Effectiveness of a multimodal community intervention program to prevent suicide and suicide attempts: a quasi-experimental study

Yutaka Ono, Akio Sakai, Kotaro Otsuka, Hidenori Uda, Hirofumi Oyama, Naoki Ishizuka, Shuichi Awata, Yasushi Ishida, Hiroto Iwasa, Yuichi Kamei, Yutaka Motohashi, Jun Nakamura, Nobuyuki Nishi, Naoki Watanabe, Toshihiko Yotsumoto, Atsuo Nakagawa, Yuriko Suzuki, Miyuki Tajima, Eriko Tanaka, Hironori Sakai, Naohiro Yonemoto, Yutaka Ono, Akio Sakai, Kotaro Otsuka, Hidenori Uda, Hirofumi Oyama, Naoki Ishizuka, Shuichi Awata, Yasushi Ishida, Hiroto Iwasa, Yuichi Kamei, Yutaka Motohashi, Jun Nakamura, Nobuyuki Nishi, Naoki Watanabe, Toshihiko Yotsumoto, Atsuo Nakagawa, Yuriko Suzuki, Miyuki Tajima, Eriko Tanaka, Hironori Sakai, Naohiro Yonemoto

Abstract

Background: Multilevel and multimodal interventions have been suggested for suicide prevention. However, few studies have reported the outcomes of such interventions for suicidal behaviours.

Methods: We examined the effectiveness of a community-based multimodal intervention for suicide prevention in rural areas with high suicide rates, compared with a parallel prevention-as-usual control group, covering a total of 631,133 persons. The effectiveness was also examined in highly populated areas near metropolitan cities (1,319,972 persons). The intervention started in July 2006, and continued for 3.5 years. The primary outcome was the incidence of composite outcome, consisting of completed suicides and suicide attempts requiring admission to an emergency ward for critical care. We compared the rate ratios (RRs) of the outcomes adjusted by sex, age group, region, period and interaction terms. Analyses were performed on an intention-to-treat basis and stratified by sex and age groups.

Findings: In the rural areas, the overall median adherence of the intervention was significantly higher. The RR of the composite outcome in the intervention group decreased 7% compared with that of the control group. Subgroup analyses demonstrated heterogeneous effects among subpopulations: the RR of the composite outcome in the intervention group was significantly lower in males (RR = 0.77, 95% CI 0.59-0.998, p = 0.0485) and the RR of suicide attempts was significantly lower in males (RR = 0.39, 95% CI 0.22-0.68, p = 0.001) and the elderly (RR = 0.35, 95% CI 0.17-0.71, p = 0.004). The intervention had no effect on the RR of the composite outcome in the highly populated areas.

Interpretation: Our findings suggest that this community-based multimodal intervention for suicide prevention could be implemented in rural areas, but not in highly populated areas. The effectiveness of the intervention was shown for males and for the elderly in rural areas.

Trial registration: ClinicalTrials.gov NCT00737165 UMIN Clinical Trials Registry UMIN000000460.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Location map of the study…
Figure 1. Location map of the study areas.
Pink-coloured areas indicate rural study areas. Orange-coloured areas indicate highly populated study areas.
Figure 2. Flow chart of the study.
Figure 2. Flow chart of the study.
Figure 3. Figure 3 shows the proportion…
Figure 3. Figure 3 shows the proportion of adherence with required components of the intervention in the rural areas.
The blue line indicates the proportion of the intervention group, and the red line indicates that of the control group. The dotted lines indicate interquartile ranges. The proportion is shown from the 3.5 years before the start of the study period. The six-month period before the start of the study period was the reference period.
Figure 4. Figure 4 shows the proportion…
Figure 4. Figure 4 shows the proportion of adherence with required components of the intervention in the highly populated areas.
The blue line indicates the proportion of the intervention group, and the red line indicates that of the control group. The dotted lines indicate interquartile ranges. The proportion is shown from the 3.5 years before the start of the study period. The six-month period before the start of the study period was the reference period.
Figure 5. Primary outcome (composite outcome, consisting…
Figure 5. Primary outcome (composite outcome, consisting of completed suicides and suicide attempts requiring admission to an emergency ward for critical care) for all and for subgroups (sex and age) in rural areas and in highly populated areas.
Figure 6. Secondary outcome (completed suicides) for…
Figure 6. Secondary outcome (completed suicides) for all and for subgroups in rural areas and in highly populated areas.
Figure 7. Secondary outcome (suicide attempts) for…
Figure 7. Secondary outcome (suicide attempts) for all and for subgroups in rural areas and in highly populated areas.

