Study ID | Publication | Type of study | Country of origin | Setting | Target group(s) | Type of intervention | Outcomes (according to the authors of the publication/researchers who conducted the studies) | Limitations |
Ahrens et al 1993 | British Journal of Psychiatry | Retrospective group comparison | International | Community | Affective disorder | Length of lithium treatment needed to eliminate high mortality in affective disorders | Recent studies show long-term lithium treatment reduces expected suicidal activity and overall mortality of patients with affective disorders. Based on the data from the lithium clinics in Berlin and Hamilton (n = 512), a minimum length of two years of continued lithium treatment is needed to reduce the high mortality resulting from affective disorders. | |
Ahrens et al 1995a | JOURNAL OF AFFECTIVE DISORDERS | Observational | International | Community | Affective disorder | Comparison of suicide & cardiovascular deaths in patients on lithium with general population rates | In a sample of 827 patients on long-term lithium treatment, 7 suicides were observed and 1.3 expected. This is significant excess, but markedly lower than that found in patients with affective disorders not given lithium. Cardiovascular mortality was not found to be higher in these patients than in the general population. | These findings cannot prove definitively that long-term lithium treatment counteracts factors responsible for the excess suicide and cardiovascular mortality of affective disorders but they are compatible with this assumption. |
Ahrens et al 1995b | CANADIAN JOURNAL OF PSYCHIATRY | Observational | International | Community | Affective disorder | Comparison of suicide & cardiovascular deaths in patients on lithium with general population rates | In-patients given lithium for two years or longer (n = 641), both suicide and cardiovascular mortality were the same as, or only slightly higher, than in the general population; in patients given lithium for less than two years (n = 186), both mortalities remained high. The authors conclude that in addition to its ability to prevent recurrences, prophylactic lithium treatment appears capable of reducing both the excess suicide risk and excess cardiovascular mortality of affective illness. | |
Alexopoulos et al 2005 | AMERICAN JOURNAL OF PSYCHIATRY | RCT | USA | Community | Depressed elderly | Comparison of TAU or care management given to elderly depressed patients (randomised via their general practice) | Patients receiving the intervention fared better then those receiving usual care | |
Aoun & Johnson 2001 | Australian & New Zealand Journal of Mental Health Nursing | Retrospective group comparison | Australia | Mixed | People at high risk of suicide or self-harm | Consumer survey of the introduction of intensive outreach from a suicide intervention counsellor for people in the community at-risk of suicidal behaviour | The overall outcome of this study is that, from the consumer's perspective, a high intensity approach to suicide intervention resolved or improved the presenting problem and their ability to deal with it. | |
Aoun 1999 | Australian & New Zealand Journal of Mental Health Nursing | Retrospective group comparison | Australia | Mixed | People at high risk of suicide or self-harm | Introduction of intensive outreach from a suicide intervention counsellor for people in the community at-risk of suicidal behaviour | The programme was effective in producing a systems change within the hospital by implementing a protocol of best practice and in improving the inter-sectoral liaison between community-based referrals and treatment agencies through professional and community education. The early indications suggest a reduction in the rate of hospital admissions for repeated suicide attempts for cases that were managed by the suicide intervention counsellor through a high-intervention approach. | |
Appleby et al 1999 | Lancet | Case control | UK | Community | People discharged from psychiatric hospital | Assessed the relationship of suicide in severe mental illness to aspects of aftercare | Those who took their own lives were more likely to have had their care reduced at the final appointment in the community before death. Suicide was also associated with a history of self-harm, suicidal thoughts during aftercare and the most recent admission as the first illness. Only 34% of suicides had an identifiable key worker, the essence of the Care Programme Approach. This frequency was no higher than that for controls, reflecting the difficulty of identifying those likely to commit suicide. The authors conclude that reductions in care are strongly associated with suicide by people with mental illness, and may be contributory. The implication is that maintaining care beyond the point of clinical recovery is important in protecting high-risk individuals. Several clinical variables indicate high risk, but greater risk is not an issue generally addressed in health service provisions. | |
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Apter et al 1994 | Journal of the American Academy of Child & Adolescent Psychiatry | Before/after (self as control) | Israel | In-patient open ward | Adolescent in-patients with OCD or depression | Fluvoxamine treatment | Fluvoxamine proved relatively safe and was especially effective in the patients with OCD. Although fluvoxamine also appeared effective in decreasing depression and bulimic symptoms, its impact on impulsive, suicidal, and anorectic symptoms was less clear. The authors conclude that preliminary evidence suggests that short-term treatment of adolescents with fluvoxamine is relatively safe and may be effective for OCD and some affective spectrum symptoms. | |
Aseltine & DeMartino 2004 | American Journal of Public Health | Pseudo-randomised controlled trial | USA | School or high school | General population adolescents | 'SoS' programme in school (youths taught to recognise signs of suicide in themselves and others) | Significantly lower rates of suicide attempts and greater knowledge and more adaptive attitudes about depression and suicide were observed among students in the intervention group. The modest changes in knowledge and attitudes partially explained the beneficial effects of the programme. | |
Baker et al 2004ps | BRITISH JOURNAL OF PSYCHIATRY | RCT | USA | In-patient open ward | Manic depression (bipolar affective disorder) | Olanzapine or placebo with each of lithium or valproate | Addition of olanzapine to ongoing lithium or valproate monotherapy significantly improved depressive symptom, mania and suicidality ratings in in patients with acute dysphoric mania. | |
Barak et al 2006 | Neuropsycho-pharmacology | Case control | Israel | In-patient open ward | Older people with major depression | SSRIs | Older depressed patients treated with anti-depressants may be at reduced risk of attempting suicide. | |
Bateman & Fonagy 1999 | AMERICAN JOURNAL OF PSYCHIATRY | RCT | UK | Out-patient unit | Personality disorder/borderline personality disorder | Partial hospitalization vs TAU | Patients who were partially hospitalized showed a statistically significant decrease on all measures in contrast to the control group, which showed limited change or deterioration over the same period. An improvement in depressive symptoms, a decrease in suicidal and self-mutilatory acts, reduced in-patient days, and better social and interpersonal function began at 6 months and continued until the end of treatment at 18 months. The authors conclude that psychoanalytically oriented partial hospitalization is superior to standard psychiatric care for patients with borderline personality disorder. | Replication is needed with larger groups, but these results suggest that partial hospitalization may offer an alternative to in-patient treatment. |
