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      Suicide prevention efforts in the United States and their effectiveness

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          Abstract

          Purpose of review

          Suicide is a serious public health problem in the United States, and suicide rates have been increasing for more than a decade. Rural areas are more impacted than urban areas, reinforcing that social, cultural, and economic factors contribute to risk. This article reviews recent work about these contributors to suicide and how they may inform prevention efforts.

          Recent findings

          Current research has shown that suicide is more than a mental health problem with a psychiatric or medical solution. Universal screening and referral by gatekeepers target a large group with a low baseline risk, and there are few treatments proven to reduce death by suicide, as well as a severe shortage of mental health providers in the United States to provide them. Instead, suicide prevention polices can target various other factors that contribute to elevated suicide risk at the population level, including reducing socioeconomic deprivation and access to firearms, both of which are often higher in rural areas. Internet-based interventions also hold promise as they are highly scalable, accessible almost anywhere, and often anonymous.

          Summary

          Understanding factors that increase suicide risk guide development of evidence-based policies targeted at high-risk groups. Population-level interventions should be developed in collaboration with the target audience for cultural appropriateness.

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          Most cited references27

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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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            Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT).

            Approximately 50% of patients with schizophrenia or schizoaffective disorder attempt suicide, and approximately 10% die of suicide. Study results suggest that clozapine therapy significantly reduces suicidal behavior in these patients. A multicenter, randomized, international, 2-year study comparing the risk for suicidal behavior in patients treated with clozapine vs olanzapine was conducted in 980 patients with schizophrenia or schizoaffective disorder, 26.8% of whom were refractory to previous treatment, who were considered at high risk for suicide because of previous suicide attempts or current suicidal ideation. To equalize clinical contact across treatments, all patients were seen weekly for 6 months and then biweekly for 18 months. Subsequent to randomization, unmasked clinicians at each site could make any interventions necessary to prevent the occurrence of suicide attempts. Suicidal behavior was assessed at each visit. Primary end points included suicide attempts (including those that led to death), hospitalizations to prevent suicide, and a rating of "much worsening of suicidality" from baseline. Masked raters, including an independent suicide monitoring board, determined when end point criteria were achieved. Suicidal behavior was significantly less in patients treated with clozapine vs olanzapine (hazard ratio, 0.76; 95% confidence interval, 0.58-0.97; P =.03). Fewer clozapine-treated patients attempted suicide (34 vs 55; P =.03), required hospitalizations (82 vs 107; P =.05) or rescue interventions (118 vs 155; P =.01) to prevent suicide, or required concomitant treatment with antidepressants (221 vs 258; P =.01) or anxiolytics or soporifics (301 vs 331; P =.03). Overall, few of these high-risk patients died of suicide during the study (5 clozapine vs 3 olanzapine-treated patients; P =.73). Clozapine therapy demonstrated superiority to olanzapine therapy in preventing suicide attempts in patients with schizophrenia and schizoaffective disorder at high risk for suicide. Use of clozapine in this population should lead to a significant reduction in suicidal behavior.
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              Widening rural-urban disparities in youth suicides, United States, 1996-2010.

              Little is known about recent trends in rural-urban disparities in youth suicide, particularly sex- and method-specific changes. Documenting the extent of these disparities is critical for the development of policies and programs aimed at eliminating geographic disparities.
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                Author and article information

                Journal
                Curr Opin Psychiatry
                Curr Opin Psychiatry
                COIP
                Current Opinion in Psychiatry
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0951-7367
                1473-6578
                May 2021
                05 January 2021
                : 34
                : 3
                : 299-305
                Affiliations
                [a ]BulletPoints Project
                [b ]University of California Firearm Violence Research Center
                [c ]Department of Psychiatry and Behavioral Sciences
                [d ]Department of Emergency Medicine, University of California, Davis, California, USA
                Author notes
                Correspondence to Amy Barnhorst, MD, Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA 95817, USA. E-mail: abarnhorst@ 123456ucdavis.edu
                Article
                YCO340304 00017
                10.1097/YCO.0000000000000682
                8048720
                33405481
                d3f8e277-7fbc-4d7c-9b7e-fe297b9fb136
                Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                Categories
                THE IMPACT OF URBANISATION ON MENTAL HEALTH: Edited by Jair Mari and Sandro Galea
                Custom metadata
                TRUE

                cultural competency,firearm,lethal means,social determinants of health,suicide

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