Reduce Suicide Rates Research Articles

Suicide Prevention Strategies

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 suicide. 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.

Are mental health insurance mandates effective? Evidence from suicides

Many states in the US have passed laws mandating insurance companies to provide or offer some form of mental health benefits. These laws presumably lower the price of obtaining mental health services for many adults, and as a result, might improve health outcomes. This paper analyzes the effectiveness of mental health insurance mandates by examining the influence of mandates on adult suicides, which are strongly correlated with mental illness. Data on completed suicides in each state for the period 1981-2000 are analyzed. Ordinary least squares and two-stage least squares results show that mental health mandates are not effective in reducing suicide rates.

Per capita income is related to suicide rates in men but not in women

Background Suicide is an important medical and social problem. It has been suggested that socioeconomic factors play a more important role in suicide for men than for women. This study examined the relation between per capita income and suicide rates in men and women in European countries. Methods Correlations were computed to examine relations between per capita income and suicide rates in men and women in 34 European countries. Using median split, countries were divided into two groups according to per capita income. Suicide rates in countries with higher per capita income were compared with suicide rates in countries with lower per capita income. Results There was a trend towards a negative correlation between per capita income and suicide rates in men. Men in countries with lower per capita income commit suicide more frequently than men in countries with higher per capita income. Conclusion Socioeconomic improvements are needed to reduce suicide rates.

Is Suicide Ideation a Surrogate Endpoint for Geriatric Suicide?

The present study explored the validity of treating suicide ideation as a surrogate endpoint that can serve as a proxy for suicide in clinical intervention research with suicidal seniors. Two criteria; that suicide ideation is modulated by the proposed intervention and that modulation of suicide ideation leads to a quantitative reduction in suicide rates, were the focus of this review. A series of literature searches of the PsychINFO and Medline databases were conducted on the terms geriatric, elderly, seniors, suicide, self-destruction, clinical, randomized, trial, treatment, intervention , and ideation . Articles were analyzed if they provided sufficient information to examine whether an intervention effectively led to a reduction in suicide ideation among seniors. Two hundred and eight articles were considered for potential inclusion in this study, with 19 articles meeting final inclusion criteria. The articles reviewed were divided into three broad categories: articles supporting suicide ideation as a surrogate endpoint for geriatric suicide ( n = 6); those not supporting this hypothesis ( n = 1); and those providing insufficient information to test the hypothesis ( n = 12). The present analysis provided modest evidence for suicide ideation as a surrogate endpoint for geriatric suicide, due, in part, to a paucity of randomized controlled trials of treatment interventions for suicidal seniors, thus demonstrating a clear need for research in this area. Implications of utilizing surrogate endpoints in suicide research are discussed.

Australian mental health reform: time for real outcomes

After 12 years of national mental health reform, major service gaps and poor experiences of care are common. The mental health community reports little progress in implementing its key priorities, such as expanded early-intervention programs, comanagement of people with mental health problems and related alcohol or substance misuse, and widening of the spectrum of acute care settings. We propose new national targets for reducing the social and economic costs of poor mental health; these include increased access to effective care, reduced suicide rates and improved rates of return to full social and economic participation. We detail specific service reforms designed to maximise the chance of achieving these targets, and prioritise youth health and integrated primary care programs. New independent and national reporting systems on the progress of mental health reform are urgently required.

