What Strategies Can We Use to Prevent Death by Suicide?

Peter M. Yellowlees, MBBS, MD


October 11, 2018

This is the Medscape Psychiatry Minute. I'm Dr. Peter Yellowlees. Suicide is a huge public health problem and a matter of intense distress for too many patients and their families, as well as for clinicians. Although we know that suicide can be prevented at the individual level by treating depression effectively, we don't have a strong evidence base for preventing death by suicide at a population level.

Now, a team of investigators from the Geisel School of Medicine in Dartmouth, New Hampshire, has compared suicide prevention strategies with controls across 72 randomized controlled trials (RCTs) and six pooled analyses.[1] They found that the World Health Organization (WHO) brief intervention and contact study[2] was associated with significantly lower odds of suicide. Six RCTs of cognitive-behavioral therapy for suicide prevention and six RCTs of lithium treatment yielded nonsignificant findings. The researchers concluded that the WHO study is a promising suicide prevention strategy; however, no other intervention led to a statistically significant effect for reducing suicide.

So where does this leave us? First, it is clear that research on the prevention of what is still a relatively rare event is difficult and has been relatively unsuccessful. However, the WHO study, which occurred in several underdeveloped nations, is fascinating. This study showed that education and regular personal follow-up of all suicide attempters did lead to statistically significantly smaller numbers of eventual suicides in the intervention group compared with controls.

This suggests that we should view any unsuccessful suicide attempt as a risk marker for eventual suicide, and that all such individuals should ideally receive regular, ongoing clinical follow-up.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.


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