The Scottish Government

Listen

The international survey and consultation with the expert group produced the following key recommendations:

• Three reviews should be commissioned on the determinants of suicidal behaviour, covering: (i) a comprehensive biopsychosocial model of suicidal behaviour; (ii) current knowledge of risk conditions and risk factors for suicidal behaviour; (iii) what protects against suicidal behaviour
• Two further reviews should be commissioned on the subject of interventions for suicidal behaviour: (i) preventing suicidal behaviour in key risk groups; (ii) preventing suicidal behaviour in the general population
• Work on the epidemiology of suicide and deliberate self-harm should not be commissioned as a review, but as a separate project based on secondary data analysis
• Reviews should recognise the importance of assessing the transferability of findings to the Scottish context
• Review research teams should include a practitioner and/or a service user perspective.

Background

The last 30 years have seen a massive increase in suicide in Scotland, with rates more than doubling among young adult men. As a result suicide prevention has become an urgent public health issue. In 2002, following an extensive consultative process, the Scottish Executive's National Programme for Improving Mental Health and Well-Being launched Choose Life, the National Strategy and Action Plan to Prevent Suicide in Scotland. Choose Life set a target of reducing the rate of people committing suicide in Scotland by 20% by 2013 (Scottish Executive, 2002). The Executive allocated 12 million over the period 2003-06 to support the implementation of the Choose Life strategy and action plans at national and local levels.

One of the main objectives of Choose Life is to improve the quality, collection, availability and dissemination of information relating to suicide and suicidal behaviour, and on relevant effective interventions. To meet this objective, the Scottish Executive has embarked on an extensive research process to ensure that practice is supported by a reliable, up-to-date evidence base. The work reported here is a scoping study to define the territory for a series of research reviews to co-ordinate the evidence base and inform the development and implementation of suicide prevention policy in Scotland. The reviews will determine what primary research is required to address gaps in the evidence base relating to suicide and suicidal behaviour.

Research Aims

The overall aims of this research were to:

• Co-ordinate information about the interests and areas of expertise of organisations and individuals specialising in suicide-related research
• Establish the territory and focus of the series of reviews, with reference to: information on prevalence; risk and protective factors; and the effectiveness of specific preventive interventions.

Approach

The project was undertaken in two linked stages.

• Stage 1: identified and established contact with researchers across the world who specialise in suicide and suicide-related research. This group was invited to participate in a web-based survey to identify their key interest areas, their perception of how the reviews should be divided up, the issues on which the reviews should focus, and the main gaps in the existing evidence base related to suicide and suicidal behaviour. The survey data were coded and frequencies were calculated and sorted to identify priority themes. This information was used to develop the key elements of a framework for dividing up the reviews. The framework reflected and incorporated all priority issues, perceived gaps and most common suggestions for dividing up the reviews.
• Stage 2: identified the focus and structure of the reviews to be commissioned. This involved analysis of the priority themes arising from the survey data and a two-part consultation with a group of (mainly Scottish based) suicide and suicidal behaviour experts (researchers, policy makers, practitioners responsible for policy implementation, mental health service users and other relevant stakeholders). The expert group was consulted in two phases. In the first phase members were presented with the survey data and asked to assess the framework for dividing up the reviews. In the second phase members were asked to comment on 5 research review topic options which were based on the survey findings and feedback from the first phase of expert group consultation.

Main Findings

Issues arising from the international survey

Sixty-two researchers from 14 different countries responded to the electronic survey. The key findings of the survey were as follows:

• The reviews should be split between suicide and deliberate self-harm, and should separately address determinants, interventions and epidemiology
• The key priorities for focus were understanding more about preventative interventions for risk groups, particularly those with mental illness and those who misuse alcohol and drugs (at service level), and for the general population (at societal level). Another key suggestion for focus was epidemiological investigation.
• Participants perceived gaps in the evidence to be concentrated around the effectiveness of preventative interventions, interventions for deliberate self-harm and good quality epidemiological data

Consultation with the expert group: phase 1

The expert group was presented with a framework for dividing up the reviews and asked to comment on its viability, methodological considerations and questions the reviews should answer. The key recommendations of this phase were:

• The reviews should incorporate socio-economic factors that increase risk of suicide or deliberate self harm, the impact of the quality of environment and differences between high risk groups
• Experts emphasised the importance of understanding determinants and interventions for suicide and suicidal behaviour at societal, service, community and individual levels
• Experts felt that it was difficult to justify the separation of risk and protective factors in different reviews.

Consultation with the expert group: phase 2

In the second phase members were asked to comment on 5 research review topic options which were based on the survey findings and feedback from the first phase of expert group consultation. The expert group recommended that:

• Reviews should recognise the importance of assessing the transferability of findings to the Scottish context and discuss the implications of findings for future monitoring, evaluation and research
• Review research teams should include a practitioner and/or a service user perspective and combine diverse disciplinary perspectives.
• Work on the epidemiology of suicide and deliberate self-harm should not be commissioned as a review, but as a separate project based on secondary data analysis.

The five suggested review topics

• Towards a comprehensive biopsychosocial model of suicidal behaviour, which takes account of and combines different disciplinary understandings and perspectives.
• Current knowledge of risk conditions and risk factors for suicidal behaviour, focusing both on societal and cultural factors, and population subgroups which are at increased risk of suicidal behaviour.
• What protects against suicidal behaviour, differentiating and identifying relationships between individual protective factors and environmental protective factors
• Preventing suicidal behaviour in key risk groups: what works and what doesn't work?
• Preventing suicidal behaviour in the general population: what works and what doesn't work?