Many interventions are in place to reduce and prevent suicide. Below we present research on interventions that have shown the potential to reduce suicide attempts, or have actually reduced suicide. We also include studies showing interventions that have been used successfully to treat illnesses known to be associated with suicide.
Several studies have shown that teaching general practitioners to recognize and treat depression decreases suicide rates among their patients. One study showed that as antidepressant use increased, rates of suicide decreased. These studies demonstrate that educating physicians to recognize and appropriately treat depression can reduce suicide rates.
System-wide Suicide Prevention Approaches: the U.S. Air Force as a Model Program
The U.S. Air Force implemented a top-down, system-wide approach to suicide prevention. The 11-pronged model program began with the Chief of Staff and was disseminated through all personnel levels, from commanders to peers, as well as to families and in the community. Educating participants about factors that lead to suicide, and creating rapid intervention teams building on the Air Force buddy system, led to reduced rates of suicide and other adverse outcomes. After the conclusion of the intensive program, the suicide rate again rose. The Air Force maintains tight control of enrollee actions thus making it challenging to successfully reproduce this effective program outside that environment.
Most studies looking at access to means—whether guns, pills, carbon monoxide, bridges, or other suicide methods—have found that making these methods less available reduces suicide rates.
All studies looking at sensational reporting of a suicide show that such reporting increases the risk of contagion, or copycat suicide. As approximately 10% of all suicides in the U.S. are associated with a contagion event, education of reporters in all media is essential to decreasing suicide rates.
Follow-up Interventions for Suicide Attempters that Reduce Suicide
In a study of those admitted to the hospital for treatment after a suicide attempt, participants were asked at discharge whether they had follow up treatment. The study sample was divided into three groups: those who said they had follow-up treatment, those who did not but received the treatment intervention described below, and those who received no intervention. The participants who received the intervention were sent personal letters inquiring about their condition: They received letters monthly for the first four months, every other month for the next eight months, and every three months for the next four years. The study followed all three groups (those who said they had follow-up treatment, those who got the letters and those with no follow up) for five years. The suicide rate in those who were sent the letters was significantly lower during the first two years after their attempt compared with the other two groups. This demonstrates the importance of continued frequent and personal contact after hospitalization for a suicide attempt.
Another study involved people who made suicide attempts identified in emergency units in five countries: Brazil, India, Sri Lanka, Republic of Iran, and China. Study participants either received the hospital’s usual treatment, or usual treatment plus one hour of emergency room education and follow-up contacts either by telephone or in person during the weeks and months after their suicide attempt. The study showed a marked decrease in suicide rates among those who received the intervention compared with those who did not. This study also highlights the need for continued, frequent, and personal contact following a suicide attempt.
Postcard Intervention to Decrease Suicide Attempts
Studies on sending postcards to those who have been seen in an emergency department for a suicide attempt have shown variable results. This suggests that the postcards may not represent a sufficiently personal intervention, and therefore are less effective in decreasing subsequent rates of suicide or suicide attempts.
Targeted Psychotherapy for Suicide Attempters
Studies comparing treatment as usual to manualized short-term Cognitive Behavioral Therapy for suicide attempters (CBT) or Dialectic Behavior Therapy (DBT) for repeated suicide attempters showed greatly reduced rates of suicide attempts during the 18 months following the attempt for those who received either CBT or DBT compared with those who received treatment as usual. This points to the need for increasing the very limited supply of therapists trained in these therapies.
Medication Treatment for Depression
Every one of the 22 FDA-approved antidepressants currently on the market has been proven significantly more effective in reducing depressive symptoms compared with a placebo. Many of these drugs also are proven to prevent relapse in individuals who have had at least three episodes of depression. Additional medications have been approved to help with specific symptoms that persist or with side effects from the medications. Often more than one antidepressant will be prescribed to fully treat depression.
Lithium has been proven effective as a secondary medication in patients treated with antidepressants, and as a first line medication for the treatment of manic episodes or to prevent relapse in bipolar patients. Many small studies show that lithium is also effective in preventing suicide in patients with bipolar illness and in those with recurrent depression. However, no large study has demonstrated lithium’s effectiveness in preventing suicide. Data on the treatment of patients with schizophrenia show that clozapine is more effective than other comparable medications in decreasing suicide attempts and suicides. This highlights the importance of ongoing medication management for patients who are depressed or have other mental disorders.
We currently have no way to predict which medication will be best for a particular patient. Physicians use a trial and error approach to find the most effective medication for each patient with the fewest or most acceptable side effects.
New treatments are always underdevelopment. Ketamine is one such experimental drug that has some severe side effects and can be addicting and is being tested for the treatment of depression and for reducing acute suicidal symptoms. It is an excitatory amino acid (building blocks for our bodies) that acts as a neurotransmitter, helping one nerve communicate with another.
Screening and Engaging Individuals in Clinical Treatment
AFSP’s Interactive Screening Program (ISP) is an anonymous, web-based, interactive questionnaire for those who may be distressed or are experiencing symptoms of depression or other mental disorders that could put them at risk for suicide. The ISP connects the user to an online counselor who offers personalized support aimed at bringing them in for an evaluation. ISP was initially designed for use in colleges and is currently being used in over 70 colleges, graduate schools and medical schools nationwide. Research has shown that people who participated in interactive screening were three to four times more likely to come in for a face-to-face mental health evaluation. It has been adapted for use with Veteran and military personnel, former and current National Football League players and in law enforcement and corporate settings.