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Suicide Prevention Programs

Introduction

In the most recent publicly available data from the Centers for Disease Control and Prevention, the National Center for Health Statistics reported that in 2009, suicide (intentional self-harm) was ranked as the 10th leading cause of death in the United States, totaling 36,909 deaths.1 Related to those deaths, age differences emerged indicating suicide ranked as the second leading cause of death in adults aged 25–34 and third among preteens (aged 10–14) and youth (aged 15–24).1 These alarming statistics bring awareness to a problem requiring the attention of policymakers, researchers, clinicians, and family members who may be able to influence individuals at risk for suicide.

Factors that may be associated with an increased risk of suicide include (1) a prior suicide attempt; (2) suicidal ideation (i.e., thoughts about suicide); (3) co-occurring physical or mental health disorders; (4) co-occurring substance abuse; (5) family history of suicide, substance abuse, or mental health disorders; (6) individual differences in brain chemistry; (7) use of certain medications; (8) traumatic or stressful experiences such as abuse, family violence, or money problems; (9) easy access to the means for committing suicide; and (10) exposure to suicidal behavior in others, either directly or indirectly through cultural or religious beliefs.2–5

Suicide prevention interventions may focus on reducing risk factors, enhancing protective factors, or both.2 Suicide protective factors might include securing needed medical or psychological treatment, building and maintaining a social support network, or developing effective problem-solving skills.2

This report summarizes recent findings from published systematic reviews assessing the effect of suicide prevention interventions on reducing suicidal behavior among diverse populations. Evidence from these systematic reviews provides considerations on how to address a problem that threatens our nation’s public health.

Search Strategy and Criteria

The search was limited to systematic reviews published between January 1, 2000, and March 28, 2012, reported in English. The reviews were retrieved from the online catalog of the U.S. Government’s National Library of Medicine, PubMed (http://www.pubmed.gov) to ensure free access to abstracts and in some cases full-text articles. Systematic reviews reported in the context of guidelines, consensus statements, or studies were not the target of the search.

The strategy to conduct the search was as follows:

("Self-injurious Behavior"[Mesh] OR "suicide" OR "suicidal" OR "suicidality") AND (systematic[sb] OR Meta-Analysis[pt]) AND English[lang] AND "Humans"[MeSH Terms] AND "2000/01/01"[PDAT] : "2012/03/28"[PDAT]

Each part of the strategy is described below:

  1. Topics: The following PubMed Medical Subject Heading and keywords were used to limit the search to self-injurious behavior, including suicide: "Self-injurious Behavior"[Mesh] OR "suicide" OR "suicidal" OR "suicidality."
  2. Additional limits: Limits were used restricting the search to systematic reviews (with a separate designation for those containing meta-analyses) and articles published in English, focusing on humans, and published no earlier than 2000. Results were then narrowed by hand to systematic reviews focusing on the efficacy of suicide prevention interventions.

Results

The literature search yielded a total of 13 systematic reviews; 6 of these included a meta-analysis. The reviews assessed the effectiveness of suicide prevention interventions for high-risk individuals as well as the general public. The number of studies included in the systematic reviews ranged from 5 to 93 with an average of 22 studies (median = 18), and the studies were conducted in the United States and internationally. The systematic reviews can be categorized into two areas of suicide prevention programming: (1) suicide prevention interventions for individuals without a history of self-harm or suicide attempts (Reviews 1, 4, 6, 8, and 11) or (2) interventions to prevent repeated self-harm or repeated suicide attempts (Reviews 2, 3, 5, 7–10, 12, and 13). Study populations were varied and included both males and females of different races, ranging from children to older adults. Four reviews exclusively focused on interventions targeting youth (Reviews 2, 4, 10, and 12), one focused on military personnel or veterans (Review 1), two focused on older adults (Reviews 7 and 11), and one focused on interventions for adults with a personality disorder (Review 9).

Most of the interventions were multicomponent and delivered in a variety of settings such as schools, homes, emergency departments, primary care clinics, community counseling centers, and military settings. The objective of the reviews was to assess the effectiveness of interventions designed to prevent suicidal behavior or reduce deliberate self-harm that could lead to subsequent suicide. The interventions included psychosocial interventions (dialectical behavior therapy, cognitive behavioral therapy, family therapy, mentalization-based treatment, and schema-focused therapy); pharmacological interventions; school-based interventions; gatekeeper training models; interventions initiated in emergency rooms; community-based depression screening and health education; and interventions to increase community, school, and family cohesiveness. Overall, it appears that suicide prevention interventions for individuals without a history of suicidal behavior are effective in increasing knowledge about suicide risk factors. These promising results were found in prevention intervention studies with youth and older adults. Suicide prevention interventions for individuals with a history of suicidal behavior showed limited effects in reducing deliberate self-harm or suicidal ideation. Cognitive-based approaches appear to be somewhat effective in reducing suicidal ideation among young people, but at present there is no evidence to support the effectiveness of any specific treatment to reduce self-harm. Dialectical behavioral therapy shows some promise in reducing suicide behaviors in patients diagnosed with borderline personality disorder.

With research in this field still emerging, there is a need to investigate which intervention components or strategies produce the best outcomes. Given the mixed findings from studies assessing deliberate self-harm, this area warrants greater attention from the field in an effort to prevent subsequent suicide risk. Suicide prevention strategies should seek to target vulnerable populations who present an imminent threat. To fortify future research, program developers and researchers are encouraged to note the limitations of published studies such as small samples, flaws in study designs, and lack of long-term follow-up on suicide rates.

Systematic Reviews

Read the PDF for the descriptive information for each of the 13 systematic reviews.


1Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System. (2003). National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/ncipc/wisqars.
2Centers for Disease Control and Prevention. Injury Center, Violence Prevention. (2012, April). Suicide prevention. Retrieved from http://www.cdc.gov/ViolencePrevention/suicide/index.html.
3Substance Abuse and Mental Health Services Administration. (2011, December). Getting through tough times. Retrieved from http://www.samhsa.gov/ECOnomy/#suicide.
4Substance Abuse and Mental Health Services Administration. (2008, June). Suicide. Retrieved from http://www.oas.samhsa.gov/suicide.cfm#Suicide.
5National Institute of Mental Health. (2012, April). Suicide in the U.S., statistics and prevention: A fact sheet of statistics on suicide with information on treatments and suicide prevention. Retrieved from http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml#factors.