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: Risk factors for suicide attempts have rarely been studied comprehensively in more than one psychiatric disorder, preventing estimation of the relative importance and the generalizability of different putative risk factors across psychiatric diagnoses. The authors conducted a study of suicide attempts in patients with mood disorders, psychoses, and other diagnoses. Their goal was to determine the generalizability and relative importance of risk factors for suicidal acts across diagnostic boundaries and to develop a hypothetical, explanatory, and predictive model of suicidal behavior that can subsequently be tested in a prospective study. METHOD: Following admission to a university psychiatric hospital, 347 consecutive patients who were 14–72 years old (51% were male and 68% were Caucasian) were recruited for study. Structured clinical interviews generated axis I and axis II diagnoses. Lifetime suicidal acts, traits of aggression and impulsivity, objective and subjective severity of acute psycho...

https://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.156.2.181

Toward a clinical model of suicidal behavior in psychiatric patients.

BACKGROUND: The psychological autopsy method offers the most direct technique currently available for examining the relationship between particular antecedents and suicide. This systematic review aimed to examine the results of studies of suicide that used a psychological autopsy method. METHOD: A computer aided search of MEDLINE, BIDS ISI and PSYCHLIT, supplemented by reports known to the reviewers and reports identified from the reference lists of other retrieved reports. Two investigators systematically and independently examined all reports. Median proportions were determined and population attributable fractions were calculated, where possible, in cases of suicide and controls. RESULTS: One hundred and fifty-four reports were identified, of which 76 met the criteria for inclusion; 54 were case series and 22 were case-control studies. The median proportion of cases with mental disorder was 91% (95 % CI 81-98%) in the case series. In the case-control studies the figure was 90% (88-95%) in the cases and 27% (14-48%) in the controls. Co-morbid mental disorder and substance abuse also preceded suicide in more cases (38%, 19-57%) than controls (6%, 0-13%). The population attributable fraction for mental disorder ranged from 47-74% in the seven studies in which it could be calculated. The effects of particular disorders and sociological variables have been insufficiently studied to draw clear conclusions. CONCLUSIONS: The results indicated that mental disorder was the most strongly associated variable of those that have been studied. Further studies should focus on specific disorders and psychosocial factors. Suicide prevention strategies may be most effective if focused on the treatment of mental disorders. Language: en

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291702006943

Psychological autopsy studies of suicide: a systematic review.

Background. The psychological autopsy method offers the most direct technique currently available for examining the relationship between particular antecedents and suicide. This systematic review aimed to examine the results of studies of suicide that used a psychological autopsy method. Method. A computer aided search of MEDLINE, BIDS ISI and PSYCHLIT, supplemented by reports known to the reviewers and reports identified from the reference lists of other retrieved reports. Two investigators systematically and independently examined all reports. Median proportions were determined and population attributable fractions were calculated, where possible, in cases of suicide and controls. Results. One hundred and fifty-four reports were identified, of which 76 met the criteria for inclusion; 54 were case series and 22 were case–control studies. The median proportion of cases with mental disorder was 91% (95% CI 81–98%) in the case series. In the case–control studies the figure was 90% (88–95%) in the cases and 27% (14–48%) in the controls. Co-morbid mental disorder and substance abuse also preceded suicide in more cases (38%, 19–57%) than controls (6%, 0–13%). The population attributable fraction for mental disorder ranged from 47–74% in the seven studies in which it could be calculated. The effects of particular disorders and sociological variables have been insufficiently studied to draw clear conclusions. Conclusions. The results indicated that mental disorder was the most strongly associated variable of those that have been studied. Further studies should focus on specific disorders and psychosocial factors. Suicide prevention strategies may be most effective if focused on the treatment of mental disorders.

Psychological autopsy studies of suicide: a systematic review. (vol 33, pg 395, 2003)

Suicide is analyzed in terms of motivations to escape from aversive self-awareness. The causal chain begins with events that fall severely short of standards and expectations. These failures are attributed internally, which makes self-awareness painful. Awareness of the self's inadequacies generates negative affect, and the individual therefore desires to escape from self-awareness and the associated affect. The person tries to achieve a state of cognitive deconstruction (constricted temporal focus, concrete thinking, immediate or proximal goals, cognitive rigidity, and rejection of meaning), which helps prevent meaningful self-awareness and emotion. The deconstructed state brings irrationality and disinhibition, making drastic measures seem acceptable. Suicide can be seen as an ultimate step in the effort to escape from self and world.

Suicide as escape from self.

One hundred suicides were investigated retrospectively by interviewing surviving relatives. Nine-three per cent were diagnosed mentally ill, 85 per cent suffering from depression or alcoholism. Eighty per cent were seeing a doctor and 80 per cent were prescribed psychotropic drugs. Over a half had given warnings of suicidal thinking. Some suicides may be preventable with modern psychiatric treatment, but our investigation showed that these methods were not always being effectively deployed.

A Hundred Cases of Suicide: Clinical Aspects

1. A consecutive series of 75 suicides was compared with 150 living comparison cases equivalent in age group, sex, single marital status and area of residence. 2. Similar proportions of parents of suicides and controls survived to enter the final quinquennium before suicide. 3. Within this quinquennium, significantly more suicides than controls were bereaved of either parent, and of their mothers. 4. The three years before suicide showed the greatest excess of maternal bereavement among suicides. 5. Almost 60% of the bereaved suicides showed a predisposition to mental illness before their bereavement: they had psychiatric treatment, attempted suicide or had a positive family history. 41% received psychiatric treatment after they were bereaved and before killing themselves. 6. Male suicides had significantly more maternal bereavement than male controls; female suicides did not differ significantly from controls. 7. Single suicides were significantly more often bereaved of a mother than single controls; currently married suicides and controls did not differ significantly. 8. Unmarried sons recently bereaved of a mother appeared a vulnerable group for suicide.

Suicide Following Bereavement of Parents

Suicide and barbiturate prescribing.

A consecutive series of 75 suicides occurring in southern England was compared with twice as many living subjects from the general population equivalent in age-group, sex and whether or not they had ever married. The hypothesis was tested that the suicides would more often have lost a parent by death before age 16. No difference was found between the suicides and the general population comparison group in the amount of early parental bereavement.

P. Sainsbury

Papers

A Hundred Cases of Suicide: Clinical Aspects

Suicide Following Bereavement of Parents

Suicide and barbiturate prescribing.

Early parental bereavement and suicide