Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review
Abstract
Objective:
Methods:
Results:
Conclusions:
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METHODS
Intervention Superior to Control | Intervention Not Superior to Control | |||||
---|---|---|---|---|---|---|
Intervention | Studies (N) | N | % | N | % | Scalabilityb |
General practitioner educationc | 12 | 10 | 83 | 2 | 17 | Yes |
Education for youth suicidal | 3 | 3 | 100 | 0 | 0 | Yes |
behavior (targeting youths for training/education) | ||||||
Education for youth suicidal | 6 | 1 | 17 | 5 | 83 | Yes |
behavior prevention (targeting adults for training/education) | ||||||
Pharmacotherapy | 17 | 4 | 24 | 13 | 76 | Yes |
Psychotherapy (CBT, DBT) | 18 | 9 | 50 | 9 | 50 | Yes (CBT) |
Medication and psychotherapy | 3 | 1 | 33 | 2 | 67 | NA |
Group psychotherapy | 2 | 1 | 50 | 1 | 50 | NA |
Contact and/or active outreach | 10 | 7 | 70 | 3 | 30 | Yes |
Brain stimulation | 2 | 0 | 0 | 2 | 100 | NA |
Collaborative care | 1 | 1 | 100 | 0 | 0 | NA |
Firearms restrictiond | 49 | 48 | 98 | 1 | 2 | Yes |
Internet based | 3 | 0 | 0 | 3 | 100 | NA |
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RESULTS
Education
General practitioner and nonpsychiatrist physician education.
Source | Prevention Strategy | Length of Intervention | Population | Study Type | Location | Outcome |
---|---|---|---|---|---|---|
Oyama et al., 2005 (15) | Educational intervention for nurse depression screening and GP management | 8 years, screening and depression management | Older adults | Quasi-experimentalb | Japan | Greater reduction in female suicide in intervention region compared with control region (IRR=0.35). No regional difference in male suicides. |
Oyama et al., 2006 (17) | Educational intervention for nurse depression screening and GP management | 10 years, screening and depression management | Older adults | Quasi-experimentalb | Japan | Reduction of 64% in female suicide rate in the intervention region (IRR=0.36), but no change in the control region. No change in male suicide rate. |
Oyama et al., 2006 (16) | Educational intervention for nurse depression screening and GP management | 10 years, screening and depression management | Older adults | Quasi-experimentalb | Japan | Greater reduction in female suicide rates in intervention region compared with control region (IRR=0.43). No regional differences in male suicides. |
Oyama et al., 2006 (14) | Educational intervention for nurse depression screening and GP management | 5 years, screening and depression management | Older adults | Quasi-experimentalb | Japan | Reduction of 74% in female suicide rate in the intervention region (IRR=0.26), significant using a one-tailed test, and no change in the control region. No change in male suicide rate. |
Henriksson and Isacsson, 2006 (18) | Yearly 2-day GP training sessions | 8 years, GP screening and depression treatment | Adults | Quasi-experimentalb | Sweden | Preintervention (1970–1994) suicide rate was higher in Jämtland County (Sweden) than nationwide (p<0.05), but during intervention period (1995–2002) it dropped in intervention region, so the two rates no longer differed. |
Szanto et al., 2007 (12) | Annual educational program for GPs and their nurses | 5 years, GP supervised depression management | Adults | Quasi-experimentalb | Hungary | Decrease in suicide rate in intervention region greater than the larger county (p<0.001) and Hungary (p<0.001). |
Alexopoulos et al., 2009 (22) | GP training and case managers | 2 years, algorithm-based treatment advice | Older adults | Randomized controlled trialc | United States | Intervention group more likely to receive antidepressants or psychotherapy (p<0.001), and those with major depression had lower rates of suicidal ideation at 4, 8, and 24 months (p=0.04). No difference in suicidal behavior. |
Hegerl et al., 2010 (21) | Four-level intervention program including GP education | 2 years, GP depression management | Adults | Quasi-experimentalb | Germany | Intervention region had greater reduction in suicidal acts (suicides and suicide attempts) (p<0.0065) and attempts (p<0.0005) versus control from baseline to 1-year follow-up of the 2-year intervention (2000–2003).The reduction in attempts was more pronounced for high-lethality than low-lethality methods and persisted for 4 years. |
Hübner-Liebermann et al., 2010 (19) | Four-level intervention program including GP education in depression management | 5 years, GP depression management | Adults | Quasi-experimentalb | Germany | Suicide rate declined in the intervention region (p=0.02) but not in the control region. |
Roškar et al., 2010 (27) | One-day GP educational program | 3 years, GP depression management | Adults | Quasi-experimentald | Slovenia | Intervention group had greater increase in antidepressant prescriptions (p<0.05) compared with control group, but no group differences in suicide rate. |
Almeida et al., 2012 (26) | GP practice audit with feedback on depression and self-harm, educational materials, and control education GP group | 2 years, GP depression management | Older adults | Randomized controlled triale | Australia | Intervention group had less self-harm behaviors (odds ratio=0.80, p<0.05) over 2 years. |
Hegerl et al., 2019 (20) | Four-level intervention program including GP training, GP consultation hotline | 2 years, GP depression treatment | Adults | Quasi-experimentalb | Germany, Hungary, Ireland, Portugal | In Portugal, the intervention region saw a greater reduction in suicidal acts (suicides and suicide attempts) (p=0.05) and attempts (p=0.02) compared with control region. No group differences found in the other countries. |
Education for youth suicidal behavior prevention.
System-level education.
Screening
Treatment Interventions
Pharmacotherapy.
Psychotherapy.
Comparison of pharmacotherapy and psychotherapy.
Group psychotherapy.
Contact and/or active outreach following a suicide attempt or suicidal ideation crisis.
Brain stimulation.
Collaborative care.
Internet-based interventions.
Means Restriction
DISCUSSION
CONCLUSIONS
Acknowledgments
Footnote
Supplementary Material
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