Antidepressants and Suicide

At the outset let me declare that in my 35 years of psychiatric practice I have accepted pharmaceutical company hospitality and also support for various research projects, and I have written not only on the use of antidepressants, but also on nonpharmacological methods in the treatment of depression. I believe that I do not have an ideological bias for or against one form of treatment or another, or indeed their combinations; rather, the bottom line is whether or not a person afflicted with depression improves and recovers. Since the introduction of the newer antidepressants in the late 1980s there have been sporadic reports of suicidal ideation and behavior in those who have been placed on Serotonin Specific Re-uptake Inhibitor (SSRI) antidepressants (Teicher et al., 1990; Healy & Whitaker, 2003), which has led to questioning their use. On the other hand, large population studies such as those undertaken by Isacsson (2002) in Sweden, Olfson et al. (2003) in the United States, and Hall et al. (2003) in Australia have been reassuring in noting an association between increased prescribing of antidepressants and a reduction of suicide rates. Nevertheless, there has still been a body of opinion expressing reservations about the use of such antidepressants (Healy & Whitaker, 2003), and, not unexpectedly, there has been ongoing community and professional debate about this important public health issue. In 2004 a remarkable study was published in the Journal of the American Medical Association by Jick et al. This study is important because it addresses a number of concerns that have been raised. Jick et al. had access to the United Kingdom General Practice Research Database, which has enrolled more than three million people since its inception in 1987, and which contains over 35 million patient-years of data available for research. This enabled them to examine the frequency of emergent suicidal behavior following the use of two distinct pharmacological classes of antidepressants, the older tricyclic antidepressants and the newer SSRIs, in large numbers of patients. In fact, the numbers were such that one could never anticipate enlisting so many participants in a formal research project. They identified 159,810 persons aged between 10 and 69 years who had had at least one prescription of amitriptyline, dothiepin (tricyclic antidepressants), fluoxetine, or paroxetine (SSRIs) in the period 1993 to 1999. Subjects were excluded if they had had a recorded prescription for another antidepressant, or if they had diagnoses other than depression, in order to produce a more homogeneous study population. There were 36,165 who had taken amitriptyline, 46,587 who had taken dothiepin, 49,671 who had taken fluoxetine, and 35,465 who had taken paroxetine. The mean number of study antidepressantprescriptions for these persons were similar for each drug. Jick et al. analyzed the data for both nonfatal suicidal behavior as well as suicide. Nonfatal suicidal behavior was a first time record of either suicidal ideation or attempted suicide. Up to four control subjects without suicidal behavior were identified, and matched by age, sex, and duration of contact in the register, for each suicidal subject. For the suicide analysis similar selection criteria were utilized, and up to 10 controls were selected for each suicide. Jick et al. found that there were 555 persons with a first time episode of nonfatal suicidal behavior, including suicidal ideation, and there were 2062 control subjects. There was no difference between the four study drugs in terms of the emergence of suicidal ideation or behavior, and there was no evidence of any effect modification by age or sex. Compared with those who started taking an antidepressant more than 90 days before their first suicidal behavior, those who started taking their antidepressant within 1 to 9 days before developing suicidal behav-

Anti-depressants, suicide, and drug regulation

Policymakers are increasingly concerned that a relatively new class of anti-depressant drugs, selective serotonin re-uptake inhibitors (SSRI), may increase the risk of suicide for at least some patients, particularly children. Prior randomized trials are not informative on this question because of small sample sizes and other limitations. Using variation across countries over time in SSRI sales and suicide, we find that an increase of one pill per capita (a 13 percent increase over 1999 levels) is associated with a 2.5 percent reduction in suicide rates, a relationship that is more pronounced for adults than for children. Our findings suggest that expanding access to SSRIs for adults may be a cost-effective way to save lives, although policymakers are right to remain cautious about pediatric use of SSRIs.

Mental Health Service Delivery and Suicide Risk: The Role of Individual Patient and Facility Factors

This study explores suicide rates as a quality measure and identifies risk factors for suicide among psychiatric inpatients. Data from a prospective mortality study of psychiatric inpatients from 128 U.S. Department of Veterans Affairs hospitals throughout the United States were utilized to examine the relationship of death by suicide to patient-level sociodemographic, clinical, and mental health service delivery characteristics, as well as to facility-level measures of service delivery. Data were collected on all patients discharged with a diagnosis of schizophrenia, major depression, posttraumatic stress disorder, or bipolar disorder (N=121,933) between 1994 and 1998. There were 481 suicides in the study sample. Several variables were associated with higher risk for suicide risk, including length of stay less than 14 days, poorer continuity of care, and lack of readmission within 6 months. These variables were significant even after adjustment for state suicide rates, the proportion of members of racial minority groups in the state population, and state-level social capital. Suicide rates are not likely to be a useful indicator of the quality of mental health care because of the instability of suicide rates, difficulty collecting data, and the lack of association between suicide and facility quality of care. The lack of association with facility-level variables suggests that systemic changes in these performance measures would be unlikely to significantly reduce suicide rates.

