Preventing suicide and self-harm: What works?
In June and July two major systematic reviews in the area of suicide and self-harm prevention were published in Lancet Psychiatry. One review by Zalsman et al (2016) reported on the evidence base for suicide prevention initiatives over the past ten years. The second review by Hawton et al (2016) presented new evidence on the effectiveness of psychosocial treatments for self-harm. Both reviews represent a major resource for stakeholders in health services and policy development relating to suicide and self-harm prevention.
Suicide prevention strategies revisited 10-year systematic review
The purpose of this review was to synthesise and summarise the evidence for the effectiveness of suicide prevention initiatives since the review by Mann et al in 2005, which is timely considering the recommendations from WHO for governments of all WHO members states to develop and implement a national suicide prevention programme (WHO, 2014). As many countries are developing suicide prevention strategies, up-to-date, high-quality evidence is required.
A total of 164 studies were included in the review. The outcomes from these studies strengthen the evidence base in several areas of suicide prevention, including restricting access to lethal means, school-based awareness programmes in reducing suicide attempts and ideation, psychological treatments, in particular Cognitive Behavioural Therapy and Dialectical Behaviour Therapy, and pharmacological treatment, in particular lithium and clozapine.
The review identified emerging evidence for suicide prevention by screening in primary care, general public awareness campaigns and implementing media guidelines for the reporting of suicide.
Implementation of these evidence based interventions has the potential to change public health strategies in suicide prevention plans, strengthen the recommendations of the WHO global report on suicide prevention (WHO, 2014), and significantly reduce the number of deaths due to suicide.
Psychosocial interventions following self-harm in adults: A systematic review and meta-analysis
Self-harm (intentional acts of non-fatal self-poisoning or self-injury) is common, particularly in adolescents and young adults aged 15-35 years, often repeated, and strongly associated with suicide, in particular among men. Effective aftercare of individuals who self-harm is therefore important. A Cochrane systematic review and meta-analysis was conducted on the effectiveness of psychosocial interventions for self-harm.
The review included 55 randomised controlled trials including 17,699 participants. The most commonly evaluated intervention involved CBT-based psychological therapy with a duration of an average of 10 sessions. At follow-up, people who had received CBT were significantly less likely to have engaged in repeated self-harm compared to those receiving treatment as usual. For people with a history of multiple self-harm episodes, Dialectical Behaviour Therapy was identified as reducing the frequency of repeated self-harm, but did not reduce the proportion of individuals repeating self-harm. However, the number of RCTs conducted so far is relatively small.
I would strongly recommend that this new evidence be integrated in implementing the evidence based core interventions of the Irish National Strategy to Reduce Suicide in Ireland, Connecting for Life, 2015-2020 (Department of Health, 2015).
Prof Ella Arensman,
National Suicide Research Foundation &
Department of Epidemiology and Public Health, UCC
Department of Health. National Strategy to Reduce Suicide in Ireland, Connecting for Life, 2015-2020. Department of Health, Dublin, 2015.
Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Townsend E, van Heeringen K, Hazell P. Self-harm: A systematic review of the efficacy of psychosocial treatments for adults. Lancet Psychiatry, 201; 3(8):740-50.
Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, Hegerl U, Lonnqvist J, Malone K, Marusic A, Mehlum L, Patton G, Phillips M, Rutz W, Rihmer Z, Schmidtke A, Shaffer D, Silverman M, Takahashi Y, Varnik A, Wasserman D, Yip P, Hendin H. Suicide Prevention Strategies:A Systematic Review. JAMA.2005; 294(16):2064-2074.
Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, Carli V, Hoschl C, Barzilay R, Balazs J, Purebl G, Kahn JP, Sáiz PA, Bursztein Lipsicas C, Bobes J, Cozman D, Hegerl U, Zohar J. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry, 2016; 3(7), 646-59.
World Health Organization. Suicide Prevention – A Global Imperative. WHO – Geneva, 2014.
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