The effect of national suicide prevention programs on suicide rates in 21 OECD nations

Suicide has become a serious and growing public health problem in many countries. To address the problem of suicide, some countries have developed comprehensive suicide prevention programs as a collective political effort. However, no prior research has offered a systematic test of their effectiveness using cross-national data. This paper evaluates whether the national suicide prevention programs in twenty-one OECD nations had the anticipated effect of reducing suicide rates. By analyzing data between 1980 and 2004 with a fixed-effect estimator, we test whether there is a statistically meaningful difference in the suicide rates before and after the implementation of national suicide prevention programs. Our panel data analysis shows that the overall suicide rates decreased after nationwide suicide prevention programs were introduced. These government-led suicide prevention programs are most effective in preventing suicides among the elderly and young populations. By contrast, the suicide rates of working-age groups, regardless of gender, do not seem to respond to the introduction of national prevention programs. Our findings suggest that the presence of a national strategy can be effective in reducing suicide rates.     

Suicide prevention: a vital national public health issue

Suicide continues to be a major public health problem in the United States, with 30,000 deaths per year. The suicide rate, which hovers around 10-12/100,000, has remained virtually unchanged over the past three decades. In 1999 the Surgeon General proposed a national plan to serve as a roadmap toward developing a comprehensive national suicide prevention strategy. The key features of this plan were encapsulated in the acronym AIM, Awareness, Intervention and Methodology, to define the relevant components of a national strategy. This refers to increasing public awareness of the problem of mental illness and suicide, providing increased access to treatment and prevention resources and developing improved research methodologies. Despite the overall numbers, suicide is a low base-rate event, which makes studying intervention and prevention strategies very difficult, as very large subject samples are required for meaningful outcome assessments. Suicide prevention and prevention research have received substantially fewer public resources than many other medical conditions, and apparent public health risks such as bioterrorism. It is for this reason that a comprehensive, national public health based suicide prevention program is required.     

Risk factors for suicide among Indian adolescents at a boarding school

Suicide rates among American Indians, especially adolescents, are higher than those for the general population. This paper summarizes the relevant literature on prevalence of, and risk factors for, suicide among American Indian groups, with a strong emphasis on adolescents. Data concerning risk of suicide for a sample of high school students attending an Indian boarding school are presented. Approximately 23 percent of these students had attempted suicide at some time in the past, and 33 percent reported suicidal ideation within the past month. Students at greatest risk for suicide include those who reported having either family or friends who had attempted suicide and those who reported on standardized psychological measures as having experienced greater depressive symptomatology, greater quantity and frequency of alcohol use, or little family support. In a 1988 survey of community-based programs for Indian adolescents, 194 were identified as carrying out significant suicide prevention activities. Forty-one of those programs were school-based; they emphasized early identification of students' mental health problems and reduction of specific risk factors such as substance abuse.     

A proposed approach to suicide prevention in Japan: the use of self-perceived symptoms as indicators of depression and suicidal ideation

The incidence of suicide in Japan has increased markedly in recent years, making suicide a major social problem. Between 1997 and 2006, the annual number of suicides increased from 24,000 to 32,000; the most dramatic increase occurred in middle-aged men, the group showing the greatest increase in depression. Recent studies have shown that prevention campaigns are effective in reducing the total number of suicides in various areas of Japan, such as Akita Prefecture. Such interventions have been targeted at relatively urban populations, and national data from public health and clinical studies are still needed. The Japanese government has established the goal of reducing the annual number of suicides to 22,000 by 2010; toward this end, several programs have been proposed, including the Mental Barrier-Free Declaration, and the Guidelines for the Management of Depression by Health Care Professionals and Public Servants. However, the number of suicides has not declined over the past 10 years. Achieving the national goal during the remaining years will require extensive and consistent campaigns dealing with the issues and problems underlying suicide, as well as simple screening methods for detecting depression. These campaigns must reach those individuals whose high-risk status goes unrecognized. In this review paper, we propose a strategy for the early detection of suicide risk by screening for depression according to self-perceived symptoms. This approach was based on the symposium Approach to the Prevention of Suicide in Clinical and Occupational Medicine held at the 78th Conference of the Japanese Society of Hygiene, 2008.     

