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Published Online: 18 February 2021

Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review

Abstract

Objective:

The authors sought to identify scalable evidence-based suicide prevention strategies.

Methods:

A search of PubMed and Google Scholar identified 20,234 articles published between September 2005 and December 2019, of which 97 were randomized controlled trials with suicidal behavior or ideation as primary outcomes or epidemiological studies of limiting access to lethal means, using educational approaches, and the impact of antidepressant treatment.

Results:

Training primary care physicians in depression recognition and treatment prevents suicide. Educating youths on depression and suicidal behavior, as well as active outreach to psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior. Meta-analyses find that antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered. Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention. Cognitive-behavioral therapy and dialectical behavior therapy prevent suicidal behavior. Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression. Education of gatekeepers about youth suicidal behavior lacks effectiveness. No randomized trials have been reported for gatekeeper training for prevention of adult suicidal behavior. Algorithm-driven electronic health record screening, Internet-based screening, and smartphone passive monitoring to identify high-risk patients are understudied. Means restriction, including of firearms, prevents suicide but is sporadically employed in the United States, even though firearms are used in half of all U.S. suicides.

Conclusions:

Training general practitioners warrants wider implementation and testing in other nonpsychiatrist physician settings. Active follow-up of patients after discharge or a suicide-related crisis should be routine, and restricting firearm access by at-risk individuals warrants wider use. Combination approaches in health care systems show promise in reducing suicide in several countries, but evaluating the benefit attributable to each component is essential. Further suicide rate reduction requires evaluating newer approaches, such as electronic health record–derived algorithms, Internet-based screening methods, ketamine’s potential benefit for preventing attempts, and passive monitoring of acute suicide risk change.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 611 - 624
PubMed: 33596680

History

Received: 16 June 2020
Revision received: 8 September 2020
Accepted: 2 November 2020
Published online: 18 February 2021
Published in print: July 2021

Keywords

  1. Antidepressants
  2. Depressive Disorders
  3. Suicide and Self-Harm

Keywords

  1. Prevention
  2. Suicidal Ideation
  3. Neuroimaging

Authors

Details

J. John Mann, M.D. [email protected]
Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuroscience, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach).
Christina A. Michel, M.A.
Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuroscience, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach).
Randy P. Auerbach, Ph.D.
Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuroscience, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach).

Notes

Send correspondence to Dr. Mann ([email protected]).

Funding Information

Dr. Mann receives royalties from the Research Foundation for Mental Hygiene for commercial use of the Columbia-Suicide Severity Rating Scale. Dr. Auerbach is a member of the Research Grants Committee for the American Foundation for Suicide Prevention. Ms. Michel reports no financial relationships with commercial interests.Funding from NIMH provided partial support for Dr. Mann (grant 5P50MH090964) and Dr. Auerbach (grant U01MH108168) in the preparation of this manuscript.

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