Primary studies included in this broad synthesis

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Primary study

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Restricting access to a suicide hotspot does not shift the problem to another location. An experiment of two river bridges in Brisbane, Australia.

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Authors Law CK , Sveticic J , De Leo D
Journal Australian and New Zealand journal of public health
Year 2014
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This article is included in 1 Broad synthesis Broad syntheses (1 reference) 3 Systematic reviews Systematic reviews (3 references)

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BACKGROUND: Restricting access to lethal means is a well-established strategy for suicide prevention. However, the hypothesis of subsequent method substitution remains difficult to verify. In the case of jumping from high places ('hotspots'), most studies have been unable to control for a potential shift in suicide locations. This investigation aims to evaluate the short- and long-term effect of safety barriers on Brisbane's Gateway Bridge and to examine whether there was substitution of suicide location. METHODS: Data on suicide by jumping - between 1990 and 2012, in Brisbane, Australia - were obtained from the Queensland Suicide Register. The effects of barrier installation at the Gateway Bridge were assessed through a natural experiment setting. Descriptive and Poisson regression analyses were used. RESULTS: Of the 277 suicides by jumping in Brisbane that were identified, almost half (n=126) occurred from the Gateway or Story Bridges. After the installation of barriers on the Gateway Bridge, in 1993, the number of suicides from this site dropped 53.0% in the period 1994-1997 (p=0.041) and a further reduction was found in subsequent years. Analyses confirmed that there was no evidence of displacement to a neighbouring suicide hotspot (Story Bridge) or other locations. CONCLUSIONS: The safety barriers were effective in preventing suicide from the Gateway Bridge, and no evidence of substitution of location was found.

Primary study

Unclassified

Risk-behaviour screening for identifying adolescents with mental health problems in Europe.

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Journal European child & adolescent psychiatry
Year 2014
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This article is included in 1 Broad synthesis Broad syntheses (1 reference)

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Indicated prevention of mental illness is an important public health concern among youth. The aim of this study was to establish a European school-based professional screening among adolescents, which included variables on both a broad range of risk-behaviours and psychopathology; and to investigate the indicative value of adolescent risk-behaviour and self-reported psychopathology on help-seeking and psychological problems that required subsequent mental healthcare. A two-stage professional screening approach was developed and performed within the multi-centre study "Saving and Empowering Young Lives in Europe" (SEYLE). The first stage of screening comprised a self-report questionnaire on a representative sample of 3,070 adolescents from 11 European countries. In the second stage, students deemed at-risk for mental health problems were evaluated using a semi-structured clinical interview performed by healthcare professionals. 61 % of participants (n = 1,865) were identified as being at-risk in stage one. In stage two, 384 participants (12.5 % of the original sample) were found to require subsequent mental healthcare during semi-structured, clinical assessment. Among those, 18.5 % of pupils were identified due to screening for psychopathology alone; 29.4 % due to screening for risk-behaviours alone; and 52.1 % by a combination of both. Young age and peer victimization increased help-seeking, while very low body mass index, depression, suicidal behaviour and substance abuse were the best predictors of referral to mental healthcare. Screening of risk-behaviours significantly increased the number of detected students requiring subsequent mental healthcare. Screening of risk-behaviours added significant value in identifying the significant amount of European pupils with mental health problems. Therefore, attention to adolescent risk-behaviours in addition to psychopathology is critical in facilitating prevention and early intervention. Identifying factors that increase compliance to clinical interviews are crucial in improving screening procedures.

Primary study

Unclassified

Effectiveness of online self-help for suicidal thoughts: results of a randomised controlled trial.

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Journal PloS one
Year 2014
Links Pubmed DOI PubMed Central

This article is included in 3 Systematic reviews Systematic reviews (3 references) 1 Broad synthesis Broad syntheses (1 reference)

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BACKGROUND: Many people with suicidal thoughts do not receive treatment. The Internet can be used to reach more people in need of support. OBJECTIVE: To test the effectiveness of unguided online self-help to reduce suicidal thoughts. METHOD: 236 adults with mild to moderate suicidal thoughts were randomised to the intervention (n=116) or a waitlist control group (n=120). Assessments took place at baseline, and 2, 4 and 6 weeks later. Primary outcome was suicidal thoughts. Secondary outcomes were depressive symptoms, anxiety, hopelessness, worry, and health status. RESULTS: The intervention group showed a small significant effect in reducing suicidal thoughts (d=0.28). Effects were more pronounced for those with a history of repeated suicide attempts. There was also a significant reduction in worry (d=0.33). All other secondary outcomes showed small but non-significant improvements. CONCLUSIONS: Although effect sizes were small, the reach of the internet could enable this intervention to help many people reduce their suicidal thoughts. TRIAL REGISTRATION: Netherlands Trial Register NTR1689.

