Open Access Research article

Employing crisis postcards with case management in Kaohsiung, Taiwan: 6-month outcomes of a randomised controlled trial for suicide attempters

Wei-Jen Chen12, Chi-Kung Ho3, Shi-Sen Shyu2, Cheng-Chung Chen1, Guei-Ging Lin1, Li-Shiu Chou1, Yun-Ju Fang3, Pin-Yang Yeh3, Tieh-Chi Chung4 and Frank Huang-Chih Chou14*

Author Affiliations

1 Kaohsiung City Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan

2 Graduate Institute of Counselling Psychology and Rehabilitation Counselling, National Kaohsiung Normal University, Kaohsiung, Taiwan

3 Kaohsiung City Government Bureau of Health, Kaohsiung, Taiwan

4 Institute of Health Care, Meiho University, Neipu, Pingtung, Taiwan

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BMC Psychiatry 2013, 13:191  doi:10.1186/1471-244X-13-191

Published: 17 July 2013



Suicide attempts constitute a serious clinical problem and have important implications for healthcare resources. The aim of the present study was to evaluate the effectiveness of case management using crisis postcards over a 6-month follow-up period.


A randomised controlled trial was conducted in Kaohsiung, Taiwan. Prevention of further suicide attempts was compared between two groups with and without the postcard intervention. The intervention group consisted of 373 participants (139 males, 234 females; age: 39.8 ± 14.0 yrs.). The control group consisted of 388 participants (113 males, 275 females; age: 40.0 ± 16.0 yrs.). A survival analysis was used to test the effectiveness of the crisis postcard intervention for the prevention of suicide reattempts. Per-protocol and intention-to-treat analyses were conducted.


The intention-to-treat analysis indicated that the crisis postcard had no effect (hazard ratio = 0.84; 95% CI = 0.56 – 1.29), whereas the per-protocol analysis showed a strong benefit for the crisis postcard (hazard ratio = 0.39; 95% CI = 0.21 – 0.72).


Although the results of the present study indicated that the postcard intervention did not reduce subsequent suicide behaviour, our study provides an alteration to the postcard intervention. Further studies need to be conducted to clarify whether this type of intervention can reduce subsequent suicidal behaviour, with a particular focus on reducing the rate of loss to follow-up.

Suicide re-attempts; Case management; Crisis postcard