Evaluating community-based suicide prevention initiatives in rural and remote Australia: a scoping review

Suicide rates in rural and remote areas of Australia are notably higher compared to urban regions, with the incidence increasing with greater remoteness. Factors contributing to this include limited access to mental health services, social isolation and economic challenges, which result in lower rates of diagnosis and treatment for mental health disorders. This is particularly among men, youth and Australian Indigenous populations. Community-based suicide prevention programs aim to reduce barriers to mental health care and to increase awareness and support for those in need. This scoping review evaluates the impacts and outcomes of these initiatives in rural and remote Australia, identifying evidence-based practices, knowledge gaps and opportunities for future research.

The scoping review followed the PRISMA-ScR framework (2018). Key databases and grey literature were searched for studies published between 2014 and 2024 from Australia, New Zealand and the Pacific region, focusing on farmers, youth, Indigenous populations and LGBTQIA+ communities. Eligible sources were analysed using Braun and Clarke's (2006) thematic analysis approach.

Eleven studies involving 2866 participants were included. Most interventions (60%) lasted 18-24 months, while the remainder were 6-12 months long. The interventions primarily focused on education, raising awareness of services and skill improvement, with only three studies evaluating direct interventions with at-risk individuals. Self-reported improvements in knowledge and skills post-intervention were not reflected in validated measures, with most changes not being statistically significant, although showing positive trends. Baseline levels of psychological distress and depression were very high among Indigenous participants, indicating that brief interventions may not be sufficient to significantly reduce distress.

A major challenge is the prevalence of publications describing the initial set-up of community-based interventions or pilot studies without follow-up evaluations. This gap is due to insufficient funding, inadequate initial financial planning, unplanned costs and the cessation of programs due to a lack of sustained staffing and funding. While implementation methods are known, there is little evidence for their sustained implementation.

Despite numerous community-based suicide prevention programs, rigorous evaluations are rare. This lack of assessment results in missed opportunities for knowledge acquisition and ability to identify financial inefficiencies. The few evaluations conducted indicate minimal short-term impact, highlighting the complexity of suicide prevention, especially in rural and remote areas. It may be overly optimistic to expect that a multifaceted issue like suicide, influenced by social determinants such as economic stability, social relationships, cultural norms, access to health care and education, can be effectively addressed through short-term, isolated interventions.