Effective Programs on Suicide Prevention: Combination of Review of Systematic Reviews with Expert Opinions

Ali Fakhari, Hosein Azizi, Mostafa Farahbakhsh, Elham Davtalab Esmaeili

Abstract


Background: Health managers often do not have adequate information for decision making on what strategy makes an effective impact on suicide prevention. Despite the availability of global Suicide Prevention Programs (SPP), no previous investigation has developed combinations of a review study with expert opinions. This study was aimed to identify effective programs for suicide prevention. Methods: We used two methods for selecting the effective SPP. (1) review of systematic reviews: we systematically searched to find relevant review studies through Medline, Cochrane Library, PsycINFO, and gray literatures. (2) Expert panel opinions: effective programs identified from the previous step were combined with expert views via the Hanlon method. Results: A total of 27 since some of them were reports met the inclusion criteria. After full‑text screening 9 records included. We found the following 12 SPP for prioritizing and rating the most effective interventions by an expert panel: (1) case management of Suicide Attempters (SAs), (2) identification and treatment of depression, (3) registry for suicide, (4) identifying local determinants of Suicidal behavior (SB), (5) public awareness campaigns, (6) gatekeepers’ training, (7) conducting research, (8) school‑based training, (9) improving knowledge and attitudes, (10) restricting access to means, (11) at‑risk people screening, (12) mass media. Conclusions: Seven effective SPP identified after combined 12 included interventions with expert panel opinion: (1) Case management of SAs, (2) Identification and treatment of depression, (3) Improving a registry for suicide, (4) Identifying local determinants of SB, (5) Public awareness campaigns, (6) Training gatekeepers, and (7) Conducting research.

Keywords


Expert testimony; Iran; suicide; review; systematic reviews

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References


Zalsman G, Hawton K, Wasserman D, van Heeringen K,

Arensman E, Sarchiapone M, et al. Suicide prevention strategies

revisited: 10‑year systematic review. Lancet Psychiatry

;3:646‑59.

Fleischmann A, De Leo D. The World Health Organization’s

report on suicide: A fundamental step in worldwide suicide

prevention. Crisis 2014;35:289‑91.

Farahbakhsh M, Fakhari A, Davtalab Esmaeili E, Azizi H,

Mizapour M, Asl Rahimi V, et al. The role and comparison

of stressful life events in suicide and suicide attempt:

A descriptive‑analytical study. Iran J Psychiatry Behav Sci

;14:e96051. doi: 10.5812/ijpbs.96051.

World Health Organization. Suicide in the world: Global health

estimates. In.: World Health Organization; 2019. https://www.who.

int/data/global-health-estimates. [Last accessed on 2022 Aug 03].

World Health Organization. Public health action for the

prevention of suicide: A framework. 2012. https://apps.who.int/

iris/handle/10665/75166. [Last accessed on 2022 Aug 03].

Gunnell D, Frankel S. Prevention of suicide: Aspirations and

evidence. BMJ 1994;308:1227‑33.

Hawton K. United Kingdom legislation on pack sizes of

analgesics: Background, rationale, and effects on suicide and

deliberate self‑harm. Suicide Life Threat Behav 2002;32:223‑9.

Yip PS. Towards evidence-based suicide prevention programs.

Crisis. 2011;32:117-20. doi: 10.1027/0227-5910/a000100. PMID:

Katz C, Bolton SL, Katz LY, Isaak C, Tilston-Jones T, Sareen J,

et al. A systematic review of school-based suicide prevention

programs. Depress Anxiety 2013;30:1030‑45.

Azizi H, Davtalab‑Esmaeili E, Farahbakhsh M, Zeinolabedini M,

Mirzaei Y, Mirzapour M. Malaria situation in a clear area of Iran:

An approach for the better understanding of the health service

providers’ readiness and challenges for malaria elimination in

clear areas. Malaria J 2020;19:1‑10.

Matsubayashi T, Ueda M. The effect of national suicide

prevention programs on suicide rates in 21 OECD nations. Soc

Sci Med 2011;73:1395‑400.

Van der Feltz‑Cornelis CM, Sarchiapone M, Postuvan V,

Volker D, Roskar S, Grum AT, et al. Best practice elements of

multilevel suicide prevention strategies. Crisis 2011;32:319‑33.

