Table 1 Characteristics of the included studies on suicide prevention in primary healthcare settings
From: Effective suicide prevention strategies in primary healthcare settings: a systematic review
First author | Year | Country | Study design | Major findings/recommendations to suicide prevention in PHC | Target group | Sample size | Type of mental health provider | Effectiveness/outcome measures |
|---|---|---|---|---|---|---|---|---|
WHO [24] | 2012 | WHO | Report | 1. Prevention strategies at the general population level (a) Restrict access to means of self-harm/suicide (b) Develop policies to reduce the harmful use of alcohol as a component of suicide prevention (c) Assist and encourage the media to follow responsible reporting practices of suicide 2. Prevention strategies for vulnerable sub-populations at risk (a) Gatekeeper training (especially various types of healthcare providers) (b) Mobilizing communities (c) Survivors (who have lost someone to suicide) 3. Prevention strategies at the individual level (a) Identification and treatment of mental disorders (b) Management of persons who attempted suicide or who are at risk 4. Improving case registration and conducting research 5. Monitoring and evaluation | General population | Report | Report | Report |
National Action Alliance for Suicide Prevention Executive Committee [25] | 2011 | Report | Report | (1) Screening and risk assessment, (2) intervening to increase coping to ensure safety, (3) treating and caring for persons at-risk of suicide, and (4) follow-up and case management of attempters | General population | Report | Report | Report |
Azizi et al. [7] | 2021 | Iran | Longitudinal | A community-based suicide prevention program was conducted in primary healthcare context for the general population of Malekan County from 2014 to 2017: (1) establishing a research team, (2) creating suicide registration system, (3) conducting research, (4) staff training, (5) case management of suicide attempters, and (6) public awareness campaigns | General population | 117,000 | General practitioners, community health workers, family physicians, and emergency nurses | Suicide, attempt, and re-attempt were lowered by 75%, 22%, and 42%, at the study end, respectively |
Hogan et al. [26] | 2016 | USA | Theoretical model | (1) Establishing a top leadership for suicide prevention, (2) educating heath service providers, (3) screening and risk assessment, (4) systematic suicide care protocol, (5) evidence-based treatment of suicidality, (6) provision of excellent support during care transition, and (7) measuring outcomes and conducting quality improvement | General population | Report | NR | Without implementation |
Solin et al. [27] | 2021 | Finland | Interventional | Training for healthcare providers | General population | 2027 | General practitioners, nurses, public health nurses, and social work professionals | Increased the self-perceived competence of the participants |
Malakouti et al. [4] | 2015 | Iran | Field trial | A field trial was conducted to evaluate the integration of suicide prevention program with primary healthcare in two counties in Iran (intervention and control regions). Interventions included screening and treatment of depressive disorders, training of health service provider, providing intervention protocol for identification and treatment | General population | 522,246 | General practitioners, health technicians, community health workers, and psychiatrists | Suicide surveillance capacity enhanced and subsequently reduced the number of suicides |
Wintersteen et al. [28] | 2013 | USA | Longitudinal | Staff training, screening, and available services on referrals to the emergency department | Adolescents ages 12–18 | 56,352 | Medical, nursing, social work, and reception staff | There were 87% fewer referrals to the ED during the intervention year in the intervention clinic |
Almeida et al. [29] | 2012 | Australia | Interventional | Educational intervention; consisted of a practice audit with personalized automated audit feedback, printed educational material, and 6 monthly educational newsletters delivered over a period of 2 years | 60 years or older | 21,762 | general practitioners | The intervention had no effect on recovery from depression or self-harm behavior, but it prevented the onset of new cases of self-harm behavior during follow-up |
George et al. [30] | 2009 | USA | Interventional | The intervention consisted of services of 15 trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 24 months | 60 years or older | 599 | Care managers, physicians | Compared with patients receiving usual care, the intervention group had a 2.2 times greater decline in suicidal ideation over 24 months |
Hegerl U et al. [31] | 2006 | Germany | Interventional | A 2-year intervention program was performed at four levels: training of family doctors and support through different methods, a public relations campaign informing about depression, cooperation with community facilitators (teachers, priests, local media, etc.), and support for self-help activities as well as for high-risk groups | Patients with depression | 480,000 | Family doctors, teachers, priests, local media, etc. | A reduction in the frequency of suicidal acts was found (19.4% vs. 24%) |