Best practice elements of multilevel suicide prevention strategies: a review of systematic reviews

Christina M van der Feltz-Cornelis, Marco Sarchiapone, Vita Postuvan, Daniëlle Volker, Saska Roskar, Alenka Tančič Grum, Vladimir Carli, David McDaid, Rory O'Connor, Margaret Maxwell, Angela Ibelshäuser, Chantal Van Audenhove, Gert Scheerder, Merike Sisask, Ricardo Gusmão, Ulrich Hegerl, Christina M van der Feltz-Cornelis, Marco Sarchiapone, Vita Postuvan, Daniëlle Volker, Saska Roskar, Alenka Tančič Grum, Vladimir Carli, David McDaid, Rory O'Connor, Margaret Maxwell, Angela Ibelshäuser, Chantal Van Audenhove, Gert Scheerder, Merike Sisask, Ricardo Gusmão, Ulrich Hegerl

Abstract

Background: Evidence-based best practices for incorporation into an optimal multilevel intervention for suicide prevention should be identifiable in the literature.

Aims: To identify effective interventions for the prevention of suicidal behavior.

Methods: Review of systematic reviews found in the Pubmed, Cochrane, and DARE databases. Steps include risk-of-bias assessment, data extraction, summarization of best practices, and identification of synergistic potentials of such practices in multilevel approaches.

Results: Six relevant systematic reviews were found. Best practices identified as effective were as follows: training general practitioners (GPs) to recognize and treat depression and suicidality, improving accessibility of care for at-risk people, and restricting access to means of suicide. Although no outcomes were reported for multilevel interventions or for synergistic effects of multiple interventions applied together, indirect support was found for possible synergies in particular combinations of interventions within multilevel strategies.

Conclusions: A number of evidence-based best practices for the prevention of suicide and suicide attempts were identified. Research is needed on the nature and extent of potential synergistic effects of various preventive activities within multilevel interventions.

