ArticlesSuicide prevention strategies revisited: 10-year systematic review
Introduction
Over 800 000 people worldwide die each year by suicide,1 accounting for 1·4% of deaths worldwide. Suicide can occur at any point in the lifespan, and is the second most frequent, and in some countries the leading, cause of death among young people aged 15–24 years.1 In addition, around 20–30 times as many suicide attempts occur.2
Suicide occurs because of a convergence of genetic,3 psychological,4 social, and cultural risk factors, combined with experiences of trauma and loss.5 Internal or external risk factors and the relations between them can be explained in models of suicide, such as stress–diathesis,6 gene–environment,7 and gene–environment and timing interactions.8
The complexity of this multifaceted phenomenon and low base rates, make research on suicide prevention highly challenging.9 However, the recognition of suicide prevention as a public health priority10 and national prevention programmes have encouraged research, detection, treatment, and management of people at risk for suicide in many countries.11, 12 A major review of the effectiveness of approaches to suicide prevention was done by Mann and colleagues in 2005.13 We did a systematic review using similar methodology to assess progress in suicide prevention research since that influential study.
Section snippets
Search strategy
We searched PubMed and the Cochrane library for all relevant English language studies published between Jan 1, 2005, and Dec 31, 2014. The initial search used the Medical Subject Headings identifiers for “suicide” (including the subheadings “suicide, attempted”, and “prevention and control”). “Suicide” was then combined with depression, health education, health promotion, public opinion, mass screening, family physicians, medical education, primary health care, antidepressive drugs,
Results
Our literature search identified 1797 papers. Another 24 were obtained from other sources (figure). 224 papers were selected because they reported primary outcomes of interest or included applicable intermediate outcomes. These papers were assessed for eligibility, and 80 were excluded because of irrelevance or low evidence.
Heterogeneity in study methodology and in populations prevented a formal meta-analysis. We therefore present a narrative synthesis of the results in key domains of suicide
Discussion
The heterogeneity of strategies and outcome measures, as well as absence of good standards for evidence level in the literature, limits conclusions about the current effectiveness of suicide prevention strategies. However, there have clearly been major advances since the review by Mann and colleagues in 2005.13
There is now strong evidence that restricting access to lethal means is associated with a decrease in suicide and that substitution to other methods appears to be limited. This is clearly
References (191)
- et al.
The neurobiology of suicide
Lancet Psychiatry
(2014) - et al.
The psychology of suicidal behaviour
Lancet Psychiatry
(2014) - et al.
Suicide
Lancet
(2009) - et al.
Genetic vulnerability, timing of short-term stress and mood regulation: a rodent diffusion tensor imaging study
Eur Neuropsychopharmacol
(2015) - et al.
Firearms laws and the reduction of violence: a systematic review
Am J Prev Med
(2005) - et al.
Gun control and suicide: the impact of state firearm regulations in the United States, 1995–2004
Health Policy
(2011) - et al.
Restricting access to a suicide hotspot does not shift the problem to another location. An experiment of two river bridges in Brisbane, Australia
Aust N Z J Public Health
(2014) - et al.
The European Psychiatric Association (EPA) guidance on suicide treatment and prevention
Eur Psychiatry
(2012) - et al.
Suicidal thinking and behavior during treatment with sertraline in late-life depression
Am J Geriatr Psychiatry
(2007) - et al.
Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder
Behav Res Ther
(2010)