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Interventions to prevent suicide - Community

Read Overview

In this section:

• Key Messages |
• Interventions |
• References |
• Contributors |

Key Messages

• Suicide is often impulsive and the urge short-lived, so restriction of access to means may save lives
• The impact on the overall suicide rate will depend on the proportion of people using that means in any given society
• Media reporting can precipitate copycat attempts. Total blackouts, though effective, may not be acceptable in societies with a free press, but it may be valuable to engage the media in debate about voluntary guidelines and good practice in reporting
• Training of key people in the community to recognise and refer high-risk individuals can be effective
• Depression screening and group activity show benefit for elderly women
• Keeping in touch with elderly people by phone is promising
• General public awareness and education campaigns have not been shown to be effective in reducing suicide.

Population Interventions

Population interventions that work

Means restriction

Suicidal behaviour is often impulsive, those involved may be ambivalent, and the urge to self-harm may subside quickly. If the means are immediately available, suicide may result, but if they are not some lives can be saved. While this approach does not lend itself to a randomised controlled trial, there is persuasive review evidence of the effectiveness of the following methods:

• Firearms control legislation
• Restrictions on pesticides
• Detoxification of domestic gas
• Restriction on prescription and sale of barbiturates
• Changing the packaging of analgesics to blister packs
• Mandatory use of catalytic converters in motor vehicles
• Construction of barriers at jumping sites
• Use of lower toxicity antidepressants.

While those with a persistent determination to take their own lives may seek another method to replace one which has been made difficult or inaccessible (“method substitution”), others will not. The effect on the overall suicide rate in any given population depends on how large a contribution that particular method makes to the total number of deaths by suicide, so you will need to consider what methods are most commonly used in your area. Where the method is common, restriction of means has led to lower overall suicide rates.

Gun control

A North American review of the impact of gun control legislation between 1982 and 1997 showed a high correlation between extent of gun ownership and rates of suicide (as well as homicide). There was a substantial and abrupt decline in firearm-related suicide (and homicide) following implementation of handgun control laws in Washington, DC. There was no change in the frequency of use of other methods of suicide, and no change in adjacent areas where gun control had not been implemented. Several other studies in the 1990s in other US states, Canada and internationally found similar results. ^{1 3 4 5}

Detoxification of domestic gas

There is review evidence of a fall in overall suicide rates ranging from 19% to 33% after the switch from coal gas to natural gas in Switzerland and in the UK. ³

Barbiturates

There is review evidence of a 23% reduction in overall suicide rate in Australia following barbiturate restriction. ³

Reduction of carbon monoxide content of vehicle exhausts

There is review evidence of a reduction in overall suicide rate in the UK following the mandatory control of vehicle emissions by the introduction of catalytic converters. ³

Restrictions on access to alcohol

There is review evidence that restrictions in access to alcohol coincided with decreases in overall suicide rate in the former USSR and Iceland. ^{3 4}

Media blackouts

Media blackouts on reporting suicide have coincided with decreases in suicide rates. ⁴ A campaign to decrease media coverage of subway suicides in Austria cut subway suicides by 80%. ³ Unfortunately, the review did not provide any more specific information on this campaign.

Gatekeeper training

Gatekeeper training has shown evidence of effectiveness in institutional settings such as the US Air Force and the Norwegian Army. ^{3 4} Gatekeepers are “natural community helpers”, adults whose contact with potentially vulnerable populations provide an opportunity to identify at-risk individuals and direct them to appropriate assessment and treatment.

See Factfile Gatekeeper training

Depression screening and group activity for elderly people

Depression screening and group activity for several hundred elderly people conducted by public health nurses in rural Japan reduced the risk of suicide in women by 74% compared with the historical trend and with controls in similar areas where the intervention was not offered. No effect was seen on men. ⁶

This intervention programme included three components: screening for depression using first a self-report questionnaire and then assessment by trained public health nurses; mental health workshops three to four times a year, involving a psychoeducational programme providing information regarding depression; and a monthly group activity programme involving participation in social, voluntary and recreational activities and exercise. The programme ran for five years (1999-2004) in a district with a population of 1685. The outcome was evaluated by comparing pre- and post-changes in the risk of completing suicide compared with the historical trend in the same district over the period 1993-1998, and with neighbouring districts not exposed to the intervention. The age-adjusted risk ratio was 0.26 (90% confidence interval 0.07-0.98). The authors of the study state that, since there was an explicit hypothesis that the intervention should have a beneficial, if any, impact, it was appropriate to use 90% confidence intervals.

Population interventions that may work

Media training and guidelines

Interventions aimed at educating journalists and developing guidelines for the media on responsible reporting of suicide had encouraging results in Austria and Switzerland, but have been inadequately evaluated elsewhere. ^{3 5} Following implementation of media guidelines in Switzerland, the number of articles increased but they were significantly shorter, less sensational, and less likely to include pictures. ³ Following implementation of media guidelines in Austria, suicide rates declined 7% in the first year, nearly 20% in the 4-year follow-up period, and subway suicides (a particular focus of the media guidelines) decreased by 75%. ⁵

Telehelp/Telecheck

One review reports a study of the effectiveness of Telehelp/Telecheck for 12,135 elderly people in Italy which found one suicide over four years compared with an expected 7.44. ⁷ However, it was not possible to find more specific information on this study from this review.

See Factfile Telehelp

Population interventions that do not work

Public awareness and education campaigns

Public awareness and education campaigns have seldom been evaluated. Where they have, researchers have found modest effects on attitudes, but no detectable effects on suicidal acts. ³

What we don't know

We do not really understand much about what underpins the wide variations in suicide rate between different societies and between different periods of time within the same society. We can identify interventions that appear to impact on the suicide rate at a particular time or place, but have only limited knowledge of the broader influences that may explain the huge international inequalities and secular trends.

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