Implementation of an integrated community-based suicide prevention programme, Gujarat, India: cluster randomised...

Area of Science:

• Global Public Health
• Mental Health Research
• Intervention Science

Background:

• Suicide is a significant public health issue in low- and middle-income countries (LMICs).
• Evidence on large-scale suicide prevention interventions in these regions is limited.
• Existing research often lacks comprehensive, multi-component approaches.

Purpose of the Study:

• To evaluate an integrated suicide prevention intervention in rural India.
• To assess the intervention's impact on suicide deaths and attempts.
• To examine the implementation and effectiveness of school-based programs, means restriction, and enhanced risk identification.

Main Methods:

• A pragmatic cluster randomized controlled trial involving 124 villages in Mehsana, India.
• Intervention included school-based awareness, community pesticide storage, and training for community health workers (CHWs).
• Intention-to-treat analysis used mixed-effects Poisson regression; novel suicide surveillance system captured primary outcomes.

Main Results:

• No significant reduction in the combined outcome of suicide attempts and deaths.
• A 43% reduction in suicide deaths was observed in the intervention arm (IRR 0.57, 95% CI: 0.32-1.02).
• High student participation (≥90%) with reduced depression/ideation; high pesticide locker uptake (88.83%); CHWs showed improved knowledge and identified 108 at-risk individuals.

Conclusions:

• The multicomponent intervention significantly reduced suicide deaths but not suicide attempts.
• The study demonstrates the feasibility and impact of scaled-up, complex interventions in LMICs.
• Findings advance suicide prevention research and highlight the importance of integrated approaches.