References

    1. World Health Organization (2012) Public health action for the prevention of suicide: A framework. Geneva, Switzerland: WHO Press.
    1. Fountoulakis KN, Gonda X, Rihmer Z (2011) Suicide prevention programs through community intervention. J Affect Disord 130(1–2): 10–6.
    1. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, et al. (2005) Suicide prevention strategies: a systematic review. JAMA 294(16): 2064–74.
    1. van der Feltz-Cornelis CM, Sarchiapone M, Postuvan V, Volker D, Roskar S, et al. (2011) Best practice elements of multilevel suicide prevention strategies: a review of systematic reviews. Crisis 32(6): 319–33.
    1. Ono Y (2004) Suicide prevention program for the elderly: the experience in Japan. Keio J Med 53(1): 1–6.
    1. Oyama H, Watanabe N, Ono Y, Sakashita T, Takenoshita Y, et al. (2005) Community-based suicide prevention through group activity for the elderly successfully reduced the high suicide rate for females. Psychiatry Clin Neurosci 59(3): 337–44.
    1. Oyama H, Sakashita T, Ono Y, Goto M, Fujita M, et al. (2008) Effect of community-based intervention using depression screening on elderly suicide risk: a meta-analysis of the evidence from Japan. Community Ment Health J 44(5): 311–20.
    1. Fujita T (2003) Rapid Increases of Suicide Deaths in Metropolitan Areas. J Natl Inst Public Health 52: 295–301.
    1. Ono Y, Awata S, Iida H, Ishida Y, Ishizuka N, et al. (2008) A community intervention trial of multimodal suicide prevention program in Japan: a novel multimodal community intervention program to prevent suicide and suicide attempt in Japan, NOCOMIT-J. BMC Public Health 8: 315.
    1. Fitzmaurice GM, Laird NM, Ware JH (2011) Applied Longitudinal Analysis, 2nd Edition. New Jersey: John Wiley & Sons, Inc.
    1. Wasserman D, Wasserman C, editors (2009) Oxford textbook of suicidology and suicide prevention: a global perspective. New York: Oxford University Press Inc.
    1. O’Brien PC, Fleming TR (1979) A multiple testing procedure for clinical trials. Biometrics 35(3): 549–56.
    1. Des Jarlais DC, Lyles C, Crepaz N (2004) Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health 94(3): 361–6.
    1. Armstrong R, Waters E, Moore L, Riggs E, Cuervo LG, et al. (2008) Improving the reporting of public health intervention research: advancing TREND and CONSORT. J Public Health (Oxf) 30(1): 103–9.
    1. Knox KL, Litts DA, Talcott GW, Feig JC, Caine ED (2003) Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: cohort study. BMJ 327(7428): 1376.
    1. Arsenault-Lapierre G, Kim C, Turecki G (2004) Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry 4: 37.
    1. Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM (2003) Psychological autopsy studies of suicide: a systematic review. Psychol Med 33(3): 395–405.
    1. Hegerl U, Althaus D, Schmidtke A, Niklewski G (2006) The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality. Psychol Med 36(9): 1225–33.
    1. Szanto K, Kalmar S, Hendin H, Rihmer Z, Mann JJ (2007) A suicide prevention program in a region with a very high suicide rate. Arch Gen Psychiatry 64(8): 914–20.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe