Intensively managing patients with severe depressive disorder at high risk of suicide through a combination of in-person and telephone counseling and digital communication can lower their suicide risk, a study has found.
Kyung Hee University Hospital said on the 21st that a joint research team led by Professors Paik Jong-woo and Lee Sang-min of the psychiatry department and Professor Lee Hwa-young of the psychiatry department at Soonchunhyang University Cheonan Hospital demonstrated the efficacy of "hospital-based active case management" (ACM) for patients with severe depressive disorder in the high-risk suicide group.
ACM is a treatment support program in which mental health professionals such as nurses and social workers actively intervene, adjusting the frequency of contact according to the patient's level of suicide risk and providing management through various methods including in-person counseling, telephone counseling, and digital communication.
The research team tracked 314 depressive disorder patients in the high-risk suicide group who received outpatient care at six institutions—Kyung Hee University Hospital, Korea University Anam Hospital, Soonchunhyang University Cheonan Hospital, Wonju Severance Christian Hospital, Ilsan CHA Hospital, and Chungnam National University Hospital—from January 2021 to July 2024. Patients were divided into a standard treatment group (156 patients) and an ACM combined treatment group (158 patients) and observed for six months.
As a result, the Columbia Suicide Severity Rating Scale (C-SSRS) score of the ACM combined treatment group decreased by an average of 9.22 points over six months, showing a clear suicide risk mitigation effect compared with the standard treatment group (a decrease of 7.23 points). Improvement effects in major symptom assessment scales, including depression, anxiety, and subjective loneliness, were also prominent in the ACM combined treatment group. The study completion rate, which indicates treatment adherence, was 83.5% (132 patients) for the ACM combined treatment group, higher than the 72.4% (113 patients) for the standard treatment group. Regular contact and the formation of trusting relationships are analyzed to have had a positive effect on patients' treatment participation and continuous management.
"The suicide prevention effect of hospital-based active case management has been verified through a multicenter randomized controlled clinical trial," said corresponding author Professor Paik Jong-woo. "I hope that intensive case management services will be provided through health insurance in outpatient settings in the future and become a core system of suicide prevention policy."
This research was conducted with support from the Patient-Centered Clinical Research Coordinating Center (PACEN) of the Ministry of Health and Welfare, among others, and was published in "JAMA Network Open," an international academic journal issued by the American Medical Association.
