• Bibtex: @beautrais2010
  • Bibliography: Beautrais, A. L., Gibb, S. J., Faulkner, A., Fergusson, D. M., & Mulder, R. T. (2010). Postcard intervention for repeat self-harm: Randomised controlled trial. The British Journal of Psychiatry, 197(1), 55–60. https://doi.org/10.1192/bjp.bp.109.075754

Example citation

A postcard intervention in New Zealand reduced re-presentation for psychiatric, but not all-cause, emergency visits

My notes

  • Six postcards sent over 12 months after self-harm presentation at the psychiatric emergency department. All patients were included, regardless of adherence to care after the acute episode.
    • Schedule: w2, w6, 3m, 6m, 9m, 12m
  • Recruitment from the clinic, all participants gave pre-randomization written consent
  • They only had a planned sample size of 700! Way different from the luxton2020 trial which had like 4k post-hoc needed sample size. They cite recruitment difficulties.
  • Null effects for emergency department re-presentation (OR = 0.92) and either ED or psychiatric emergency units (OR = 0.87).
    • But there was a difference in proportion of participants re-presenting to psychiatric emergency department (OR = 0.57)
  • Total number of re-presentations, IRR = 0.46.
  • Findings no longer significant when controlling for previous self-harm presentations.

“However, after 8 months of recruitment, inspection of preliminary results revealed a larger than anticipated difference between intervention and control groups in the rate of re-presentation to the psychiatric emergency service for further self-harm. In addition, over the first 8 months of the trial there had been ongoing difficulties with recruitment procedures, with clinical staff reluctant to recruit participants to the trial. Therefore, consideration was given to stopping the trial early.” (Beautrais et al., 2010, p. 56)


BackgroundSelf-harm and suicidal behaviour are common reasons for emergency department presentation. Those who present with self-harm have an elevated risk of further suicidal behaviour and death.AimsTo examine whether a postcard intervention reduces self-harm re-presentations in individuals presenting to the emergency department.MethodRandomised controlled trial conducted in Christchurch, New Zealand. The intervention consisted of six postcards mailed during the 12 months following an index emergency department attendance for self-harm. Outcome measures were the proportion of participants re-presenting with self-harm and the number of re-presentations for self-harm in the 12 months following the initial presentation.ResultsAfter adjustment for prior self-harm, there were no significant differences between the control and intervention groups in the proportion of participants re-presenting with self-harm or in the total number of re-presentations for self-harm.ConclusionsThe postcard intervention did not reduce further self-harm. Together with previous results this finding suggests that the postcard intervention may be effective only for selected subgroups. PDF: beautrais_2010_postcard_intervention_for_repeat_self-harm_-_randomised_controlled_trial.pdf