Postcards from the EDge


This simple postcard prevented repetition of hospital-treated-self-poisoning events by 50% over a 2 year period. The postcard was send 8 times during the first year. The treatment was effective in women not in men. The intervention did not reduce the proportion of individuals who repeated self poisoning. So the number of patients repeating self poisoning did not reduce significantly but the rate of repetition of hospital treated self posoining was halved in the group receiving the postcard 8 times in the first year of this 2 year follow-up. Apart from this postcard all patients received treatment as usual.

In a case of self-poisoning patients are admitted to the hospital for treatment and psychiatric evaluation. After evaluation discharge destination is determined as well as follow-up. This study was preformed in New South Wales, Australia, the Hunter Area Toxicology Service to be precise.

How?
The investigators used an elegant study design: Zelen design or single consent version. After evaluation patients were first randomized. Those randomized to the experimental condition than were asked for consent. Only patients randomized to the intervention were asked for informed consent. The control group had 394 participants, the intervention group 378.

In the intervention group 21.1% of patients had one or more readmissions for self-poisoning compared with 22.8% in the control group 24 months after baseline.

There were 310 cumulative readmissions in the control group and 145 in the intervention group.

The control group used 422 bed-days and the intervention group 183 bed-days.
The intervention also has a substantial cost-effectiveness.

Limitations
1. It is not known to what extend the population and clinical service model is generalizable to other settings
2. Only patients with self-poisoning were included not other forms of self-harm.
3. No data on mortality and suicide outcomes are available yet.
4. The mechanism for the long term benefits remains speculative.

Conclusion:
Elegant and solid study design with excellent internal validity. Creative and simple supportive measure for patients with self-poisoning. Might have only limited applicability to comparable regions and works only for women apparently. Other comparable studies showed no reduction in the number of patients admitted for self-poisoning but they didn’t look at the rate of self-poisoning.

Article Discussed:
Br J Psychiatry. 2007 Dec;191:548-53.
Postcards from the EDge: 24-month outcomes of a randomised controlled trial for
hospital-treated self-poisoning.
Carter GL, Clover K, Whyte IM, Dawson AH, D’Este C.

Earlier Article: Free Full Article
BMJ. 2005 Oct 8;331(7520):805. Epub 2005 Sep 23.
Postcards from the EDge project: randomised controlled trial of an intervention
using postcards to reduce repetition of hospital treated deliberate self
poisoning.
Carter GL, Clover K, Whyte IM, Dawson AH, D’Este C.

Movie with the same title: Postcard from the edge (Wikipedia)
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