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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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        David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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          Our aim was to calculate the global burden of disease and risk factors for 2001, to examine regional trends from 1990 to 2001, and to provide a starting point for the analysis of the Disease Control Priorities Project (DCPP). We calculated mortality, incidence, prevalence, and disability adjusted life years (DALYs) for 136 diseases and injuries, for seven income/geographic country groups. To assess trends, we re-estimated all-cause mortality for 1990 with the same methods as for 2001. We estimated mortality and disease burden attributable to 19 risk factors. About 56 million people died in 2001. Of these, 10.6 million were children, 99% of whom lived in low-and-middle-income countries. More than half of child deaths in 2001 were attributable to acute respiratory infections, measles, diarrhoea, malaria, and HIV/AIDS. The ten leading diseases for global disease burden were perinatal conditions, lower respiratory infections, ischaemic heart disease, cerebrovascular disease, HIV/AIDS, diarrhoeal diseases, unipolar major depression, malaria, chronic obstructive pulmonary disease, and tuberculosis. There was a 20% reduction in global disease burden per head due to communicable, maternal, perinatal, and nutritional conditions between 1990 and 2001. Almost half the disease burden in low-and-middle-income countries is now from non-communicable diseases (disease burden per head in Sub-Saharan Africa and the low-and-middle-income countries of Europe and Central Asia increased between 1990 and 2001). Undernutrition remains the leading risk factor for health loss. An estimated 45% of global mortality and 36% of global disease burden are attributable to the joint hazardous effects of the 19 risk factors studied. Uncertainty in all-cause mortality estimates ranged from around 1% in high-income countries to 15-20% in Sub-Saharan Africa. Uncertainty was larger for mortality from specific diseases, and for incidence and prevalence of non-fatal outcomes. Despite uncertainties about mortality and burden of disease estimates, our findings suggest that substantial gains in health have been achieved in most populations, countered by the HIV/AIDS epidemic in Sub-Saharan Africa and setbacks in adult mortality in countries of the former Soviet Union. Our results on major disease, injury, and risk factor causes of loss of health, together with information on the cost-effectiveness of interventions, can assist in accelerating progress towards better health and reducing the persistent differentials in health between poor and rich countries.

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

            Distributed under the Hogrefe OpenMind License []

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