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

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      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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      Most cited references 42

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      Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

      David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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        The PHQ-9: validity of a brief depression severity measure.

        While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.


            Author and article information

            [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@
            Hogrefe Publishing
            September 27 2011
            : 32
            : 6
            : 319-333
            © 2011 Hogrefe Publishing.

            Distributed under the Hogrefe OpenMind License []

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