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Systematic Review

Population- and Community-Based Interventions to Prevent Suicide

A Systematic Review

Published Online:https://doi.org/10.1027/0227-5910/a000873

Abstract.Background: Suicide is estimated to account for 1.4% of deaths worldwide, making it among the leading causes of premature death. Public health approaches to reduce suicide have the potential to reach individuals across the spectrum of suicide risk. Aims: To review the effectiveness of newer community-based or population-level suicide prevention strategies. Methods: We conducted a systematic review of literature published from January 2010 to November 2020 to evaluate the effectiveness of community- and population-level interventions. The US Center for Disease Control framework was used for grouping studies by strategy. Results: We included 56 publications that described 47 unique studies. Interventions that reduce access to lethal means, implement organizational policies and culture in police workplace settings, and involve community screening for depression may reduce suicide deaths. It is unclear if other interventions such as public awareness and education campaigns, crisis lines, and gatekeeper training prevent suicide. Evidence was inconsistent for community-based, multistrategy interventions. The most promising multistrategy intervention was the European Alliance Against Depression. Limitations: Most eligible studies were observational and many lacked concurrent control groups or adjustment for confounding variables. Conclusions: Community-based interventions that may reduce suicide deaths include reducing access to lethal means, implementing organizational policies in workplace settings, screening for depression, and the multistrategy European Alliance Against Depression Program. Evidence was unclear, inconsistent, or lacking regarding the impact of many other single- or multistrategy interventions on suicide deaths.

References

  • Bertolote, J. M., & Fleischmann, A. (2002). Suicide and psychiatric diagnosis: A worldwide perspective. World Psychiatry, 1(3), 181–185. First citation in articleMedlineGoogle Scholar

  • Chen, Y.-Y., Chen, F., Chang, S.-S., Wong, J., & Yip, P. S. F. (2015). Assessing the efficacy of restricting access to barbecue charcoal for suicide prevention in Taiwan: A community-based intervention trial. PLoS ONE, 10(8), Article e0133809. 10.1371/journal.pone.0133809 First citation in articleCrossref MedlineGoogle Scholar

  • Chung, Y. W., Kang, S. J., Matsubayashi, T., Sawada, Y., & Ueda, M. (2016). The effectiveness of platform screen doors for the prevention of subway suicides in South Korea. Journal of Affective Disorders, 194, 80–83. 10.1016/j.jad.2016.01.026 First citation in articleCrossref MedlineGoogle Scholar

  • Collings, S., Jenkin, G., Stanley, J., McKenzie, S., & Hatcher, S. (2018). Preventing suicidal behaviours with a multilevel intervention: A cluster randomised controlled trial. BMC Public Health, 18(1), Article 140. 10.1186/s12889-018-5032-6 First citation in articleCrossref MedlineGoogle Scholar

  • Dezsö, D., Konrad, N., Seewald, K., & Opitz-Welke, A. (2018). Implementation of a suicide risk screening instrument in a remand prison service in Berlin. Frontiers in Psychiatry, 9, Article 665. 10.3389/fpsyt.2018.00665 First citation in articleCrossref MedlineGoogle Scholar

  • Doran, C. M., Ling, R., Gullestrup, J., Swannell, S., & Milner, A. (2016). The impact of a suicide prevention strategy on reducing the economic cost of suicide in the New South Wales construction industry. Crisis, 37(2), 121–129. 10.1027/0227-5910/a000362 First citation in articleLinkGoogle Scholar

  • Godoy Garraza, L., Kuiper, N., Goldston, D., McKeon, R., & Walrath, C. (2019). Long‐term impact of the Garrett Lee Smith Youth Suicide Prevention Program on youth suicide mortality, 2006–2015. Journal of Child Psychology and Psychiatry, 60(10), 1142–1147. 10.1111/jcpp.13058 First citation in articleCrossref MedlineGoogle Scholar

  • Godoy Garraza, L., Walrath, C., Goldston, D. B., Reid, H., & McKeon, R. (2015). Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on suicide attempts among youths. JAMA Psychiatry, 72(11), 1143–1149. 10.1001/jamapsychiatry.2015.1933 First citation in articleCrossref MedlineGoogle Scholar

  • Graetz, N., Preston, S. H., Peele, M., & Elo, I. T. (2020). Ecological factors associated with suicide mortality among non-Hispanic whites. BMC Public Health, 20(1), Article 1339. 10.1186/s12889-020-09379-w First citation in articleCrossref MedlineGoogle Scholar

