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Review | Clinician's Corner

Suicide Prevention Strategies: A Systematic Review

J. John Mann, MD; Alan Apter, MD; Jose Bertolote, MD; Annette Beautrais, PhD; Dianne Currier, PhD; Ann Haas, PhD; Ulrich Hegerl, MD; Jouko Lonnqvist, MD; Kevin Malone, MD; Andrej Marusic, MD, PhD; Lars Mehlum, MD; George Patton, MD; Michael Phillips, MD; Wolfgang Rutz, MD; Zoltan Rihmer, MD, PhD, DSc; Armin Schmidtke, MD, PhD; David Shaffer, MD; Morton Silverman, MD; Yoshitomo Takahashi, MD; Airi Varnik, MD; Danuta Wasserman, MD; Paul Yip, PhD; Herbert Hendin, MD
JAMA. 2005;294(16):2064-2074. doi:10.1001/jama.294.16.2064.
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Context 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.

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

Data Sources and Study Selection 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.

Data Extraction 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.

Data Synthesis 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.

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Figure. Targets of Suicide Prevention Interventions
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Circled letters refer to relevant prevention interventions listed on right.

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