Follow-Up for Parasuicidal Patients

To the Editor: It was refreshing and encouraging from both the empirical and the clinical perspective to read in the June issue the well-designed and well-executed study by Drs. Motto and Bostrom in which they demonstrated a reduced rate of suicide in parasuicidal individuals who were randomly assigned to a group that was sent letters for five years after hospitalization for depressive or suicidal episodes (1). The letters were sent monthly and bimonthly for a year and then quarterly. In their report they noted several other studies that have shown similar salutary effects from cost-effective follow-up procedures with parasuicidal individuals.

I would like to describe another study that lends support to the value of clinical follow-up (2). We conducted an intervention trial of broad-spectrum behavior therapy versus insight-oriented therapy for individuals with a history of multiple suicide attempts. In the two years before admission to our program, the 24 participants had a total of 70 suicide attempts that required medical attention, which was validated by medical records and significant others. During the two years after admission, only 11 such attempts were documented. We ascribed the main effects to a combination of our brief treatment and follow-up contacts for assessment by our research associate two, six, 12, 24, and 36 weeks after discharge from our program.

Ten days of behavior therapy yielded better outcomes than an equivalent amount of insight-oriented therapy on all measures. However, the overall reductions in subsequent suicide attempts were similar for both treatment conditions, suggesting that empathic follow-up contacts with reminders to seek continuing treatment is a low-cost and effective means of reducing morbidity among parasuicidal individuals.

Dr. Liberman is professor of psychiatry and director of the psychiatric rehabilitation program at the University of California, Los Angeles.