Visiting and managing patients with major depressive disorder who have attempted suicide, instead of waiting for them to come to the hospital, can reduce the rate of reattempted suicidal behavior, a study showed. 

As its effectiveness has been proven, calls are mounting for the system to be established, for instance, by including it in the reimbursement list.

The Patient-Centered Medical Technology Optimization Research Corps (PACEN) under the National Evidence-based Healthcare Coordinating Agency (NECA) released the results of a study titled “Evaluation of the Effectiveness of Hospital-Based Intensive Case Management for Patients with Major Depressive Disorder with Suicidal Ideation” on Thursday.

Professor Paik Jong-woo of the Department of Psychiatry at Kyung Hee University College of Medicine conducted the study.

Korea has the highest suicide rate in the Organization for Economic Cooperation and Development (OECD) at 27.3 per 100,000 people as of 2023.

The researchers noted that until now, suicide prevention interventions have mainly centered on patients who voluntarily seek medical care, limiting access to high-risk groups with a history of suicide attempts or mental illness.

They also noted that current hospital-based case management initiatives are limited in scope, targeting only emergency room visitors or those about to be discharged after hospitalization, and have low service intensity and continuity of care.

To address these limitations and evaluate the effectiveness of hospital-based intensive case management services, the study divided 245 patients with major depressive disorder with suicidal ideation into two groups: one group received usual care (control group), in which patients visited a healthcare provider as needed, and the other group received intensive case management (intensive case management group) for six months, including monthly face-to-face counseling and crisis intervention by a multidisciplinary team, including medical staff.

The results showed that among patients who reported suicidal behavior at the first visit, 70 percent of those in the intensive case management group did not attempt again, compared to 60 percent in the control group. The intensive case management group also experienced a 24 percent greater reduction in suicidal ideation than the control group, and greater improvements in depression and anxiety symptoms (53 percent and 135 percent, respectively) than the control group.

Notably, even among patients who did not complete the six-month intervention, hospital-based intensive case management resulted in one hospitalization for a suicide attempt compared to five hospitalizations and one actual death in usual care. It suggests that hospital-based intensive case management services contributed substantially to suicide prevention.

Experts attending the clinical appraisal meeting recognized that the study provided a high level of evidence based on a randomized controlled trial (RCT). In particular, as hospital-based intensive case management has been quantified and implemented nationwide in Japan based on similar findings, the results of this study can be used as a key basis for domestic institutionalization and appropriate numbering, they added.

Based on this assessment, the researchers recommended that the scope of the program should be gradually expanded to include suicide attempters and people with high-risk mental illnesses such as schizophrenia and depressive disorders, regardless of whether they are hospitalized, and that the management system should start with hospital-based interventions and gradually spread to the community, including primary healthcare institutions and mental health welfare centers.

The team also emphasized the need for number design and institutional support to maintain the professionalism and quality of case managers.