  • Guyatt, G. H., Oxman, A. D., Kunz, R., Vist, G. E., Falck-Ytter, Y., & Schünemann, H. J. (2008). What is “quality of evidence” and why is it important to clinicians? BMJ, 336(7651), 995–998. 10.1136/bmj.39490.551019.BE First citation in articleCrossref MedlineGoogle Scholar

  • Hegerl, U., Maxwell, M., Harris, F., Koburger, N., Mergl, R., Székely, A., Arensman, E., Van Audenhove, C., Larkin, C., Toth, M. D., Quintão, S., Värnik, A., Genz, A., Sarchiapone, M., McDaid, D., Schmidtke, A., Purebl, G., Coyne, J. C., & Gusmão, R., & OSPI-Europe Consortium. (2019). Prevention of suicidal behaviour: Results of a controlled community-based intervention study in four European countries. PLoS ONE, 14(11), Article e0224602. 10.1371/journal.pone.0224602 First citation in articleCrossref MedlineGoogle Scholar

  • Hegerl, U., Mergl, R., Havers, I., Schmidtke, A., Lehfeld, H., Niklewski, G., & Althaus, D. (2010). Sustainable effects on suicidality were found for the Nuremberg alliance against depression. European Archives of Psychiatry and Clinical Neuroscience, 260(5), 401–406. 10.1007/s00406-009-0088-z First citation in articleCrossref MedlineGoogle Scholar

  • Hemmer, A., Meier, P., & Reisch, T. (2017). Comparing different suicide prevention measures at bridges and buildings: Lessons we have learned from a national survey in Switzerland. PLoS ONE, 12(1), Article e0169625. 10.1371/journal.pone.0169625 First citation in articleCrossref MedlineGoogle Scholar

  • Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., & Sterne, J. A. C. & Cochrane Bias Methods Group. (2011). The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 343, Article d5928. 10.1136/bmj.d5928 First citation in articleCrossref MedlineGoogle Scholar

  • Hübner-Liebermann, B., Neuner, T., Hegerl, U., Hajak, G., & Spiessl, H. (2010). Reducing suicides through an alliance against depression? General Hospital Psychiatry, 32(5), 514–518. 10.1016/j.genhosppsych.2010.06.008 First citation in articleCrossref MedlineGoogle Scholar

  • Hultcrantz, M., Rind, D., Akl, E. A., Treweek, S., Mustafa, R. A., Iorio, A., Alper, B. S., Meerpohl, J. J., Murad, M. H., Ansari, M. T., Katikireddi, S. V., Östlund, P., Tranæus, S., Christensen, R., Gartlehner, G., Brozek, J., Izcovich, A., Schünemann, H., & Guyatt, G. (2017). The GRADE Working Group clarifies the construct of certainty of evidence. Journal of Clinical Epidemiology, 87, 4–13. 10.1016/j.jclinepi.2017.05.006 First citation in articleCrossref MedlineGoogle Scholar

  • Jo, S.-J., Yun, M. K., & Lee, M.-S. (2019). Effects of a province-based strategy to prevent suicide using charcoal burning: A preliminary time series analysis. Psychiatry Investigation, 16(8), 621–624. 10.30773/pi.2019.06.13 First citation in articleCrossref MedlineGoogle Scholar

  • Kato, R., & Okada, M. (2019). Can financial support reduce suicide mortality rates? International Journal of Environmental Research and Public Health, 16(23), Article 4797. 10.3390/ijerph16234797 First citation in articleCrossref MedlineGoogle Scholar

  • Knox, K. L., Pflanz, S., Talcott, G. W., Campise, R. L., Lavigne, J. E., Bajorska, A., Tu, X., & Caine, E. D. (2010). The US Air Force suicide prevention program: Implications for public health policy. American Journal of Public Health, 100(12), 2457–2463. 10.2105/AJPH.2009.159871 First citation in articleCrossref MedlineGoogle Scholar

  • Lai, C. C. S., Law, Y. W., Shum, A. K. Y., Ip, F. W. L., & Yip, P. S. F. (2020). A community-based response to a suicide cluster. Crisis, 41(3), 163–171. 10.1027/0227-5910/a000616 First citation in articleLinkGoogle Scholar

  • Law, C.-k., Sveticic, J., & De Leo, D. (2014). Restricting access to a suicide hotspot does not shift the problem to another location. An experiment of two river bridges in Brisbane, Australia. Australian and New Zealand Journal of Public Health, 38(2), 134–138. 10.1111/1753-6405.12157 First citation in articleCrossref MedlineGoogle Scholar

