Effectiveness of a communal, multilevel, interdisciplinary suicide prevention program

Completed suicide (CS) is among the leading causes of death. Suicide attempts (SAs) are more frequent and are a significant contributor to overall morbidity. However, there is only few data on community-based suicide prevention using systemic approaches. We have implemented a communal suicide prevention program and tested whether it reduced the number of SA and CS.

"FraPPE" comprised measures proposed by previous studies: low-threshold outpatient services, a SA postvention, a hotline targeting individuals with suicidal intent, qualification of gatekeepers and general practitioners, and a campaign to refer SA cases to psychiatric services and antistigma campaigns. The intervention lasted for 25 months.

For CS, 7.7 cases per month were recorded during baseline, compared to 9 cases per month in the intervention phase. For SA, the numbers were 39.2 and 40.7, respectively. These numbers did not differ significantly. The most frequent diagnostic group was affective disorders, followed by substance use disorders. The average age was lower in the SA group. More males committed suicide (p < 0.001), whereas the sex ratio was balanced in SA.

The communal suicide prevention measures implemented in FraPPE did not reduce the number of suicides and SAs. This should be interpreted with caution, as a number of prevention measures were already executed in the region. Also, data were confounded by the COVID-19 pandemic. Our awareness campaign may also have reduced the dark field, leading to increased reporting. We thus propose to enact registries on suicidal behaviors, to obtain better data and develop new preventive measures.