In the 1970s, California psychiatrist Jerome Motto grappled with a problem that is still familiar today: many people hospitalized for suicide were disconnected from services after discharge. Instead of trying to force them back into intensive treatment, Motto tested a remarkably simple idea. He sent periodic letters to former patients that included brief, non-soliciting messages, such as, “We hope things go well for you” (Motto, 1976).
The letters offered no treatment, required no response, and placed no expectations on the recipients. Yet, in one of the earliest randomized studies in suicide prevention, people who received these care letters were less likely to die by suicide than those who received usual care (Moto & Bostrom, 2001). The findings were surprising because the intervention appeared to work not through treatment, but through something much simpler: maintaining a sense of human connection.
What makes Moto’s work particularly interesting is that it emerged outside the dominant medical model of the time. Years later, he thought the idea was partly inspired by his own experiences receiving letters during military service in World War II, which helped him remember and feel connected during difficult times. In many ways, Intervention was built on a simple but powerful premise: Knowing that someone is thinking about you can matter.
Over the next decades, this idea evolved into what is now known as the brief intervention and contact (BIC) approach. Despite variations in format, these interventions have the same goal: to provide brief, structured support during a period of increased risk following a suicide attempt. Typically delivered by physicians or trained paraprofessionals, these involve one to twelve contacts and are used in a range of health care and emergency settings to support recovery and encourage ongoing engagement with care (Stanley, Brodsky, and Monahan, 2023).
The present review builds on this tradition, systematically examining the evidence for brief interventions and contacts among adults following a suicide attempt (Homan et al, 2026).
What started as a simple letter expressing care and concern has evolved into an entire family of suicide prevention interventions.
methods
This was a well-conducted systematic review that searched 6 databases with a well-designed search strategy designed according to the PICO framework. Inclusion criteria were randomized controlled trials that evaluated specific brief psychosocial interventions in adults seeking treatment after a suicide attempt. All screening, data extraction and risk of bias processes were conducted in parallel, increasing the rigor of the study. In addition to assessing risk of bias (ROB2; Stern et al., 2019), the authors also independently graded the certainty of evidence (GRADE; Guyatt et al., 2008). Post-treatment effects were explored using random-effects meta-analyses with post-hoc subgroup analyzes and meta-regression analyzes were also conducted to explore i) differences in intervention type and ii) potential moderators of treatment effects.
Result
A total of 36 studies were included in the review, and 33 of these were included in the meta-analysis. The studies were conducted between 1993 and 2025 and took place around the world, although primarily in Europe and the Americas.
Interventions included brief psychotherapeutic interventions (n=17), remote contact interventions (n=11) and multimodal interventions (n=4). Four studies had ‘other’ interventions which included psychoeducation with brief contact and brief admissions. Interventions were generally brief, with most consisting of 3 to 5 sessions, although the number of contacts varied significantly across studies.
Most of the included studies (n = 22) were rated as having some concerns, mainly due to deviations from the intended intervention and bias in outcome measurement.
Compared to a control group, the brief intervention and contact (BIC) approach:
- significantly reduced suicide attempt again Immediately after treatment and during follow-up, although the effects appeared to wane slightly over time. The evidence was rated as moderate certainty.
- significantly reduced suicidal thoughts After treatment, however, this was not maintained over time. The evidence was rated as moderate certainty.
- Did No reduce significantly self harm After treatment, nor over time, although only four studies contributed data to this analysis; The evidence was rated as having very low certainty.
- may improve Linkage to mental health services after treatment. Although the results were in favor of BIC, the effect was not statistically significant and was based on only six studies; The evidence was rated low certainty.
Subgroup analyzes revealed that the reduced risk for brief psychoactive interventions was strongest due to sparse or heterogeneous research on other types of BIC such as remote contact interventions or multimodal interventions.
Meta-regression analysis found that type of intervention, population, intervention format, risk of bias, and year of publication No Explain the heterogeneity between studies.
In 36 studies, brief intervention and contact were associated with fewer suicide re-attempts, especially when psychotherapeutic approaches were used.
conclusion
Brief interventions and contacts, particularly ‘ultra-brief’ (less than 6 sessions) psychoactive interventions, have an impact on both suicidal attempts and ideation immediately after treatment, with some evidence showing long-term effects for suicide attempts. However the results should be taken with caution; The evidence was sparse, had moderate levels of bias, and was generally rated as moderate to low certainty.
Brief interventions can help people cope with the period of high risk following a suicide attempt.
