Abstract
BACKGROUND: For patients with self-harm behaviors, the urge to hurt themselves persists after hospital discharge, leading to costly readmissions and even death. Hence, postdischarge intervention programs that reduce self-harm behavior among patients should be part of a cogent community mental health care policy. OBJECTIVE: We aimed to determine whether a combination of a self-help mobile app and volunteer support could complement treatment as usual (TAU) to reduce the risk of suicide among these patients. METHODS: We conducted a pragmatic randomized controlled trial on discharged patients aged between 18 and 45 years with self-harm episodes/suicide attempts, all of whom were recruited from 4 hospital emergency departments in Hong Kong. Participants were randomly assigned to one of three groups: (1) mobile app + TAU ("apps"), (2) mobile app + volunteer support + TAU ("volunteers"), or (3) TAU only as the control group ("TAU"). They were asked to submit a mobile app-based questionnaire during 4 measurement time points at monthly intervals. RESULTS: A total of 40 participants were recruited. Blending volunteer care with a preprogrammed mobile app was found to be effective in improving service compliance. Drawing upon the interpersonal-psychological theory of suicide, our findings suggested that a reduction in perceived burdensomeness and thwarted belongingness through community-based caring contact are linked to improvement in hopelessness, albeit a transient one, and suicide risk. CONCLUSIONS: A combination of volunteer care with a self-help mobile app as a strategy for strengthening the continuity of care can be cautiously implemented for discharged patients at risk of self-harm during the transition from the hospital to a community setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT03081078; https://clinicaltrials.gov/study/NCT03081078.