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      Overview evidence on interventions for population suicide with an eye to identifying best-supported strategies for LMICs

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          Abstract

          Globally, over 800 000 people died by suicide in 2012 and there are indications that for each adult who died of suicide there were likely to be many more attempting suicide. There are many millions of people every year who are affected by suicide and suicide attempts, taking into consideration the family members, friends, work colleagues and communities, who are bereaved by suicide. In the WHO Mental Health Action Plan 2013–2020, Member States committed themselves to work towards the global target of reducing the suicide rate in countries by 10% by 2020. Hence, the first-ever WHO report on suicide prevention, Preventing suicide: a global imperative, published in September 2014, is a timely call to take action using effective evidence-based interventions. Their relevance for low- and middle-income countries is discussed in this paper, highlighting restricting access to means, responsible media reporting, introducing mental health and alcohol policies, early identification and treatment, training of health workers, and follow-up care and community support following a suicide attempt.

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          Most cited references36

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          The global distribution of fatal pesticide self-poisoning: Systematic review

          Background Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown. Methods We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning. Results We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm. Conclusion Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.
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            Risk factors for suicide in China: a national case-control psychological autopsy study.

            Suicide is the fifth most important cause of death in China, but the reasons for the high rate and unique pattern of characteristics of those who kill themselves are unknown. We pretested, and then administered a comprehensive interview to family members and close associates of 519 people who committed suicide and of 536 people who died from other injuries (controls) randomly selected from 23 geographically representative sites in China. After adjustment for sex, age, location of residence, and research site, eight significant predictors of suicide remained in the final unconditional logistic regression model. In order of importance they were: high depression symptom score, previous suicide attempt, acute stress at time of death, low quality of life, high chronic stress, severe interpersonal conflict in the 2 days before death, a blood relative with previous suicidal behaviour, and a friend or associate with previous suicidal behaviour. Suicide risk increased substantially with exposure to multiple risk factors: none of the 265 deceased people who were exposed to one or fewer of the eight risk factors died by suicide, but 30% (90/299) with two or three risk factors, 85% (320/377) with four or five risk factors, and 96% (109/114) with six or more risk factors died by suicide. Despite substantial differences between characteristics of people who commit suicide in China and the west, risk factors for suicide do not differ greatly. Suicide prevention programmes that concentrate on a single risk factor are unlikely to reduce suicide rates substantially; preventive efforts should focus on individuals exposed to multiple risk factors.
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              The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis.

              Research suggests that access to firearms in the home increases the risk for violent death.
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                Author and article information

                Journal
                Glob Ment Health (Camb)
                Glob Ment Health (Camb)
                GMH
                Global Mental Health
                Cambridge University Press (Cambridge, UK )
                2054-4251
                2016
                12 February 2016
                : 3
                : e5
                Affiliations
                [1 ]Department of Mental Health and Substance Abuse, World Health Organization , Geneva, Switzerland
                [2 ]Department of Epidemiology and Public Health, National Suicide Research Foundation, University College Cork , Cork, Ireland
                [3 ]American Association of Suicidology, USA
                [4 ]National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet , Stockholm, Sweden
                [5 ]Australian Institute for Suicide Research and Prevention , Brisbane, Australia
                [6 ]University of Melbourne , Melbourne, Australia
                [7 ]SNEHA, Voluntary Health Services , Chennai, India
                Author notes
                [* ]Address for correspondence: A. Fleischmann, Department of Mental Health and Substance Abuse, World Health Organization , Geneva, Switzerland. (Email: fleischmanna@ 123456who.int )
                Article
                S2054425115000278 00027
                10.1017/gmh.2015.27
                5314741
                28596874
                05299f5c-745c-4c0c-9235-3a2effce40f1
                © The Author(s) 2016

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 November 2014
                : 23 November 2015
                : 03 December 2015
                Page count
                References: 54, Pages: 8
                Categories
                Interventions
                WHO Action Plan
                Review

                evidence-based,intervention,interventions,low- and middle-income countries,suicide,suicide attempt

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