Elderly Suicide: An analysis of coroner's inquests into two hundred cases in Cheshire 1989 - 2001

Elderly suicide is an index of more widespread disorder and discontent among the elderly, and furthermore is a potentially preventable cause of death. This study used coroner's inquest records of 200 elderly in Cheshire who killed themselves, and in which their unexpected deaths attracted a verdict of suicide. Sociodemographic characteristics, clinical aspects of the suicidal process and health care contact before death are reviewed. Unlike most available studies, cases of unexpected death in which an open verdict was given were not included in this study, which covered a 13 year period. The findings are interpreted and compared to the currently available literature on suicide in the elderly. Late life suicide is characterised by less warning, higher lethality and greater prevalence of depression and physical illness. However, suicide risk often remains undetected. All suicidal behaviour in the elderly should be taken seriously by psychiatric and primary care services, in order to reduce suicide rates in the elderly.

Association between mortality from suicide in England and antidepressant prescribing: an ecological study.

BackgroundAntidepressant prescribing has been increasing in England. Studies in other countries suggest that while this may be associated with reduced suicide rates, it may also be associated with increased fatal poisoning from antidepressant drugs. We therefore conducted an ecological study to assess the association between prescription rates for antidepressants and suicide or fatal antidepressant-related poisoning in England.MethodsThe Office for National Statistics provided information on the number of suicides, antidepressant-related poisoning deaths and populations for England between 1993 and 2002. The Department of Health supplied data on prescriptions for all antidepressants dispensed in England. Associations between prescriptions and deaths were assessed using Spearman's rank correlation coefficient.ResultsThere were 46,747 suicides, 3,987 deaths involving tricyclic antidepressants and 430 involving selective serotonin re-uptake inhibitors and other antidepressants. Increased antidepressant prescribing was statistically associated with a fall in suicide rates (Spearman's rs = -0.73, p = 0.02) and fatal poisoning involving tricyclic antidepressants (rs = -0.64, p = 0.05). In contrast, increased prescribing of selective serotonin re-uptake inhibitors and other antidepressants was statistically associated with an increase in fatal poisoning involving these drugs (rs = 0.99, p < 0.001).ConclusionIncreased prescribing of antidepressants may indicate improved diagnosis and treatment of depression in primary care. Our analysis suggests that this was accompanied by lower suicide rates. A decrease in poisoning deaths involving tricyclic antidepressants may suggest a change in preference for using serotonin reuptake inhibitors and other antidepressant drugs for high-risk patients. This may also partially explain the increase in deaths involving these drugs. Due to the ecological nature of the design, we cannot say conclusively whether reduced suicide rates are a direct consequence of increased antidepressant prescribing rates. To confirm these associations, individual level data on prescribing and suicide is needed.

Association between youth-focused firearm laws and youth suicides.

