Background: A past history of suicide attempts is the most common risk factor for suicide. It is also known that a certain period of time after discharge from hospital is associated with a high risk of suicide. Therefore, it has been suggested that interventions after discharge for suicide attempters might reduce their reattempts. From 2010 to 2014, we carried out a case management program with`sequential cooperation'between general and psychiatric hospitals for suicide attempters at Ibaraki Prefectural Medical Center of Psychiatry. Although we invited all patients who had attempted suicide to participate in the program, a large proportion of patients did not participate. There might be differences in suicide reattempts between those who participated in the program and those who did not. Therefore, to clarify the effect of the case management program, we retrospectively investigated and compared the suicide reattempts between patients who were involved in the program and those who were not.
 Methods: The subjects of our study were suicide attempters who were admitted to other general hospitals first due to the attempt, and then transferred to our psychiatric hospital. The intervention group was comprised of patients who agreed to participate in the program. The control group was comprised of patients who did not agree to participate in the program. We retrospectively investigated the duration from when they were discharged to when any of suicide reattempt, actual suicide, or readmission to our hospital occurred and defined it as the survival time. Then, we conducted Kaplan-Meier survival analysis, comparing the survival time between the intervention and control groups.
 Results: The duration from discharge to any of the events among the intervention group was significantly longer than that of the control group (log-rank test, P=0.024). Mean durations were 134.3 and 64.4 weeks in the intervention and control groups, respectively.
 Conclusion: The present results suggest that sequential cooperation of general and psychiatric hospitals could prevent recurrent suicidal behaviors after discharge. This model for suicide prevention can be generalized and could be useful in rural areas of Japan, where access to general hospital psychiatry is limited. Further studies should be conducted to confirm our results.
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