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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
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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