Integrating Mental Health Services into Humanitarian Relief Responses to Social Emergencies,Disasters, and Conflicts: A Case Study

Utilizing lessons learned from development and implementation of “Project Liberty” in New York City, created in response to the attacks of September 11, 2001, this paper explores the importance of integrating structured mental health services with community-based social service programs offered in large-scale humanitarian relief responses. Relevant international research studies illustrating similar integrated programs are also reviewed. The primary approach is community-based and resilience-enhancement focused, offering structure, stability, support, and community cohesion, with an added integrated screening component to identify persons with severe treatable mental health conditions. Because there is thus far little evidence that resilience-enhancing programs are effective for severe mental health conditions, a secondary program initiated in parallel would be staffed with more specialized providers offering services for those referred from the primary program. The key implication supports the establishment of more effective links between programs and professionals from different disciplines, who then can more effectively implement integrated program responses to large-scale disasters.     

The Challenge of Suicide Prevention

Suicide is a global phenomenon. It is estimated that 0.5–1.2 million people worldwide die by suicide each year. Taking into account the global epidemiologic data concerning suicide and the economic impact of this phenomenon on diverse societies, this review aims to examine national suicide prevention strategies. Recognition of suicide as an international public health problem, increased reporting by countries on suicide rates to the WHO, and recognition of the costs (associated with suicide) to society have been crucial influences on the establishment of national strategies. Past reviews on national suicide prevention strategies highlight the fact that those countries with established national strategies share a number of themes relating to intervention. These are grounded in international guidance on suicide prevention and accepted epidemiologic and treatment-based research. This paper highlights comparative rates of suicide around the world, explores the economic implications of suicide and the nature of specific established national strategies for prevention. This paper highlights the urgency for the development of national suicide prevention strategies in all countries. Clearly, countries can learn from each other and integrate established, shared themes. It is argued that nations need to move towards nation-specified prevention strategies with effective structures for research, monitoring, and evaluation. This has been seen in countries such as Finland and New Zealand, where strategies have been effective in building inter-agency working and so benefiting different stake-holders.     

Suicide in Asia: opportunities and challenges

Asian countries account for approximately 60% of the world's suicides, but there is a great mismatch in the region between the scale of the problem and the resources available to tackle it. Despite certain commonalities, the continent itself is culturally, economically, and socially diverse. This paper reviews current epidemiologic patterns of suicide, including suicide trends, sociodemographic factors, urban/rural living, suicide methods, sociocultural religious influences, and risk and protective factors in Asia, as well as their implications. The observed epidemiologic distributions of suicides reflect complex interplays among the traditional value/culture system, rapid economic transitions under market globalization, availability/desirability of suicide methods, and sociocultural permission/prohibitions regarding suicides. In general, compared with Western countries, Asian countries still have a higher average suicide rate, lower male-to-female suicide gender ratio, and higher elderly-to-general-population suicide ratios. The role of mental illness in suicide is not as important as that in Western countries. In contrast, aggravated by access to lethal means in Asia (e.g., pesticide poisoning and jumping), acute life stress (e.g., family conflicts, job and financial security issues) plays a more important role than it does in Western countries. Some promising suicide prevention programs in Asia are illustrated. Considering the specific socioeconomic and cultural aspects of the region, community-based suicide intervention programs integrating multiple layers of intervention targets may be the most feasible and cost-effective strategy in Asia, with its populous areas and limited resources.     

Associations of Physical and Sexual Health with Suicide Attempts Among Female Sex Workers in South Korea

This study investigated suicidal behavior prevalence and its association with physical and sexual health, and behavior-related factors among female sex workers in South Korea. Using time location sampling, we recruited 1,083 sex workers for an interviewer-administered questionnaire regarding sexual behavior, sociodemographics, and self-rated health (SRH) status. Participants were also tested for sexually transmitted diseases (STDs). We used binary logistic regression analysis to define suicide attempt factors. Around 28 % of sex workers in the sample reported that they had attempted suicide in the past year. Suicide attempts were independently associated with drinking alcohol almost every day, not using condom regularly, STD infection experience, and unfavorable SRH status. Higher suicide attempt likelihood was associated with poor sexual and physical health, but there was no significant association with the number of customers per week. We thus need to revive STD screening programs provided by the government and to support mental health programs.     