Bohus et al 2004 | Behaviour Research And Therapy | Group comparison (nuclear whether prospective or retrospective) | Germany | Mixed | Personality disorder/borderline personality disorder | In-patient dialectical behaviour therapy vs community based waitlist control with 'treatment as usual' | The DBT group improved significantly more than participants on the waiting list on 7 of the 9 variables analyzed, including depression, anxiety, interpersonal functioning, social adjustment, global psychopathology and self-mutilation. The data suggest that 3 months of in-patient DBT treatment is significantly superior to non-specific out-patient treatment. Within a relatively short time frame, improvement was found across a broad range of psychopathological features. | |
Brent et al 1993 | American Journal of Diseases of Children | Case control | USA | Community | Adolescent suicide victims | Restriction of access to firearms | Hand guns and loaded guns in the home were particularly significant risk factors for suicide in those with no apparent psychiatric disorder. | |
Brent et al 1997 | Arch. Gen. Psychiatry | Group comparison | USA | Community | Depressed adolescents | Comparison of CBT, systemic behaviour family therapy ( SBFT) & nondirective supportive therapy ( NST) in treatment of depressed adolescents | All 3 treatments showed significant and similar reductions in suicidality and functional impairment. Parents' views of the credibility of cognitive behaviour therapy improved compared with parents' views of both SBFT and NST. The authors conclude that Cognitive behaviour therapy is more efficacious than SBFT or NST for adolescent MDD in clinical settings, resulting in more rapid and complete treatment response. | |
Brown et al 2004 | Journal of personality disorders | Cohort study | USA | Community | Personality disorder/borderline personality disorder | Whether cognitive therapy ( CT) has an impact on risk factors for suicide (suicide ideation, hopelessness, depression & other symptoms) for people with borderline personality disorder. | The results revealed significant and clinically important decreases on measures of suicide ideation, hopelessness, depression, number of borderline symptoms and dysfunctional beliefs at termination and 18-month assessment interviews. | Uncontrolled clinical trial |
Brown et al 2005 | JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | RCT | USA | Community | People attending an emergency department following 'attempted suicide' | Whether cognitive therapy reduced rate of repetition for suicide attempts over 18 months | Participants in the cognitive therapy group had a significantly lower suicide re-attempt rate and were 50% less likely to re-attempt suicide than participants in the usual care group. The severity of self-reported depression was significantly lower for the cognitive therapy group than for the usual care group at 6 months, 12 months and 18 months. The cognitive therapy group reported significantly less hopelessness than the usual care group at 6 months. There were no significant differences between groups based on rates of suicide ideation at any assessment point. The authors conclude that Cognitive therapy was effective in preventing suicide attempts for adults who recently attempted suicide. | |
Bruce et al 2004 | JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | RCT | USA | Community | Depressed older people | Treatment guidelines for older people with care management vs TAU at primary care (i.e. GP practice) level | Rates of suicidal ideation declined faster in intervention patients compared with usual care patients. | |
Carter et al 2005 | BRITISH MEDICAL JOURNAL | RCT | Australia | Community | People discharged from hospital after suicide attempt/self-harm | Postcard sent from ED to discharged person at 1,2,3,4,6,8,10 & 12 months post admission for self-poisoning | A postcard intervention reduced repetitions of deliberate self poisoning, although it did not significantly reduce the proportion of individual repeaters. | |
Cedereke et al 2002a | European Psychiatry | RCT | Sweden | Community | People who had made at least one 'suicide attempt' | Repeated telephone contact (twice at 4 month intervals ) plus TAU compared to TAU | The randomised groups did not differ in repetition of suicide attempts during follow-up or in improvement in other areas. In individuals with no initial treatment the intervention group improved more in certain psychological symptom dimensions. | The main impact of telephone interventions seems to have been on patients who, at their suicide attempt, had treatment other than psychiatric treatment or who had no treatment. |
Chengappa et al 1999 | JOURNAL OF CLINICAL PSYCHIATRY | Mirror image design | USA | Open psychiatric wards | Psychiatric in-patients with psychosis & with borderline personality disorder | Impact of clozapine on self-mutilation & related aggression in psychotic patients with borderline personality disorder | After clozapine treatment, there were statistically significant reductions in incidents of self-mutilation, seclusion, the use of prn. anti-anxiety medications, and injuries to staff and peers. | |
Chiesa & Fonagy 2003 | BRITISH JOURNAL OF PSYCHIATRY | Pseudo-randomised controlled trial | UK | Mixed | Personality disorder/borderline personality disorder | Medium stay in-patient plus subsequent 'step-down' planned care as out-patient vs in-patient only (step down is basically gradual reduction in care with no abrupt stop) | Improvements were significantly greater in the step-down programme for social adjustment and global assessment of mental health. Patients in the programme were found to self-mutilate, attempt suicide and be readmitted significantly less at 24- and 36-month follow-up than patients in the in-patient group. | |
Chiesa et al 2004 | AMERICAN JOURNAL OF PSYCHIATRY | Pseudo-randomised controlled trial | UK | Mixed | personality disorder/borderline personality disorder | Long-term psychoanalytically oriented residential programme vs a phased 'step-down'; psychosocial programme with brief in-patient stay vs a general community psychiatric model | The results of this study suggest that for personality disorders, a specialist step-down programme is more effective than both long-term residential treatment and general psychiatric treatment in the community. | |
Clarkin et al 2001 | Journal of personality disorders | Pre-test post-test | USA | Mixed | Females with borderline personality disorder | Effectiveness of Transference Focused Psychotherapy in reducing suicidal behaviour , use of services etc | Compared to the year prior to treatment, the number of patients who made suicide attempts significantly decreased, as did the medical risk and severity of medical condition following self-injurious behaviour. Compared to the year prior, study patients during the treatment year had significantly fewer hospitalizations as well as number and days of psychiatric hospitalization. | Uncontrolled study so need for caution in interpreting results |
