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: The Global Burden of Disease 2015 Study provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015, finding several countries in sub-Saharan Africa had very large gains in life expectancy, rebounding from an era of exceedingly high loss of life due to HIV/AIDS.
4,804 citations
TL;DR: Examination of prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors.
Abstract: Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.
2,147 citations
Cites background from "Suicide prevention strategies: a sy..."
...A recent systematic review of suicide prevention programs revealed that restricting access to lethal means and training physicians to recognize and treat depression and suicidal behavior have shown impressive effects in reducing suicide rates (135)....
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...Following this, efforts will be required to build on findings from recent natural experiments, quasi-experiments, and true experiments on methods of suicide prevention (135)....
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TL;DR: There is cross-national variability in the prevalence of suicidal behaviours, but strong consistency in the characteristics and risk factors for these behaviours.
Abstract: Background
Suicide is a leading cause of death worldwide; however, the prevalence and risk factors for the immediate precursors to suicide – suicidal ideation, plans and attempts – are not wellknown, especially in low- and middle-income countries.
Aims
To report on the prevalence and risk factors for suicidal behaviours across 17 countries.
Method
A total of 84 850 adults were interviewed regarding suicidal behaviours and socio-demographic and psychiatric risk factors.
Results
The cross-national lifetime prevalence of suicidal ideation, plans, and attempts is 9.2% (s.e.=0.1), 3.1% (s.e.=0.1), and 2.7% (s.e.=0.1). Across all countries, 60% of transitions from ideation to plan and attempt occur within the first year after ideation onset. Consistent cross-national risk factors included being female, younger, less educated, unmarried and having a mental disorder. Interestingly, the strongest diagnostic risk factors were mood disorders in high-income countries but impulse control disorders in low- and middle-income countries.
Conclusion
There is cross-national variability in the prevalence of suicidal behaviours, but strong consistency in the characteristics and risk factors for these behaviours. These findings have significant implications for the prediction and prevention of suicidal behaviours.
2,050 citations
University of Melbourne1, Royal Children's Hospital2, Columbia University3, University of London4, World Health Organization5, American University of Beirut6, University of Oregon7, Public Health Foundation of India8, University College London9, Burnet Institute10, United Nations Population Fund11, Aga Khan University12, University of Toronto13, Obafemi Awolowo University14, Jawaharlal Nehru University15, UNICEF16, Kunming Medical University17
TL;DR: This Commission outlines the opportunities and challenges for investment in adolescent health and wellbeing at both country and global levels (panel 1).
1,976 citations
TL;DR: Estimates suggest that mental disorders rank among the most substantial causes of death worldwide, and efforts to quantify and address the global burden of illness need to better consider the role of mental disorders in preventable mortality.
Abstract: Importance Despite the potential importance of understanding excess mortality among people with mental disorders, no comprehensive meta-analyses have been conducted quantifying mortality across mental disorders. Objective To conduct a systematic review and meta-analysis of mortality among people with mental disorders and examine differences in mortality risks by type of death, diagnosis, and study characteristics. Data sources We searched EMBASE, MEDLINE, PsychINFO, and Web of Science from inception through May 7, 2014, including references of eligible articles. Our search strategy included terms for mental disorders (eg, mental disorders, serious mental illness, and severe mental illness), specific diagnoses (eg, schizophrenia, depression, anxiety, and bipolar disorder), and mortality. We also used Google Scholar to identify articles that cited eligible articles. Study selection English-language cohort studies that reported a mortality estimate of mental disorders compared with a general population or controls from the same study setting without mental illness were included. Two reviewers independently reviewed the titles, abstracts, and articles. Of 2481 studies identified, 203 articles met the eligibility criteria and represented 29 countries in 6 continents. Data extraction and synthesis One reviewer conducted a full abstraction of all data, and 2 reviewers verified accuracy. Main outcomes and measures Mortality estimates (eg, standardized mortality ratios, relative risks, hazard ratios, odds ratios, and years of potential life lost) comparing people with mental disorders and the general population or people without mental disorders. We used random-effects meta-analysis models to pool mortality ratios for all, natural, and unnatural causes of death. We also examined years of potential life lost and estimated the population attributable risk of mortality due to mental disorders. Results For all-cause mortality, the pooled relative risk of mortality among those with mental disorders (from 148 studies) was 2.22 (95% CI, 2.12-2.33). Of these, 135 studies revealed that mortality was significantly higher among people with mental disorders than among the comparison population. A total of 67.3% of deaths among people with mental disorders were due to natural causes, 17.5% to unnatural causes, and the remainder to other or unknown causes. The median years of potential life lost was 10 years (n = 24 studies). We estimate that 14.3% of deaths worldwide, or approximately 8 million deaths each year, are attributable to mental disorders. Conclusions and relevance These estimates suggest that mental disorders rank among the most substantial causes of death worldwide. Efforts to quantify and address the global burden of illness need to better consider the role of mental disorders in preventable mortality.
1,927 citations
References
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01 Jan 2005
TL;DR: In this article, the authors evaluated the effectiveness of a 10-session cognitive therapy inter-vention designed to prevent repeated suicide attempts in a randomized controlled trial of 120 individuals who attempted suicide and were evaluated at a hospital emergency department within 48 hours of the attempt.
