Evidence-based national suicide prevention taskforce in Europe: A consensus position paper (original) (raw)
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Suicide prevention strategies revisited: 10-year systematic review
The Lancet Psychiatry, 2016
Background Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the eff ectiveness of suicide prevention interventions since 2005. Methods We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identifi cation of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis. Findings We identifi ed 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). Schoolbased awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0•45, 95% CI 0•24-0•85; p=0•014) and suicidal ideation (0•5, 0•27-0•92; p=0•025). The anti-suicidal eff ects of clozapine and lithium have been substantiated, but might be less specifi c than previously thought. Eff ective pharmacological and psychological treatments of depression are important in prevention. Insuffi cient evidence exists to assess the possible benefi ts for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions. Interpretation In the quest for eff ective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs.
Issues in designing, implementing, and evaluating suicide prevention strategies
Psychiatry, 2009
Suicide is one of the leading causes of death globally. Suicide prevention has become a policy priority in many countries. Some countries have implemented national suicide prevention strategies, in line with guidance from the united nations and the World Health organization. However, there are still several issues that require further attention in relation to suicide prevention strategies. First, although a growing number of countries have adopted national suicide prevention strategies, suicide prevention is still not a health priority globally. Second, there is an ongoing debate regarding the efficacy and effectiveness of individual interventions. although evidence on interventions from 'gold standard' studies (e.g. randomized controlled trials) is desirable, this is often not achievable. using the best available evidence is a pragmatic approach to the development of suicide prevention strategies. third, best practice is informed by evaluating what does and does not work. this requires an evaluation of both the efficacy of specific interventions and the effectiveness of suicide prevention strategies as health policy initiatives. a focus on international evaluation data would help to develop global understanding of best practice in relation to suicide prevention.
The European Psychiatric Association (EPA) guidance on suicide treatment and prevention
2011
Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year. SUICIDAL CRISIS: Acute intervention should start immediately in order to keep the patient alive. DIAGNOSIS: An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high.
2015
Prevention conducted a comprehensive literature review of suicide prevention/intervention trials to assess the quality of the scientific evidence. Evidence acquisition: A literature “review of reviews ” was conducted by searching the most widely used databases for mental health and public health research. The quality of the reviews was evaluated using the Revised Assessment of Multiple Systematic Reviews system; the quality of the scientific evidence for the suicide preventions/interventions was assessed using U.S. Preventive Services Task Force criteria. The reviews were limited to peer-reviewed publications with human subjects published in English. Evidence synthesis: Ninety-eight systematic reviews and 45 primary sources on suicide prevention/interventions published between January 2000 and September 2012 were evaluated. The results suggest that the quality of both the systematic reviews and the scientific evidence for suicide preventions/interventions were mixed. The majority of...
25 years of suicide research and prevention: How much has changed?
Clinical Child Psychology and Psychiatry, 2020
Twenty five years ago the 1995 World Health Report noted that suicide was the second leading cause of death for young people in most countries (second only to accidents), with rates rising more quickly than those of any other age group (World Health Organization, 1995). It was on this backdrop that the first issue of Clinical Child Psychology and Psychiatry (CCPP) was released. It included an appropriately timed paper aiming to increase treatment adherence and follow-up among adolescents presenting to the emergency room for a suicide attempt (Rotheram-Borus, Piacentini, Miller et al., 1996). To this end, the authors developed an intervention program for multidisciplinary staff in the emergency room with later publications showing promising results (Rotheram-Borus, Piacentini, Van Rossem et al., 1996; Rotheram-Borus et al., 2000). Other brief interventions offered in emergency rooms have since been developed, such as the Family Intervention for Suicide Prevention (Asarnow et al., 2009), Therapeutic Assessment (Ougrin et al., 2011), and the Safety Planning Intervention (Stanley et al., 2018). Today, 25 years after the first issue of CCPP, suicide is the third leading cause of death among young people between the ages of 15 and 19 (World Health Organization, 2019), with rates decreasing throughout the world among all age groups (Naghavi & Global Burden of Disease Self-Harm Collaborators, 2019). Public health initiatives to reduce access to common means for suicide, such as toxic pesticides, have played a significant role in decreasing suicide rates in many areas of the world (Mew et al., 2017). However, suicide remains the second leading cause of death among 10to 19-year-olds in the United States (Centers for Disease Control and Prevention, 2018) where the number of visits to the emergency department for suicidal thoughts and attempts among children and adolescents doubled between 2007 and 2015 (Burnstein et al., 2019). Furthermore, global research on risk factors predicting suicidal behaviors has led to examining the same risk factors for 50 years without improving our ability to predict and prevent suicide (Franklin et al., 2017). This might seem to suggest that the answer to the question, "How much has changed?" regarding the past 25 years of suicide research and prevention would be a defeated response of "not much." Beyond the research-supported use of public health interventions restricting access to lethal means to reduce risk for suicide, I believe there are several positive changes in more recent years that offer reason for optimism. First, converging evidence suggests that the development of suicide ideation and the progression from suicide ideation to attempt occur across distinct pathways. That is, they are separate processes with separate explanations and predictors (Klonsky et al., 2018).
Background document for the Thematic Conference on Prevention of Depression and Suicide under the European Pact for Mental Health and Wellbeing, 2009
Depressive disorder and suicide are pressing public health challenges. Depressive disorder is a major contributor to the European burden of disease, incurring high social and economic costs and constituting a major threat to Europe’s productivity. Depressive disorder can lead to suicide, but prevention of both depressive disorders and suicide are possible and cost-effective. Evidence-based solutions which the EU, Member States and stakeholders can adopt and implement do exist in the form of policies, practices and initiatives aimed at tackling depression and suicide.