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      Best Practice Elements of Multilevel Suicide Prevention Strategies : A Review of Systematic Reviews

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          Abstract

          Background: Evidence-based best practices for incorporation into an optimal multilevel intervention for suicide prevention should be identifiable in the literature. Aims: To identify effective interventions for the prevention of suicidal behavior. Methods: Review of systematic reviews found in the Pubmed, Cochrane, and DARE databases. Steps include risk-of-bias assessment, data extraction, summarization of best practices, and identification of synergistic potentials of such practices in multilevel approaches. Results: Six relevant systematic reviews were found. Best practices identified as effective were as follows: training general practitioners (GPs) to recognize and treat depression and suicidality, improving accessibility of care for at-risk people, and restricting access to means of suicide. Although no outcomes were reported for multilevel interventions or for synergistic effects of multiple interventions applied together, indirect support was found for possible synergies in particular combinations of interventions within multilevel strategies. Conclusions: A number of evidence-based best practices for the prevention of suicide and suicide attempts were identified. Research is needed on the nature and extent of potential synergistic effects of various preventive activities within multilevel interventions.

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          The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials

          David Moher, Kenneth F Schulz, Douglas G. Altman (2001)
          To comprehend the results of a randomized controlled trial (RCT), readers must understand its design, conduct, analysis and interpretation. That goal can only be achieved through complete transparency from authors. Despite several decades of educational efforts, the reporting of RCTs needs improvement. Investigators and editors developed the original CONSORT (Consolidated Standards of Reporting Trials) statement to help authors improve reporting by using a checklist and flow diagram. The revised CONSORT statement presented in this paper incorporates new evidence and addresses some criticisms of the original statement. The checklist items pertain to the content of the Title, Abstract, Introduction, Methods, Results and Discussion. The revised checklist includes 22-items selected because empirical evidence indicates that not reporting the information is associated with biasedestimates of treatment effect or the information is essential to judge the reliability or relevance of the findings. We intended the flow diagram to depict the passage of participants through an RCT. The revised flow diagram depicts information from four stages of a trial (enrolment, intervention allocation, follow-up, and analysis). The diagram explicitly includes the number of participants, for each intervention group, included in the primary data analysis. Inclusion of these numbers allows the reader to judge whether the authors have performed an intention-to-treat analysis. In sum, the CONSORT statement is intended to improve the reporting of an RCT, enabling readers to understand a trial's conduct and to assess the validity of its results.
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            Risk factors for suicidality in Europe: results from the ESEMED study.

            Eduardo J Lopes Torres, Marcelo de Oliveira, M. Mar Bernal … (2007)
            Precise knowledge of the epidemiology of suicidality provides necessary information for designing prevention programs. The aims of the present study were to investigate the prevalence and correlates of suicidal ideas and attempts in the general population of Europe. The European Study on the Epidemiology of Mental Disorders (ESEMED) is a cross-sectional household survey carried out in a probability representative sample of non-institutionalised adults (aged 18 years or older) of six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain). The Composite International Diagnostic Interview (CIDI 3.0) was administered to 21,425 individuals. Lifetime prevalence of suicidal ideation was 7.8% and of suicidal attempts 1.3%. Being women, younger and divorced or widowed were associated with a higher prevalence of suicide ideation and attempts. Psychiatric diagnoses were strongly related to suicidality. Among them, major depressive episode (Rate ratio 2.9 for lifetime ideas and 4.8 for lifetime attempts), dysthymia (RR 2.0 and 1.6), GAD (RR 1.8 and 2.3 for lifetime), PTSD (RR 1.9 and 2.0) and alcohol dependence (RR 1.7 and 2.5) were the most important. Population attributable risks for lifetime suicidal attempt was 28% for major depression. Information about suicidal ideas and attempts was self reported, psychiatric diagnoses were made using fully structured lay interviews rather than clinician-administered interviews. In spite of meaningful country variation in prevalence, risk factors for suicidality are consistent in the European countries. Population prevention programmes should focus on early diagnosis and treatment of major depression and alcohol abuse and in those individuals with recent appearance of suicidal ideas.
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              Screening and case-finding instruments for depression: a meta-analysis.

