Evidence
This section contains a brief overview of the research carried out in this area. The evidence is divided into the settings listed here.
View overview
We have looked at the literature to find out what works in suicide prevention, and where more research is still needed. This will help you develop an evidence based local suicide prevention strategy, and will indicate the need for evaluation when you plan to use promising interventions that are unproven. There are few interventions for which there is strong evidence.
Suicide is a fairly rare event. This means that research on prevention needs to involve large samples if it is to avoid “Type II errors” (i.e. failing to detect a real difference). Many studies are underpowered.
It would be unethical to provide no treatment to someone identified as a suicide risk. Interventions are therefore usually tested against “standard care”, which is often not clearly described, and may be partially effective. Unless the new intervention is dramatically better, it can be easy to conclude that nothing works.
While the majority of people who take their own lives are suffering from some form of mental illness, and we take it as read that best practice in clinical care has a major contribution to make to suicide prevention, we have not included here any recommendations for clinical treatment. Reviews of treatment for mental illness can be found in Clinical Evidence (http://www.clinicalevidence.com).
Interventions to prevent suicide
- Schools |
- Higher education |
- Community |
- Primary care |
- Secondary care hospitals, clinics and community health Services |
- Prisons and other custodial settings
View Methodology
Topics searched
We searched for studies on interventions to reduce the rate of suicide in high risk groups and vulnerable groups.
High risk groups
- Young men (aged 20–39 years)
- People who are currently, or have recently been, in contact with mental health services
- People who have attempted suicide or self harmed within the previous 12 months
- Prisoners
- High risk occupational groups: agricultural workers, nurses, or doctors
Vulnerable groups
- Socially excluded and deprived groups (including unemployed and homeless)
- People from black and ethnic minorities
- People who misuse drugs or alcohol, or both
- Victims and survivors of abuse, including child sexual abuse
- Children and young people under 18
- Women during and after pregnancy
- Older people
- People bereaved by suicide
- Gay, lesbian, bisexual, and transgender people
We included any interventions targeted at reducing or preventing suicides or suicidal behaviour (for example, a telephone line providing advice to young men, or a counselling service in prison). We excluded interventions consisting solely of drugs or clinical procedures such as brain stimulation.
We included only studies that had outcomes relating to completed suicides, not solely outcomes relating to suicidal ideation or suicide attempts.
We excluded studies conducted in developing countries because these interventions may not be applicable to settings in the United Kingdom.
Dates and study types searched
We searched for systematic reviews published from 1990 until December 2006 and randomised controlled trials published from 2001 until December 2006.
Databases searched
We searched Medline, PsycInfo, and the Cochrane Library for relevant studies. We also searched DARE, NHS EED, Trip database, Health evidence.ca, the National Library for Health (NLH), and the WHO Health Evidence Network (HEN).
Search strategies
These are searches that have been conducted on Ovid Medline (http://gateway.ovid.com/). The other searches have been adapted from this one to accommodate the search engine of each specific database.
1. Suicide/
2. Suicide, Attempted/
3. (kill? adj3 (themselv$ or herself or himself)).ti,ab.
4. (suicid$ adj3 (attempt$ or reattempt$ or commit$)).ti,ab.
5. (suicid$ adj3 (complet$ or success$ or succeed$)).ti,ab.
6. pc.fs.
7. prevent$.ti,ab.
8. (decreas$ or reduc$ or control$ or diminish$ or halt$).ti,ab.
9. (intervention$ or program$ or campaign$).ti,ab.
10. prophyla$.ti,ab.
11. (high$ adj2 risk$).ti,ab.
12. (at-risk or at risk).ti,ab.
13. Men/
14. (young$ adj2 (men? or man? or male?)).ti,ab.
15. Inpatients/
16. ((suicid$ or self harm$) adj3 (previous$ or repeat$ or past$ or reattempt$)).ti,ab.
17. Prisoners/
18. (inmate? or prisoner?).ti,ab.
19. exp Agriculture/
20. Physicians/
21. Nurses/
22. (farmer? or doctor? or nurse? or physician?).ti,ab.
23. (deprived or social$ exclu$).ti,ab.
24. (unemploy$ or homeless$).ti,ab.
25. (black? or visible minorit$ or ethnic minorit$ or refugee? or immigrant?).ti,ab.
26. ((drug? or alcohol? or substance?) adj3 (abus$ or misus$ or using or addict$)).ti,ab.
27. ((physical$ or sex$) adj3 (abuse? or assault$ or attack$)).ti,ab.
28. child/
29. adolescence/
30. pregnan$.ti,ab.
31. Aged/
32. (older or elderly or senior$).ti,ab.
33. (bereav$ adj4 suicid$).ti,ab.
34. exp Homosexuality/
35. Bisexuality/
36. (gay? or lesbian$ or homosexual$ or bisexual$ or transgender$ or transsex$).ti,ab.
37. (inpatient$ or psychiatric hospital? or psychiatric institut$).ti,ab.
38. (mental health adj2 (clinic? or service? or institut$)).ti,ab.
39. Mental Health Services/
40. Community Mental Health Services/
41. Poverty/
42. or/1-5
43. or/6-10
44. or/11-41
45. 42 and 43 and 44
Filter
The following filter was used to include only randomised controlled trials or systematic reviews:
1. ("review" or "review academic" or "review tutorial").pt.
2. (medline or medlars or embase).tw,sh
3. (scisearch or psychinfo or psycinfo).tw,sh.
4. (psychlit or psyclit).tw,sh.
5. cinahl.tw,sh.
6. ((hand adj2 search$) or (manual$ adj2 search$)).tw,sh.
7. (electronic database$ or bibliographic database$ or computeri?ed database$ or online database$).tw,sh
8. (pooling or pooled or mantel haenszel).tw,sh.
9. (peto or dersimonian or der simonian or fixed effect).tw,sh.
10. or/2-9 47239
11. 1 and 10
12. meta-analysis.pt.
13. meta-analysis.sh.
14. (meta-analys$ or meta analys$ or metaanalys$).tw,sh.
15. (systematic$ adj5 review$).tw,sh.
16. (systematic$ adj5 overview$).tw,sh.
17. (quantitativ$ adj5 review$).tw,sh.
18. (quantitativ$ adj5 overview$).tw,sh.
19. (quantitativ$ adj5 synthesis$).tw,sh
20. (methodologic$ adj5 review$).tw,sh.
21. (methodologic$ adj5 overview$).tw,sh.
22. (integrative research review$ or research integration).tw.
23. or/12-22
24. 11 or 23
25. exp Randomized controlled trials/
26. "randomized controlled trial".pt.
27. "controlled clinical trial".pt.
28. (random$ or placebo$).ti,ab,sh.
29. ((singl$ or double$ or triple$ or treble$) and (blind$ or mask$)).tw,sh.
30. or/25-29
31. (animals not humans).sh.
32. 30 not 31