For which strategies of suicide prevention is there evidence of effectiveness?

Summary

The issue

Suicide is a serious public health problem in the European Region, where rates vary from about 40 per million people (in Greece) to about 400 per million (in Hungary). Suicide rates among adolescents and young adults have also increased considerably over the last decades. Many widely-used suicide prevention programmes have never been scientifically assessed, thus making it uncertain which are effective. The objective of this report is to synthesize research findings from systematic reviews to address this question.

Findings

About 30 types of suicide preventive interventions were evaluated in the published research, which covered the whole spectrum of primary and secondary prevention efforts. More than half of these interventions fall into the domain of treatment rather than prevention and maintenance.

Limited evidence indicates that no single intervention appeared to be effective in reducing the suicide rate. Evidence from systematic reviews (rated as “good” in relation to their methodological quality) indicated that some interventions targeting at-risk individuals appeared promising.

School-based suicide prevention programmes focusing on behavioural change and coping strategies in the general school population indicated lowered suicidal tendencies, improved ego identification and coping skills. Programmes focusing on skill training and social support for at-risk students were effective in reducing risk factors and enhancing protective factors.

Two meta-analyses showed a reduction in self-harm (suicidal behaviour) rates in patients with a history of deliberate self-harm, for the following interventions:

• problem-solving therapy
• provision of an emergency contact card
• flupenthixol therapy
• dialectic behavioural therapy
• cognitive behavioural therapy.

Policy considerations

Due to the limited evidence and the heterogeneity of the interventions, it is not possible to determine if one single intervention was more effective than another. A broad array of suicide preventive interventions addressing different risk factors at various levels will be required.

In the general school population, suicide prevention programmes based on behavioural change and coping strategies were found to be effective. In adolescents at high risk, school-based suicide prevention programmes based on skill training and social support appeared to be effective in reducing risk factors and enhancing protective factors.

For adult patients who have attempted suicide or deliberate self-harm, there is some evidence, in a very controlled setting, of the benefits of cognitive behavioural therapy. Trends towards benefits were also seen with the use of problem solving, emergency cards, dialectical therapy and the medication flupenthixol.

An evaluation framework with standardized definitions of suicide and parasuicide should be established to help evaluate the effectiveness of planned strategies.