ContextIn 2002, an estimated 877 000 lives were lost worldwide through
suicide. Some developed nations have implemented national suicide prevention
plans. Although these plans generally propose multiple interventions, their
effectiveness is rarely evaluated.ObjectivesTo examine evidence for the effectiveness of specific suicide-preventive
interventions and to make recommendations for future prevention programs and
research.Data Sources and Study SelectionRelevant publications were identified via electronic searches of MEDLINE,
the Cochrane Library, and PsychINFO databases using multiple search terms
related to suicide prevention. Studies, published between 1966 and June 2005,
included those that evaluated preventative interventions in major domains;
education and awareness for the general public and for professionals; screening
tools for at-risk individuals; treatment of psychiatric disorders; restricting
access to lethal means; and responsible media reporting of suicide.Data ExtractionData were extracted on primary outcomes of interest: suicidal behavior
(completion, attempt, ideation), intermediary or secondary outcomes (treatment
seeking, identification of at-risk individuals, antidepressant prescription/use
rates, referrals), or both. Experts from 15 countries reviewed all studies.
Included articles were those that reported on completed and attempted suicide
and suicidal ideation; or, where applicable, intermediate outcomes, including
help-seeking behavior, identification of at-risk individuals, entry into treatment,
and antidepressant prescription rates. We included 3 major types of studies
for which the research question was clearly defined: systematic reviews and
meta-analyses (n = 10); quantitative studies, either randomized
controlled trials (n = 18) or cohort studies (n = 24);
and ecological, or population- based studies (n = 41). Heterogeneity
of study populations and methodology did not permit formal meta-analysis;
thus, a narrative synthesis is presented.Data SynthesisEducation of physicians and restricting access to lethal means were
found to prevent suicide. Other methods including public education, screening
programs, and media education need more testing.ConclusionsPhysician education in depression recognition and treatment and restricting
access to lethal methods reduce suicide rates. Other interventions need more
evidence of efficacy. Ascertaining which components of suicide prevention
programs are effective in reducing rates of suicide and suicide attempt is
essential in order to optimize use of limited resources.

Suicide prevention strategies: a systematic review.

Objective To review critically the past 10 years of research on youth suicide. Method Research literature on youth suicide was reviewed following a systematic search of PsycINFO and Medline. The search for school-based suicide prevention programs was expanded using two education databases: ERIC and Education Full Text. Finally, manual reviews of articles' reference lists identified additional studies. The review focuses on epidemiology, risk factors, prevention strategies, and treatment protocols. Results There has been a dramatic decrease in the youth suicide rate during the past decade. Although a number of factors have been posited for the decline, one of the more plausible ones appears to be the increase in antidepressants being prescribed for adolescents during this period. Youth psychiatric disorder, a family history of suicide and psychopathology, stressful life events, and access to firearms are key risk factors for youth suicide. Exciting new findings have emerged on the biology of suicide in adults, but, while encouraging, these are yet to be replicated in youths. Promising prevention strategies, including school-based skills training for students, screening for at-risk youths, education of primary care physicians, media education, and lethal-means restriction, need continuing evaluation studies. Dialectical behavior therapy, cognitive-behavioral therapy, and treatment with antidepressants have been identified as promising treatments but have not yet been tested in a randomized clinical trial of youth suicide. Conclusions While tremendous strides have been made in our understanding of who is at risk for suicide, it is incumbent upon future research efforts to focus on the development and evaluation of empirically based suicide prevention and treatment protocols.

Youth suicide risk and preventive interventions: A review of the past 10 years.

