Prevention of suicide: aspirations and evidence

Abstract

The Health of the Nation white paper set a target for 15% reduction in overall suicide rates by the year 2000. If the targets are to be achieved interventions must be identified which are of proved effectiveness. This paper examines the evidence on the available interventions and points of access to the population at risk. No single intervention has been shown in a well conducted randomised controlled trial to reduce suicide. The greatest potential seems to arise from limiting the availability of methods. In particular it is likely that the introduction of the catalytic convertor will lead to reduced lethality of care exhausts and reductions in suicide using this method. General practitioner education programmes, the effectiveness of lithium and maintenance antidepressants, and limits on the quantity of medicines available over the counter or on prescription should all be evaluated. Particular high risk groups include people recently discharged from psychiatric hospitals and those with a history of parasuicide. Many social processes affect suicide rates and these rather than specific interventions may help or hinder the ability to realise the Health of the Nation targets. Well conducted trials are essential to distinguish complex social processes from the effects of specific interventions for suicide prevention. This review of the available evidence offers little support for the aspiration that the posited targets can be achieved on the basis of current knowledge and current policy.

Perfil das tentativas de suicídio por sobredose intencional de medicamentos atendidas por um Centro de Controle de Intoxicações do Paraná, Brasil

“…Esses números são de grande valia para medidas de detecção, assistência e prevenção do comportamento suicida, uma vez que, aproximadamente, um quarto dos pacientes tenta o suicídio novamente no ano seguinte 20 , e 30% a 47% dos suicídios consumados apresentam histórico de tentativa prévia 21 Os registros analisados se encontravam armazenados em um banco de dados do programa Epi Info versão 6.04 (Centers for Disease Control and Prevention, Atlanta, Estados Unidos). Foram encontrados 2.436 casos de intoxicações por medicamentos nesse período, sendo 1.673 (50,9%) devido à circunstância "tentativa de suicídio".…”

Detailed analyses of self‐poisoning episodes presenting to a large regional teaching hospital in the UK

“…In the year 2000 there were 4740 suicides in England making it the third most important cause of 'life years lost' after ischaemic heart disease and cancer [1,2]. One thousand one hundred and eighty of the 4740 suicides (24.9%) were attributable to 'deliberate self harm' (DSH) [1].…”

Hjelper selvmordsforebyggende tiltak?

“…Selvmord forekommer så sjelden at hvis man skulle bevise at et forebyggende tiltak reduserte selvmordshyppigheten med 15 %, måtte undersøk-elsen omfatte 13 millioner personer. Skulle man bevise at selvmordshyppigheten falt med 15 % over en 8-årsperiode for den som hadde gjort selvmordsforsøk, måtte man ta for seg 45 000 forsøkere, og skulle man bevise et tilsvarende fall for selvmord i løpet av det første år etter utskrivningen fra en psykiatrisk institusjon, måtte man ta for seg 142 000 innlagte pasienter (Gunnell & Frankel 1994). I praksis er dette naturligvis umulige oppgaver, slik Goldney (1998) drøfter i en utmerket oversikt over den foreliggende litteratur på området.…”