Effects of educating local government officers and healthcare and welfare professionals in suicide prevention

Suicide is a major public health issue. In Japan, local governments are responsible for suicide prevention, and local government officers are therefore expected to act as gatekeepers for suicide prevention. In this study, through a questionnaire survey, the authors examined the current knowledge and attitudes concerning suicide prevention among local government officers and healthcare and welfare professionals, and the effects of providing suicide prevention education on their knowledge of and attitudes toward suicide and its prevention. One hundred eighty-three local government officers and 432 healthcare/welfare professionals completed the survey before and after a single education session. Before the session, the local government officers and healthcare/welfare professionals showed mainly positive attitudes toward suicide prevention efforts, with little difference between the two groups. After the training, knowledge and attitudes were further improved for most questionnaire items. Respondents with one or more experiences of suicide prevention training showed significantly more knowledge and positive attitudes before the training than those with no such experience. Moreover, knowledge of depression and having a sympathetic attitude were found to be especially associated with the overall attitude that "suicide can be prevented". Training in suicide prevention was shown to be effective in promoting appropriate knowledge and attitudes among local government officers and healthcare/welfare professionals who are gatekeepers for preventing suicide. Our findings confirm the importance of suicide prevention education, and will contribute to creating a standard educational program on suicide prevention in Japan.     

School Personnel Perspectives on their School’s Implementation of a School-Based Suicide Prevention Program

Youth suicide is a national public health priority, with policymakers highlighting schools as an ideal setting in which to deliver suicide prevention programs. Over the past decade, the number of schools implementing such programs has grown substantially, yet little is known about how successfully such programs are being implemented. This study examines the implementation of a district-wide suicide prevention program through key informant interviews with school personnel. Schools with higher rates of implementing district protocols for at-risk students had an organized system to respond to at-risk students, a process for effectively responding to students who were at-risk for suicide, and strong administrative support. In contrast, schools that had lower rates of implementing district protocols relied on a handful of individuals for suicide prevention activities and had limited administrative support. Attention to organizational factors leading to successful implementation of school-based suicide prevention programs may enhance the role of schools in national adolescent suicide prevention efforts.     

Toward a public mental health promotion and intervention system for youth

Substantial limitations exist at all levels of mental health care for youth in most communities in the United States. Particular gaps exist in the areas of prevention, mental health promotion, and early intervention programs. The national movement toward enhancing mental health programs for youth in schools offers an important opportunity to fill gaps in the prevention-services continuum toward the development of a Public Mental Health Promotion and Intervention System for Youth. A strategy--the Child and Adolescent Program Planning Schema (CAPPS)--is presented to analyze gaps in a community's system of mental health programs for youth, and to facilitate planning toward development of a full continuum of programs from broad, population-based prevention, and mental health promotion strategies to treatment of youth with more established problems.     

广州市理工院校大学生自杀态度的调查分析

目的了解理工院校大学生心理健康状况及其自杀态度,为大学生自杀预防提供依据。方法采用分层整群随机抽样方法,对广州市理工大学大学生进行问卷调查,内容为自杀态度问卷（SAQ）。结果自杀态度在不同年级的学生间存在差异,对自杀行为、自杀者、安乐死持矛盾中立态度者占多数,对自杀者家属持理解认同态度占多数。结论自杀态度各指标均提示必须加强大学生的心理健康教育以预防自杀行为的发生。     

Community-Based Services for Homeless Adults Experiencing Concurrent Mental Health and Substance Use Disorders: A Realist Approach to Synthesizing Evidence