Strengths and limitations
This is clearly a well-conducted review. The attention paid to statistical considerations is impressive, resulting in a set of findings that are both accessible and appropriately nuanced. By examining diversity, conducting multiple complementary analyses, and classifying the certainty of the evidence, the authors provide readers with a clear understanding not only of what the evidence suggests, but also where it should be interpreted with caution. At no point do they exaggerate their conclusions.
As is often the case with systematic reviews, many limitations lie not in the review itself, but in the studies available for inclusion. Despite the best efforts of the authors, they were synthesizing evidence that was highly skewed and, in many cases, at risk of bias. Again, the authors are fully transparent about these limitations and are careful not to overstate their findings.
One thing that particularly stood out to me was that almost all of the studies included were conducted in high-income Western countries. This reflects a broader issue within mental health research, but it makes me wonder what the state of play is for brief interventions and contacts in low- and middle-income countries. How might these interventions need to be adapted to different health care systems, cultures, and communities? And will they be equally effective?
Most of the included studies came from high-income Western countries, raising questions about global applicability.
Implications for practice
The findings of this review add to the growing body of evidence suggesting that brief intervention and contact can reduce the risk of repeat suicide attempts following a hospital-treated suicide attempt. For policy makers and service providers, this is encouraging. The interventions included in this review were relatively brief, generally low cost, and often delivered by existing services. At a time when mental health systems are stretched and demand is increasingly exceeding capacity, approaches that can be implemented without intensive resource requirements are attractive.
However, what impressed me most about this review was not what it tells us about what works, but what it doesn’t tell us. Why It works.
As discussed earlier, the origins of brief contacts can be traced to Jerome Motto’s care letters: simple messages sent to people after hospital discharge to let them know that someone remembered them and cared about what happened next. Over time, that simple idea has evolved into a series of structured interventions, many of which now sit firmly within the clinical model of care. Indeed, the strongest evidence in this review was seen for brief psychophysical interventions rather than simple contact-based approaches.
This is not necessarily a bad thing. The review shows that structured interventions can save lives and reduce repeated suicide attempts, and this alone is an important finding. Yet I wonder whether in our efforts to develop, refine, and manualize these approaches, we risk losing sight of the very thing that inspired them in the first place.
More than 50 years after Moto first posted his caregiving papers, we still know surprisingly little about the mechanisms underpinning brief interventions and contacts. Do medical supplies matter? Continuity of care? Practical support? Problem-solving opportunity? Or is there something inherently powerful about knowing that no one has forgotten you during a period of intense crisis?
To me, this is where future research should focus. The question is no longer whether brief intervention and contact can reduce repeat suicide attempts; This review suggests that they can. The more interesting question is how these interventions achieve that effect, and whether the active ingredient lies within the intervention itself or within the human relationship it seeks to create. Understanding that difference may ultimately help us design more effective, more scalable, and perhaps more compassionate approaches to suicide prevention.
Perhaps the most important question is not whether brief interventions work, but rather why they work.
Statement of Interests
Laura Hemming has none to declare.
Editor
Edited by Andre Tomlin.
Link
primary paper
Stephanie Homann, Marta Anna Marciniak, Sophia Michel, Anna-Marie Bertram, Charlotta Ruhlmann, Annamaria Petho, Lara Kirchhofer, Leonie Beale, Robin Segerer, Philipp Homann, Sebastian Olbrich, Rory C O’Connor, Birgit Klemm (2026). Effectiveness of brief interventions and contacts after suicide attempts: a systematic review and meta-analysis.. EClinicalMedicine, 93.
Other references
Guyatt, G. H., Oxman, A. D., Wist, G. E., Kunz, R., Falk-Yeter, Y., Alonso-Coello, P., and Schueneman, H. J. (2008). GRADE: An emerging consensus on rating quality of evidence and strength of recommendations.. bmj, 336(7650), 924-926.
Motto, JA (1976). Suicide prevention for high-risk individuals who refuse treatment. suicide and life–threatening behavior, 6(4), 223-230.
Motto, JA, & Bostrom, AG (2001). A randomized controlled trial of suicide prevention after crisis.. psychiatric services, 52(6), 828-833.
Stanley, B., Brodsky, B., and Monahan, M. (2023). Brief and ultra-brief suicide-specific interventions. Center, 21(2), 129-136.
Stern, J.A., Savovic, J., Page, M.J., Albers, R.G., Blencowe, N.S., Boutron, I., … and Higgins, J.P. (2019). ROB 2: a revised tool to assess risk of bias in randomized trials.. bmj, 366.
