Strategies to prevent death by suicide: Meta-analysis of randomised controlled trials

Abstract

Few randomised controlled trials (RCTs) have shown decreases in suicide.To identify interventions for preventing suicide.We searched EMBASE and Medline from inception until 31 December 2015. We included RCTs comparing prevention strategies with control. We pooled odds ratios (ORs) for suicide using the Peto method.Among 8647 citations, 72 RCTs and 6 pooled analyses met inclusion criteria. Three RCTs ( = 2028) found that the World Health Organization (WHO) brief intervention and contact (BIC) was associated with significantly lower odds of suicide (OR = 0.20, 95% CI 0.09-0.42). Six RCTs ( = 1040) of cognitive-behavioural therapy (CBT) for suicide prevention and six RCTs of lithium ( = 619) yielded non-significant findings (OR = 0.34, 95% CI 0.12-1.03 and OR = 0.23, 95% CI 0.05-1.02, respectively).The WHO BIC is a promising suicide prevention strategy. No other intervention showed a statistically significant effect in reducing suicide.

An Emergency Department‐Initiated Intervention to Lower Relapse Risk after Attempted Suicide

“…Because we stuck to a strictly naturalistic design and included data from the real clinical practice, recruiting all suicide attempt patients treated at the ED level with no exclusion criteria, the results likely capture the implemented program's true effectiveness. The effect estimates are consistent with those of other interventions aimed at contact maintenance (Zalsman et al., ), including studies conducted in other European countries (Cebriá et al., ; Reijas, Ferrer, González, & Iglesias, ), the United States (Miller et al., ), and several low‐ and middle‐income countries (LMIC) (Riblet, Shiner, Young‐Xu, & Watts, ). In keeping with the literature, risk factors for reattempts included a personal history of previous suicide attempts, the presence of a diagnosed psychiatric disorder, female gender, and concurrent alcohol or drug abuse, while family support was a protective factor.…”

“…Contact‐enhancing programs, specifically directed at establishing brief contacts and maximizing access to clinical and social resources, are considered effective: Accordingly, a range of evidence‐based contact maintenance programs including the use of letters, telephone calls, messages, or case management have been successfully developed, deployed, and scaled‐up (Berrouiguet et al., ; Dekker, Vergouwen, Buster, & Honig, ; Vaiva et al., ). Recently, the WHO Brief Intervention and Contact (WHO BIC), a strategy searching to enhance contact after a suicide attempt, was the only intervention to significantly lower the risk of suicide in a recent meta‐analysis of randomized control trials (RCT) including other therapeutic and pharmacologic strategies and a variety of different locales (Riblet et al., ). In the ED‐Safe study, an RCT conducted in North American subjects, a brief ED‐based intervention, consisting on postdischarge resources and telephone calls, significantly decreased reattempts, with an incidence rate ratio (95% CI) of 0.72 (0.52–1.00) (Miller et al., ).…”

Effectiveness of a village-based intervention for depression in community-dwelling older adults: a randomised feasibility study

“…In Korea, suicide rates are higher in rural areas than in urban regions [4], which might be due to the large numbers of elderly people living in rural areas. Suicide prevention strategies tailored by age and residential area are needed; however, only a few trials have examined this issue in older adults living in rural areas [5].…”

Digital Technology Adoption in Psychiatric Care: an Overview of the Contemporary Shift from Technology to Opportunity

“…App-based suicide mitigation interventions may benefit from a design similar to this. A subsequent meta-analysis of RCTs for suicide prevention by Riblet et al (2017) found three RCTs of the WHO BIC model to significantly lower the risk of suicide, while similar studies of CBT and lithium did not have a significant effect on risk of completed suicide.…”