Attempted suicide: efficacy of treatment programs

Persons with a history of attempted suicide have an increased risk of eventually committing suicide. Eleven controlled perspective studies are reviewed on treatment programs aimed at reducing the rates of suicide and of repeated suicidal attempt in these considered at risk. None of these aftercare programs had a demonstrable impact on the suicide rate, and only in one investigation was a significant reduction of repeated attempts observed. Lack of statistical power and inadequate treatment strategies are discussed as major contributors to this failure. Recent evidence of a reduction of suicide rates and mortality by consequent and long-term treatment of patients with affective disorders, as well as reports of undertreatment of depression prior to completed suicide, might provide a new stimulus for the development and evaluation of aftercare programs for those who attempt suicide. The available evidence advocates a shift of emphasis from crisis management to the identification and treatment of psychiatric illness in this risk group.