them two; this consultation is expected to take place between day 22 and day 45 after hospital discharge. If the patient does not have a GP, a health-care professional (HCP) will be provided. .GP (or HCP) will also be contacted at 6 and 13 months.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Existence of a suicide	Reiteration of suicidal attempt after hospital discharge	6 months
Existence of a suicide	Reiteration of suicidal attempt after hospital discharge	13 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of suicide attempts	To know total number of suicide	6 and 13 months after hospital discharge
Number of deaths by suicide	To know number of deaths by suicide	6 and 13 months after hospital discharge
Scores at the Hospital Anxiety and Depression Scale (HADS)	Pass the scale HADS	6 and 13 months after hospital discharge
Assessment of suicidal risk by the Sad Persons Scale and the Columbia Suicide Severity Rating Scale (C-SSRS).	Pass the scale Columbia	6 and 13 months after hospital discharge

Collaborators and Investigators

• Sponsor: University Hospital Center of Martinique
• Collaborators: Centre Hospitalier de Cayenne; Centre Hospitalier Universitaire de Pointe-a-Pitre; Centre Hospitalier de Monteran, Guadeloupe; Centre Hospitalier de Ouest Guyanais Franck Joly; Centre d Accueil Psychiatrique Ouest-Centre, La Réunion; Centre d Accueil d Urgences Médico Psychologique, La Réunion; Centre d Accueil Psychiatrique Nord, La Réunion; Etablissement Publique de Santé Mentale de la Réunion
• Investigators: Principal Investigator: JEHEL Louis, MD-PhD, CHU de Martinique

Publications and helpful links

General Publications

• Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev. 2021 Apr 22;4(4):CD013668. doi: 10.1002/14651858.CD013668.pub2.

Study record dates

Study Major Dates

• Study Start (ACTUAL): October 9, 2017
• Primary Completion (ACTUAL): August 8, 2019
• Study Completion (ACTUAL): October 16, 2020

Study Registration Dates

• First Submitted: January 30, 2017
• First Submitted That Met QC Criteria: February 2, 2018
• First Posted (ACTUAL): February 9, 2018

Study Record Updates

• Last Update Posted (ACTUAL): January 28, 2021
• Last Update Submitted That Met QC Criteria: January 26, 2021
• Last Verified: October 1, 2020

More Information

Terms related to this study

• Keywords: Relapse prevention; Suicide; Case Management; Intervention Study; Secondary Prevention; Suicide attempted
• Additional Relevant MeSH Terms: Behavioral Symptoms; Self-Injurious Behavior; Suicide; Suicide, Attempted
• Other Study ID Numbers: 15/B/04

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No