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Caring Letters Prevent Suicide

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Letter that reads: "Dear Hohn, It has been some time since you were here at the hospital, and we hope...


Suicide is a leading cause of death, and it is notoriously difficult to prevent.


Regularly receiving letters from a caring person helps people at risk for committing suicide feel connected and stay alive.

The Details

Between 1969 and 1974, psychiatric hospitals in San Francisco admitted 3,005 people for depression or suicidal tendencies. Psychiatrist Jerome Motto and statistician Alan Bostrom randomly assigned some 843 of these patients to one of two groups after they were discharged from the hospital.

In the contact group, patients received periodic handwritten letters from a health care professional who had earlier interviewed them. The letters expressed concern, care, and a desire to stay in contact. For instance, one letter read:

Dear John,

It has been some time since you were here at the hospital, and we hope things are going well for you. If you wish to drop us a note, we would be glad to hear from you.



A handwritten note

Patients in the contact group received 8 letters in the first year. They then received 4 letters every year over the next four years, for a total of 24 letters over 5 years.

Patients in the control group did not receive letters from the hospital.

Two years after leaving the hospital—the span of time when at-risk patients are most likely to kill themselves—only 1.80% of patients in the contact group had committed suicide, compared to 3.52% of patients in the control group. Even 13 years after hospital discharge, patients who had received letters from the hospital still had lower rates of suicide than those who had not.

Why This Works

Receiving regular letters that express care can help us feel connected to others. This feeling of connection is especially important during dark times. About 25% of patients in the contact group sent back grateful messages like:

“You will never know what your little notes mean to me. I always think someone cares about what happens to me, even if my family did kick me out,” and

“It gives me great pleasure to know that someone is concerned.”

When This Works Best

Many people at high risk for suicide refuse medical treatment, often because they don’t want to be labeled as mentally ill. Communicating care and concern and creating a sense of social connection without demanding anything in return can help people survive the two-year period following a psychiatric crisis, when they are most likely to take their lives.

The Original Study

Motto, J. A., & Bostrom, A. G. (2001). A randomized controlled trial of postcrisis suicide prevention. Psychiatric Services, 52(6), 828-833.

In the Media


See Also

Carter, G. L., Clover, K., Whyte, I. M., Dawson, A. H., & D'Este, C. (2005). Postcards from the EDge project: Randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning. BMJ, 331(7520), 805-807.

Related Topics

Health Relationships