Effective suicide prevention strategies in primary healthcare settings: a systematic review (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.
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...
Best practice elements of multilevel suicide prevention strategies: a review of systematic reviews
Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2011
Background: Evidence-based best practices for incorporation into an optimal multilevel intervention for suicide prevention should be identifiable in the literature. Aims: To identify effective interventions for the prevention of suicidal behavior. Methods: Review of systematic reviews found in the Pubmed, Cochrane, and DARE databases. Steps include risk-of-bias assessment, data extraction, summarization of best practices, and identification of synergistic potentials of such practices in multilevel approaches. Results: Six relevant systematic reviews were found. Best practices identified as effective were as follows: training general practitioners (GPs) to recognize and treat depression and suicidality, improving accessibility of care for at-risk people, and restricting access to means of suicide. Although no outcomes were reported for multilevel interventions or for synergistic effects of multiple interventions applied together, indirect support was found for possible synergies in particular combinations of interventions within multilevel strategies. Conclusions: A number of evidence-based best practices for the prevention of suicide and suicide attempts were identified. Research is needed on the nature and extent of potential synergistic effects of various preventive activities within multilevel interventions.
Suicide prevention in primary care
Postgraduate Medicine, 2000
Suicide prevention has been named a national priority and much work has been done to review existing evidence and identify gaps in how our nation's mental health and health care systems address this public health challenge. A national task force that was part of the effort to update the national suicide prevention strategy reviewed research and best practices from the field and concluded that suicide prevention could be improved in health care. The task force found three common characteristics among successful suicide prevention programs in health care settings. Health care staff in these organizations: k Believed that suicide can be prevented in the population they serve through improvements in service access and quality, and through systems of continuous improvement; k Created a culture that finds suicide unacceptable and sets and monitors ambitious goals to prevent suicide; and k Employed evidence-based clinical care practice, including standardized risk stratification, evidence-based interventions, and patient engagement approaches 1. Addressing Suicide Prevention for Underserved Patients 1 Background: Suicide-The Problem and the Opportunity 2 A. Why primary care should make suicide care a priority 2 B. Primary care teams can be champions of the Zero Suicide Approach 4 C. How primary care providers and administrators can take action 5 Part One: Routine Screening and Assessment in Primary Care 6 A. Linking suicide and depression screening in primary care 6 B. Know common risk factors and warning signs 7 C. Review of screening protocol and tools 8 D. Suicide risk assessment 9 Part Two: Care Management and Referral Processes 14 A. Care Management Plan 14 B. Brief evidence-based interventions 15 C. Referrals and the Stepped Care Model 18 D. Care transitions 19 Part Three: Other Considerations 23 A. Recommendation for monitoring through the Quality Improvement program 24 B. Addressing concerns about liability 24 C. Resources and tools for workforce development 25 The Association of Clinicians for the Underserved would like to acknowledge the partnership and support of Centene Corporation on this toolkit. Their generous funding, thought leadership, and collaboration allowed ACU to create this resource and its associated trainings. Additionally, ACU would like to acknowledge the partnership with the Institute for Family Health and Dr. Virna Little in the development of this project. Their expertise was instrumental in the material included here and the associated trainings for primary care providers. BACKGROUND: Suicide-The Problem and the Opportunity A. Why primary care should make suicide care a priority The rate of suicide deaths is increasing Suicide is a leading cause of death of the United States, cited as the cause of death for nearly 45,000 Americans in 2016 2. The suicide rate among individuals age 10 and older has increased by 30 percent since 1999 3. A report released by the Centers for Disease Control and Prevention (2018) revealed that suicide rates increased in all but one state between 1999 and 2016. In 2016, 9.8 million adults aged 18 and older, or about 4 percent of the adult population, reported serious thoughts of suicide 4. Suicide is linked to social determinants of health 5 Suicide is rarely caused by any single factor. Diagnosed depression or other mental health conditions are reported for less than half (46 percent) of suicide deaths. Other factors that contribute to suicide deaths include relationship problems, substance use, physical illness and chronic conditions, job loss, and financial troubles 6. The National Strategy for Suicide Prevention calls for a comprehensive approach to suicide prevention that includes action at individual, family, community, and societal levels 7. Primary care teams are uniquely positioned to identify risk and intervene Primary care providers in particular have a unique opportunity to incorporate suicide prevention into established health risk assessment and patient safety practices 8. Approximately 45 percent of individuals who died by suicide visited a primary care provider in the month before their death 9, 10. Suicide is often discussed in the context of mental illness, and suicide prevention is considered an issue that mental health agencies and systems should address. However, given that mental health conditions are only one of many factors that contribute to suicide risk, it is incumbent upon all sectors of the U.S. healthcare system to adopt evidence-based approaches to identify and care for those at risk for suicide. Health Disparities and Suicide Facts Gender k The suicide rate for males (21.3 per 100,000) is triple the rate for females (6.0) in the U.S. in 2016 11. k Suicide was the 7th leading cause of death among all males in the U.S. and the 2nd leading cause of death for males aged 15-34 in 2015 12. k Although males are at higher risk for suicide, between 1999 and 2016 the suicide rate increased at a higher rate among females (2.6%) as compared to males (1.1%) 13. Age k Young adults, aged 18 to 25 are more likely to have serious thoughts of suicide (approximately 8.8 percent) 14. k Although White males 75 years of age and older have the highest rates of suicide (48.0 per 100,000), the highest number of deaths from suicide occur among males aged 50-54 15. Race/Ethnicity k American Indian and Alaska Native populations have the highest rates of suicide overall, followed by non-Hispanic Whites, Asian and Pacific Islands, Blacks, and Hispanic/Latino(a). Urban/Rural k Suicide rates are higher in rural communities than in urban communities overall. The gap in suicide rates between rural and urban areas grew steadily between 1999 and 2015. k Non-Hispanic blacks were the only population that differed in this trend and have higher suicide rates in urban areas than in rural areas. k The suicide rate among American Indian and Alaska Native populations in rural areas is double the national average 16. k Access to firearms may contribute to disparities in suicide rates in rural areas 17. Special Populations k Justice involved individuals are at increased risk for suicidal thoughts or behaviors. Suicide is the third leading cause of death in prisons 18. k The suicide rate among Veterans is 41% higher than among the general U.S. population 19. k Youth in foster care may also be at an increased risk for suicidal behaviors.
Contemporary principles of suicide prevention
Medicinski pregled, 2016
Introduction. Suicide remains a significant public health problem worldwide. This study is aimed at analyzing and presenting contemporary methods in suicide prevention in the world as well as at identifying specific risk groups and risk factors in order to explain their importance in suicide prevention. Material and Methods. The literature search covered electronic databases PubMed, Web of Science and Scopus. In order to select the relevant articles, the authors searched for the combination of key-words which included the following medical subject heading terms (suicide or suicide ideation or attempted) and (prevention or risk factors) and (man or elders or mental disorders). Data analysis covered meta-analyses, systematic reviews and original scientific papers with different characteristics of suicide preventions, risk factors and risk groups. Results. Worldwide evidence-based interventions for suicide prevention are divided in universal, selective and indicated interventions. Rest...
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).