Suicide is a significant global health issue, accounting for approximately 700,000 deaths annually.1 Despite the presence of various risk factors associated with suicide, the ability to predict individual risk remains limited.2,3 A crucial risk factor for completed suicide is a history of previous suicide attempts, with estimates suggesting that for every completed suicide, there are around 20 to 30 attempts.1,2,4 Suicide attempts and reattempts pose substantial public health challenges,5 particularly as individuals are at a heightened risk of relapse within 3 to 12 months following an attempt.6,7 Consequently, preventive interventions aimed at reducing reattempts should prioritize this critical period.

While psychopharmacological treatments can be beneficial, they are often ineffective when used as the sole intervention for preventing suicide attempts and fatalities.8,9 This underscores the need for further research to identify the optimal duration and structure of preventive interventions in suicide prevention. Previous studies have demonstrated that brief contact interventions, such as telemedicine-based follow-up programs, serve as low-cost alternatives for suicide prevention, providing continuous support to at-risk patients. .10 According to the literature, brief telemedicine contacts include modalities such as telephone, internet, and video conferencing, and they promote accessibility.11 This approach has been shown to reduce the rate of reattempts12–17 and extend the time before relapse,12,18 while also improving adherence to mental health services.18

However, there is still no agreement on the ideal number of follow-up calls or how long these interventions should last, but a minimum follow-up period of 12 months has been suggested.19,20 In a previous study conducted by our team with a six-month follow-up, we observed an increase in the time until reattempt, as well as improved adherence, but no significant reduction in the number of reattempts.18 Conversely, another intervention program with a 12-month follow-up indicated a decreased risk of reattempts among participants.12

To address the ongoing debate surrounding follow-up duration and frequency of contact, we designed a study to evaluate the effectiveness of a telemedicine-based brief intervention for individuals who have attempted suicide.

This non-randomized controlled study evaluated the impact of a 12-month telemedicine-based follow-up intervention on suicidal relapse among patients after a suicide attempt. The findings demonstrate that participants in the intervention group had a significantly lower rate of reattempts and a longer average time to their first reattempt compared to the control group. Furthermore, survival until the first reattempt was higher in the intervention group, indicating a 54 % reduction in the risk of suicide reattempt. Interestingly, adherence to the intervention did not significantly influence survival outcomes. These results contribute to the growing evidence supporting the integration of structured follow-up interventions into standard mental health care protocols to reduce suicide reattempts and improve patient outcomes. Building and developing the therapeutic alliance during the different phases of the therapeutic relationship can contribute to better clinical outcome.23

In contrast to our previous study,18 which found no significant reduction in reattempts with a shorter follow-up period this 12-month intervention demonstrated clear benefits in reducing both the frequency and timing of reattempts. These findings are consistent with evidence from a recent systematic review, which suggests that extending brief contact interventions beyond 12 months provides greater reductions in suicide reattempts (RR = 0.46; 95 % CI 0.10–0.82) compared to interventions lasting 12 months or less (RR = 0.67; 95 % CI 0.54–0.80).20 Although the extended duration likely contributed to the intervention's effectiveness, other factors may also have influenced the results. Compared to our previous 6-month study,18 the current sample included older patients, a higher proportion of hospitalizations after the index suicide attempt, and a lower use of drug poisoning as a method—all of which may indicate greater clinical severity. These differences could partially explain the improved outcomes. However, due to the non-randomized design and limited clinical data, it is not possible to isolate the effect of duration from other variables.

In our study, adherence to the telemedicine protocol was moderate to high, with half of the sample completing 4 or 5 calls over the 12-month period. The number of calls during follow-up is a key factor influencing both adherence and effectiveness. Previous studies employing similar telephone follow-up designs have used between 117 and 1123 calls, with 6 calls being the most common approach.11,24 Our protocol consisted of 5 calls distributed over 12 months, and although adherence did not significantly affect survival outcomes, this unexpected finding may be due to several factors. Minimal engagement early after discharge may have been sufficient to offer some benefit. Also, small group sizes could have limited statistical power, and our adherence measure—based only on number of calls—may not fully capture patient engagement. Determining the optimal number of calls to maximize both effectiveness and adherence remains a critical area for future research. There is a growing interest in this topic,25,26 but the scarcity of robust comparative studies underscores the need for further research and strategies to apply these findings in clinical practice.