Condelli et al 1997 | BEHAVIOURAL Sciences & the Law | Pre-test post-test | USA | Prison | prison inmates | Effect of an Intermediate Care Programme (not quite psychiatric hospitalisation but nearly) for inmates in prison, in terms of decreased suicide attempts & other outcomes | The highest reductions occurred in mental health observations (65%), suicide attempts (63%), and emergency medications (43%). Lower reductions occurred in correctional infractions and restrictions (26% to 31%). The authors conlude that Intermediate Care Programmes are effective in managing risk. | |
Coryell et al 2001 | Acta Psychiatrica Scandinavica | Case control | USA | Mixed | Affective disorder | Naturalistic follow-up of people receiving a range of anti-depressant treatments | Results do not support previous suggestions that lithium has uniquely anti-suicidal properties. | |
Cotgrove et al 1995 | Journal of Adolescence | RCT | UK | Community | Adolescents discharged from hospital following 'attempted suicide' | Token(green card) allowing readmission to hospital on demand vs TAU | Of the 47 adolescents who were allocated tokens, only three (6%) made further suicide attempts in the following year, and five (11%) made use of their tokens to gain admission into hospital. In the control group of 58 adolescents, seven (12%) made further suicide attempts. | Although the differences between the groups did not reach the level of statistical significance, the results do suggest lower rates of repeat suicide attempts in the group which received the token, even if it was not used. |
Cunningham-Owens et al 2001 | Acta Psychiatrica Scandinavica | RCT. | UK | Community | Schizophrenic out-patients | Educational | The intervention failed to improve outcome. While insight and treatment attitudes improved, suicidal ideation increased. The authors conclude that here are limits to which psycho-educational interventions can be simplified without loss of effectiveness in terms of relapse prevention in schizophrenia. Enhanced insight may be associated with increased suicidal ideation. | |
Davidson et al 2004 | Psychological Medicine | RCT | UK | Community | Repeaters | Prevention of parasuicide by manual assisted CBT | When treated by therapists rated as more competent than other therapists who received equivalent brief training, patients with recurrent self-harm show significant clinical improvements. However, this benefit is not identified across all outcome measures and is not fully apparent until 12-month follow-up. | |
De et al 1995 | AMERICAN JOURNAL OF PSYCHIATRY | Cross-sectional comparison | Italy | Community | General population elderly | Telephone service designed to provide older people with home assistance (telehelp = alarm system ; telecheck is where person is contacted twice a week for assessment of needs and social support - both combined here) | Only one death by suicide was found in the older people connected to Tele-Help/Tele-Check, compared with the expected number of 7.44 for the general population. Since many of the traditional risk factors for suicide were concentrated in the older people studied, the authors conclude Tele-Help/Tele-Check service appears to provide support of great interest for the prevention of suicide in older people. | |
Deykin et al 1986 | Journal of Adolescent Health Care | Prospective follow-up | USA | Community | Youths at risk for suicide | Youth programme (community education) | The intervention programme was effective in increasing subjects' concordance with medical regimen. To a lesser degree, the intervention also facilitated early help-seeking among adolescents with suicidal thoughts and appeared to diminish slightly the overall occurrence of Emergency Room admissions for suicidal behaviours. However, the intervention programme had no demonstrable effect on the occurrence of repeat suicidal episodes. | |
Duggan et al 2003 | BRITISH JOURNAL OF PSYCHIATRY | Mathematical modelling (hypothetical time series) | UK | Community | Treatment resistant schizophrenia | Mathematical modelling of likely suicide and economic impact of model with all 'suitable' patients prescribed clozapine compared with current levels of prescribing | It was estimated that an average of 53 lives could be saved in the UK each year. If clozapine is cost-neutral, the cost per life-year saved is £5108. If clozapine achieves a 10% reduction in annual support costs, the net saving is £8.7 million per annum. An average of 167 acute beds would be freed each year. | Assumptions made in this study are open to question, in particular the assumption that Clozapine is cost-neutral. |
Eagles et al 2003 | BRITISH JOURNAL OF PSYCHIATRY | Qualitative (non-specific) | UK | Community | Severe mental illness and suicidal ideation | Social networks vs standard psychiatry | Three-quarters of patients were in contact with psychiatric services when feeling at their lowest, and this contact was generally deemed to be helpful. Social networks were considered just as helpful as psychiatric services by the half of patients who discussed their feelings with friends or relatives. Religious beliefs and affiliations were helpful. Negative influences included the media and the stigma of psychiatric illness. Efforts at suicide prevention might usefully focus on enhancing patients' social networks, increasing the likelihood of early contact with psychiatric services and decreasing the stigma attached to psychiatric illness. | Larger studies of patients exposed to different service models would be informative. |
Etzsersdorfer 1993 | Crisis | Case study | Austria | In-patient open ward | People who had made at least one suicide attempt | Psychiatric in-patient treatment | This paper presents a case study of a 55-year-old housewife who committed suicide after psychiatric in-patient treatment following a previous severe suicide attempt. The social and psychological situation of the patient is described, with special emphasis on her relationships with her husband, the therapist, and the other staff members on the ward. The steps in her "suicidal career" are described. The paper then discusses the significance of this case, and the conclusions that were drawn by the therapy team about how in-patient treatment after suicide attempts could be better managed. | |
Evans et al 1999 | Psychological Medicine | RCT | UK | Out-patient unit | Personality disorder/borderline personality disorder | Manual-assisted cognitive-behaviour therapy ( MACT) | Thirty-two patients (18 MACT; 14 TAU) were seen at follow-up and 10 patients in each group had a suicidal act during the 6 months. The rate of suicidal acts per month was lower with MACT and self-rated depressive symptoms also improved. The treatment involved a mean of 2.7 sessions and the observed average cost of care was 46% less with MACT. | |
Gagiano et al 1995 | Journal of Clinical Psychopharmacology | RCT | South Africa | Community | Major depression | Treatment with moclobemide (anti-depressant): comparison of most effective dosage - 150mg twice daily, 100mg three times daily or 150mg three times daily | No clear differences between the treatment groups could be shown with respect to response on the Hamilton Rating Scale for Depression ( HAM-D), the Zung Self Rating Scale, or the Clinical Global Impression of efficacy and severity. There was, however, a slightly higher response rate with respect to the anxiety/agitation subscale of the HAM-D in the 150-mg twice-daily group. In all groups, there was a marked and comparable response with respect to suicidal ideation. Moclobemide, 150 mg twice daily, is the optimal initial daily dosage schedule. | |