  • Law, C. K., & Yip, P. S. F. (2011). An economic evaluation of setting up physical barriers in railway stations for preventing railway injury: Evidence from Hong Kong. Journal of Epidemiology & Community Health, 65(10), 915–920. 10.1136/jech.2010.115188 First citation in articleCrossref MedlineGoogle Scholar

  • Law, Y. W., Yeung, T. L., Ip, F. W. L., & Yip, P. S. F. (2019). Evidence-based Suicide Prevention: Collective Impact of engagement with community stakeholders. Journal of Evidence-Based Social Work, 16(2), 211–227. 10.1080/23761407.2019.1578318 First citation in articleCrossrefGoogle Scholar

  • Lee, S.-U., Park, J.-I., Lee, S., Oh, I.-H., Choi, J.-M., & Oh, C.-M. (2018). Changing trends in suicide rates in South Korea from 1993 to 2016: A descriptive study. BMJ Open, 8(9), Article e023144. 10.1136/bmjopen-2018-023144 First citation in articleCrossref MedlineGoogle Scholar

  • Lung, F.-W., Liao, S.-C., Wu, C.-Y., & Lee, M.-B. (2017). The effectiveness of suicide prevention programmes: Urban and gender disparity in age-specific suicide rates in a Taiwanese population. Public Health, 147, 136–143. 10.1016/j.puhe.2017.01.030 First citation in articleCrossref MedlineGoogle Scholar

  • Mann, J. J., 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., …, & Hendin, H. (2005). Suicide prevention strategies. JAMA, 294(16), 2064–2074. 10.1001/jama.294.16.2064 First citation in articleCrossref MedlineGoogle Scholar

  • Mann, J. J., Michel, C. A., & Auerbach, R. P. (2021). Improving suicide prevention through evidence-based strategies: A systematic review. American Journal of Psychiatry, 178(7), 611–624. 10.1176/appi.ajp.2020.20060864 First citation in articleCrossref MedlineGoogle Scholar

  • Matsubayashi, T., Sawada, Y., & Ueda, M. (2014). Does the installation of blue Lights on train platforms shift suicide to another station?: Evidence from Japan. Journal of Affective Disorders, 169, 57–60. 10.1016/j.jad.2014.07.036 First citation in articleCrossref MedlineGoogle Scholar

  • Matsubayashi, T., Ueda, M., & Sawada, Y. (2014). The effect of public awareness campaigns on suicides: Evidence from Nagoya, Japan. Journal of Affective Disorders, 152-154, 526–529. 10.1016/j.jad.2013.09.007 First citation in articleCrossref MedlineGoogle Scholar

  • Mishara, B. L., & Martin, N. (2012). Effects of a comprehensive police suicide prevention program. Crisis, 33(3), 162–168. 10.1027/0227-5910/a000125 First citation in articleLinkGoogle Scholar

  • Montgomery, A. E., Dichter, M., Byrne, T., & Blosnich, J. (2020). Intervention to address homelessness and all-cause and suicide mortality among unstably housed US Veterans, 2012–2016. Journal of Epidemiol Community Health, 75(4), 380–386. 10.1136/jech-2020-214664 First citation in articleCrossrefGoogle Scholar

  • Nakanishi, M., Endo, K., Ando, S., & Nishida, A. (2020). The impact of Suicide Prevention Act (2006) on suicides in Japan. Crisis, 41(1), 24–31. 10.1027/0227-5910/a000599 First citation in articleLinkGoogle Scholar

  • Nakanishi, M., Yamauchi, T., & Takeshima, T. (2015). National strategy for suicide prevention in Japan: Impact of a national fund on progress of developing systems for suicide prevention and implementing initiatives among local authorities. Psychiatry and Clinical Neurosciences, 69(1), 55–64. 10.1111/pcn.12222 First citation in articleCrossref MedlineGoogle Scholar

  • Ono, Y., Sakai, A., Otsuka, K., Uda, H., Oyama, H., Ishizuka, N., Awata, S., Ishida, Y., Iwasa, H., Kamei, Y., Motohashi, Y., Nakamura, J., Nishi, N., Watanabe, N., Yotsumoto, T., Nakagawa, A., Suzuki, Y., Tajima, M., Tanaka, E., Sakai, H., & Yonemoto, N. (2013). Effectiveness of a multimodal community intervention program to prevent suicide and suicide attempts: A quasi-experimental study. PLoS ONE, 8(10), Article e74902. 10.1371/journal.pone.0074902 First citation in articleCrossref MedlineGoogle Scholar

