title: Effectiveness of a multimodal community intervention program to prevent suicide and suicide attempts: a quasi-experimental study.
abstract: BACKGROUND
  Multilevel and multimodal interventions have been suggested for suicide prevention. However, few studies have reported the outcomes of such interventions for suicidal behaviours.
  
  
  METHODS
  We examined the effectiveness of a community-based multimodal intervention for suicide prevention in rural areas with high suicide rates, compared with a parallel prevention-as-usual control group, covering a total of 631,133 persons. The effectiveness was also examined in highly populated areas near metropolitan cities (1,319,972 persons). The intervention started in July 2006, and continued for 3.5 years. The primary outcome was the incidence of composite outcome, consisting of completed suicides and suicide attempts requiring admission to an emergency ward for critical care. We compared the rate ratios (RRs) of the outcomes adjusted by sex, age group, region, period and interaction terms. Analyses were performed on an intention-to-treat basis and stratified by sex and age groups.
  
  
  RESULTS
  In the rural areas, the overall median adherence of the intervention was significantly higher. The RR of the composite outcome in the intervention group decreased 7% compared with that of the control group. Subgroup analyses demonstrated heterogeneous effects among subpopulations: the RR of the composite outcome in the intervention group was significantly lower in males (RR = 0.77, 95% CI 0.59-0.998, p = 0.0485) and the RR of suicide attempts was significantly lower in males (RR = 0.39, 95% CI 0.22-0.68, p = 0.001) and the elderly (RR = 0.35, 95% CI 0.17-0.71, p = 0.004). The intervention had no effect on the RR of the composite outcome in the highly populated areas.
  
  
  CONCLUSIONS
  Our findings suggest that this community-based multimodal intervention for suicide prevention could be implemented in rural areas, but not in highly populated areas. The effectiveness of the intervention was shown for males and for the elderly in rural areas.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00737165 UMIN Clinical Trials Registry UMIN000000460.
authors.affiliation: National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan ; NOCOMIT-J Group, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ono
authors.forename: Akio
authors.initials: A
authors.lastname: Sakai
authors.forename: Kotaro
authors.initials: K
authors.lastname: Otsuka
authors.forename: Hidenori
authors.initials: H
authors.lastname: Uda
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Oyama
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishizuka
authors.forename: Shuichi
authors.initials: S
authors.lastname: Awata
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Hiroto
authors.initials: H
authors.lastname: Iwasa
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kamei
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Motohashi
authors.forename: Jun
authors.initials: J
authors.lastname: Nakamura
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Nishi
authors.forename: Naoki
authors.initials: N
authors.lastname: Watanabe
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yotsumoto
authors.forename: Atsuo
authors.initials: A
authors.lastname: Nakagawa
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Miyuki
authors.initials: M
authors.lastname: Tajima
authors.forename: Eriko
authors.initials: E
authors.lastname: Tanaka
authors.forename: Hironori
authors.initials: H
authors.lastname: Sakai
authors.forename: Naohiro
authors.initials: N
authors.lastname: Yonemoto
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D013406:Suicide, Attempted / Q000517:prevention & control*; D000092864:Suicide Prevention