Gerber 2003 | unpublished study | RCT | UK | Community | General population adolescents | CBT with adolescents in the Scottish school system | Reductions in suicidal ideation as a potential outcome of the CBT. | Authors provide no data to support outcomes |
Glick et al 2004 | JOURNAL OF CLINICAL PSYCHIATRY | RCT | International | Mixed | Schizophrenia | Effects of the use of concomitant psychotropic medication ( CPM) during a large study of clozapine vs olanzapine for prevention of suicidal behaviour | The results support the conclusion that the effects of clozapine in reducing the risk of suicidal behaviour derive from its intrinsic pharmacology and not from the influence of concomitant psychotropic medications. | |
Goodwin et al 2003 | JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | Cohort study | USA | Mixed | Manic depression (bipolar affective disorder) | To compare risk of suicide attempt & suicide death during treatment with lithium with that during treatment with divalproex | Risk of suicide death was 2.7 times higher during treatment with divalproex than during treatment with lithium. Corresponding hazard ratios for non-fatal attempts were 1.7 for attempts resulting in hospitalization and 1.8 for attempts diagnosed in the emergency department. The authors conclude that among patients treated for bipolar disorder, risk of suicide attempt and suicide death is lower during treatment with lithium than during treatment with divalproex. | |
Guthrie et al 2001 | BRITISH MEDICAL JOURNAL | RCT | UK | Community | People attending A&E following self-poisoning | Use of brief psychodynamic interpersonal therapy to reduce deliberate self-poisoning | Participants randomised to the intervention had a significantly greater reduction in suicidal ideation at 6 month follow-up compared with those in the control group. They were more satisfied with their treatment and were less likely to report repeated attempts to harm themselves at follow-up. | |
Heiligenstein et al 1993 | International Clinical Psycho pharmacology | RCT | USA | Out-patient unit | Major depression | Fluoxetine | Fluoxetine was statistically significantly more likely to reduce suicidal ideation compared with placebo. | |
Hirschfeld et al 2005 | Depression and Anxiety | RCT | USA | Not known | Major depression | Treatment of depression with duloxetine | Compared to placebo-treated patients, duloxetine-treated patients experienced greater improvement in the HAMD17 total score at Week 2. The individual symptoms showing the most rapid improvements (Week 1) were depressed mood, guilt, suicidal ideation, work/activities, and psychic anxiety as well as VAS back pain and shoulder pain. At subsequent visits, significant improvements were observed in retardation; hypochondriasis; general somatic symptoms; middle and late insomnia; and gastrointestinal symptoms, genital symptoms (level of sexual interest or ease of sexual arousal), insight, and early insomnia. Significant advantages for duloxetine were not achieved at any visit for agitation, somatic anxiety, or weight loss. | |
Hopko et al 2003 | Journal of personality disorders | Case study | USA | Community | Borderline personality disorder | Mianserin vs nomifensine vs placebo | Presents a behavioural activation treatment for depression ( BATD) that has shown promising results in treating clinically depressed patients and a theoretical conceptualization for why BATD may prove particularly useful in reducing the frequency of suicide-related behaviours and other symptoms characteristic of patients with borderline personality disorder. Also presents theoretical consistencies between BATD and the well-established intervention of dialectical behaviour therapy ( DBT; Linehan, 1993), which may allow for their practical integration, and conclude with a case study that illustrates the assimilation of these strategies in the treatment of a patient with borderline personality disorder. | |
Houck et al 2002 | The Journal of School Nursing | Pre-test post-test | USA | Community | Depressed adolescents | Weekly school-based support group to enhance coping skills and provide emotional support | At the conclusion of the group intervention, there was a 55% decrease in suicidal ideation, a 27% decrease in perceived stress, and a 26% decrease in family distress. In addition, most of the students became engaged in formal treatment for the first time. | |
Isacsson et al 1997 | Acta Psychiatrica Scandinavica | Retrospective epidemiological | Sweden | Mixed | Affective disorder | Analysis of national Swedish suicide rates & statistics on national use of anti-depressants 1992-1994 to examine the relationship between the two | Most people completing suicide were not taking anti-depressants immediately before their death, even though 40-85% may have been depressed. Under-treatment and therapeutic failure are the main problems with anti-depressants, not the risk of using anti-depressants in overdose. The huge increase in the use of anti-depressants in Sweden since 1990-1991 has been paralleled by a significant decrease in suicide rates. | |
Isacsson et al 2000 | Acta Psychiatrica Scandinavica | Retrospective epidemiological | Sweden | Mixed | Affective disorder | Analysis of national Swedish suicide rates & statistics on national use of anti-depressants 1978-1996 to test the hypothesis that there is a close association between the two | The author hypothesized that a 5-fold increase in the use of anti-depressants might reduce Swedish suicide rates by 25%. A subsequent 3.5-fold increase in the use of anti-depressants provided a 'natural experimental situation' for prospectively testing this hypothesis. Suicide rates decreased in accordance with the a priori hypothesis. Alcohol consumption and unemployment rates did not correlate well with suicide rates. | This naturalistic study is not conclusive. The increased use of anti-depressants appears, however, to be one of the contributing factors to the decrease in the suicide rate. |
Kasper et al 1995 | International Clinical Psychopharmacology | RCT | International | Mixed | Major depression | Comparison of fluvoxamine vs imipramine | Overall, compared with placebo, more HAM-D (depression) items were improved by fluvoxamine than imipramine. Fluvoxamine but not imipramine was significantly superior to placebo in severely depressed patients. | |
Kessing et al 2005 | ARCHIVES OF GENERAL PSYCHIATRY | Cohort study | Denmark | Mixed | Affective disorder | Treatment with lithium in reducing completed suicide | In this nationwide study including all patients treated with lithium, it was found that continued lithium treatment was associated with reduced suicide risk regardless of sex and age. | |
King et al 2003 | Suicide & Life-Threatening BEHAVIOUR | Pre-test post-test | Australia | Community | Depressed adolescents | Telephone counselling | Significant decreases in suicidality and significant improvement in mental state were found to occur during the course of counselling sessions, suggesting positive immediate impact. | |
Kleindienst & Greil 2000 | Neuropsychobiology | RCT | Germany | Out-patient unit | Personality disorder/borderline personality disorder | Comparison of lithium and carbamazepine | Lithium appears to be superior to carbamazepine in classical bipolar cases and might have additional impact on proneness to suicide. The distinctly larger group of patients with non-classical features might profit more from carbamazepine which seems to be well accepted by the patients. Hence, treatment alternatives to lithium are desirable for the majority of bipolar patients. | |