  • Oyama, H., & Sakashita, T. (2016). Long-term effects of a screening intervention for depression on suicide rates among Japanese community-dwelling older adults. The American Journal of Geriatric Psychiatry, 24(4), 287–296. 10.1016/j.jagp.2015.10.008 First citation in articleCrossref MedlineGoogle Scholar

  • Oyama, H., & Sakashita, T. (2017). Community-based screening intervention for depression affects suicide rates among middle-aged Japanese adults. Psychological Medicine, 47(8), 1500–1509. 10.1017/S0033291717000204 First citation in articleCrossref MedlineGoogle Scholar

  • Page, A., Taylor, R., Gunnell, D., Carter, G., Morrell, S., & Martin, G. (2011). Effectiveness of Australian youth suicide prevention initiatives. The British Journal of Psychiatry, 199(5), 423–429. 10.1192/bjp.bp.111.093856 First citation in articleCrossref MedlineGoogle Scholar

  • Perron, S., Burrows, S., Fournier, M., Perron, P.-A., & Ouellet, F. (2013). Installation of a bridge barrier as a Suicide Prevention Strategy in Montréal, Québec, Canada. American Journal of Public Health, 103(7), 1235–1239. 10.2105/AJPH.2012.301089 First citation in articleCrossref MedlineGoogle Scholar

  • Pirkis, J., Rossetto, A., Nicholas, A., Ftanou, M., Robinson, J., & Reavley, N. (2019). Suicide prevention media campaigns: A systematic literature review. Health Communication, 34(4), 402–414. 10.1080/10410236.2017.1405484 First citation in articleCrossref MedlineGoogle Scholar

  • Pirkis, J., Too, L. S., Spittal, M. J., Krysinska, K., Robinson, J., & Cheung, Y. T. D. (2015). Interventions to reduce suicides at suicide hotspots: A systematic review and meta-analysis. The Lancet Psychiatry, 2(11), 994–1001. 10.1016/S2215-0366(15)00266-7 First citation in articleCrossref MedlineGoogle Scholar

  • Ross, V., Koo, Y. W., & Kõlves, K. (2020). A suicide prevention initiative at a jumping site: A mixed-methods evaluation. EClinicalMedicine, 19, Article 100265. 10.1016/j.eclinm.2020.100265 First citation in articleCrossref MedlineGoogle Scholar

  • Santesso, N., Glenton, C., Dahm, P., Garner, P., Akl, E. A., Alper, B., Brignardello-Petersen, R., Carrasco-Labra, A., De Beer, H., Hultcrantz, M., Kuijpers, T., Meerpohl, J., Morgan, R., Mustafa, R., Skoetz, N., Sultan, S., Wiysonge, C., Guyatt, G., & Schünemann, H. J. (2020). GRADE guidelines 26: Informative statements to communicate the findings of systematic reviews of interventions. Journal of Clinical Epidemiology, 119, 126–135. 10.1016/j.jclinepi.2019.10.014 First citation in articleCrossref MedlineGoogle Scholar

  • Sareen, J., Isaak, C., Bolton, S.-L., Enns, M. W., Elias, B., Deane, F., Munro, G., Stein, M. B., Chateau, D., Gould, M., & Katz, L. Y. (2013). Gatekeeper training for suicide prevention in First Nations community members: A randomized controlled trial. Depression & Anxiety, 30(10), 1021–1029. 10.1002/da.22141 First citation in articleCrossref MedlineGoogle Scholar

  • Schilling, E. A., Aseltine, R. H., Jr., & James, A. (2016). The SOS Suicide Prevention Program: Further evidence of efficacy and effectiveness. Prevention Science, 17(2), 157–166. 10.1007/s11121-015-0594-3 First citation in articleCrossref MedlineGoogle Scholar

  • Shekelle, P., Bagley, S., & Munjas, B. (2009). Strategies for suicide prevention in veterans. https://www.hsrd.research.va.gov/publications/esp/Suicide-Prevention-2009.pdf First citation in articleGoogle Scholar

  • Shelef, L., Tatsa-Laur, L., Derazne, E., Mann, J. J., & Fruchter, E. (2016). An effective suicide prevention program in the Israeli Defense Forces: A cohort study. European Psychiatry, 31, 37–43. 10.1016/j.eurpsy.2015.10.004 First citation in articleCrossref MedlineGoogle Scholar

  • Sinyor, M., Schaffer, A., Redelmeier, D. A., Kiss, A., Nishikawa, Y., Cheung, A. H., Levitt, A. J., & Pirkis, J. (2017). Did the suicide barrier work after all? Revisiting the Bloor Viaduct natural experiment and its impact on suicide rates in Toronto. BMJ Open, 7(5), Article e015299. 10.1136/bmjopen-2016-015299 First citation in articleCrossref MedlineGoogle Scholar