Primary study

Unclassified

Can early follow-up after deliberate self-harm reduce repetition? A prospective study of 325 patients.

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Journal Journal of affective disorders
Year 2014
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This article is included in 1 Broad synthesis Broad syntheses (1 reference)

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BACKGROUND: Patients who deliberately harm themselves often repeat their self-destructive acts. The objective of this study was to assess whether a follow-up visit within 10 days to a psychiatric consultant could reduce the frequency of repeated deliberate self-harm (DSH). METHODS: A cohort of 325 consecutive DSH patients attending two large emergency departments in Stockholm, Sweden, were included and followed for 6 months. Any visit to a psychiatric consultant within 10 days was registered as an early follow-up. Repeated DSH episode within 6 months among the 325 patients was detected via nationwide registers. MAIN OUTCOME MEASURE: Repeated DSH within 6 months. RESULTS: At 6 months follow-up 22 (24%) of 92 patients with an early follow-up had repeated their DSH acts compared to 58 (25%) of 233 patients without an early follow-up (OR 1.06 (95% CI: 0.60-1.85) p-value 0.85). After adjustment for possible confounders, multivariable analysis showed an OR of 1.22 (95% CI: 0.62-2.38, p-value 0.56). LIMITATIONS: Early follow-up was registered as any visit to a psychiatric consultant and no information regarding actions taken at the visit were obtained. CONCLUSION: After adjusting for other factors associated with repetition there was an association of patients who were offered and thereafter attended an early follow-up visit and a decreased risk of repeated DSH.

Primary study

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The effect of public awareness campaigns on suicides: evidence from Nagoya, Japan.

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Authors Matsubayashi T , Ueda M , Sawada Y
Journal Journal of affective disorders
Year 2014
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This article is included in 1 Broad synthesis Broad syntheses (1 reference) 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Public awareness campaigns about depression and suicide have been viewed as highly effective strategies in preventing suicide, yet their effectiveness has not been established in previous studies. This study evaluates the effectiveness of a public-awareness campaign by comparing suicide counts before and after a city-wide campaign in Nagoya, Japan, where the city government distributed promotional materials that were aimed to stimulate public awareness of depression and promote care-seeking behavior during the period of 2010-2012. METHODS: In each of the sixteen wards of the city of Nagoya, we count the number of times that the promotional materials were distributed per month and then examine the association between the suicide counts and the frequency of distributions in the months following such distributions. We run a Poisson regression model that controls for the effects of ward-specific observed and unobserved heterogeneities and temporal shocks. FINDINGS: Our analysis indicates that more frequent distribution of the campaign material is associated with a decrease in the number of suicides in the subsequent months. The campaign was estimated to have been especially effective for the male residents of the city. LIMITATION: The underlying mechanism of how the campaign reduced suicides remains to be unclear. CONCLUSION: Public awareness campaigns can be an effective strategy in preventing suicide.

Primary study

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How to decrease suicide rates in both genders? An effectiveness study of a community-based intervention (EAAD).

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Journal PloS one
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis Broad syntheses (1 reference) 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: The suicide rate in Hungary is high in international comparison. The two-year community-based four-level intervention programme of the European Alliance Against Depression (EAAD) is designed to improve the care of depression and to prevent suicidal behaviour. Our aim was to evaluate the effectiveness of a regional community-based four-level suicide prevention programme on suicide rates. METHOD: The EAAD programme was implemented in Szolnok (population 76,311), a town in a region of Hungary with an exceptionally high suicide rate. Effectiveness was assessed by comparing changes in suicide rates in the intervention region after the intervention started with changes in national suicide rates and those in a control region (Szeged) in the corresponding period. RESULTS: For the duration of the programme and the follow-up year, suicide rates in Szolnok were significantly lower than the average of the previous three years (p = .0076). The suicide rate thus went down from 30.1 per 100,000 in 2004 to 13.2 in 2005 (-56.1 %), 14.6 in 2006 (-51.4 %) and 12.0 in 2007 (-60.1 %). This decrease of annual suicide rates in Szolnok after the onset of the intervention was significantly stronger than that observed in the whole country (p = .017) and in the control region (p = .0015). Men had the same decrease in suicide rates as women. As secondary outcome, an increase of emergency calls to the hotline service (200%) and outpatient visits at the local psychiatry clinic (76%) was found. CONCLUSIONS: These results seem to provide further support for the effectiveness of the EAAD concept. Whilst the majority of suicide prevention programs mainly affect female suicidal behaviour, this programme seems to be beneficial for both sexes. The sustainability and the role of the mediating factors (social service and health care utilization, community attitudes about suicide) should be key points in future research.

