Telemedice-based and integrated-care suicide prevention

Abstract

Suicide is a major health issue worldwide involving nearly 800.000 deaths per year (WHO, 2017) and is the principal cause of external death in the Basque Country resulting in 180 casualties in year 2016 (Eustat, 2017). Preventive interventions have shown efficacy at reducing suicidal behaviour up to a 25-30%, hence they are one of the priorities of public health policies according to Mental Health Strategy of the Basque Country (2010) and local research is being promoted by the Health Department of Basque Government. As history of prior suicide attempts is one of the highest risk factor for committed suicide, the main objective of this project is to evaluate the efficacy of a telemedice-based intervention at reducing future suicide attempts by a 12-month telephone follow-up after a recent attempt. This integrated-care research project involves the collaboration of 4 centres of the Basque Public Health System – Osakidetza: OSI Araba (Coordinator), OSI Barrualde, Gipuzkoa Public Mental Health Network and Consejo Sanitario (CS). Following a multidisciplinary approach, the different mental health professionals of these centres, including psyquiatrists, psychologists and nurses, coordinate across different assistance levels, i.e., Psychiatry Service, Primary Care (CS) and, in necessary cases, Emergency Service and Social Services. Prospective and non-randomized study will be conducted in Araba University Hospital, Outpatient Public MH Network of Gipuzkoa and Hospital Galdakao, in which 260 patients with a recent suicide attempt will have a 12-month telephone follow-up (5 calls: week 1, month 1, month 3, month 6, month 12) carried out by trained nurses of the patient counselling service of CS. As a control group, another 260 patients will receive Treatment as Usual (TAU). Simultaneously, a cost study will be carried out during 12 months after first suicide attempt, calculating both direct (health services, pharmacotherapy and counselling programme costs) and indirect costs (associated work leaves and costs). Additionally, this project endeavours to shed light on the neurobiology of suicidal behaviour by exploring the relation between suicide attempts and inflammation parameters. A longitudinal sub-study will be carried out by OSI Araba, in which 20 patients treated with telemedicine, 20 patients with TAU and 20 healthy subjects will undergone a blood-sample extraction for analysis of peripheral inflammatory markers and a clinical assessment. The objective of this sub-study is to analyse the possible influence of telemedicine on the reduction of inflammatory levels and the relation of these biological parameters with clinical outcomes.

Keywords

• suicide
• suicide attempts
• telemedicine
• inflammation
• integrated research