Suicide Prevention

What works in suicide prevention?

It is really tough to say Suicide is a low base-rate behavior and thus is difficult to

systematically evaluate.

Focus is on bending the curve

Public awareness ads Effectiveness of campaigns rarely evaluated

Studies have shown modest effects on attitudes about

The causes of mental illness and treatment

“have no detectable effect on primary outcomes of decreasing suicidal acts or on intermediate measures, such as more treatment seeking or increased antidepressant use” (Mann, et al., 2005)

Physician screening

Depression is underdiagnosed and treated in primary care medical settings Most suicides occur within a month of a primary care visit (Mann, et

al., 2005)

Studies that have looked at whether educating primary care physicians about mental illness affects detection and treatment have been mixed

Treatment initiatives involving care management have demonstrated a significant reduction in suicide attempts compared to treatment as usual.

Gatekeeper Training

Training individuals who are likely to be in contact with

Those at risk to recognize the signs of someone who is in distress and to make referrals.

Studies in the military have found that gatekeeper training successfully reduces suicide rates

Mental Health Screening

No evidence that screening increases suicide risk

Results in a 10 – 47% increase in the rate of detection and diagnosis of depression (Mann et al., 2005)

Lack of studies looking at the effect of screening on suicide

Treatments That Work

Pharmacotherapy Lithium for bipolar disorder and clozapine for schizophrenia

Meta analyses have not found significant benefit of antidepressants in reducing suicides or suicide attempts

Higher prescription rates of antidepressants are associated with lower suicide rates in several countries.

Psychotherapy Many effective treatments: cognitive behavioral therapy, problem-

solving therapy, interpersonal psychotherapy, dialectical behavior therapy, and CAMS to name just a few

Cognitive therapy halved the suicide reattempt rate compared with those who received usual care (Mann et al., 2005)

Tell me some good news

Although suicide is very difficult to prevent, there are things we can do, sometimes even small things, to make a difference.

Caring Letters

A study led by Jerome Motto sent brief caring postal letters following treatment discharge (initially monthly, tapering to quarterly) for five years.

Compared to those who had no further contact, the caring letters group had a significantly lower suicide rate for the first two years of the trial

Related interventions using phone calls, texting, and post cards have been shown to reduce suicidal behavior

On-going clinical trial using caring letters in the military

What’s required to save a life?

You don’t need a PhD or an MD. Heck, you don’t need a degree

You don’t need formal training

You don’t need to have experienced depression or suicidal thoughts

You have to care and be brave enough to ask someone if they are alright

We have a ton of work to do, and you have a place in that work