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Review calls for more research on suicide prevention methods

Results from a 10-year systematic review found sufficient evidence supporting effective methods of suicide prevention, though none stood out as superior.

“Over 800,000 people worldwide die each year by suicide, accounting for 1.4% of deaths worldwide. Suicide can occur at any point in the lifespan, and is the second most frequent, and in some countries the leading, cause of death among young people aged 15 to 24 years. In addition, around 20 to 30 times as many suicide attempts occur,” Gil Zalsman, MD, of Tel Aviv University, Israel, and colleagues wrote.

To determine efficacy of suicide prevention interventions since 2005, researchers conducted a systematic review of 1,797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomized controlled trials, 67 cohort trials and 22 ecological or population-based investigations.

Researchers found that evidence for limiting access to lethal means to prevent suicide has increased since 2005, particularly regarding control of analgesics, which has decreased by 43% since 2005, and hot spots for suicide by jumping, which has decreased by 86% since 2005.

School-based awareness programs have successfully reduced suicide attempts (OR = 0.45; 95% CI, 0.24-0.85; P = .014) and suicidal ideation (OR = 0.5; 95% CI, 0.27-0.92; P = .025).

Researchers found substantial evidence of efficacy of clozapine and lithium for suicide prevention, though it may be “less specific than previously thought,” they wrote.

Effective pharmacological and psychological treatments for depression are significant to suicide prevention, according to researchers.

Potential benefits of suicide prevention screening in primary care were unable to be determined due to insufficient evidence.

Gatekeeper training, physician education and internet and helpline support also require further investigation.

Paucity of randomized clinical trials significantly limited the evaluation of preventive interventions, according to researchers.

“This review fulfils an important role in highlighting areas of potential discrepancy between expert opinion (eg, need for follow-up care), legislation (eg, black-box warnings on antidepressant use in youth), or public policy (eg, general public awareness campaigns), and available scientific data, identifying areas in which research must be focused to effect meaningful change on suicide,” Gustavo Turecki, MD, PhD, of McGill University, Douglas Mental Health University Institute, Montreal, wrote in an accompanying editorial. – by Amanda Oldt

Disclosure: Zalsman reports no relevant disclosures. Turecki reports receiving grants from Pfizer Canada and honoraria from Bristol-Myers Squibb Canada and Janssen Canada, and grants from the Canadian Institute of Health Research, the NIH and the Fonds de Recherche du Québec-Santé. Please see the full study for a list of all authors’ relevant financial disclosures.