Cummins N, Scherer S, Krajewski J, Schnieder S, Epps J,

Quatieri TF. A review of depression and suicide risk assessment

using speech analysis. Speech Commun 2015;71:10‑49.

Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A,

et al. Suicide prevention strategies: A systematic review. JAMA

;294:2064‑74.

Lapierre S, Erlangsen A, Waern M, De Leo D, Oyama H,

Scocco P, et al. A systematic review of elderly suicide prevention

programs. Crisis 2011;32:88‑98.

Sisask M, Värnik A. Media roles in suicide prevention:

A systematic review. Int J Environ Res public Health

;9:123‑38.

Harlow AF, Bohanna I, Clough A. A systematic review of

evaluated suicide prevention programs targeting indigenous

youth. Crisis 2014;35:310‑21.

Parra‑Uribe I, Blasco‑Fontecilla H, Garcia‑Parés G,

Martínez‑Naval L, Valero‑Coppin O, Cebrià‑Meca A, et al.

Risk of re‑attempts and suicide death after a suicide attempt:

A survival analysis. BMC Psychiatry 2017;17:163.

Beautrais AL. Further suicidal behavior among medically serious

suicide attempters. Suicide Life Threat Behav 2004;34:1‑11.

Neeleman J. A continuum of premature death. Meta‑analysis

of competing mortality in the psychosocially vulnerable. Int J

Epidemiol 2001;30:154‑62.

Calear AL, Christensen H, Freeman A, Fenton K, Grant JB,

Van Spijker B, et al. A systematic review of psychosocial

suicide prevention interventions for youth. Eur Child

Adolesc Psychiatry 2016;25:467‑82.

The Lancet Global Health. Suicide prevention: Keeping the

momentum. Lancet Global health 2017;5:e838.

Goosen S, Kunst AE, Stronks K, van Oostrum IE,

Uitenbroek DG, Kerkhof AJ. Suicide death and hospital‑treated

suicidal behaviour in asylum seekers in the Netherlands:

A national registry‑based study. BMC Public Health 2011;11:484.

Fakhari A, Farahbakhsh M, Azizi H, Esmaeili ED, Mirzapour M,

Rahimi VA, et al. A longitudinal study of suicide and suicide

attempt in northwest of Iran: incidence, predictors, and

socioeconomic status and the role of sociocultural status. BMC

Public Health 2021;21:1486. https://doi.org/10.1186/s12889-02111527-9.

Hawton K, i Comabella CC, Haw C, Saunders K. Risk factors

for suicide in individuals with depression: A systematic review.

J Affect Disord 2013;147:17‑28.

Bhar SS, Brown GK. Treatment of depression and suicide in

older adults. Cogn Behav Pract 2012;19:116‑25.

Isacsson G, Rich CL. Antidepressant drug use and suicide

prevention. Int Rev Psychiatry 2005;17:153‑62.

Moutier C, Norcross W, Jong P, Norman M, Kirby B, McGuire T,

et al. The suicide prevention and depression awareness program

at the University of California, San Diego School of Medicine.

Acad Med 2012;87:320‑6.

Covington D, Hogan M, Abreu J, Berman A, Breux P, Coffey E,

et al. Suicide Care in Systems Framework. National Action

Alliance: Clinical Care and Intervention Task Force; 2011.

Szumilas M, Kutcher S. Post‑suicide intervention programs:

A systematic review. Can J Public Health 2011;102:18‑9.

Cox GR, Owens C, Robinson J, Nicholas A, Lockley A,

Williamson M, et al. Interventions to reduce suicides at suicide

hotspots: A systematic review. BMC Public Health 2013;13:214.

Clifford AC, Doran CM, Tsey K. A systematic review of

suicide prevention interventions targeting indigenous peoples in

Australia, United States, Canada and New Zealand. BMC Public

Health 2013;13:463.

Cusimano MD, Sameem M. The effectiveness of middle and high

school‑based suicide prevention programmes for adolescents:

A systematic review. Injury Prev 2011;17:43‑9.

Robinson J, Cox G, Malone A, Williamson M, Baldwin G,

Fletcher K, et al. A systematic review of school‑based

interventions aimed at preventing, treating, and responding

to suicide‑related behavior in young people. Crisis

;34:164‑82.