Kudoh et al 2002 | ANAESTHESIA and Analgesia | RCT | Japan | In-patient open ward | Major depression | Ketamine to improve post-op state for depressed patients | Small-dose ketamine improved the post-operative depressive state and relieved post-operative pain in depressed patients. | |
LaFromboise & Howard 1995 | Journal of Counselling Psychology | Quasi-experimental | USA | School or high school | Native Americans | Culturally tailored intervention programme (introducing Life Skills Development into the curriculum) | Students exposed to the curriculum scored better than the non-intervention group at post-test on suicide probability & hopelessness. They also showed greater ability to perform problem-solving and suicide intervention skills in a behavioural assessment. | |
Lapierre 1991a | International Clinical Psychopharmacology | RCT | USA | Not known | Major depression | Sertraline | The overall results showed sertraline to be consistently superior to placebo and equivalent in therapeutic effect to amitriptyline on a number of measures including depression, anxiety, insomnia and suicidal ideation. Efficacy was found in both moderately and severely depressed patients whose primary psychiatric diagnoses included single-episode and recurrent major depression, with and without melancholia. Sertraline was also found to be effective in patients with a high baseline anxiety score on the Hamilton Rating Scale for Depression. | |
Lapierre 1991b | International Clinical Psychopharmacology | RCT | USA | Out-patient unit | Major depression | Sertraline | Sertraline was of equal efficacy to amitriptyline. | |
Leenaars & Lester 2004 | Crisis | Trend analysis | Canada | Community | General population/unspecified | Suicide prevention centres | A study by Leenaars and Lester (1995) found that suicide prevention centres in the provinces of Canada in 1985 had a preventive, but non-significant, impact on the suicide rates of the provinces. The present study replicated that study for 1994-1998 and found a similar preventive impact, although weak, of suicide prevention centres on the provincial suicide rates. | |
Leenaars et al 2003 | Death Studies | Retrospective epidemiological study | Canada | Community | General population/unspecified | Effects of legislative gun control laws on suicide rates (Canada's Criminal Law Amendment Act of 1977, 'Bill C-51') | It appears that Bill C-51 may have had an impact on suicide rates, even after controlling for social variables. | |
Linehan et al 1993 | ARCHIVES OF GENERAL PSYCHIATRY | RCT | USA | Community | Personality disorder/borderline personality disorder | DBT vs treatment as usual in the community | In general, the superiority of DBT over treatment-as-usual, found in previous studies at the completion of 1 year of treatment, was retained during a 1-year follow-up. | |
Linehan et al 2006 | ARCHIVES OF GENERAL PSYCHIATRY | RCT | USA | Mixed | Personality disorder/borderline personality disorder | DBT vs community treatment by non-behavioural psychotherapy | DBT was associated with better outcomes in the ITT analysis than community treatment in most target areas and appeared to be uniquely effective in reducing suicide attempts. | |
Low et al 2001 | Behavioural and Cognitive Psychotherapy | Prospective follow-up | UK | Secure in-patient unit | Self-harming females with borderline personality disorder | DBT | There was a significant reduction in self-harm during therapy which was maintained at 6-month follow-up as well as improvements in other areas, including survival and coping beliefs and suicide ideation. | |
March et al 2004 | JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | RCT | USA | Out-patient unit | Adolescents with major depression | Fluoxetine vs CBT vs CBT+fluoxetine vs placebo | Compared with placebo, the combination of fluoxetine with CBT was statistically significant. Clinically significant suicidal thinking, which was present in 29% of the sample at baseline, improved significantly in all 4 treatment groups. Fluoxetine with CBT showed the greatest reduction. The authors conclude that the combination of fluoxetine with CBT offered the most favourable trade-off between benefit and risk for adolescents with major depressive disorder. | |
May et al 2005 | American Journal of Public Health | Prospective follow-up | USA | Community | Native Americans | Community-wide public health oriented prevention programme | Data from this community-based approach document a downward trend - measured by both magnitude and temporal trends in the specifically targeted age cohorts - in suicidal acts. The sequential decrease in age-specific rates of suicide attempts and gestures is indicative of the programme's success. | |
Mcdaniel et al 1990 | Military Medicine | Retrospective group comparison | USA | US Navy bases | US navy personnel | Suicide prevention & stress management training for US navy instructors | Suicide prevention efforts produced a significant reduction in suicide attempts. | |
Meltzer et al 2003 | ARCHIVES OF GENERAL PSYCHIATRY | RCT | International | Community | Schizophrenia | Clozapine vs olanzapine | Clozapine therapy demonstrated superiority to olanzapine therapy in preventing suicide attempts in patients with schizophrenia and schizoaffective disorder at high risk for suicide. | |
Metha et al 1998 | Suicide & Life-Threatening BEHAVIOUR | Retrospective cross-sectional comparison | USA | Community | General population adolescents | State level initiatives directed at youth suicide prevention (any legislative, educational or other state-based initiative) | The results revealed that while changes in suicide rates over time were statistically significant, there was no relation between these changes and any of the variables studied. | |
Miller et al 1984 | American Journal of Public Health | Retrospective epidemiological study | USA | Community | General population/unspecified | Suicide prevention centres | The authors studied 1968 through 1973, the years of greatest growth of suicide prevention facilities, comparing suicide rates in counties that added these centres with counties that did not do so. An association of centres with the reduction of suicides in young white females emerged. This finding was replicated on a different set of counties for a different timespan. | |
Moller & Steinmeyer 1994 | European Neuropsychopharmacology | RCT | Germany | In-patient open ward | Major depression | Paroxetine vs amitriptyline | Global antidepressive efficacy was comparable under dosages of 30 mg paroxetine or 150 mg amitriptyline per day. A differentiated analysis failed to confirm the hypothesis of a faster reduction of suicidal cognitions by paroxetine. | |
Morriss et al 2005 | PsychologicAl Medicine | Cross-sectional comparison | UK | Community | General population adolescents | Educational intervention for front-line health professionals ( STORM) | The suicide rate in 1994-1996 was 8.8 per 100 000 before this educational intervention and unchanged at 8.6 per 100 000 in 1998-2000 after it. The authors conclude that brief educational interventions to improve the assessment and management of suicide for front-line health professionals in contact with suicidal patients may not be sufficient to reduce the population suicide rate. | |