Firearms are used in approximately half of all youth suicides. Many state and federal laws include age-specific restrictions on the purchase, possession, or storage of firearms; however, the association between these laws and suicides among youth has not been carefully examined. To evaluate the association between youth-focused firearm laws and suicides among youth. Quasi-experimental design with annual state-level data on suicide rates among US youth aged 14 through 20 years, for the period 1976-2001. Negative binomial regression models were used to estimate the association between state and federal youth-focused firearm laws mandating a minimum age for the purchase or possession of handguns and state child access prevention (CAP) laws requiring safe storage of firearms on suicide rates among youth. Association between youth-focused state and federal firearm laws and rates of firearm, nonfirearm, and total suicides among US youth aged 14 to 17 and 18 through 20 years. There were 63 954 suicides among youth aged 14 through 20 years during the 1976-2001 study period, 39 655 (62%) of which were committed with firearms. Minimum purchase-age and possession-age laws were not associated with statistically significant reductions in suicide rates among youth aged 14 through 20 years. State CAP laws were associated with an 8.3% decrease (rate ratio [RR], 0.92; 95% confidence interval [CI], 0.86-0.98) in suicide rates among 14- to 17-year-olds. The annual rate of suicide in this age group in states with CAP laws was 5.97 per 100 000 population rather than the projected 6.51. This association was also statistically significant for firearm suicides (RR, 0.89; 95% CI, 0.83-0.96) but not for nonfirearm suicides (RR, 1.00; 95% CI, 0.91-1.10). CAP laws were also associated with a significant reduction in suicides among youth aged 18 through 20 years (RR, 0.89; 95% CI, 0.85-0.93); however, the association was similar for firearm suicides (RR, 0.87; 95% CI, 0.82-0.92) and nonfirearm suicides (RR, 0.91; 95% CI, 0.85-0.98). There is evidence that CAP laws are associated with a modest reduction in suicide rates among youth aged 14 to 17 years. As currently implemented, minimum age restrictions for the purchase and possession of firearms do not appear to reduce overall rates of suicide among youth.

Change in suicide rates for patients with schizophrenia in Denmark, 1981-97: nested case-control study

Objective To study the change in risk of suicide among patients with schizophrenia and related disorders.Design Nested case-control design with linked data.Setting 4 longitudinal Danish registers.Participants 18 744 people aged...

Building a case for understanding the lived experiences of males who attempt suicide in Alberta, Canada.

Suicide is a serious public health concern in Alberta, with, on average, over 400 Albertans taking their own lives annually. The case for concern is even more pronounced when one considers that for younger Albertans (those aged less than 45 years), suicide is the second leading cause of death. While trends in rates of suicide fluctuate over time, it is important to note that suicide rates for males have been at least three times higher than the corresponding rates for females since the 1950s. Furthermore, these differences have increased so that, by the 1990s the rate for male suicide was four times higher than that of females. In addition, rates are increasing at a faster pace in younger cohorts. Despite the existence of numerous positivistically orientated studies, and the introduction of a range of strategies to help prevent suicide, significant reductions in suicide rates have not been achieved. Similarly, while there is a substantial literature on the issue of suicide in Canada, there remain many gaps in our knowledge. Our understanding of the experiences and the meanings attributed to these experiences that motivate contemporary Albertan males to attempt suicide is far from complete. In order to design interventions to help reduce the suicide rate, whether these are interventions at the preprimary, primary or secondary level of care, it is necessary to gain a more detailed and comprehensive understanding of this highly complex behaviour. Consequently, there is an urgent need to better understand the particular life experiences and the meanings that individuals attach to these experiences. Accordingly, this paper makes the case for the use of hermeneutic, phenomenological investigations, as a means to further elucidate the lived experiences of suicidal Alberta males.

Antidepressant prescribing and suicide rate in Northern Ireland

Purpose. – Although antidepressants are the most commonly used treatment for depressive illness, there is uncertainty if their use is associated with a reduction in suicide rate. Antidepressant prescribing in Northern Ireland has increased over fivefold in the decade 1989–1999. The authors sought to explore whether this increase was associated with a reduction in suicide rate taking into account social and political factors thought also to have an influence on suicide. Materials and methods. – Factors that have been suggested to influence suicide were entered into a linear regression with frequency of suicide and undetermined deaths (referred to as suicide rate) as the dependent variable. The above factors were antidepressant prescribing, unemployment rate, household alcohol expenditure and persons charged with terrorist offences. The rise in younger suicides, in recent decades, suggests this analysis should be carried out separately for younger (less than 30 years) and older (30 years and above) suicides separately. The predictors in the two models are based on aggregate data for the total group. Result. – In the younger group there was no association between antidepressant prescribing and suicide. For the older group increased antidepressant prescribing was associated with a reduction in suicide rate over the 10 years of the study. Conclusion. – Increasing antidepressant prescribing appears to be an effective strategy for reducing suicide. This has been demonstrated in older individuals.