This review examines the descriptive epidemiology, and risk and protective factors for youth suicide and suicidal behavior A model of youth suicidal behavior is articulated, whereby suicidal behavior ensues as a result of an interaction of socio-cultural, developmental, psychiatric, psychological, and family-environmental factors On the basis of this review, clinical and public health approaches to the reduction in youth suicide and recommendations for further research will be discussed

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Adolescent suicide and suicidal behavior

Crime fell sharply in the United States in the 1990s, in all categories of crime and all parts of the nation. Homicide rates plunged 43 percent from the peak in 1991 to 2001, reaching the lowest levels in 35 years. The Federal Bureau of Investigation’ s (FBI) violent and property crime indexes fell 34 and 29 percent, respectively, over that same period. These declines occurred essentially without warning: leading experts were predicting an explosion in crime in the early and mid-1990s, precisely the point when crime rates began to plunge. Although experts failed to anticipate the decline, there has been no shortage of hypotheses to explain the drop in crime after the fact. Table 1 presents a tally of a Lexis-Nexis search of the most frequently cited reasons for the crime decline in articles in major newspapers over the period 1991‐ 2001. The single most frequent explanation given is the innovative policing strategies put into place. The crime decline is also frequently attributed to increased imprisonment, changes in the market for crack cocaine, the aging of the population, tougher gun control laws, the strong economy and increases in the number of police. In this paper, I attempt to sort out why crime declined in the 1990s. I begin with a review of the facts. I then analyze the leading explanations for why crime fell, looking at possible determinants that changed in some substantial way in the 1990s. Most of the supposed explanations listed in Table 1 actually played little direct role in the crime decline, including the strong economy of the 1990s, changing demographics, better policing strategies, gun control laws, concealed weapons laws and increased use of the death penalty. Four factors, however, can account for virtually

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Understanding Why Crime Fell in the 1990s: Four Factors that Explain the Decline and Six that Do Not

Evidence for a substantial deterrent effect is much firmer than it was two decades ago. However, large gaps in knowledge on the links between policy actions and behavior make it difficult to assess the effectiveness of policy options for deterring crime. There are four major impediments. First, analyses must estimate not only short-term consequences but also calibrate long-term effects. Some policies that are effective in preventing crime in the short term may be ineffective or even criminogenic in the long run because they may erode the foundation of the deterrent effect-fear of stigmatization. Second, knowledge about the relationship of sanction risk perceptions to policy is virtually nonexistent; such knowledge would be invaluable in designing effective crime-deterrent policies. Third, estimates of deterrent effects based on data from multiple governmental units measure a policy's average effectiveness across unit. It is important to understand better the sources of variation in response across place a...

Criminal Deterrence Research at the Outset of the Twenty-First Century

Background Whether restricting access to handguns will reduce firearm-related homicides and suicides is currently a matter of intense debate. In 1976 the District of Columbia adopted a law that banned the purchase, sale, transfer, or possession of handguns by civilians. We evaluated the effect of implementing this law on the frequency of homicides and suicides. Methods Homicides and suicides committed from 1968 through 1987 were classified according to place of occurrence (within the District of Columbia or in adjacent metropolitan areas where the law did not apply), cause (homicide or suicide), mechanism of death (firearms or other means), and time of occurrence (before or after the implementation of the law). The number of suicides and homicides was calculated for each month during the study period, and differences between the mean monthly totals before and after the law went into effect were estimated. Results In Washington, D.C., the adoption of the gun-licensing law coincided with an abrupt ...

Effects of restrictive licensing of handguns on homicide and suicide in the District of Columbia.

Restrictions on carrying concealed weapons are among the most common gun control policies.' These statutes limit who may have a deadly weapon-usually a handgun-hidden on their person when outside the home. By reducing access to guns in public, concealed weapons laws seek to make firearms less available for violence.2 Details of concealed weapons laws vary greatly among localities, but most approaches fall into two categories. One of these is a discretionary system, sometimes called "may issue" licensing.3 Under this policy, legal authorities grant licenses only to those citizens who can establish a compelling need for carrying a gun. The other approach is a non-discretionary, or "shall issue," system.4 Here the authorities must provide a license to any applicant who meets specified criteria. Because legal officials are often unwilling to allow concealed weapons, adopting a shall issue policy usually increases the number of persons with permits to carry guns.5 In 1985, the National Rifle Association announced that it would

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David McDowall

Papers

Effects of restrictive licensing of handguns on homicide and suicide in the District of Columbia.

Easing Concealed Firearms Laws: Effects on Homicide in Three States

Book Review Gun Violence: The Real Costs By Philip J. Cook and Jens Ludwig. 242 pp. New York, Oxford University Press, 2000. $25. 0-19-513793-0