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      Prevention of suicidal behavior Translated title: Prevención de la conducta suicida Translated title: Prévention du comportement suicidaire

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          Abstract

          More than 800 000 people die every year from suicide, and about 20 times more attempt suicide. In most countries, suicide risk is highest in older males, and risk of attempted suicide is highest in younger females. The higher lethal level of suicidal acts in males is explained by the preference for more lethal methods, as well as other factors. In the vast majority of cases, suicidal behavior occurs in the context of psychiatric disorders, depression being the most important one. Improving the treatment of depression, restricting access to lethal means, and avoiding the Werther effect (imitation suicide) are central aspects of suicide prevention programs. In several European regions, the four-level intervention concept of the European Alliance Against Depression (www.EAAD.net), simultaneously targeting depression and suicidal behavior, has been found to have preventive effects on suicidal behavior. It has already been implemented in more than 100 regions in Europe.

          Translated abstract

          Más de 800000 personas fallecen cada año por suicidio, y cerca de 20 veces más intentan suicidarse. En la mayoría de los países el riesgo suicida es más elevado en hombres de mayor edad y el riesgo de intento suicida es más alto en mujeres jóvenes. La mayor letalidad de los actos suicidas en los hombres se explica por la preferencia de métodos más letales como también por otros factores. En la gran mayoría de los casos, la conducta suicida ocurre en el contexto de los trastornos psiquiátricos, siendo la depresión uno de los más importantes. Aspectos centrales de los programas de prevención del suicidio lo constituyen la mejoría en el tratamiento de la depresión, la restricción en el acceso a medios letales y la evitación del efecto Werther (suicidio por imitación). En varias regiones europeas se ha encontrado que el concepto de intervención de cuarto nivel de la European Alliance Against Depression (www.EAAD.net), que se orienta simultáneamente a la depresión y la conducta suicida, tiene efectos preventivos en la conducta suicida. Esto ya ha sido implementado en más de 100 regiones de Europa.

          Translated abstract

          Plus de 800 000 personnes meurent chaque année par suicide et environ 20 fois plus tentent de se suicider. Dans la plupart des pays, le risque suicidaire est plus élevé chez les hommes âgés et le risque de tentative de suicide est plus élevé chez les femmes jeunes. Le taux de décès plus élevé des actes suicidaires chez les hommes s'explique par le choix de méthodes plus létales et par d'autres facteurs. Dans la grande majorité des cas, le comportement suicidaire survient dans le contexte de troubles psychiatriques dont la dépression représente le plus important. Les programmes de prévention du suicide sont axés sur l'amélioration du traitement de la dépression, la restriction de l'accès aux moyens létaux et la prévention de l'effet Werther (suicide mimétique). Dans plusieurs régions européennes, le concept d'intervention a quatre niveaux de l'European Alliance Against Depression (www.EAAD.net), ciblant simultanément la dépression et le comportement suicidaire, a montré des effets préventifs sur le comportement suicidaire. Il est déjà mis en oeuvre dans plus de 100 régions en Europe.

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          Most cited references31

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          World Health Organization.

          Ala Alwan (2007)
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            Psychological autopsy studies of suicide: a systematic review.

            The psychological autopsy method offers the most direct technique currently available for examining the relationship between particular antecedents and suicide. This systematic review aimed to examine the results of studies of suicide that used a psychological autopsy method. A computer aided search of MEDLINE, BIDS ISI and PSYCHLIT, supplemented by reports known to the reviewers and reports identified from the reference lists of other retrieved reports. Two investigators systematically and independently examined all reports. Median proportions were determined and population attributable fractions were calculated, where possible, in cases of suicide and controls. One hundred and fifty-four reports were identified, of which 76 met the criteria for inclusion; 54 were case series and 22 were case-control studies. The median proportion of cases with mental disorder was 91% (95 % CI 81-98%) in the case series. In the case-control studies the figure was 90% (88-95%) in the cases and 27% (14-48%) in the controls. Co-morbid mental disorder and substance abuse also preceded suicide in more cases (38%, 19-57%) than controls (6%, 0-13%). The population attributable fraction for mental disorder ranged from 47-74% in the seven studies in which it could be calculated. The effects of particular disorders and sociological variables have been insufficiently studied to draw clear conclusions. The results indicated that mental disorder was the most strongly associated variable of those that have been studied. Further studies should focus on specific disorders and psychosocial factors. Suicide prevention strategies may be most effective if focused on the treatment of mental disorders.
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              Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis.

              Internet-delivered cognitive behavior therapy (ICBT) has been tested in many research trials, but to a lesser extent directly compared to face-to-face delivered cognitive behavior therapy (CBT). We conducted a systematic review and meta-analysis of trials in which guided ICBT was directly compared to face-to-face CBT. Studies on psychiatric and somatic conditions were included. Systematic searches resulted in 13 studies (total N=1053) that met all criteria and were included in the review. There were three studies on social anxiety disorder, three on panic disorder, two on depressive symptoms, two on body dissatisfaction, one on tinnitus, one on male sexual dysfunction, and one on spider phobia. Face-to-face CBT was either in the individual format (n=6) or in the group format (n=7). We also assessed quality and risk of bias. Results showed a pooled effect size (Hedges' g) at post-treatment of -0.01 (95% CI: -0.13 to 0.12), indicating that guided ICBT and face-to-face treatment produce equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there are still few studies for each psychiatric and somatic condition and many conditions for which guided ICBT has not been compared to face-to-face treatment. Thus, more research is needed to establish equivalence of the two treatment formats. Copyright © 2014 World Psychiatric Association.
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                Author and article information

                Contributors
                Journal
                Dialogues Clin Neurosci
                Dialogues Clin Neurosci
                Dialogues Clin Neurosci
                Dialogues in Clinical Neuroscience
                Les Laboratoires Servier (France )
                1294-8322
                1958-5969
                June 2016
                June 2016
                : 18
                : 2
                : 183-190
                Affiliations
                Department of Psychiatry and Psychotherapy, University Hospital of Leipzig, Leipzig, Germany
                Author notes
                Article
                10.31887/DCNS.2016.18.2/uhegerl
                4969705
                27489458
                a09f4f4e-5357-4830-9ffd-980cdb383841
                Copyright: © 2016 Institut la Conference Hippocrate - Servier Research Group

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Clinical Research

                Neurosciences
                antidepressant,depression,multifaceted intervention,suicide prevention
                Neurosciences
                antidepressant, depression, multifaceted intervention, suicide prevention

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