A structured case management program reduced suicidal thoughts and depressive symptoms in people with major depression and active suicide risk, compared to usual psychiatric care alone . The effect was modest but clinically meaningful, suggesting hospital-based psychosocial interventions may help address suicide prevention at scale.
South Korea faces a persistent public health crisis: it maintains the highest suicide rate among developed nations tracked by the OECD. Major depressive disorder is the leading psychiatric diagnosis in suicide deaths in the country, yet evidence from large-scale clinical trials testing long-term interventions remains scarce. This randomized controlled trial enrolled 314 outpatients with major depression who had either current suicidal thoughts or a suicide attempt within the previous two months, filling a critical gap in the evidence base.
Researchers randomly assigned participants to one of two paths. Half received six months of structured assertive case management (ACM) layered on top of their standard psychiatric treatment, typically medication and routine outpatient care. The other half continued with usual psychiatric care alone. Case management involved care coordinators working with patients on treatment adherence, safety planning, psychoeducation, and coordination between providers and family members. The researchers tracked outcomes using validated assessment tools: the Columbia-Suicide Severity Rating Scale (C-SSRS) as the primary measure, plus scales for depression, suicidal ideation, anxiety, and quality of life.
The case management group showed significantly greater reduction in overall suicidal thoughts and behaviors at six months compared to controls. The C-SSRS total score dropped 9.22 points in the ACM group versus 7.23 points in controls, a between-group difference of about 1.99 points. Secondary outcomes favored case management across the board: depressive symptoms decreased more in the ACM group (9.19-point reduction on the Hamilton Depression Rating Scale versus 6.23 points), suicidal ideation showed greater improvement (7.96-point reduction on the Beck Scale versus 5.58 points), and anxiety symptoms declined more steeply (3.90-point reduction on the GAD-7 versus 1.85 points). One suicide death occurred in the control group; none in the case management group, though the small number limits conclusions about this outcome.
Follow-up rates suggest the intervention was acceptable: 132 of 158 case management participants (83.5%) and 113 of 156 control participants (72.4%) completed the six-month assessment. The demographic profile was predominantly female (66%), with a mean age of 32 years, representing a relatively young, high-risk population. Intention-to-treat analysis preserved the integrity of random assignment and prevented selective dropout bias from inflating benefits.
This trial establishes that adding structured case management to standard psychiatric treatment produces measurable gains in suicidal thoughts and depression severity. The effect sizes are moderate, not transformative: patients in case management improved somewhat more than those receiving standard care alone. This matters for policy makers considering how to deploy limited mental health resources; it suggests that hospital-based psychosocial infrastructure can be part of a public health answer to suicide prevention.
For individuals in crisis or with active suicidal ideation, the findings support advocating for case management services if available through your psychiatric provider or hospital. These services typically include appointment adherence support, safety planning, coordination with family and providers, and psychoeducation about depression and suicide risk. They are not replacements for psychiatric medication, therapy, or emergency services, but adjuncts that appear to enhance outcomes.
The trial does not address whether specific therapy types, particular medications, or lifestyle changes amplify case management benefits. Participants in both groups received standard psychiatric treatment, so the added value of case management cannot be isolated from baseline care. The study also excluded people with psychosis, bipolar disorder, or active substance dependence, limiting generalizability to those populations.
| Parameter | Details |
|---|---|
| Study type | Randomized controlled trial (RCT) |
| Sample size | 314 (158 ACM, 156 control); 245 completed follow-up |
| Population | Outpatients aged 18+ with major depression and current suicidal ideation or attempt within 2 months |
| Intervention | 6 months of assertive case management + standard psychiatric care |
| Control | Usual psychiatric care alone |
| Primary outcome | Change in Columbia-Suicide Severity Rating Scale (C-SSRS) total score |
| Secondary outcomes | Depression (HDRS), suicidal ideation (BSS), anxiety (GAD-7), quality of life, service use |
| Location | 6 general hospitals in South Korea |
| Duration | January 2021 to July 2024 |
| Main result | ACM group showed 1.99-point greater reduction in C-SSRS (P=0.005); depression and anxiety also favored ACM |
| Evidence tier | S tier (large RCT, pre-registered, intention-to-treat analysis) |
Park, J. H., et al. (2024). Hospital-based psychosocial case management and suicide prevention in South Korea: A randomized clinical trial. *JAMA Network Open*.
PubMed: https://pubmed.ncbi.nlm.nih.gov/42412433/
Clinical Trial Registry: KCT0008123
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