ALGOS: the development of a randomized controlled trial testing a case management algorithm designed to reduce suicide risk among suicide attempters

TLDR

Suicide attempts are a serious clinical problem, carry a high risk of repetition, and yet no proven interventions reduce recurrence. The study examines whether the ALGOS algorithm reduces repeated suicide attempts over six months and targets specific subgroups to optimize case‑management benefits. The multicentre RCT evaluated the ALGOS algorithm, a case‑management decision tree that uses systematic telephone contact, crisis cards for first‑attempters, and short letters or postcards for those lost to follow‑up. The ALGOS algorithm proved reproducible, inexpensive, and provides guidelines for managing patients with poor healthcare compliance while targeting subgroups to enhance case‑management benefits. The trial is registered at ClinicalTrials.gov (NCT01123174).

Abstract

Suicide attempts (SA) constitute a serious clinical problem. People who attempt suicide are at high risk of further repetition. However, no interventions have been shown to be effective in reducing repetition in this group of patients. Multicentre randomized controlled trial. We examine the effectiveness of «ALGOS algorithm»: an intervention based in a decisional tree of contact type which aims at reducing the incidence of repeated suicide attempt during 6 months. This algorithm of case management comprises the two strategies of intervention that showed a significant reduction in the number of SA repeaters: systematic telephone contact (ineffective in first-attempters) and «Crisis card» (effective only in first-attempters). Participants who are lost from contact and those refusing healthcare, can then benefit from «short letters» or «postcards». ALGOS algorithm is easily reproducible and inexpensive intervention that will supply the guidelines for assessment and management of a population sometimes in difficulties with healthcare compliance. Furthermore, it will target some of these subgroups of patients by providing specific interventions for optimizing the benefits of case management strategy. The study was registered with the ClinicalTrials.gov Registry; number: NCT01123174.