Consultations with community-based service providers in Toronto identified a lack of strong research evidence about successful community-based interventions that address the needs of homeless clients experiencing concurrent mental health and substance use disorders. We undertook a collaborative research effort between academic-based and community-based partners to conduct a systematic evidence synthesis drawing heavily from Pawson’s realist review methodology to focus on both whether programs are successful and why and how they lead to improved outcomes. We examined scholarly and nonscholarly literature to explore program approaches and program elements that lead to improvements in mental health and substance use disorders among homeless individuals with concurrent disorders (CD). Information related to program contexts, elements, and successes and failures were extracted and further supplemented by key informant interviews and author communication regarding reviewed published studies. From the ten programs that we reviewed, we identified six important and promising program strategies that reduce mental health and, to a far lesser degree, substance use problems: client choice in treatment decision-making, positive interpersonal relationships between client and provider, assertive community treatment approaches, providing supportive housing, providing supports for instrumental needs, and nonrestrictive program approaches. These promising program strategies function, in part, by promoting and supporting autonomy among homeless adults experiencing CD. Our realist informed review is a useful methodology for synthesizing complex programming information on community-based interventions.     

Temperature-associated suicide mortality: contrasting roles of climatic warming and the suicide prevention program in Finland

Objectives

Suicide is a notable cause of death worldwide, and while suicidal behavior appears to be associated with variations in temperature, no estimations are available of climate change impacts on suicide rates. The study aims to evaluate the influence of temperature on suicide mortality, especially on multi-decadal and longer time scales, that is, at scales on which the ongoing warming distinctly operates and is correspondingly appropriate for the current policy responses to warming climate.

Methods

Our results are based on an extraordinarily long record of deaths from suicide in Finland from 1751 to 2008, and a similarly long climatic record of ambient temperatures correlative of environmental change in the study region.

Results

We show that temperature variability explains more than 60 % of the total suicide variance up until the initiation of a national suicide prevention program. Despite ongoing warming, suicide rates have declined since the initiation of the program.

Conclusion

By understanding the complexity of suicidal behavior as a response to ambient warming and the observed effects of interventions, our results underline the pressing need for a network of prevention programs to battle against temperature-mediated health hazards.     

Suicides in Aboriginal and Torres Strait Islander children: analysis of Queensland Suicide Register

Objective: Suicide rates among Indigenous Australian children are higher than for other Australian children. The current study aimed to identify factors associated with Indigenous child suicide when compared to other Australian children. Methods: Using the Queensland Suicide Register, suicides in Indigenous children (10–14 years) and other Australian children in the same age band were compared. Results: Between 2000 and 2010, 45 child suicides were recorded: 21 of Indigenous children and 24 of other Australian children. This corresponded to a suicide rate of 10.15 suicides per 100,000 for Indigenous children – 12.63 times higher than the suicide rate for other Australian children (0.80 per 100,000). Hanging was the predominant method used by all children. Indigenous children were significantly more likely to suicide outside the home, to be living outside the parental home at time of death, and be living in remote or very remote areas. Indigenous children were found to consume alcohol more frequently before suicide, compared to other Australian children. Current and past treatments of psychiatric disorders were significantly less common among Indigenous children compared to other Australian children. Conclusions: Western conceptualisation of mental illness may not adequately embody Indigenous people's holistic perspective regarding mental health. Further development of culturally appropriate suicide prevention activities for Aboriginal and Torres Strait Islander children is required.     

Staff perceptions of care for deliberate self-harm patients in rural Western Australia: a qualitative study

ABSTRACT: Suicide has been a major community concern in Esperance, a geographically isolated port on the south coast of Western Australia. This study to explores the views of regional health staff on barriers to the effective management of deliberate self-harm (DSH) and ways in which those barriers could be addressed. Semi-structured interviews were tape-recorded, transcribed and subjected to qualitative content analysis. Interviewees included 77% of general practitioners (n = 7), 18% of nurses ( n = 13) and 55% of mental health professionals (n = 5). The most important barrier was a lack of structure to treating DSH, resulting in deficiencies and inconsistencies in its management. Suggestions to improve the management of DSH included better communication between services, support for nurses in raising the issue of suicide, use of a simple risk assessment tool, the development of a nurse liaison position, and a multidisciplinary planning group.
The higher rates of DSH and completed suicide in rural and remote regions compared with metropolitan areas make secondary prevention particularly important.     

