Postcards as Prevention

Postcards sent to patients treated for deliberate self-poisoning significantly reduced the number of repeat episodes of self-poisoning by these patients. The postcards also significantly reduced the number of psychiatric admissions (for any reason) by these patients during a five-year follow-up period.

Eight postcards (mailed in sealed envelopes) were sent to patients over the 12 months after they were treated in a hospital for deliberate self-poisoning. The postcards featured messages such as “It has been a short time since you were here at the Newcastle Mater Hospital and we hope things are going well for you. If you wish to drop us a note we would be happy to hear from you.” The card also included the names of two doctors and the hospital’s address and telephone number. Patients in both the postcard and control groups also received the usual treatment afforded patients treated for self-poisoning.

Over the next five years, the rate of return visits for treatment of self-poisoning of the group of patients that received postcards was 50 percent less than the rate of the group of patients that had not received postcards. The postcard group also had a rate of admissions to psychiatric hospitals (for any reason) that was 33 percent less than that of the no-postcard group.

The postcards did not reduce the suicide rate or significantly reduce the proportion of patients treated for at least one repeat episode of self-poisoning. Almost 25 percent of the postcard patients and about 27 percent of the no-postcard patients returned to the hospital for at least one additional episode of intentional self-poisoning. However, members of the postcard group had, on average, fewer additional return visits to the hospital for intentional self-poisoning and fewer admissions to psychiatric hospitals for any reason. Thus, the postcards resulted in a substantial savings in workload and cost for both general and psychiatric hospitals.

Most of the decrease in the rate of return visits to the hospital was due to a decrease in the number of return visits by women who had histories of three or more episodes of self-poisoning prior to the episode after which they began to receive postcards. The intervention did not reduce the return rate for men or for patients without a history of self-poisoning. The authors pointed out that small sample sizes may have affected their ability to obtain statistically significant differences in the analyses by gender and self-poisoning history (i.e. if they had been tracking a larger group of patients, they may have found similar decreases in return episodes for men and for women without an extensive history of self-poisoning). The decrease in the rate of admissions to psychiatric hospitals was statistically significant regardless of gender or prior history of self-poisoning.

This summary is based on: Carter, G.L., Clover, K., Whyte, I. M., Dawson, A. H., & D’Este, C. (2013). Postcards from the EDge: 5-year outcomes of a randomised controlled trial for hospital-treated self-poisoning. British Journal of Psychiatry, 202(5):372-380.