{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T02:35:17Z","timestamp":1783478117280,"version":"3.55.0"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n South Korea maintains the highest suicide rate in the Organization for Economic Cooperation and Development, with major depressive disorder (MDD) being the leading diagnosis among suicide deaths. Evidence from large-scale randomized clinical trials (RCTs) is limited, particularly for diagnosis-specific, long-term programs in outpatient settings.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the effectiveness of a structured, hospital-based case management program in reducing suicidal ideation and associated clinical outcomes among patients with MDD.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This RCT was conducted at 6 general hospitals in South Korea from January 18, 2021, to July 31, 2024. Participants included outpatients 18 years or older with MDD who had current suicidal ideation or a suicide attempt within the past 2 months. All efficacy analyses were performed according to the intention-to-treat principle.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Participants were randomized 1:1 to receive either 6 months of structured assertive case management (ACM) as an adjunct to standard treatment (n\u2009=\u2009158) or usual psychiatric care alone (control [n\u2009=\u2009156]).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the change from baseline to 6 months in the overall severity of suicidal thoughts and behaviors (STBs), as assessed by the Columbia\u2013Suicide Severity Rating Scale (C-SSRS). Secondary outcomes included changes in depression, suicidal intent and ideation, anxiety, loneliness, impulsivity, quality of life, and service utilization.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 314 participants enrolled (mean [SD] age, 32.3 [13.1] years; 207 [65.9%] female), 158 were randomized to the ACM group and 156 to the control group; 245 (132 in the ACM and 113 in the control groups) completed the 6-month follow-up. The ACM group showed a significantly greater mean (SD) reduction in C-SSRS total score than the control group (\u22129.22 [0.49] vs \u22127.23 [0.50]; adjusted mean difference, \u22121.99 [95% CI, \u22123.37 to \u22120.61];\n P<\/jats:italic>\n \u2009=\u2009.005). Greater mean improvements were also observed in the ACM group for depressive symptoms (Hamilton Depression Rating Scale mean [SD] change, \u22129.19 [0.70] vs \u22126.23 [0.69];\n P<\/jats:italic>\n \u2009=\u2009.003), suicidal ideation (Beck Scale for Suicidal Ideation mean [SD] change, \u22127.96 [0.62] vs \u22125.58 [0.75];\n P<\/jats:italic>\n \u2009=\u2009.01), and anxiety (Generalized Anxiety Disorder\u20137 mean [SD] change, \u22123.90 [0.44] vs \u22121.85 [0.48];\n P<\/jats:italic>\n \u2009=\u2009.002). No significant between-group differences were observed in suicide attempts, and 1 suicide death occurred in the control group.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this RCT of outpatients with MDD and high suicide risk, ACM significantly reduced C-SSRS total scores and psychological distress compared with usual care. These findings provide a critical, high-level evidence base for the national implementation of standardized, hospital-centered psychosocial interventions as a scalable public health strategy for suicide prevention.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n Clinical Research Information Service Identifier:\n KCT0008123<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.20950","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T15:30:19Z","timestamp":1783438219000},"page":"e2620950","source":"Crossref","is-referenced-by-count":1,"title":["Hospital-Based Psychosocial Case Management and Suicide Prevention in South Korea"],"prefix":"10.1001","volume":"9","author":[{"given":"Sang Min","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of 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Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwang-Yeon","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Chungnam National University College of Medicine, Daejeon, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A-La","family":"Park","sequence":"additional","affiliation":[{"name":"Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myungjae","family":"Baik","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ah Rah","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Kyung Hee University College of Medicine, 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