Bulletin of the World Health Organization

Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries

Alexandra Fleischmann, José M Bertolote, Danuta Wasserman, Diego De Leo, Jafar Bolhari, Neury J Botega, Damani De Silva, Michael Phillips, Lakshmi Vijayakumar, Airi Värnik, Lourens Schlebusch, Huong Tran Thi Thanh


To determine whether brief intervention and contact is effective in reducing subsequent suicide mortality among suicide attempters in low and middle-income countries.


Suicide attempters (n = 1867) identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, China) participated, from January 2002 to October 2005, in a randomized controlled trial to receive either treatment as usual, or treatment as usual plus brief intervention and contact (BIC), which included patient education and follow-up. Overall, 91% completed the study. The primary study outcome measurement was death from suicide at 18-month follow-up.


Significantly fewer deaths from suicide occurred in the BIC than in the treatment-as-usual group (0.2% versus 2.2%, respectively; χ² = 13.83, P < 0.001).


This low-cost brief intervention may be an important part of suicide prevention programmes for underresourced low- and middle-income countries.