Motto & Bostrom 2001 | Psychiatric Services | RCT | USA | Community | People at high risk of suicide or self-harm | No contact after discharge vs treatment post -discharge vs contact or letter | A systematic programme of contact with persons who are at risk of suicide and who refuse to remain in the health care system appears to exert a significant preventive influence for at least 2 years. Diminution of the frequency of contact and discontinuation of contact appear to reduce and eventually eliminate this preventive influence. | |
Motto
1976 | Suicide & Life-Threatening BEHAVIOUR | RCT | USA | Community | High risk people who declined treatment programmes | No contact & no treatment after discharge vs treatment post -discharge vs no treatment but contact by telephone or letter | Suicidal deaths were found to diverge progressively in the 3 groups, the treatment subjects showing the highest rates, the no-contact group coming next, and the contact subjects showing the lowest. The observed divergence between the contact and no-contact groups provides tentative evidence that a high-risk population for suicide can be identified and that a systematic approach to reducing that risk can be applied. | |
Mufson et al 2004 | ARCHIVES OF GENERAL PSYCHIATRY | RCT | USA | School or high school | Depressed adolescents | Interpersonal psychotherapy
( IPT-A) vs TAU | Adolescents treated with IPT-A compared with TAU showed greater symptom reduction and improvement in overall functioning. The authors conclude that Interpersonal psychotherapy delivered in school-based health clinics is an effective therapy for adolescent depression. | |
Nordentoft et al 2005 | European Psychiatry | Pre-test
post-test | Denmark | Community | General population adults | In-patient suicide prevention centre vs none | The intervention group obtained a significantly greater improvement in Beck's Depression Inventory, Hopelessness Scale, Rosenberg's Self-Esteem Scale and CAGE-score and a significantly lower repetition rate. | Although the design cannot exclude selection bias, it seems likely that the improvement in the intervention group was facilitated by the treatment |
Nutting et al 2005 | Annals of Family Medicine | RCT | USA | Community | Depressed people | Brief training of physicians and office GP nurses to provide care management vs guided development of quality improved teams for depression care in GP practices vs TAU | Depressed patients with recent suicidal ideation were detected on 40.7% of index visits in intervention practices, compared with 20.5% in usual care practices, with HMO plan type and male sex associated with detection. The interventions had no effect on referral of patients, starting an anti-depressant, or suicidal ideation reported at a 6-month follow-up. | |
Omar 2005 | International Journal of Adolescent Medicine and Health | Qualitative (non-specific) | USA | Community | General population adolescents | Stop Youth Suicide campaign, community-based programme | This article describes a grass roots, community-based programme for youth suicide prevention and its impact on the community. The authors claim that over a 4-year period, the programme has responded to many e-mails and phone calls from teens and/or their parents asking for help. During these years, many of these children that were seeking help ended up receiving appropriate help that contributed to changing their lives and helping them stay alive and also utilizing them to help others in that period. | |
Owens et al 2004 | British Journal of General Practice | Psychological autopsy | UK | Community | People known or thought to have completed suicide | Recognition and treatment of mental illness by GPs | Using data from a study of suicide completers who were not in contact with specialist mental health services, the authors found that the rate of detection and treatment of mental health problems in primary care was high. The major barrier to receipt of care for mental health problems prior to suicide was non-consultation. The study also shows that detection and management in primary care does not necessarily result in prevention of suicide. | |
Oyama et al 2004 | Community Mental Health Journal | Cross-sectional comparison | Japan | Community | Rural older people aged 65+ | Community- based prevention programme for ruralolder people | During the 10-year implementation of the programme based on strategies including screening for depression, follow-up with mental health care or psychiatric treatment and health education on depression, the relative risks estimated by the age-adjusted odds ratios for both males and females were reduced to almost one quarter more than a regional historical trend, with a better response to education for females than for males. | |
Oyama et al 2006a | Psychiatry and Clinical Neurosciences | Cross-sectional comparison | Japan | Community | Rural older people aged 65+ | Community based prevention programme for rural older people | During 1999-2004, this programme, including depression screening and group activity was conducted by the public health nurses in the Minami district (population 1685) of Nagawa town, rural Japan. The suicide risk for Minami's elderly females was reduced by 74% more than the historical trend, while there was no change in the risk of Minami's males, nor in the male or female references. This local intervention using public health nursing would be effective against suicide for older females. | |
Oyama et al 2006b | Crisis | Quasi-experimental | Japan | Community | General population older people | Community-based programme to prevent suicide | Risk of completing suicide in females was reduced by 70% but not in males. | |
Papakostas et al 2003 | Journal of Nervous and Mental Disease | Prospective follow-up | USA | Out-patient unit | Treatment-resistant major depression ( TRD) | Treatment with nortriptyline ( NT) | A full 6-week trial of NT, a noradrenergic tricyclic anti-depressant, may be particularly useful in patients who have failed to respond to several anti-depressants and also report significant hopelessness. | |
Perseius et al 2003 | Archives of Psychiatric Nursing | Qualitative content analysis | Sweden | Not known | Personality disorder/borderline personality disorder | DBT | Patients unanimously regarded the DBT-therapy as life-saving and something that has given them a bearable life situation. The patients and the therapists are concordant on the effective components of the therapy: the understanding, respect, and confirmation in combination with the cognitive and behavioural skills. The experienced effectiveness of DBT is contrasted by the patient's pronouncedly negative experiences from psychiatric care before entering DBT. | |
Potkin et al 2003 | Biological Psychiatry | RCT | International | Not known | Schizophrenia | Clozapine versus olanzapine | Clozapine, in general, was more effective than olanzapine in decreasing the risk of suicidality, regardless of risk factors present. | |
Randell et al 2001 | Suicide & Life-Threatening BEHAVIOUR | RCT | USA | School or High School | School or high school students | Brief counsellors care (C- CARE) vs C_ CARE & 'Coping and Support Training' peer -group intervention ( CAST) vs TAU | This study evaluated the immediate post-intervention effects of 2 brief suicide prevention protocols: a brief interview--Counsellors CARE (C- CARE) and C- CARE plus a 12-session Coping and Support Training ( CAST) peer-group intervention. Subjects were students "at risk" of high school dropout and suicide potential in Grades 9-12 from 7 high schools (N = 341). Students were assigned randomly to C- CARE plus CAST, C- CARE only, or "intervention as usual". C- CARE and CAST led to increases in personal control, problem-solving coping, and perceived family support. Both C- CARE plus CAST and C- CARE only led to decreases in depression, and to enhanced self-esteem and family goals met. All 3 groups showed equivalent decreases in suicide risk behaviours, anger control problems, and family distress. | |
