Investigating the feasibility of an enhanced contact intervention in self- harm and suicidal behaviour: a protocol for a randomised controlled trial delivering a Social support and Wellbeing Intervention following Self Harm (SWISH) Nilufar Ahmed, 1 Ann John, 1 Saiful Islam, 1 Richard Jones, 2 Pippa Anderson, 1 Charlotte Davies, 2 Ashra Khanom, 1 Shaun Harris, 1 Peter Huxley 3 To cite: Ahmed N, John A, Islam S, et al. Investigating the feasibility of an enhanced contact intervention in self- harm and suicidal behaviour: a protocol for a randomised controlled trial delivering a Social support and Wellbeing Intervention following Self Harm (SWISH). BMJ Open 2016;6:e012043. doi:10.1136/bmjopen-2016- 012043 ▸ Prepublication history for this paper is available online. To view these files please visit the journal online (http://dx.doi.org/10.1136/ bmjopen-2016-012043). Received 24 March 2016 Revised 17 August 2016 Accepted 26 August 2016 1 Swansea University, Swansea, UK 2 Hywel Dda University Health Board, Haverfordwest, UK 3 Bangor University, Bangor, UK Correspondence to Dr Nilufar Ahmed; n.ahmed@swansea.ac.uk ABSTRACT Introduction: Self-harm is a strong predictor for suicide. Risks for repeat behaviour are heightened in the aftermath of an index episode. There is no consensus on the most effective type of intervention to reduce repetition. Treatment options for patients who do not require secondary mental health services include no support, discharge to general practitioner or referral to primary care mental health support services. The aim of this study is to assess whether it is feasible to deliver a brief intervention after an episode and whether this can reduce depressive symptoms and increase the sense of well-being for patients who self-harm. Methods: This is a non-blinded parallel group randomised clinical trial. 120 patients presenting with self-harm and/or suicidal ideation to mental health services over a 12-month period who are not referred to secondary services will be randomised to either intervention plus treatment as usual (TAU), or control (TAU only). Patients are assessed at baseline, 4 and 12 weeks with standardised measures to collect data on depression, well-being and service use. Primary outcome is depression scores and secondary outcomes are well-being scores and use of services. The findings will indicate whether a rapid response brief intervention is feasible and can reduce depression and increase well-being among patients who self-harm and do not require secondary services. Ethics and dissemination: Ethical approval was granted by the UK National Health Service (NHS) Ethics Committee process (REC 6: 14/WA/0074). The findings of the trial will be disseminated through presentations to the participating Health Board and partners, peer- reviewed journals and national and international conferences. Trial registration number: ISRCTN76914248; Pre-results. BACKGROUND Self-harm is the strongest risk factor for future suicide 1 resulting in over 200 000 hos- pital presentations annually in England and Wales 23 and is associated with high personal, social and medical costs. 4 Repetition is common, with 15–25% re-presenting to the same hospital within a year of the index episode. 5 The highest risk of repeat self-harm is within 3–6 months after the index episode 6 with the risk for suicide in the year following self-harm almost 50 times higher than in the general population. 7 Depressive symptoms are prevalent among those with self-harm and suicidal ideation 8 and is strongly linked with progression to attempt suicide. 9 Owing to the strong link between a mental health condition and self- Strengths and limitations of this study ▪ The development of an enhanced contact inter- vention for people who have little or no support following self harm. ▪ A focus on social issues that are present in the person’s life. ▪ A cost-effective intervention that can work along- side existing services, supporting patients during a vulnerable time and keeping them engaged whilst they are awaiting assessment from other services. ▪ As this is an unblinded trial, there is a risk of bias in the data. ▪ We are not collecting any social outcome measures. Ahmed N, et al. BMJ Open 2016;6:e012043. doi:10.1136/bmjopen-2016-012043 1 Open Access Protocol group.bmj.com on November 8, 2017 - Published by http://bmjopen.bmj.com/ Downloaded from