  • Stack, S. (2015). Crisis phones – suicide prevention versus suggestion/contagion effects. Crisis, 36(3), 220–224. 10.1027/0227-5910/a000313 First citation in articleLinkGoogle Scholar

  • Stone, D., Holland, K. M., Holland, K., Holland, B., Crosby, A., Davis, S., & Wilkins, N. (2017). Preventing suicide: A technical package of policies, programs, and practice. 10.15620/cdc.44275 First citation in articleCrossrefGoogle Scholar

  • Székely, A., Konkolÿ Thege, B., Mergl, R., Birkás, E., Rózsa, S., Purebl, G., & Hegerl, U. (2013). How to decrease suicide rates in both genders? An effectiveness study of a community-based intervention (EAAD). PLoS ONE, 8(9), Article e75081. 10.1371/journal.pone.0075081 First citation in articleCrossref MedlineGoogle Scholar

  • Till, B., Sonneck, G., Baldauf, G., Steiner, E., & Niederkrotenthaler, T. (2013). Reasons to love life. Crisis, 34(6), 382–389. 10.1027/0227-5910/a000212 First citation in articleLinkGoogle Scholar

  • Tufanaru, C., Munn, Z., Aromataris, E., Campbell, J., & Hopp, L. (2020). Systematic reviews of effectiveness. In E. AromatarisZ. Munn (Eds.), JBI manual for evidence synthesis. JBI. https://synthesismanual.jbi.global First citation in articleCrossrefGoogle Scholar

  • Ueda, M., Sawada, Y., & Matsubayashi, T. (2015). The effectiveness of installing physical barriers for preventing railway suicides and accidents: Evidence from Japan. Journal of Affective Disorders, 178, 1–4. https://doi.org/10.1016/j.jad.2015.02.017 First citation in articleCrossref MedlineGoogle Scholar

  • US Department of Health and Human Services. (2021). The Surgeon General's Call to Action to Implement the National Strategy for Suicide Prevention. https://www.hhs.gov/sites/default/files/sprc-call-to-action.pdf First citation in articleGoogle Scholar

  • US Department of Veterans Affairs. (2018). National Strategy for Preventing Veteran Suicide 2018–2028. https://www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-Health-and-Suicide-Prevention-National-Strategy-for-Preventing-Veterans-Suicide.pdf First citation in articleGoogle Scholar

  • US Department of Veterans Affairs. (2020). PREVENTS: The presidents’ roadmap to empower veterans and end a national tragedy of suicide. https://www.va.gov/PREVENTS/docs/PRE-007-The-PREVENTS-Roadmap-1-2_508.pdf First citation in articleGoogle Scholar

  • Wasserman, D., Hoven, C. W., Wasserman, C., Wall, M., Eisenberg, R., Hadlaczky, G., Kelleher, I., Sarchiapone, M., Apter, A., Balazs, J., Bobes, J., Brunner, R., Corcoran, P., Cosman, D., Guillemin, F., Haring, C., Iosue, M., Kaess, M., Kahn, J.-P., …, & Carli, V. (2015). School-based suicide prevention programmes: The SEYLE cluster-randomised, controlled trial. The Lancet, 385(9977), 1536–1544. 10.1016/S0140-6736(14)61213-7 First citation in articleCrossref MedlineGoogle Scholar

  • WHO (2013). Mental health action plan: 2013–2020. https://www.who.int/publications/i/item/9789241506021 First citation in articleGoogle Scholar

  • WHO (2021). Suicide worldwide in 2019: Global health estimates. https://www.who.int/publications/i/item/9789240026643 First citation in articleGoogle Scholar

  • Yip, P. S. F., Law, C. K., Fu, K.-W., Law, Y. W., Wong, P. W. C., & Xu, Y. (2010). Restricting the means of suicide by charcoal burning. The British Journal of Psychiatry, 196(3), 241–242. 10.1192/bjp.bp.109.065185 First citation in articleCrossref MedlineGoogle Scholar

  • Zalsman, G., Hawton, K., Wasserman, D., van Heeringen, K., Arensman, E., Sarchiapone, M., Carli, V., Höschl, C., Barzilay, R., Balazs, J., Purebl, G., Kahn, J. P., Sáiz, P. A., Lipsicas, C. B., Bobes, J., Cozman, D., Hegerl, U., & Zohar, J. (2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry, 3(7), 646–659. 10.1016/S2215-0366(16)30030-X First citation in articleCrossref MedlineGoogle Scholar