Reid et al 1998 | Psychiatric Services | Retrospective epidemiological study | USA | Community | Schizophrenia | Clozapine | The annual suicide rate for all patients with schizophrenia and schizo-affective disorder was 63.1 per 100,000 patients, approximately 5 times higher than in the general population. In contrast, only one suicide occurred in 6 years among patients treated with clozapine who were of similar diagnosis, age, and sex, for a suicide rate of about 12.7 per 100,000 patients per year. The authors conclude that the study results suggest that clozapine therapy is associated with a reduced risk of suicide among patients with schizophrenia and schizo-affective disorder | |
Ross 1980 | Suicide & Life-Threatening BEHAVIOUR | Qualitative (non-specific) | USA | School or High School | School or high school students | Suicide prevention training for school personnel | Experience in providing consultation and survivor counselling to school personnel following student suicides led to the development of a programme of prevention through training school personnel. The goal of the programme was to increase the ability of resource persons available to adolescents-teachers, counsellors and school nurses-to recognize signs of suicidal depression and to respond effectively to suicidal students. This report describes that programme, the reaction of the participants and the observations of the project staff, and comments on the feasibility of this approach as a means of helping to prevent suicide among adolescents. | |
Rost et al 1998 | General Hospital Psychiatry | Prospective telephone follow-up | USA | Mixed | Depression identified by telephone screening | Provision of trained mental health services in rural areas | Primary care patients with undetected major depression report persistently poor outcomes. Comparison of outcomes with detected patients suggests that quality improvement efforts directed at improving detection without improving management of detected patients may not improve outcomes. | |
Rotherham-borus et al 1996 (study one) | Journal of the American Academy of Child & Adolescent Psychiatry | Non-randomised control group comparison | USA | Hospital emergency room | Adolescent suicide attempters presenting at hospital Emergency Room with family members | Emergency Room programme (training workshop for staff & videotape to modify families' treatment expectations & on-call family therapist vs TAU) | Attempters receiving the specialized programme were more likely to attend one treatment session and were somewhat more likely to attend more sessions than those receiving standard Emergency Room care; however, their mothers were less likely to complete treatment. In addition, participants receiving the specialized programme reported reduced psychiatric symptoms, and mothers reported more positive attitudes toward treatment and perceptions of family interactions. | |
Rotheram-Borus et al 1996 (study two) | Journal of the American Academy of Child & Adolescent Psychiatry | Quasi-experimental | USA | Emergency room | Youths at risk for suicide | Specialized care programme in hospital Emergency Room (staff training video to modify family expectations) | Adherence to treatment programme by youths and their families was significantly improved by receiving the specialized care programme in the emergency room. Adherence was also associated with decreased suicidal ideation, more cohesive family relations, and higher self-esteem than at baseline. | |
Rotherham-Borus et al 2000 | Journal of Consulting and Clinical Psychology | Quasi-experimental | USA | Emergency room | Adolescent females at risk for suicide | Specialised ER care intervention to enhance adherence to out-patient therapy (including a soap opera video) | The intervention was deemed to have a positive impact, particularly for the parents of youth with high psychiatric symptomatology. | |
Rozanov et al 2002 | Crisis | Cross-sectional comparison | Ukraine | Ukraine military bases | Ukraine military personnel | Training of military officers in suicide prevention, also of representatives of most vulnerable groups plus educational materials for soldiers. | One of the main conclusions is that the prevention activity must be organized as a continuum of actions, seminars, consultations, and materials distribution. | |
Rutz & Walinder 1992 | Acta Psychiatrica Scandinavica | Cross-sectional comparison | Sweden | Community | General population/unspecified | Educational programme for GPs on diagnosis and treatment of depression | Following the educational programmes on this Swedish island, the frequency of sick leave in patients of GPs for depressive disorders decreased, the frequency of in-patient care for depressive disorders decreased to 30% of that at the baseline; the prescription of anti-depressants increased, but prescription of major tranquilizers, sedatives and hypnotics decreased. The frequency of suicide on the island decreased significantly. This study describes the long-term effects. In 1988, 3 years after the project ended, the in-patient care for depressive disorders increased, the suicidal rate returned almost to baseline values and the prescription of anti-depressants stabilized. Thus, the effects were strictly related in time to the educational programmes, indicating that the effects were real and not only a coincidence with local trends on Gotland. Furthermore, the results indicate that educational programmes that can have pronounced effects on the health care system have to be repeated approximately every 2 years if long-term effects are to be expected. | |
Rutz 2001 | JOURNAL OF AFFECTIVE DISORDERS | Cross-sectional comparison | Sweden | Community | General population/unspecified | Educational programme for GPs on diagnosis and treatment of depression | The programme was successful in reducing suicide rates by 60%. This was accompanied by reduction of different indices measuring depressive morbidity. Prevention was successful for as long as the programme was instituted. | |
Salkovskis et al 1990 | BRITISH JOURNAL OF PSYCHIATRY | RCT | UK | Community | People at high risk of suicide or self-harm | Cognitive behavioural problem solving vs TAU | The group practising problem-solving improved significantly more than controls on ratings of depression, hopelessness, suicidal ideation and target problems at the end of treatment and at follow-up of up to one year, and there was evidence of an effect on the rates of repetition over the 6 months after treatment. | |
Smith & Glaudin 1992 | JOURNAL OF CLINICAL PSYCHIATRY | RCT | USA | Not specified | Major depression | Paroxetine vs placebo | Paroxetine produced significantly greater improvement than placebo for patients whose illness had lasted more than 1 year, and there was a significant reduction in suicidal ideation. Significantly fewer treatment drop-outs were due to lack of efficacy in those patients treated with paroxetine compared with those in the placebo group. | |
