Suicide prevention strategies: a systematic review.
World Health Organization1, University of Otago2, Columbia University3, American Foundation for Suicide Prevention4, Ludwig Maximilian University of Munich5, National Institute for Health and Welfare6, University College Dublin7, University of Oslo8, Uppsala University9, University of Würzburg10, National Defense Medical College11, Karolinska Institutet12, University of Hong Kong13
TL;DR: Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates, and other interventions need more evidence of efficacy.
Abstract: 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.
Citations
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TL;DR: It is concluded that mass media campaigns can produce positive changes or prevent negative changes in health-related behaviours across large populations.
1,870 citations
Columbia University1, Tel Aviv University2, University of Oxford3, Karolinska Institutet4, Ghent University5, University College Cork6, National Institutes of Health7, Eötvös Loránd University8, Semmelweis University9, University of Lorraine10, University of Oviedo11, University of Haifa12, Iuliu Hațieganu University of Medicine and Pharmacy13, Leipzig University14
TL;DR: The evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics and hot-spots for suicide by jumping.
1,092 citations
TL;DR: The frequency of suicidal Ideation among medical students is assessed and the relationship between suicidal ideation and burnout, symptoms of depression, and quality of life is evaluated to explore its relationship with burnout.
Abstract: The stresses of medical school can lead to suicidal ideation or burnout. The prevalence of these conditions in medical students is not known. In a survey of 4287 medical students at 7 U.S. medical ...
1,081 citations
Cites background from "Suicide prevention strategies: a sy..."
...Educating students about the frequency of depression and suicidal ideation and frequently making them aware of available resources seem to be sensible, worthy, and helpful (1, 39)....
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University of Washington1, Harvard University2, University of the West Indies3, Stanford University4, GAVI Alliance5, World Health Organization6, University of California, San Francisco7, Bill & Melinda Gates Foundation8, Peking University9, International Monetary Fund10, Columbia University11, Princeton University12, African Development Bank13, United States Agency for International Development14, Public Health Foundation of India15, Results for Development Institute16, University of Oslo17
TL;DR: A recent report by the Lancet Commission revisited the case for investment in health and developed a new investment framework to achieve dramatic health gains by 2035 as discussed by the authors, which is, a reduction in infectious, maternal, and child mortality down to universally low levels.
1,069 citations
American Foundation for Suicide Prevention1, San Francisco State University2, University of California, Los Angeles3, Pennsylvania State University4, University of Colorado Denver5, Columbia University6, University of Illinois at Chicago7, City University of New York8, University of Arizona9, University of California, San Francisco10, Drexel University11, University of Minnesota12, Fenway Health13, Yale University14, University of Pennsylvania15, Ben-Gurion University of the Negev16, University of Pittsburgh17, Howard Brown Health Center18, Kaiser Permanente19
TL;DR: This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes.
Abstract: Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.
1,050 citations
Cites background from "Suicide prevention strategies: a sy..."
...Suicide prevention strategies focus on four key domains, in addition to mental health treatment (Mann et al., 2005):...
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...Suicide Prevention Strategies Suicide prevention strategies focus on four key domains, in addition to mental health treatment (Mann et al., 2005): ◦ awareness campaigns and educational programs for the general public, primary care physicians, and community and organizational gatekeepers; ◦…...
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References
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TL;DR: A multifaceted intervention consisting of collaborative management by the primary care physician and a consulting psychiatrist, intensive patient education, and surveillance of continued refills of antidepressant medication improved adherence to antidepressant regimens in patients with major and with minor depression and resulted in more favorable depressive outcomes.
Abstract: Objective. —To compare the effectiveness of a multifaceted intervention in patients with depression in primary care with the effectiveness of "usual care" by the primary care physician. Design. —A randomized controlled trial among primary care patients with major depression or minor depression. Patients. —Over a 12-month period a total of 217 primary care patients who were recognized as depressed by their primary care physicians and were willing to take antidepressant medication were randomized, with 91 patients meeting criteria for major depression and 126 for minor depression. Interventions. —Intervention patients received increased intensity and frequency of visits over the first 4 to 6 weeks of treatment (visits 1 and 3 with a primary care physician, visits 2 and 4 with a psychiatrist) and continued surveillance of adherence to medication regimens during the continuation and maintenance phases of treatment. Patient education in these visits was supplemented by videotaped and written materials. Main Outcome Measures. —Primary outcome measures included short-term (30-day) and long-term (90-day) use of antidepressant medication at guideline dosage levels, satisfaction with overall care for depression and antidepressant medication, and reduction in depressive symptoms. Results. —In patients with major depression, the intervention group had greater adherence than the usual care controls to adequate dosage of antidepressant medication for 90 days or more (75.5% vs 50.0%;P Conclusion. —A multifaceted intervention consisting of collaborative management by the primary care physician and a consulting psychiatrist, intensive patient education, and surveillance of continued refills of antidepressant medication improved adherence to antidepressant regimens in patients with major and with minor depression. It improved satisfaction with care and resulted in more favorable depressive outcomes in patients with major, but not minor, depression. (JAMA. 1995;273:1026-1031)
1,424 citations
TL;DR: Alternative approaches to suicide-prevention efforts may be needed for those less likely to be seen in primary care or mental health specialty care, specifically young men.