Primary study

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Influences on call outcomes among veteran callers to the National Veterans Crisis Line.

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Journal Suicide & life-threatening behavior
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis Broad syntheses (1 reference)

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The association of caller and call characteristics with proximal outcomes of Veterans Crisis Line calls were examined. From October 1-7, 2010, 665 veterans with recent suicidal ideation or a history of attempted suicide called the Veterans Crisis Line; 646 had complete data and were included in the analyses. A multivariable multinomial logistic regression was conducted to identify correlates of a favorable outcome (a resolution or a referral) when compared to an unfavorable outcome (no resolution or referral). A multivariable logistic regression was used to identify correlates of responder-rated caller risk in a subset of calls. Approximately 84% of calls ended with a favorable outcome, 25% with a resolution, and 59% with a referral to a local health care provider. Calls from high-risk callers had greater odds of ending with a referral than without a resolution or referral, as did weekday calls (6:00 am to 5:59 pm EST, Monday through Friday). Responders used caller intent to die and the absence of future plans to determine caller risk. Findings suggest that the Veterans Crisis Line is a useful mechanism for generating referrals for high-risk veteran callers. Responders appeared to use known risk and protective factors to determine caller risk.

Primary study

Unclassified

Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifeline.

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Journal Suicide & life-threatening behavior
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis Broad syntheses (1 reference)

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We examined the impact of the implementation of Applied Suicide Intervention Skills Training (ASIST) across the National Suicide Prevention Lifeline's national network of crisis hotlines. Data were derived from 1,507 monitored calls from 1,410 suicidal individuals to 17 Lifeline centers in 2008-2009. Callers were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by ASIST-trained counselors. Few significant changes in ASIST-trained counselors' interventions emerged; however, improvements in callers' outcomes were linked to ASIST-related counselor interventions, including exploring reasons for living and informal support contacts. ASIST training did not yield more comprehensive suicide risk assessments.

Primary study

Unclassified

Alliance, reactions to treatment, and counter-transference in the process of recovery from suicidal phenomena in long-term dynamic psychotherapy.

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Authors Perry JC , Bond M , Presniak MD
Journal Psychotherapy research : journal of the Society for Psychotherapy Research
Year 2013
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This article is included in 1 Broad synthesis Broad syntheses (1 reference)

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OBJECTIVE: We studied therapeutic processes associated with improvement in suicidality in a naturalistic study of long-term dynamic psychotherapy. METHODS: In a naturalistic study of long-term dynamic psychotherapy (n = 53), 31 patients reported suicidal ideation, eight of whom also reported prior suicide attempts, while 22 were non-suicidal. Suicide ideation and attempts and components of therapy alliance were followed at 6 month intervals. RESULTS: Suicidal patients had more psychiatric diagnoses, were treated longer and reported more negative reactions to treatment than non-suicidal patients. Alliance moderated (a) the relationship between negative reaction to treatment and improvement in suicidal ideation and (b) the relationship between quality of patient-therapist interaction and improvement. CONCLUSIONS: Suicidal patients manifest hostility and negative reactions to treatment, indicating negative transference. Avoiding therapist errors emanating from negative countertransference improves the therapeutic interaction, which is followed by faster rate of improvement in suicidality.

Primary study

Unclassified

Mediators of a culturally-sensitive intervention for suicidal African American women.

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Journal Journal of clinical psychology in medical settings
Year 2013
Links Pubmed DOI PubMed Central

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This study explored intervention outcomes and mechanisms that could help explain why low-income, African American women with a history of intimate partner abuse and suicide attempt improve in response to a culturally-informed intervention, the Grady Nia Project. Specifically, the investigation examined whether or not the intervention had effects on the women and whether or not spiritual well-being and coping mediated the effects of the intervention on suicidal ideation and depressive symptoms. In this randomized controlled clinical trial, data from 89 women who completed both pre- and post-intervention assessments were analyzed. During the post-intervention follow-up, women in the active intervention group reported lower levels of suicidal ideation and depressive symptoms and higher levels of existential well-being and adaptive coping skills than those women randomized to the treatment as usual group. However, only existential well-being was found to mediate treatment effects on suicidal ideation and depressive symptoms. Religious well-being, as well as adaptive and maladaptive coping, did not serve a mediational function. These findings highlight the importance of designing and implementing culturally-sensitive and evidence-based strategies that enhance existential well-being in this population.