Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review

Area of Science:

• Public Health
• Psychiatry
• Epidemiology

Background:

• Suicide remains a significant public health concern globally.
• Identifying and implementing effective, scalable suicide prevention strategies is crucial.
• Existing research highlights various interventions with varying degrees of evidence.

Purpose of the Study:

• To identify scalable, evidence-based strategies for suicide prevention.
• To synthesize findings from randomized controlled trials and epidemiological studies on suicide prevention.

Main Methods:

• A comprehensive literature search was conducted on PubMed and Google Scholar for articles published between September 2005 and December 2019.
• Included studies were randomized controlled trials (RCTs) with suicidal behavior/ideation as primary outcomes or epidemiological studies on lethal means restriction, educational approaches, and antidepressant treatment.
• A total of 97 relevant studies were identified from over 20,000 initial articles.

Main Results:

• Training primary care physicians in depression recognition and treatment is effective.
• Educating youth, active outreach to psychiatric patients, and antidepressant treatment show promise in preventing suicidal behavior.
• Means restriction, particularly firearm access limitation, is effective but underutilized.
• Cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) are effective.
• Ketamine shows rapid reduction in suicidal ideation but requires further study for prevention.
• Gatekeeper training for youth lacks effectiveness, and adult gatekeeper training lacks RCT data.

Conclusions:

• Wider implementation of general practitioner training and active patient follow-up post-crisis is recommended.
• Restricting firearm access for at-risk individuals warrants broader application.
• Combination approaches in healthcare systems show promise, but component-specific benefits need evaluation.
• Further research on newer methods like EHR-derived algorithms, internet-based screening, ketamine, and passive monitoring is necessary for continued suicide rate reduction.