SUICIDE PREVENTION, A FIVE COUNTRY INTERVENTION STUDY

According to WHO estimates, yearly deaths from suicide exceed 800,000,
occurring in almost all age groups.

In this research article from the Bulletin of the World Health Organization
, Alexandra Fleischmann and colleagues report the results of a multicountry
intervention study to test brief intervention and contact with suicide
attempters against treatment as usual. Those in the study were randomly
assigned to treatment as usual or brief intervention and contact. Survival
at 18 months was significantly higher in the intervention group.

“The brief intervention and contact treatment modality included, in
addition to treatment as usual, a 1-hour individual information session as
close to the time of discharge as possible and, after discharge, nine
follow-up contacts (phone calls or visits, as appropriate) according to a
specific time-line up to 18 months (at 1, 2, 4, 7 and 11 week(s), and 4,
6,12 and 18 months), conducted by a person with clinical experience (e.g.
doctor, nurse, psychologist). The individual information session was
conducted according to
a written protocol which all sites adhered to. It included information
about suicidal behaviour as a sign of psychological and/or social distress,
risk and protective factors, basic epidemiology, repetition, alternatives
to suicidal behaviours, and referral options.”

Although conducted in developing countries, the study results are of wider
interest. Any intervention which is affordable in developing countries will
also be affordable in industrialized ones.

As for the control of suicide methods, I partly agree. I left this as the last of my priorities precisely because it is dealing with the symptom and not the cause. I also agree that there is some degree to which regulation of suicide methods will simply cause people to change methods. However, this is not entirely true. There is evidence that removing so-called “easier” methods of suicide reduces suicide rates. The pesticide problem in poorer countries provides some useful examples. In Sri Lanka, reductions in suicide have coincided with restrictions on imports and sales of the most toxic pesticides.

Further, by switching common methods of suicide to less effective ones, we can gain more time to treat people and bring them into mental health programs. For example, studies suggest that there is no greater suicidal intent in those who intentionally ingest toxic pesticides than in those who intentionally overdose on prescription drugs (as is much more common in richer countries which have greater regulation of pesticides). However, the former are much more likely to succeed in their suicide attempt. Thus by reducing availability of more effective methods, we can effectively reduce suicide rates and bring the attempted suicides into mental health programs (see here for more details: http://ije.oxfordjournals.org/content/32/6/902.long ).

Having said that, it is of course vital that there are strong support systems available both in communities and in health systems to help those who have attempted suicide or are contemplating suicide; so I completely agree that this should never stray from the forefront of our strategies.