基于分类树模型的潍坊市中学生自杀意念危险因素分析

目的 探索影响中学生自杀的影响因素,为预防中学生自杀提供干预依据。方法 采用分层整群随机抽样的方法,对潍坊市3县（市）6所初中、6所高中3185名中学生进行问卷调查,采用SPSS进行卡方检验、分类树模型等统计方法探讨影响因素。结果 3185名中学生中,自杀意念检出率为8.41%（268/3185）;单因素分析显示,同学关系差、学习成绩差、居住地为农村、经常喝酒、吸烟、睡眠质量差、心理健康状况差等的中学生自杀意念检出率高,且差异均具有统计学意义（P<0.05）。分类树模型共筛选出5个解释变量:心理健康状况、头痛情况、居住地、学习成绩和同学关系;其中最重要的影响因素为心理健康状况;分类树模型ROC曲线下面积（AUC）为0.861（95%CI=0.839~0.884,P<0.001）,预测效果较好。结论 潍坊市中学生产生自杀意念受多因素影响,心理健康状况差、头痛、居住地为农村、学习成绩差和同学关系差是中学生自杀意念发生的危险因素。     

Preventing Youth Suicide: Potential “Crossover Effects” of Existing School-Based Programs

Notable increases in youth mental health problems combined with strains on the already stretched mental health workforce raise concerns that there will be an ensuing increase in youth suicide thoughts, behaviors, and even deaths. Schools are recognized as crucial settings for youth mental health support and suicide prevention activities, yet schools also face staff shortages and ever-increasing responsibilities for student well-being. Evidence is emerging that prevention programs originally designed to improve problem-solving skills and social-emotional functioning in youth have demonstrated downstream, “crossover effects,” that is, unanticipated benefits, on youth suicidal behavior. Relatively little research on crossover effects has been conducted within school settings, despite the strong potential for commonly administered programs to have an impact on later suicide risk. We review key suicide risk factors and their proposed mechanisms of action; we also discuss factors that may protect against suicide risk. We then identify upstream prevention programs targeting the same factors and mechanisms; these programs may hold promise for downstream, crossover effects on youth suicide risk. This paper is intended to provide a framework to help researchers, practitioners, and policymakers as they consider how to prevent youth suicide using existing school-based resources. Rigorous investigation of upstream prevention programs is urgently needed to determine ideal approaches schools and communities can deploy to prevent youth suicide.

     

Suicide and attempted suicide--China, 1990-2002

Suicide is the fifth leading cause of death overall in China and the leading cause of death in persons aged 15-34 years. During 1995-1999, approximately 287,000 persons died each year from suicide, a national rate of 23 per 100,000 population. In addition, an estimated 2 million suicide attempts occur each year. To characterize suicides and attempted suicides in China, analyses were conducted of 1) a psychological autopsy study comparing suicides with other injury deaths and 2) three studies of attempted suicides. This report summarizes the results of these analyses, which indicated that 58% of China's suicides were caused by ingesting pesticide, 91% of suicide victims had never visited a mental health professional, and 45% of suicide attempts were impulsive acts performed after considering suicide for 相似文献   

MATES in construction: impact of a multimodal, community-based program for suicide prevention in the construction industry

A large-scale workplace-based suicide prevention and early intervention program was delivered to over 9,000 construction workers on building sites across Queensland. Intervention components included universal General Awareness Training (GAT; general mental health with a focus on suicide prevention); gatekeeper training provided to construction worker volunteer 'Connectors'; Suicide First Aid (ASIST) training offered to key workers; outreach support provided by trained and supervised MIC staff; state-wide suicide prevention hotline; case management service; and postvention support provided in the event of a suicide. Findings from over 7,000 workers (April 2008 to November 2010) are reported, indicating strong construction industry support, with 67% building sites and employers approached agreeing to participate in MIC. GAT participants demonstrated significantly increased suicide prevention awareness compared with a comparison group. Connector training participants rated MIC as helpful and effective, felt prepared to intervene with a suicidal person, and knew where to seek help for a suicidal individual following the training. Workers engaged positively with the after-hours crisis support phone line and case management. MIC provided postvention support to 10 non-MIC sites and sites engaged with MIC, but not yet MIC-compliant. Current findings support the potential effectiveness and social validity of MIC for preventing suicide in construction workers.