Suicide Prevention Algorithm in the French Overseas Territories

Study Overview
=================
Brief Summary
-----------------
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.

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.

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

Conditions
-----------------
Suicide Attempt

Intervention / Treatment
-----------------
* Other: APSOM vs Control


Participation Criteria
=================
Eligibility Criteria
-----------------
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

Ages Eligible for Study
-----------------
Minimum Age: 16 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control<br>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<br>* 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.<br>|
| Other: APSOM<br>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<br>* 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.<br>|

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 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Suicide, Suicide attempted, Secondary Prevention, Relapse prevention, Case Management, Intervention Study