Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

There is evidence that several intervention types, including psychotherapy, reduce repeat suicide attempts. However, these interventions are less applicable to the heterogeneous patients admitted to emergency departments (EDs). The risk of a repeat suicide attempt is especially high in the first 6 months after the initial attempt. Therefore, it is particularly important to develop effective ED interventions to prevent repeat suicide attempts during this 6-month period. We systematically reviewed randomized controlled trials of ED-initiated interventions for suicidal patients admitted to EDs using the databases MEDLINE, PsychoINFO, CINAHL, and EMBASE up to January 2015 in accordance with an a priori published protocol (PROSPERO: CRD42013005463). Interventions were categorized into four types, including active contact and follow-up interventions (intensive care plus outreach, brief interventions and contact, letter/postcard, telephone, and composite of letter/postcard and telephone), and a meta-analysis was conducted to determine pooled relative risks (RRs) and 95% confidence intervals (CIs) of a repeat suicide attempt within 6 months. Of the 28 selected trials, 14 were active contact and follow-up interventions. Two of these trials (n = 984) reported results at 6 months (pooled RR = 0.48; 95% CI: 0.31 to 0.76). There were not enough trials of other interventions to perform meta-analysis. Some trials included in the meta-analysis were judged as showing risk of bias. Active contact and follow-up interventions are recommended for suicidal patients admitted to an ED to prevent repeat suicide attempts during the highest-risk period of 6 months. PROSPERO CRD42013005463 (27 August 2013).

Background: A child’s death is one of the most stressful events that parents and siblings may experience. Interventions for bereaved families following a child’s death have been examined over the last several decades. However, there is little high-quality evidence to support any rationale for determining optimal interventions for bereaved parents and siblings. Aim: This study objectives were to evaluate the efficacy of interventions for bereaved parents and siblings following a child’s death, to collect empirical evidence of the quality of these intervention studies, and to identify methodological challenges. Design: A systematic review of data from randomized controlled trials of interventions for parents or siblings bereaved after a child loss. Data sources: We searched MEDLINE (from 1949), PsycINFO (from 1806), and CINAHL (from 1806) databases for key terms and checked the reference lists of potentially relevant articles. Results: We identified nine articles describing eight eligible trials from which we extracted data. The four types of intervention included support groups, counseling, psychotherapy, and crisis intervention. Most intervention trials showed some effect on participants in at least one outcome measure. However, we identified many severe methodological issues and outcome sets in these trials. Conclusion: Very little evidence of sufficient quality is available to confirm the effects of intervention measures on bereaved parents and siblings following a child’s death. Well-designed randomized controlled trials are needed to improve our understanding of the efficacy and implementation of interventions targeting bereaved parents and siblings.