Which suicide prevention strategies work?

A new study from Columbia University Vagelos College of Physicians and Surgeons has found that suicide mortality can be reduced by a federally coordinated approach employing scientifically proven options.

Columbia researchers J. John Mann, MD, Christina A. Michel, MA, and Randy P. Auerbach, Ph.D., conducted a systematic review, determining which suicide prevention strategies work and are scalable to national levels.

The study, “Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review,” was published online in the American Journal of Psychiatry.

The researchers found that screening school children or the general population for those at risk for suicide—the tenth leading cause of death in the U.S. with 48,344 suicide deaths in 2018—have generally not reduced suicide rates.

The outstanding exception is training primary care physicians in depression recognition and medication treatment. That approach prevents suicide, often halving the risk.

While educating the public about depression and suicidal behavior has not been shown to prevent suicidal behavior in adults, educating high school students prevents suicidal behavior, though educating their teachers or parents does not.

“Timing is everything,” said Dr. Mann. “Active outreach to psychiatric patients after discharge or following a suicidal crisis both prevent suicidal behavior.”

Although medication treatment of depression is subject to a black box warning by the FDA, meta-analyses of FDA and NIMH-funded study data find antidepressants prevent suicide attempts. But standard antidepressants take weeks to work, which has led to increased interest in intravenously administered ketamine, a promising treatment to reduce suicidal ideation in hours that is untested for suicidal behavior prevention.

The study found that the final line of defense in suicide prevention is reducing access to the most lethal methods for suicide. Half of all suicides in the United States involve a firearm that was mostly purchased years earlier, suggesting that improved gun safety in the home should be a national priority.

Combinations of these approaches in health care systems show promise in reducing suicide rates in the U.K., Denmark, and even parts of the U.S.