Spivak et al 1999 | Clin.Neuro- pharmacology | Retrospective group comparison | Israel | Not specified | Schizophrenia | Clozapine vs traditional anti-psychotics | A significant reduction in aggressive and suicidal behaviour was noted in the clozapine-treated group but not in the classical anti-psychotic-treated group. | |
Suominen et al 1998 | AMERICAN JOURNAL OF PSYCHIATRY | Prospective follow-up | Finland | Not specified | Major depression in people who had made at least one 'suicide attempt' | Treatment for depression | Although almost all of the patients complied with the recommended aftercare following the suicide attempt, after 1 month only 7 (17%) were receiving anti-depressants in adequate doses, 9 (22%) were receiving weekly psychotherapy, and none had been given ECT. The authgors conclude that it seems that few suicide attempters with major depression receive adequate treatment for depression before the suicide attempt and that, despite their well-known high risk for suicide, the treatment situation is not necessarily any better after the attempt. | |
Thompson et al 2000 | Suicide & Life-Threatening BEHAVIOUR | Repeated measures design | USA | Community | Youths at risk for suicide | School-based intervention programme emphasising personal growth and personal control with support from teachers. Intervention groups: grp 1 = 1 semester, grp 2 = 2 semester, grp 3 = no programme | For the 2 intervention groups, there were direct and/or indirect effects of teacher and peer group support on personal control, depression, and suicide risk behaviours. The general hypothesis that personal control mediates between support resources and reductions in depression and suicide risk behaviours received partial support across the study groups. | |
Thompson et al 2001 | American Journal of Public Health | Repeated measures design | USA | Community | Youths at risk for suicide | C- CARE (brief one to one counselling assessment and crisis intervention vs CAST (coping and support training in small groups together with C- CARE) vs TAU | Analyses showed significant rates of decline in attitude toward suicide and suicidal ideation were associated with the experimental interventions. C- CARE and CAST, compared with usual care, also were effective in reducing depression and hopelessness. Among females, reductions in anxiety and anger were greater in response to the experimental programmes. CAST was most effective in enhancing and sustaining personal control and problem-solving coping for males and females. | |
Thrive Initiative 2006 | SCOTTISH EXECUTIVE | Qualitative (non-specific) | USA | Community | Male survivors of childhood sexual abuse | Counselling & support service focussed on male survivors of childhood sexual abuse | Reduction in the dimensions of propensity for suicide and self-harm reported by some participants. | |
Tollefson et al 1994 | Journal of Clinical Psychopharmacology | RCT | USA | Not specified | Agitated major depression | Imipramine ( IMI) vs fluoxetine ( FLU) | Both compounds proved to be similarly effective, however, a statistically significant difference in early discontinuations because of intolerable adverse events emerged. In conclusion, among subjects with major depression, subtype agitated, the risk:benefit profile favoured FLU over IMI. | |
Tondo et al 1998 | JOURNAL OF CLINICAL PSYCHIATRY | Prospective follow-up | Italy | Community | Bipolar affective disorder | Lithium | Lithium maintenance was associated with marked reduction of life-threatening suicidal acts, the number of which sharply increased after discontinuing lithium. Suicidal behaviour was strongly associated with prior suicide attempts, longer time depressed and younger age or recent onset. | |
Toumbourou & Gregg 2002 | Journal of Adolescent Health | Non-randomised control group comparison | Australia | School or high school | School or high school students | Empowerment-based parent education groups | This whole-school parent education intervention demonstrated promising impacts on a range of risk behaviours and protective factors relevant to youth self-harm and suicide. | |
Turner 2000 | Cognitive & Behavioural Practice | RCT | USA | Emergency Room ( ER) | Personality disorder/borderline personality disorder | DBT vs client-centered therapy ( CCT) | Outcomes showed the DBT group improved more than the CCT group on most measures. The quality of the therapeutic alliance accounted for significant variance in patients' outcomes across both treatments. | |
Tyrer et al 2003 | Psychological Medicine | RCT | UK | Community | Repeated self-harm | Brief manual assisted cognitive behavioural therapy ( MACT) vs TAU | The main outcome measure, the proportion of those repeating deliberate self-harm in the 12 months of the study, showed no significant difference between those treated with MACT (39%) and treatment as usual (46%). Although brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition, the findings taken in conjunction with the economic evaluation (Byford et al. 2003) indicate superiority of MACT over TAU in terms of cost and effectiveness combined. | |
Tyrer et al 2004 | Journal of personality disorders | RCT | UK | Community | Repeated self-harm | Brief manual assisted cognitive behavioural therapy ( MACT) vs TAU | Results showed no significant difference between those repeating self-harm in the MACT group (39%) compared with the TAU group (46%). However, the treatment was cost effective (10% cheaper than TAU) and the frequency of self-harm episodes was fewer (50%) in the MACT group. It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have borderline personality disorder. | |
Vanheeringen et al 1995 | Psychological Medicine | RCT | Belgium | Community | People discharged from hospital after suicide attempt/self-harm | Motivational visits by nurses to home of 'non-compliant' patients vs. no visit | Significant beneficial effect of the experimental procedure on compliance with referral and a near-significant effect on the rate of repetition of suicidal behaviour. | |
Verheul et al 2003 | British Journal of Psychiatry | RCT | Holland | Community | Personality disorder/borderline personality disorder | DBT vs TAU | Dialectical behaviour therapy resulted in better retention rates and greater reductions of self-mutilating and self-damaging impulsive behaviours compared with usual treatment, especially among those with a history of frequent self-mutilation. | |
Waterhouse & Platt 1990 | British Journal of Psychiatry | RCT | UK | Emergency Room ( ER) | Patients presenting at ER with overdose | General hospital admission vs discharge home | One week later there were no significant differences between groups on diverse outcome measures, including repetition rate, psychological symptoms and social functioning. A second follow-up using the same measures at 16 weeks also failed to demonstrate any differences between groups, both of which showed considerable overall improvement. A parasuicide management policy consisting of assessment in a casualty department and selective discharge was appropriate for 15% of a hospital-referred population. | |
Zenere & Lazarus 1997 | Suicide & Life-Threatening BEHAVIOUR | Retrospective follow-up | USA | School or high school | School or high school students | Suicide prevention and school crisis management programme focused on school-based crisis teams | Evaluative data indicating the effectiveness of the programme as well as implications for suicide prevention and intervention are discussed. | |