Figures

Figure 1. PRISMA 2010 flow diagram
Figure 1. PRISMA 2010 flow diagram

References

    1. Adli M., Bauer M., & Rush A. J. (2006). Algorithms and collaborative-care systems for depression: Are they effective and why? A systematic review. Biological Psychiatry, 59, 1029–1038.
    1. Althaus D., & Hegerl U. (2003). The evaluation of suicide prevention activities: State of the art. The World Journal of Biological Psychiatry, 4, 156–165.
    1. Al Windi A. (2005). Depression in general practice. Nordic Journal of Psychiatry, 59, 272–277.
    1. Bernal M., Haro J. M., Bernert S., Brugha T., de Graaf R., Bruffaerts R., ... the ESEMED/MHEDEA investigators. (2007). Risk factors for suicidality in Europe: Results from the ESEMED study. Journal of Affective Disorders, 101(1-3), 27–34.
    1. Bool M., Blekman J., de Jong S., Ruiter M., & Voordouw I. (2007). Reduction of suicidality. Utrecht, Netherlands: Trimbos-Instituut.
    1. Botega N. J., & Silveira G. M. (1996). General practitioners attitudes toward depression: A study in primary care setting in Brazil. International Journal of Social Psychiatry, 42, 230–237.
    1. Bower P., Gilbody S., Richards D., Fletcher J., & Sutton A. (2006). Collaborative care for depression in primary care: Making sense of a complex intervention: Systematic review and meta-regression. British Journal of Psychiatry, 189, 484–493.
    1. De Jong F. J., van Steenbergen-Weijenburg K. M., Huijbregts K. M., Vlasveld M., Van Marwijk H. W. J., Beekman A. T. F., & Van der Feltz-Cornelis C. M. (2009). The Depression Initiative. Description of a collaborative care model for depression and of the factors influencing its implementation in the primary care setting in the Netherlands. Projects and Developments. International Journal of Integrated Care, 9, 81–89.
    1. Department of Health, Social Services and Public Safety (DHSSPS). (2006). Protect life – A shared vision. The Northern Ireland Suicide Prevention Strategy and Action Plan, 2006–2011. Belfast, Ireland: Author.
    1. Dowrick C., Gask L., Perry R., Dixon C., & Usherwood T. (2000). Do general practitioners’ attitudes toward depression predict their clinical behavior? Psychological Medicine, 30, 413–419.
    1. Dumesnil H., & Verger P. (2009). Public awareness campaigns about depression and suicide: A review. Psychiatric Services, 60, 1203–1213.
    1. Elliot L., Crombie I., Irvine L., Cantrell J., & Taylor J. (2004). The effectiveness of public health nursing: The problems and solutions in carrying out a review of systematic reviews. Journal of Advanced Nursing, 45, 117–125.
    1. Fernandez A., Haro J. M., Martinez-Alonso M., Demyttenaere K., Brugha T. S., Autonell J., ... Alonso J. (2007). Treatment adequacy for anxiety and depressive disorders in six European countries. British Journal of Psychiatry, 190, 172–173.
    1. Fleischmann A., Bertolote J. M., Wasserman D., De Leo D., Bolhari J., Botega N. J., ... Thanh H. (2008). Effectiveness of brief intervention and contact for suicide attempters: A randomized controlled trial in five countries. Bulletin of the World Health Organisation, 86, 703–709.
    1. Gilbody S., House A. O., & Sheldon T. A. (2005). Screening and case finding instruments for depression. Cochrane Database Systemic Reviews, (4), :CD002792.
    1. Gilbody S., Sheldon T., & House A. (2008). Screening and case-finding instruments for depression: A meta-analysis. Canadian Medical Association Journal, 178, 997–1003.
    1. Goldman L. S., Nielsen N. H., & Champion H. C. (1999). Awareness, diagnosis, and treatment of depression. Journal of General Internal Medicine, 14, 569–580.
    1. Goldney R. D. (2005). A pragmatic review of recent studies. Crisis, 26, 128–140.
    1. Goldney R. D., Fisher L. J., Wilson D. H., & Cheok F. (2002). Mental health literacy of those with major depression and suicidal ideation: An impediment to help seeking. Suicide and Life-Threatening Behavior, 32, 394–403.
    1. Hegerl U., & Wittenburg L. (2009). Focus on mental health care reforms in Europe: The European alliance against depression: A multilevel approach to the prevention of suicidal behavior. Psychiatric Services, 60, 596–599.
    1. Hegerl U., Althaus D., Schmidtke A., & Niklewski G. (2006). The Alliance Against Depression: Two-year evaluation of a community based intervention to reduce suicidality. Psychological Medicine, 36, 1225–1234.
    1. Hegerl U., Mergl R., Havers I., Schmidtke A., Lehfeld H., Niklewski G., & Althaus D. (2010). Sustainable effects on suicidality were found for the Nuremberg alliance against depression. European Archives of Psychiatry and Clinical Neuroscience, 260, 401–406.
    1. Hegerl U., Wittman M., Arensman E., van Audenhove C., Bouleau J. H., Van der Feltz-Cornelis C. M., ... Pfeiffer-Gerschel T. (2008). The European Alliance Against Depression (EAAD): A multifaceted, community-based action program against depression and suicidality. The World Journal of Biological Psychiatry, 9(1), 51–59.
    1. Hegerl U., Wittenburg L., Arensman E., Van Audenhove C., Coyne J. C., McDaid D., ... Bramesfeld A. (2009). Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): An evidence-based multilevel approach. BMC Public Health, 9, 428.
    1. IJff M. A., Huijbregts K. M., van Marwijk H. W., Beekman A. T., Hakkaart-van Roijen L., Rutten F. F., ... van der Feltz-Cornelis C. M. (2007). Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care: A randomized clinical trial. BMC Health Services Research, 7, 34.
    1. Isaac M., Elias B., Katz L. Y., Belik S. L., Deane F. P., Enns M. W., ... Sareen J. (2009). Gatekeeper training as a preventive intervention for suicide: A systematic review. Canadian Journal of Psychiatry, 54, 260–268.
    1. Jorm A. F., Medway J., Christensen H., Korten A. E., Jacomb P. A., & Rodgers B. (2000). Public beliefs about the helpfulness of interventions for depression: Effects on actions taken when experiencing anxiety and depression symptoms. Australian and New Zealand Journal of Psychiatry, 34, 619–626.
    1. Katon W. J., & Seelig M. (2008). Population-based care of depression: Team care approaches to improving outcomes. Journal of Occupational Environmental Medicine, 50, 459–467.