National suicide rates as an indicator of the effect of suicide on premature mortality

The health strategies of many nations include targets to reduce suicide rates. In several countries, because suicide rates are rising in young men but falling or unchanging in most other groups, achievement of target reductions might mask rises in potential years of life lost (PYLL). Analysis of routine mortality and census data for England and Wales, UK, shows that although age-standardised suicide rates fell by 18% (95% CI 15-21) between 1981 and 1998, the PYLL before age 65 years increased by 5% (4-6). National suicide reduction targets should focus on PYLL and overall suicide rates.

Clozapine reduces suicide rate, costs in schizophrenia

Clozapine reduces suicide rate, costs in schizophrenia

Clozapine reduces suicide rate, costs in schizophrenia

Clozapine reduces suicide rate, costs in schizophrenia

School Approaches to Youth Suicide Prevention

Universal and indicated school-based suicide prevention programs are described, including conceptual bases, program components, ineffective approaches, and evaluation outcomes. Controlled evaluations of second-generation programs report positive outcomes, including positive changes in knowledge, attitudes toward suicide, intent to seek help, and reduction of suicidal feelings. Two comprehensive programs reported reduced suicide rates in targeted counties subsequent to program dissemination. Caution is raised concerning variations in program quality. Currently, some model universal and indicated programs show promise and are candidates for more research on mediating and moderating variables and program outcomes.

Research endeavours into suicide: a need to shift the emphasis.

According to the World Health Organization (WHO, 2002), approximately one million people died as a result of suicide in the year 2000. Perhaps more worrisome, evidence provided by the WHO (2002) indicates that the global rate of suicide has continued to rise since 1950. Consequently, suicide should be regarded as a global problem and one that is increasing in magnitude. Drawing predominantly on policy and empirical literature emanating from Canada and the UK, this article will show that, despite a substantial research effort and the production of an associated literature, suicide rates continue to rise in the example countries. Even given the existence of numerous positivistically oriented studies, and the introduction of a range of strategies to help prevent suicide, significant reductions in suicide rates have not been achieved. Similarly, while there exists a substantial literature on the issue of suicide, there are many gaps in our knowledge and our understanding of the experiences, and the meanings attributed to these experiences that motivate people to attempt suicide is far from complete. Accordingly, the author argues that there is an urgent need to better understand the particular life experiences and the meanings that individuals attach to suicidal experiences. In order to design interventions to help reduce the suicide rate, whether these are interventions at the pre-primary, primary or secondary level of care, it is argued that it is necessary to gain a more detailed and comprehensive understanding of this highly complex behaviour. Consequently, this article makes the case for the use of hermeneutic, phenomenological investigations, in order to further elucidate the lived experiences of people who have attempted suicide.

Understanding suicidal ideation and assessing for risk

The UK government's health strategy, The Health of the Nation , included a target for reducing the population suicide rates by 15% over an 8-year period [Department of Health (1992), London: HMSO]. This thrust has been carried forward in subsequent work embodied in the ninth standard of the National Service Framework for Mental Health [Department of Health (1999), London: HMSO] and Safety First: FiveYear Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness [Department of Health (2001), London: HMSO]. A crucial aspect in reducing suicide rates is the accurate assessment of those who may be at risk to enable appropriate interventions to take place.While any person who wants to end his or her own life may find a way to do so, it is most important for the clinician to approach any potential suicide with the conviction that it is possible to prevent at least some suicides. This paper outlines best practice regarding the exploration and assessment of suicidal ideation and suicidal potential.