Abstract: OBJECTIVE: This study examined rates of contact with primary care and mental health care professionals by individuals before they died by suicide. METHOD: The authors reviewed 40 studies for which there was information available on rates of health care contact and examined age and gender differences among the subjects. RESULTS: Contact with primary care providers in the time leading up to suicide is common. While three of four suicide victims had contact with primary care providers within the year of suicide, approximately one-third of the suicide victims had contact with mental health services. About one in five suicide victims had contact with mental health services within a month before their suicide. On average, 45% of suicide victims had contact with primary care providers within 1 month of suicide. Older adults had higher rates of contact with primary care providers within 1 month of suicide than younger adults. CONCLUSIONS: While it is not known to what degree contact with mental health care and pr...
1,367 citations
"Suicide prevention strategies: a sy..." refers background in this paper
...Suicide prevention is possible because up to 83% of suicides have had contact with a primary care physician within a year of their death and up to 66% within a month.(17,18) Thus, a key prevention strategy is improved screening of depressed patients by primary care physicians and better treatment of major depression....
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...Prevention is possible because most suicides have had contact with a primary care physician within a month of death.(17,18) Primary care physicians’ lack of knowledge about or failure to screen patients for depression may contribute to nontreatment seen in most suicides....
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TL;DR: Two recent American studies have shown more than 90 per cent of suicides to be mentally ill before their death, and the familiar clinical observation that suicidal thoughts disappear when the illness is successfully treated provide a strong case for a medical policy of prevention.
Abstract: 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.
1,246 citations
"Suicide prevention strategies: a sy..." refers background in this paper
...Mood disorders, principally major depressive disorder and bipolar disorder, are associated with about 60% of suicides.(7,8,10,15,16) Other contributory factors include availability of lethal means, alcohol and drug abuse, access to psychiatric treatment, attitudes to suicide, help-seeking behavior, physical illness, marital status, age, and sex....
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TL;DR: A limited range of diagnoses--most commonly a mood disorder alone or in combination with conduct disorder and/or substance abuse--characterizes most suicides among teenagers.
Abstract: Background: The age, sex, and ethnic distribution of adolescents who commit suicide is significantly different from that of the general population. The present study was designed to examine psychiatric risk factors and the relationship between them and demographic variables. Methods: A case-control, psychologic autopsy study of 120 of 170 consecutive subjects (age, Results: By using parent informants only, 59% of subjects who committed suicide and 23% of control subjects who metDSM-IIIcriteria for a psychiatric diagnosis, 49% and 26%, respectively, had had symptoms for more than 3 years, and 46% and 29%, respectively, had had previous contact with a mental health professional. Best-estimate rates, based on multiple informants for these parameters, for suicides only, were 91%, 52%, and 46%, respectively. Previous attempts and mood disorder were major risk factors for both sexes; substance and/or alcohol abuse was a risk factor for males only. Mood disorder was more common in females, substance and/or alcohol abuse occurred exclusively in males (62% of 18-to 19-year-old suicides). The prevalence of a psychiatric diagnosis and, in particular, substance and/or alcohol abuse increased with age. Conclusion: A limited range of diagnoses—most commonly a mood disorder alone or in combination with conduct disorder and/or substance abuse—characterizes most suicides among teenagers.
1,243 citations
TL;DR: While tremendous strides have been made in 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.
Abstract: 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.
1,242 citations
"Suicide prevention strategies: a sy..." refers background in this paper
...Other specific education strategies are aimed at youth, including school and community-based programs.(114,115) Few such programs are evidencebased, reflect the current state of knowledge in suicide prevention, or evaluate effectiveness and safety for preventing suicidal behavior....
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...Few such programs are evidencebased, reflect the current state of knowledge in suicide prevention, or evaluate effectiveness and safety for preventing suicidal behavior.(114) A systematic review of studies published from 1980-1995 found that knowledge about suicide improved but there were both beneficial and harmful effects in terms of help-seeking, attitudes, and peer support....
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