Suicide Trends in At-Risk Territories (START)
Component Two of START intends to:
- Expand current knowledge of both risk and protective factors connected to non-fatal suicidal behaviours; and
- Conduct a randomized-controlled trial comparing two treatment conditions.
Increased knowledge about the contributing and protective factors involved in the suicidal act will be examined through an in-depth interview with suicide attempters following treatment in a hospital setting. The START Assessment Battery has been developed for this purpose and contains a variety of psychological scales as well as questions pertaining to personal and family history, physical health, previous suicidal behaviours and critical life factors which may have contributed to the attempt. The START Assessment Battery is a standardized form that has been previously approved and distributed to all participants in the study.
Component two also involves a randomized-controlled trial, which adheres to WHO guidelines stipulating that research studies need to improve existing systems and treatments. Consequently, this part of the study replicates the successful template of the SUPRE-MISS Study (the SUicide PREvention - Multisite Intervention Study on Suicidal Behaviours) and will compare Brief Intervention and Contact (BIC) and treatment as usual (TAU) for suicide attempters in emergency units (Bertolote et al., 2005; Fleischmann et al., 2005; Fleischmann et al., 2008). Using a randomized-controlled trial methodology, the goal of this intervention is to examine the impact of BIC on suicide mortality and repeated suicide attempts. A similar intervention has been successfully used in past research with high suicide risk psychiatric patients refusing treatment (Motto & Bostrom, 2001; Motto et al., 1981). The advantage of the BIC intervention is that it contains little or none of the skilled training required by cognitive-behavioural or other psychological or medical treatments. The BIC is also low in cost, and can be carried out with very modest resources of space, equipment and personnel. This model of intervention fits very well with the outstanding variety of approaches and clinical facilities operating in the different participating locations of START. These features are also beneficial for those researchers conducting the study in low- and middle-income countries. As in the case of the SUPRE-MISS Study, the BIC in the START is intended as an add-on to the treatment a patient would usually receive, making sure that a patient is not deprived of any usual treatment.