    1. Kennelly D. (2007). The economic costs of suicide in Ireland. Crisis, 28, 89–94.
    1. Khan A., Khan S., Kolts R., & Brown W. A. (2003). Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: Analysis of FDA reports. American Journal of Psychiatry, 160, 790–792.
    1. Kroenke K., Spitzer R. L., & Williams J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.
    1. Leitner M., Barr W., & Hobby L. (2008). Effectiveness of interventions to prevent suicide and suicidal behavior: A systematic review. Edinburgh, UK: Scottish Government Social Research.
    1. Lopez A. D., Mathers C. D., Ezzati M., Jamison D. T., & Murray C. J. (2006). Global and regional burden of disease and risk factors: Systematic analysis of population health data. Lancet, 367, 1747–1757.
    1. Mann J. J., Apter A., Bertolote J., Beautrais A., Currier D., Haas A., ... Hendin H. (2005). Suicide prevention strategies: A systematic review. Journal of the American Medical Association, 294, 2064–2074.
    1. Marušic A. (2008). Seven steps to integrating suicidology. Crisis, 29, 115–117.
    1. McDaid D., & Kennelly B. (2010). Suicide across the five continents: An economic perspective. In Wassermann D. & Wassermann C. (Eds.), Suicide across the five continents (pp. 359–368). Oxford: Oxford University Press.
    1. McGuire H., Moncrieff J., & Churchill R. (1998). Quality assessment of trials found within the scope of Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN). Baltimore, MD: International Cochrane Colloqium.
    1. Meredith L. S., Mendel P., Pearson M., Wu S. Y., Joyce G., Straus J. B., ... Unützer J. (2006). Implementation and maintenance of quality improvement for treating depression in primary care. Psychiatric Services, 57(1), 48–55.
    1. Moher D., Liberati A., Tetzlaff J., & Altman D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Journal of Clinical Epidemiology, 62, 1006–1012.
    1. Moher D., Schulz K. F., & Altman D. G. (2001). The CONSORT statement: Revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Medical Research Methodology, 1, 2.
    1. Nock M. K., Borges G., Bromet E. J., Alonso J., Angermeyer M., Beautrais A., ... Williams D. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry, 192, 98–105.
    1. Ono Y., Awata S., Iida H., Ishida Y., Ishizuka N., Iwasa H., ... Watanabe N. (2008). 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. Phillips B., Ball C., Sackett D., Badenoch D., Straus S., Haynes B., & Dawes M. (1998, updated 2009). Levels of evidence. Retrieved from .
    1. Pignone M. P., Gaynes B. N., Rushton J. L., Burchell C. M., Orleans C. T., Mulrow C. D., & Lohr K. N. (2002). Screening for depression in adults: A summary of the evidence for the U. S. Preventive Services Task Force. Annals of Internal Medicine, 136, 765–776.
    1. Rihmer Z., Kantor Z., Rihmer A., & Seregi K. (2004). Suicide prevention strategies – A brief review. Neuropsychopharmacologia Hungarica, 6, 195–199.
    1. Rost K., Nutting P., Smith J., Coyne J. C., Cooper-Patrick L., & Rubenstein L. V. (1999). The role of competing demands in the treatment provided primary care patients with major depression. Archives of Family Medicine, 9, 150–154.
    1. Rutz W., von Knorring L., & Walinder J. (1992). Long-term effects of an educational program for general practitioners given by the Swedish Committee for the Prevention and Treatment of Depression. Acta Psychiatrica Scandinavica, 85(1), 83–88.
    1. Scottish Executive. (2002). Choose life: A national strategy and action plan to prevent suicide in Scotland. Edinburgh, UK: Stationary Office.
    1. Sonneck G., & Niederkrotenthaler T. (2008). Zum österreichischen Suizidpräventionsplan [The Austrian Suicide Prevention Plan]. Spectrum Psychiatrie, 2, 20–23.
    1. Tarrier N., Taylor K., & Gooding P. (2008). Cognitive-behavioral interventions to reduce suicide behavior: A systematic review and meta-analysis. Behavior Modification, 32(1), 77–108.
    1. Tylee A., & Walters P. (2007). Underrecognition of anxiety and mood disorders in primary care: Why does the problem exist and what can be done? Journal of Clinical Psychiatry, 68(Suppl. 2), 27–30.
    1. Department of Health. (2002). National suicide prevention strategy for England. London: Author.
    1. Van der Feltz-Cornelis C. M. (2009). Toward integrated primary health care for depressive disorder in the Netherlands. The Depression Initiative. International Journal of Integrated Care, 9, 83–85.
    1. Värnik A., Kolves K., Allik J., Arensman E., Aromaa E., van Audenhove C., ... Hegerl U. (2009). Gender issues in suicide rates, trends and methods among youths aged 15–24 in 15 European countries. Journal of Affective Disorders, 113, 226.
    1. Värnik A, Kolves K., Van der Feltz-Cornelis C. M., Marusic A., Oskarsson H., Palmer A., ... Hegerl U. (2008). Suicide methods in Europe: A gender-specific analyses of countries participating in the “European Alliance Against Depression.” Journal of Epidemiology and Community Health, 62, 545–551.
    1. Vlaams Agentschap Zorg en Gezondheid. (2009). Belgian Action Plan Suicide Prevention. Brussels, Belgium: Author.
    1. von Greyerz S., & Keller-Guglielmetti E. (2005). Suizid und Suizidprävention in der Schweiz: Bericht in Erfüllung des Postulates Widmer [Suicide and suicide prevention in Switzerland: Report in fulfillment of the Postulates Widmer]. Bern, Switzerland: Federal Office of Public Health.
    1. Welsh Assembly Government. (2008). “Talk to me”: The national action plan to reduce suicide and self harm in Wales, 2008–2013. Cardiff, UK: Author.
    1. WHO. (2003). Suicide prevention in Europe. The WHO European monitoring survey on national suicide prevention programs and strategies. Copenhagen: WHO Regional Office for Europe.
    1. Williams S. B., O’Connor E. A., Eder M., & Whitlock E. P. (2009). Screening for child and adolescent depression in primary care settings: A systematic evidence review for the US Preventive Services Task Force. Pediatrics, 123, e716–e735.

Source: PubMed

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