Abstract: Context Suicide attempts constitute a major risk factor for completed suicide, yet fewinterventions specifically designed to prevent suicide attempts have been evaluated.Objective To determine the effectiveness of a 10-session cognitive therapy inter-ventiondesignedtopreventrepeatsuicideattemptsinadultswhorecentlyattemptedsuicide.Design,Setting,andParticipants Randomizedcontrolledtrialofadults(N=120)whoattemptedsuicideandwereevaluatedatahospitalemergencydepartmentwithin48 hours of the attempt. Potential participants (N=350) were consecutively recruitedfrom October 1999 to September 2002; 66 refused to participate and 164 were in-eligible. Participants were followed up for 18 months.Intervention Cognitive therapy or enhanced usual care with tracking and referralservices.MainOutcomeMeasures Incidenceofrepeatsuicideattemptsandnumberofdaysuntil a repeat suicide attempt. Suicide ideation (dichotomized), hopelessness, and de-pression severity at 1, 3, 6, 12, and 18 months.Results From baseline to the 18-month assessment, 13 participants (24.1%) in thecognitive therapy group and 23 participants (41.6%) in the usual care group made atleast1subsequentsuicideattempt(asymptotic
790 citations
TL;DR: Despite substantial differences between characteristics of people who commit suicide in China and the west, risk factors for suicide do not differ greatly and prevention programmes that concentrate on a single risk factor are unlikely to reduce suicide rates substantially.
778 citations
"Suicide prevention strategies: a sy..." refers background in this paper
...Psychiatric illness is a major contributing factor, and more than 90% of suicides have a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric illness,(7-13) with some exceptions, such as in China.(14) Mood disorders, principally major depressive disorder and bipolar disorder, are associated with about 60% of suicides....
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...All rights reserved. at Johns Hopkins University on May 14, 2010 www.jama.comDownloaded from stressors or triggers and predisposition.6 Psychiatric illness is a major contributing factor, and more than 90% of suicides have a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric illness,7-13 with some exceptions, such as in China.14 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.6 To address these causes, suicide prevention involves a multifaceted approach with particular attention to mental health....
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01 Jan 2013
TL;DR: Gilbody et al. as mentioned in this paper proposed a change group for the effective professional and organisa-tional change group at the University ofOttawa, Ontario, Canada, which is based on the Cochrane Effective Professional and Organisa-tecial Change Group (EPCG).
Abstract: AcademicUnitofPsychiatryandBehavioural Sciences, University of Leeds, Leeds, En-gland(DrGilbody);DepartmentofEpidemiologyandPublic Health, University of Newcastle upon Tyne,Newcastle upon Tyne, England (Dr Whitty); ClinicalEpidemiologyProgram,InstituteofPopulationHealth,and Cochrane Effective Professional and Organisa-tional Change Group, Ottawa Health ResearchInstitute and Center for Best Practices, University ofOttawa,Ottawa,Ontario(DrGrimshaw);andHealthServices Research Unit, University of Aberdeen, Ab-erdeen, Scotland (Dr Thomas).
721 citations
TL;DR: There is substantial potential to improve the management of depression in primary care and commonly used guidelines and educational strategies are likely to be ineffective.
Abstract: ContextDepression is commonly encountered in primary care settings yet is often
missed or suboptimally managed. A number of organizational and educational
strategies to improve management of depression have been proposed. The clinical
effectiveness and cost-effectiveness of these strategies have not yet been
subjected to systematic review.ObjectiveTo systematically evaluate the effectiveness of organizational and educational
interventions to improve the management of depression in primary care settings.Data SourcesWe searched electronic medical and psychological databases from inception
to March 2003 (MEDLINE, PsycLIT, EMBASE, CINAHL, Cochrane Controlled Trials
Register, United Kingdom National Health Service Economic Evaluations Database,
Cochrane Depression Anxiety and Neurosis Group register, and Cochrane Effective
Professional and Organisational Change Group specialist register); conducted
correspondence with authors; and used reference lists. Search terms were related
to depression, primary care,
and all guidelines and organizational and educational interventions.Study SelectionWe selected 36 studies, including 29 randomized controlled trials and
nonrandomized controlled clinical trials, 5 controlled before-and-after studies,
and 2 interrupted time-series studies. Outcomes relating to management and
outcome of depression were sought.Data ExtractionMethodological details and outcomes were extracted and checked by 2
reviewers. Summary relative risks were, where possible, calculated from original
data and attempts were made to correct for unit of analysis error.Data SynthesisA narrative synthesis was conducted. Twenty-one studies with positive
results were found. Strategies effective in improving patient outcome generally
were those with complex interventions that incorporated clinician education,
an enhanced role of the nurse (nurse case management), and a greater degree
of integration between primary and secondary care (consultation-liaison).
Telephone medication counseling delivered by practice nurses or trained counselors
was also effective. Simple guideline implementation and educational strategies
were generally ineffective.ConclusionsThere is substantial potential to improve the management of depression
in primary care. Commonly used guidelines and educational strategies are likely
to be ineffective. The implementation of the findings from this research will
require substantial investment in primary care services and a major shift
in the organization and provision of care.
685 citations
TL;DR: In this article, the authors determined whether the substantial gains made by patients with borderline personality disorder following completion of a psychoanalytically oriented partial hospitalization program, in comparison to patients treated with standard psychiatric care, were maintained over an 18-month follow-up period.
Abstract: OBJECTIVE: The aim of this study was to determine whether the substantial gains made by patients with borderline personality disorder following completion of a psychoanalytically oriented partial hospitalization program, in comparison to patients treated with standard psychiatric care, were maintained over an 18-month follow-up period. METHOD: Forty-four patients who participated in the original study were assessed every 3 months after completion of the treatment phase. Outcome measures included frequency of suicide attempts and acts of self-harm, number and duration of inpatient admissions, service utilization, and self-reported measures of depression, anxiety, general symptom distress, interpersonal functioning, and social adjustment. RESULTS: Patients who completed the partial hospitalization program not only maintained their substantial gains but also showed a statistically significant continued improvement on most measures in contrast to the patients treated with standard psychiatric care, who showed...
643 citations