title: The effectiveness of suicide prevention delivered by GPs: A systematic review and meta-analysis.
abstract: The aim of this review was to assess whether suicide prevention provided in the primary health care setting and delivered by GPs results in fewer suicide deaths, episodes of self-harm, attempts and lower frequency of thoughts about suicide.
  
  
  
  We conducted a systematic review and meta-analysis using PRIMSA guidelines. Eligible studies: 1) evaluated an intervention provided by GPs; 2) assessed suicide, self-harm, attempted suicide or suicide ideation as outcomes, and; 3) used a quasi-experimental observational or trial design. Study specific effect sizes were combined using the random effects meta-analysis, with effects transformed into relative risk (RR).
  
  
  
  We extracted data from 14 studies for quantitative meta-analysis. The RR for suicide death in quasi-experimental observational studies comparing an intervention region against another region acting as a "control" was 1.26 (95% CI 0.58, 2.74). When suicide in the intervention region was compared before and after the GP program, the RR was 0.78 (95% CI 0.62, 0.97). There was no evidence of a treatment effect for GP training on rates of suicide death in one cRCT (RR 1.07, 95% CI 0.79, 1.45). There was no evidence of effect for the most other outcomes studied.
  
  
  
  All of the studies included in this review are likely to have a high level of bias. It is also possible that we excluded or missed relevant studies in our review process CONCLUSIONS: Interventions have produced equivocal results, which varied by study design and outcome. Given these results, we cannot recommend the roll out of GP suicide prevention initiatives.
authors.affiliation: Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Work, Health and Wellbeing Unit, Population Health Research Centre, School of Health & Social Development, Deakin University, Melbourne, Australia. Electronic address: Allison.milner@unimelb.edu.au.
authors.forename: Allison
authors.initials: A
authors.lastname: Milner
authors.affiliation: Turning Point, Monash University, Melbourne, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Witt
authors.affiliation: Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Pirkis
authors.affiliation: Orygen National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hetrick
authors.affiliation: Orygen National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia.
authors.forename: Jo
authors.initials: J
authors.lastname: Robinson
authors.affiliation: Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors.forename: Dianne
authors.initials: D
authors.lastname: Currier
authors.affiliation: Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Spittal
authors.affiliation: Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Page
authors.affiliation: Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Carter
mesh_terms: D005194:Family Practice / Q000706:statistics & numerical data*; D006801:Humans; D011322:Primary Prevention / Q000379:methods*; D011613:Psychotherapy; D016728:Self-Injurious Behavior / Q000517:prevention & control; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control*; D000092864:Suicide Prevention
keywords: Doctor suicide prevention; General practice; Self-harm; Suicide attempt; Suicide ideation; Suicide prevention