In 2002, an estimated 877,000 lives were lost worldwide through suicide. Some developed
nations have implemented national suicide prevention plans. Although these plans generally
propose multiple interventions, their effectiveness is rarely evaluated.
To examine evidence for the effectiveness of specific suicide-preventive interventions
and to make recommendations for future prevention programs and research.
Relevant publications were identified via electronic searches of MEDLINE, the Cochrane
Library, and PsychINFO databases using multiple search terms related to suicide prevention.
Studies, published between 1966 and June 2005, included those that evaluated preventative
interventions in major domains; education and awareness for the general public and
for professionals; screening tools for at-risk individuals; treatment of psychiatric
disorders; restricting access to lethal means; and responsible media reporting of
Data were extracted on primary outcomes of interest: suicidal behavior (completion,
attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification
of at-risk individuals, antidepressant prescription/use rates, referrals), or both.
Experts from 15 countries reviewed all studies. Included articles were those that
reported on completed and attempted suicide and suicidal ideation; or, where applicable,
intermediate outcomes, including help-seeking behavior, identification of at-risk
individuals, entry into treatment, and antidepressant prescription rates. We included
3 major types of studies for which the research question was clearly defined: systematic
reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled
trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies
(n = 41). Heterogeneity of study populations and methodology did not permit formal
meta-analysis; thus, a narrative synthesis is presented.
Education of physicians and restricting access to lethal means were found to prevent
suicide. Other methods including public education, screening programs, and media education
need more testing.
Physician education in depression recognition and treatment and restricting access
to lethal methods reduce suicide rates. Other interventions need more evidence of
efficacy. Ascertaining which components of suicide prevention programs are effective
in reducing rates of suicide and suicide attempt is essential in order to optimize
use of limited resources.