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States with a higher concentration of suicide prevention centers in 1970 had higher suicide rates in 1970 but experienced less of an increase in the suicide rates during the next decade. The results of this study, therefore, provide some support for the beneficial impact of suicide prevention centers on the communities that they serve.
Recent increases in suicide rates internationally have focused attention on suicide as an important area of public health concern. In this review, strategies developed by various countries to halt this trend are compared. Nine out of 15 countries respond to enquiry about the state of development of suicide prevention strategies and programmes. Comprehensive strategies have been or are being developed by Finland, Norway, Australia, New Zealand and Sweden. The organization of these strategies differs between countries. The interventions have similar targets and are presented in detail There are some similarities in strategy content but evident differences in organization. Further developments should not only be based on research, but also consider the diverse experiences of other countries, and they should incorporate appropriate structures for monitoring and evaluation.
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Suicide by self-poisoning is a prevalent cause of death worldwide. A substantial proportion of individuals who poison themselves come into contact with medical services before they die. Our focus in the current study was the medical management of drug self-poisoning in industrialized countries and its possible contribution to suicide prevention. We reviewed the literature to determine the proportion of self-poisoning suicides who reach hospital alive, the sociodemographic and clinical characteristics of in-hospital overdose deaths, the in-hospital management this group of patients receives, and whether there are specific aspects of pre-hospital care and in-hospital management that have the potential to improve survival. Between 11% and 28% of individuals who died following deliberate ingestion of drugs reached hospital alive. The substances which were most frequently implicated in death were paracetamol (acetaminophen) and paracetamol compounds, tricyclic antidepressants, and benzodiazepines. Most patients received fairly intensive treatment, yet death may have been preventable in a small proportion of cases. Only one intervention (the administration of acetylcysteine) was shown to reduce mortality and this was in a highly selected group of patients (those who had ingested paracetamol and developed fulminant hepatic failure). It is possible that other interventions such as better airway management, the prompt administration of activated charcoal, and improved pre-hospital care may improve outcomes but their potential contribution to suicide prevention needs to be investigated in future studies.
Efforts to prevent suicide are reviewed. Recent studies have shown that suicide prevention centers may be effective in preventing suicide, at least among females. However, in recent years, more attention has been directed toward the possibility that restricting access to methods for suicide may be an effective way for preventing suicide. In addition, there is a growing body of research on which medications and which techniques of psychotherapy may be most effective in decreasing the risk of suicide in depressed patients.
Suicide rates vary by country and by mental disorder. What does not vary, though, is that the number of suicides per year is not declining and that a person with a mental disorder is more likely to commit suicide than one without such an illness. Although many pharmacologic interventions have been reported to reduce the risk of suicide among mentally ill patients, especially those with bipolar disorder, the effects of such interventions are inconsistent at best. Lithium is the only medication for which the evidence consistently shows an antisuicidal effect.
During the war against Japan, there were two facets of an American program to prevent suicide among the Japanese. One was a research component in the Foreign Morale Analysis Division (FMAD), a subunit of the Office of War Information. The principal FMAD figure who did most of the research on Japanese suicide and ways to prevent suicide among the Japanese military was the anthropologist Ruth Benedict, assisted by her Japanese-American aide Robert Hashima. The second facet was the suicide prevention program itself, which was put into effect toward the end of the war in the battles of Saipan and Okinawa. This program of action was undertaken by American GIs. These unheralded activities in suicide prevention merit a place in the annals of suicide prevention programs.
Concerned over the growing epidemic of death by suicide in the United States, the National Institute of Mental Health of the U.S. National Institutes of Health funded Small Business Innovation Research (SBIR) projects using innovative web-based approaches to provide resources to professionals and the general public about suicide prevention. The Preventing Suicide Network (PSN) was funded (SBIR Contract #N44MH22044) and developed over a three and a half year period (2001-2005) as part of this initiative. The PSN provides intermediaries (those who participate in activities to prevent suicide) with an online community dedicated to timely access to authoritative and problem-specific tailored information.
Until recently, national strategies have not demonstrated their effectiveness in preventing suicide. A recent series of studies have shown that more aggressive treatment of depression in the population is associated with a significant reduction in the rate of suicide. Proof that a population-based strategy for preventing suicide can be effective should be demonstrating that an etiological factor can be identified on the population level and on the individual level and that this causal factor can be corrected on the individual level. Pertinent data can be put forward and in general demonstrate that treatment of depression is an effective means of preventing suicide on the population level.
PURPOSE: General hospital psychiatric services are able to provide leadership and coordinate the development of suicide prevention programs for individuals serviced in general hospital settings. We completed this literature review to suggest priorities for programming. METHODS: Our procedure was to update the review by Gunnell and Frankel that guided priorities for Health of the Nation, the national suicide prevention strategy in the UK. We completed a search, using the terms suicide prevention and control, of all English-language research and clinical trials conducted between January 1, 1994, and May 1, 2004. RESULTS: We identified 82 papers. Of these, 48 were excluded and the remaining 34 were grouped by secondary care setting categories. We found no articles on screening tools for predicting risk of suicide, 16 articles on interventions for individuals with suicidal behaviour, 14 articles on the treatment of major psychiatric disorders, 1 article and 1 published abstract on discharge from hospital, and 2 articles on reducing access to means. CONCLUSIONS: Based on a review of each category, we make several program and policy recommendations, including regularly updating clinical assessment skills, using guidelines for assessment of patients following a suicide attempt, assessing the risk of suicide 24 to 48 hours before discharge from hospital, and incorporating education about reducing access to means into routine psychiatric care.
Because of the almost complete absence of randomized controlled trials demonstrating the effectiveness of specific treatments, there is sometimes a degree of pessimism about our ability to prevent suicidal behaviors. However, the methodological challenges to produce such research are formidable and may never be overcome. Therefore, a pragmatic review of evidence-based methods of suicide prevention is required. This review of recent studies using a variety of research strategies, both nonpharmacological and pharmacological, particularly at the community level, provides persuasive data that suicide prevention is possible. This is achievable by the application of broad community and professional education programs, as well as by the optimum management of mental disorders.
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The Swedish National Program to Develop Suicide Prevention was created through collaboration between the National Board of Health and Welfare, the National Institute of Public Health, and the Centre for Suicide Research and Prevention. These institutions aim to provide joint support for the development of suicide prevention in Sweden by, for example, encouraging educational and development project. The program was signed for the National Council for Suicide Prevention by Agneta Dreber, Director-General, National Institute of Public Health; Danula Wasserman, Professor of Psychiatry and Suicidology, Head, National Centre for Suicide Research and Prevention; and Claes Ortendahl, Director-General, National Board of Health and Welfare. This article, edited by Jan Beskow, Professor of Psychiatry at the Centre for Suicide Research and Prevention, is an abridged version submitted to Crisis at the request of the Editors.