Suicide prevention: restricting access to lethal means is effective
While many suicide prevention techniques are effective, others have not been proven to be beneficial.
Some methods of suicide prevention, including restricting access to analgesics and suicide-by-jumping hot-spots, are effective, while others, such as internet and helpline support, require further investigation, according to an international review published in Lancet Psychiatry.
Gil Zalsman, MD, Tel Aviv University, Division of Molecular Imaging and Neuropathology and Columbia University, Department of Psychiatry, and colleagues conducted a narrative analysis of 7 suicide interventions:
- Public and physician education
- Media strategies
- Restricting access to suicide means
- Internet or hotline support
Analyzed studies were published between 2005 and 2014; 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of presented evidence.
The researchers identified 1797 studies eligible for inclusion (23 systematic reviews, 12 meta-analyses, 40 randomized controlled trials, 67 cohort trials, and 22 ecological or population-based interventions). Since 2005, evidence has shown that restricting access to lethal means and jumping suicide hot-spots have reduced suicides by 43% and 86%, respectively. School-based awareness programs have reduced suicide attempts and suicidal ideation. Additionally, data confirmed the anti-suicidal effects of clozapine and lithium. Key to preventing suicide is the implementation of effective pharmacological and psychological treatments for depression.
“One of the main findings is that restricting easy access to ways of taking your own life is a key element,” noted Dr Zalsman. “Other effective measures include physical barriers being erected at known suicide spots such as high bridges. The report concludes that if an impulsive attempted suicide is deterred, often these measures are enough to save a life.”
“We found that there is no single way of preventing suicide; however implementation of the evidence-supported methods described in this study, including public and physician education and awareness together with appropriate legislation, has the potential to change public health strategies in suicide prevention plans,” said Joseph Zohar, MD, Psychiatry Department, Sheba Health Center and Sackler School of Medicine, Tel Aviv University. “With these measures, we can significantly reduce the number of deaths due to suicide.”
In an accompanying comment, Gustavo Turecki, MD, McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, emphasized that suicide prevention is a global imperative.
“Optimization of population-level suicide prevention strategies is challenging, owing to the lack of clear evidence describing the efficacy of individual approaches,” Dr Turecki noted. “This review [by Dr Zalsman and colleagues] fulfills an important role in highlighting areas of potential discrepancy between expert opinion, legislation, or public policy, and available scientific data.”
- Zalsman G, Hawton K, Wasserman D, et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. 2016; doi: 10.1016/S2215-0366(16)30030-X
- Turecki G. Preventing suicide: where are we? Lancet Psychiatry. 2016; doi: 10.1016/S2215-0366(16)30068-2