              Trevor Sheldon, Allan House, Simon Gilbody (2008)
              Screening and case-finding has been proposed as a simple, quick and cheap method to improve the quality of care for depression. We sought to establish the effectiveness of screening in improving the recognition of depression, the management of depression and the outcomes of patients with depression. We performed a Cochrane systematic review of randomized controlled trials conducted in nonmental health settings that included case-finding or screening instruments for depression. We conducted a meta-analysis and explored heterogeneity using meta-regression techniques. Sixteen studies with 7576 patients met our inclusion criteria. We found that the use of screening or case-finding instruments were associated with a modest increase in the recognition of depression by clinicians (relative risk [RR] 1.27, 95% confidence interval [CI] 1.02 to 1.59). Questionnaires, when administered to all patients and the results given to clinicians irrespective of baseline score, had no impact on recognition (RR 1.03, 95% CI 0.85 to 1.24). Screening or case finding increased the use of any intervention by a relative risk of 1.30 (95% CI 0.97 to 1.76). There was no evidence of influence on the prescription of antidepressant medications (RR 1.20, 95% CI 0.87 to 1.66). Seven studies provided data on outcomes of depression, and no evidence of an effect was found (standardized mean difference -0.02, 95% CI -0.25 to 0.20). If used alone, case-finding or screening questionnaires for depression appear to have little or no impact on the detection and management of depression by clinicians. Recommendations to adopt screening strategies using standardized questionnaires without organizational enhancements are not justified.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Crisis
                Title: Crisis
                Publisher: Hogrefe Publishing
                ISSN (Print): 0227-5910
                ISSN (Electronic): 2151-2396
                Publication date (Electronic): September 27 2011
                Publication date (Print): 2011
                Volume: 32
                Issue: 6
                Pages: 319-333
                Affiliations
                [1 ]Department of Developmental and Clinical Psychology, University of Tilburg, The Netherlands
                [2 ]Research Program Diagnosis and Treatment, Trimbos Institute, Utrecht, The Netherlands
                [3 ]Department of Health Sciences, University of Molise, Campobasso, Italy
                [4 ]Health Research Department, Primorska Institute of Natural Sciences and Technology (PINT), University of Primorska, Koper, Slovenia
                [5 ]Institute of Public Health of the Republic of Slovenia, Ljubljana, Slovenia
                [6 ]NASP, Karolinska Institute, Stockholm, Sweden
                [7 ]Personal Social Services Research Unit, LSE Health and Social Care, London School of Economics, UK
                [8 ]University of Stirling, UK
                [9 ]Society for Mental Health – pro mente tirol, Innsbruck, Austria
                [10 ]LUCAS Centre for Care Research and Consultancy, Catholic University of Leuven, Belgium
                [11 ]Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia
                [12 ]CEDOC, Department of Mental Health, New University of Lisbon, Portugal
                [13 ]Department of Psychiatry, University of Leipzig, Germany
                [14 ]Topclinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
                Author notes
                Christina M. van der Feltz-CornelisDepartment of Developmental and Clinical PsychologyTilburg UniversityPO Box 901535000 LE TilburgThe Netherlands Phone: +31 13 466-2167 Fax: +31 13 466-2067 E-mail: C.M.vdrFeltz@ 123456uvt.nl
                Article
                Publisher ID: cri_32_6_319
                DOI: 10.1027/0227-5910/a000109
                PMC ID: 3306243
                PubMed ID: 21945840
                SO-VID: 83cfd276-2fff-447d-8179-516ba9535b93
                Copyright © © 2011 Hogrefe Publishing.
                License:

                Distributed under the Hogrefe OpenMind License [ http://dx.doi.org/10.1027/a000001]

                History
                Date received : 23 April 2010
                Date revision received : 26 May 2011
                Date accepted : 31 May 2011
                Categories
                Subject: Research Trends

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: suicide prevention,depressive disorder,restriction of means,multilevel approach,review
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: suicide prevention, depressive disorder, restriction of means, multilevel approach, review

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