Suicide prevention strategies: a systematic review.
BACKGROUND
In 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.


OBJECTIVE
To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research.


METHODS
Relevant 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.


METHODS
Data 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.


RESULTS
Education 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.


CONCLUSIONS
Physician 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.
Mann
J John
JJ
New York State Psychiatric Institute, Division of Neuroscience, New York, NY 10032, USA. jjm@columbia.edu
Apter
Alan
A
Bertolote
Jose
J
Beautrais
Annette
A
Currier
Dianne
D
Haas
Ann
A
Hegerl
Ulrich
U
Lonnqvist
Jouko
J
Malone
Kevin
K
Marusic
Andrej
A
Mehlum
Lars
L
Patton
George
G
Phillips
Michael
M
Rutz
Wolfgang
W
Rihmer
Zoltan
Z
Schmidtke
Armin
A
Shaffer
David
D
Silverman
Morton
M
Takahashi
Yoshitomo
Y
Varnik
Airi
A
Wasserman
Danuta
D
Yip
Paul
P
Hendin
Herbert
H
D014150:Antipsychotic Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008402:Mass Media; D008403:Mass Screening; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy; D010819:Physician's Role; D010821:Physicians, Family; D011613:Psychotherapy; D012017:Referral and Consultation; D040242:Risk Reduction Behavior; D013405:Suicide / Q000523:psychology; D000092864:Suicide Prevention
D014150:Antipsychotic Agents