Taiwan’s National Surveillance System

February 07, 2014
News Type:  Weekly Spark, Weekly Spark Research

A large study in Taiwan demonstrated that an aftercare program for people who attempted suicide significantly decreased the rate of subsequent suicides over the two years following the initial attempt. The program also significantly increased the average time between initial suicide attempts and subsequent deaths among those participants who eventually died by suicide.

Taiwan’s National Suicide Surveillance System (NSSS) is an effort to provide three to six months of aftercare for everyone who has survived a suicide attempt. Attempt survivors are reported to the system by health care providers, first responders, and social welfare and educational agencies. Individuals registered with NSSS are contacted within three days of the attempt and offered assessment and aftercare, which includes a series of brief counseling sessions, either in person or by telephone.

An ongoing assessment process is used to make decisions about the frequency of counseling sessions, contacts, and length of follow-up. Individuals assessed as being at high risk are referred to intensive psychiatric treatment. When the risk is moderate, one to two contacts are made per week and counseling is offered to the individual and to his/her family if needed. People thought to be at low risk receive two contacts a month for at least three months. The records of attempters who refuse services are provided to local mental health centers, which continue to try to engage them.

An analysis of NSSS data from the years 2006–2008 indicated that the program decreased the risk of suicide among suicide attempt survivors receiving aftercare compared to suicide attempt survivors who refused to participate in aftercare. Over the 24-month study period (following the initial recorded suicide attempt) the risk of patients dying by suicide decreased by 63.5 percent among those who initially accepted aftercare. The probability of death by suicide among those who initially refused aftercare but later accepted services fell by 22.5 percent.

Participation in the program also increased the average time between initial suicide attempts and subsequent deaths among participants who eventually died by suicide. Half of the suicides by attempt survivors receiving aftercare occurred within 127.5 days of the initial attempt. Half of the suicides by individuals not participating in aftercare occurred within 32.5 days of the initial recorded attempt. The authors suggest that this increase in lifespan represents a substantial opportunity for additional treatment and that this finding “underscores the urgency to intervene quickly” given that half of all subsequent suicides in the sample occurred within 101 days of the initial attempt – and 25 percent occurred within 24 days of the initial attempt.

The authors pointed to the importance of creating treatment plans that respond to the needs of the two groups who were most at risk for subsequent suicides despite participating in the aftercare program. The risk of subsequently dying by suicide was 2.5 times higher for people over the age of 65 than for younger people. People over 65 who later died by suicide also tended to do so sooner than younger people. The authors suggested that these findings point to the need for promptly engaging seniors in treatment.

The authors also suggested that their findings demonstrated that the choice of means should play an important role in creating treatment plans for attempt survivors. Participants who used the means with the greatest lethal potential (in Taiwan’s case, charcoal burning and hanging) tended to employ these mechanisms in subsequent attempts. They accounted for 52 percent of all subsequent suicides among aftercare participants and were at greater long-term risk than people using other means.

Pan, Y. J., Chang, W. H., Lee, M. B., Chen, C. H., Liao, S. C., & Caine, E. D. (2013). Effectiveness of a nationwide aftercare program for suicide attempters. Psychological Medicine 43(7), 1447–1454.

Populations:  Attempt Survivors and Other People with Lived Experience
Strategies:  Effective Care/Treatment, Treatment, Care Transitions/Linkages