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Randomized Controlled Trial
. 2020 Jun 16;20(1):311.
doi: 10.1186/s12888-020-02723-9.

Effect of assertive case management intervention on suicide attempters with comorbid Axis I and II psychiatric diagnoses: secondary analysis of a randomised controlled trial

Kazunobu Norimoto  1   2 , Katsumi Ikeshita  1   3 , Toshifumi Kishimoto  1 , Kazuo Okuchi  2 , Naohiro Yonemoto  4   5 , Tatsuya Sugimoto  6 , Fuminori Chida  7 , Shigero Shimoda  1 , Yoshio Hirayasu  8 , Chiaki Kawanishi  9
Affiliations
Randomized Controlled Trial

Effect of assertive case management intervention on suicide attempters with comorbid Axis I and II psychiatric diagnoses: secondary analysis of a randomised controlled trial

Kazunobu Norimoto et al. BMC Psychiatry. .

Abstract

Background: Most suicide attempters suffer from psychiatric disorders, which are often comorbid with personality disorders. The effects of intervention on patients who have attempted suicide with comorbid Axis I and II diagnoses have not been fully elucidated. We evaluated whether assertive case management can reduce the repetition of suicidal behaviours in patients who had attempted suicide with comorbid Axis I and II diagnoses.

Methods: This study was a secondary analysis of a randomised controlled trial investigating whether assertive case management could reduce the repetition of suicide attempts, compared with enhanced usual care. Subjects were divided into those who had comorbid Axis I and II diagnoses (Axis I + II group), and those who had an Axis I diagnosis without Axis II comorbidity (Axis I group). Outcome measures were compared between patients receiving a case management intervention and patients receiving enhanced usual care, as allocated. The primary outcome measure was the incidence proportion of the first episode of recurrent suicidal behaviour at 6 months after randomisation. We calculated risk ratios (RR) with 95% confidence intervals (CI) at 6 months and 12 months after randomisation of patients in the Axis I and Axis I + II groups.

Results: Of 914 enrolled patients, 120 (13.1%) were in the Axis I + II group, and 794 (86.9%) were in the Axis I group. Assertive case management was significantly effective for the Axis I group on the primary outcome at 6 months (risk ratio [RR] 0.51, 95% confidence intervals [CI] 0.31 to 0.84). The RR of the Axis I + II group was 0.44 (95% CI 0.14 to 1.40).

Conclusions: Assertive case management not only had an effect on patients who had attempted suicide with only Axis I disorders but may also have a similar effect on patients with comorbid Axis I and II disorders.

Keywords: Assertive case management intervention; Axis I; Axis II; Comorbidity; Suicide; Suicide attempt.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Trial profile
Fig. 2
Fig. 2
a Kaplan-Meier curve for incidence of first episode of recurrent suicidal behaviour in Axis I group (attempted suicide or dying by suicide). b Kaplan-Meier curve for incidence of first episode of recurrent suicidal behaviour of the Axis I + II group (attempted suicide or dying by suicide)
See this image and copyright information in PMC

References

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