Dr Berrouiguet and Colleagues Reply

See Letter by Martí­néz-Ales et al and article by Vaiva et al

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To the Editor: We thank Martí­nez-Alés et al for their comments on our study1 in which we assessed the efficiency of the ALGOS brief contact intervention (BCI). Martí­nez-Alés and colleagues warn against statistical misinterpretations and concluding that the intervention is not efficient. It has long been asserted that the harms of statistical testing in more uncontrollable and complex research settings (such as “real world” suicide prevention) have far outweighed its benefits. As suggested by Martí­nez-Alés et al, we also performed an “as treated” analysis on the same sample.2 We also believe that the integration of web and smartphone technology may reinforce the efficiency of actual BCIs. Overall, these strategies could lead to dynamic monitoring of the risk assessment, leading to real-time, personalized interventions.3

Beyond the efforts to reach “statistical significance,” it is important to note that ALGOS results brought about an important change in French suicide prevention policy. After the ALGOS study was published, Duhem et al4 proposed assessing the efficiency of the algorithm as standard care for suicide attempters in 5 regions of France with different sociodemographic characteristics; this program is called VigilanS. The French Health Authority is currently supporting the establishment of VigilanS as a standard of care for all suicide attempters attended in emergency departments. VigilanS includes a multimodal suicide prevention program with long-term BCIs and crisis management. Furthermore, the program establishes a network of professionals working with different populations and in differing infrastructural conditions, which provides strong support for suicide prevention literacy in both care workers and at-risk populations. As affirmed by Martí­nez-Alés et al, we believe that these efforts based on an “inconclusive” randomized controlled trial will have important benefits for suicide outcomes in France and provide an easily reproducible, efficient suicide prevention strategy.

References

1. Vaiva G, Berrouiguet S, Walter M, et al. Combining postcards, crisis cards, and telephone contact into a decision-making algorithm to reduce suicide reattempt: a randomized clinical trial of a personalized brief contact intervention. J Clin Psychiatry. 2018;79(6):17m11631. PubMed CrossRef

2. Messiah A, Notredame C-E, Demarty AL, et al; AlgoS investigators. Combining green cards, telephone calls and postcards into an intervention algorithm to reduce suicide reattempt (AlgoS): P-hoc analyses of an inconclusive randomized controlled trial. PLoS One. 2019;14(2):e0210778. PubMed CrossRef

3. Berrouiguet S, Larsen ME, Mesmeur C, et al; HUGOPSY Network. Toward mHealth brief contact interventions in suicide prevention: case series from the Suicide Intervention Assisted by Messages (SIAM) randomized controlled trial. JMIR Mhealth Uhealth. 2018;6(1):e8. PubMed CrossRef

4. Duhem S, Berrouiguet S, Debien C, et al. Combining brief contact interventions (BCI) into a decision-making algorithm to reduce suicide reattempt: the VigilanS study protocol. BMJ Open. 2018;8(10):e022762. PubMed CrossRef

Sofian Berrouiguet, MDa

[email protected]

Michel Walter, MD, PhDa

Guillaume Vaiva, MD, PhDb

aDepartment of Psychiatry, University Hospital of Brest, Brest, France

bDepartment of Psychiatry, University Hospital of Lille, Universités de Lille, Lille, France

Published online: June 18, 2019.

Potential conflicts of interest: None.

Funding/support: The study discussed in this letter was funded by a Hospital Clinical Research Grant (PHRC 2009) from the French Health Ministry.

J Clin Psychiatry 2019;80(4):19lr12814a

To cite: Berrouiguet S, Walter M, Vaiva G. Dr Berrouiguet and colleagues reply. J Clin Psychiatry. 2019;80(4):19lr12814a.

To share: https://doi.org/10.4088/JCP.19lr12814a

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