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