These findings are consistent with previous studies endorsing telemedicine as an effective strategy to enhance treatment adherence, reduce suicide reattempts,19 and mitigate suicidal ideation.27 Telemedicine has proven particularly useful for improving access to care for high-risk populations and individuals in geographically isolated areas.28,29 Telehealth has become more interactive, affordable, and widely available for healthcare professionals addressing chronic conditions.30 This approach has also been validated during the COVID-19 pandemic, when in-person healthcare access was significantly restricted.25 Telephone-based interventions, in particular, have demonstrated a 5 % absolute reduction in reattempt rates and a 20 % relative risk reduction over 12 months in patients treated for suicide attempts in emergency settings.23Other studies on telecare with people at risk of suicide have found that follow-up interventions, and specifically telephone follow-up programs, have provided promising results and could be considered a useful new tool in the care of people at risk.10 Other studies on the impact of non-pharmacological preventive strategies addressing risk management focused on a telehealth monitoring protocol. When participants reported suicidal plans or intentions, the nurse contacted a physician, who provided a rapid response. Furthermore, staff immediately contacted participants when they responded affirmatively to a question about suicidal behavior.31 Support tools linked to the use of artificial intelligence also contribute to decision-making and could also allow for a more accurate assessment of suicidal risk in situations where the patient denies suicidal ideation.32 On the other hand, the collection of information through smartphones using explicit (active) and implicit (passive) methods to construct a digital phenotype, which should be integrated with genetic and epigenetic data to develop tailored therapeutic and preventive approach.33 A sample of 249 adults completed a baseline assessment of their suicidal ideation characteristics during psychiatric hospitalization, five daily ecological momentary assessments (EMAs) for 21 days after discharge, and follow-up assessments of suicide-related outcomes at 3 weeks and 6 months follow-up. The results implicated low controllability of suicidal ideation as a potentially useful marker of short-term risk for suicide attempts. This finding is of high clinical relevance, particularly because perceived controllability is a less frequently assessed characteristic of suicidal ideation in clinical settings than other characteristics of ideation commonly thought to indicate the severity of suicidal ideation (i.e., frequency, duration, intensity), and to date, almost no useful indicators of short-term suicide attempt risk have been identified that can be assessed through a single item.34

Our control group showed a suicide reattempt rate of 41.4 %, which is notably higher than the 20 % reported in a recent meta-analysis.7 Variability in reattempt rates across studies has been attributed to factors such as female sex, self-poisoning or self-cutting methods, and mental health disorders. Although we did not collect data on participants’ psychiatric diagnoses, our sample primarily consisted of women, with drug poisoning being the most common method—factors that may help explain the elevated reattempt rate in our study.

Suicide prevention remains a challenging priority, particularly among individuals with a history of suicide attempts. Hospitals provide a unique opportunity to implement preventive interventions, as many patients seek emergency care following suicide attempts and can be enrolled in post-discharge follow-up programs. In our study, two-thirds of participants were recruited following hospital admission, reflecting the severity of their attempts—a finding consistent with prior research.35 Additionally, the sample predominantly consisted of women, a common pattern observed in suicide attempt studies, though this is not typically considered a significant factor.

This study demonstrates that a 12-month telemedicine-based follow-up intervention significantly reduces both the frequency of suicide reattempts and the time to reattempt when compared to standard care alone. The findings emphasize the importance of sustained, structured contact in supporting high-risk patients during the critical post-discharge period, showing a 54 % reduction in the risk of reattempts in the intervention group. These results highlight the potential of telemedicine as an effective and cost-efficient tool for suicide prevention, supporting its integration into standard mental health care protocols, particularly for vulnerable populations at high risk of relapse. Its applicability is comprehensive, with the potential to transfer this knowledge to routine healthcare practice.

The research protocol was approved by the Clinical Research Ethics Committee of Euskadi, and all participants provided written informed consent prior to enrolment.

This study had been funded by Instituto de Salud Carlos III through the projects PI18/01055 PI15/00789 (Co-funded by European Regional Development Fund/European Social Fund. Investing in your future) PI21/00713 and PI23/01367;the Basque Foundation for Health Innovation and Research (BIOEF); Networking Center for Biomedical Research in Mental Health (CIBERSAM) and the University of the Basque Country (GIC18/107).