Evidence supports the obvious: suicides need not happen.
Evidence supports the obvious: suicides need not happen.
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DOI：
10.1016/s0140-6736(11)61917-x
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发表时间：
2012-03-17
期刊：
影响因子：
168.9
通讯作者：
Farley-Toombs, Carole
中科院分区：
文献类型：
--
作者：
Conwell, Yeates;Farley-Toombs, Carole
Although suicide is a devastating and tragic event, it is a relatively rare one. Every year in England and Wales, roughly one suicide occurs per 1000 patients in treatment with mental health providers, the group at greatest risk. 1 Yet one suicide death is too many, leaving in its wake a legacy of pain and traumatic grief. Reduction, and even elimination, of suicide deaths is a high public health and clinical priority.One consequence of the low base rate of completed suicide is that proving the effectiveness of interventions designed to reduce suicide deaths is very difficult. Without evidence to support such practices, mustering of social, institutional, and political will to sustain them might be impossible. David While and colleagues1 report such evidence in The Lancet for a range of nine widely used suicide prevention practices in public sector mental health service settings. They used data for suicides occurring from Jan 1, 1997, to Dec 31, 2006, in 12 881 patients who were in contact with any of 91 mental health services in England and Wales in the 12 months before death, describing changes in rates relative to regional uptake of key mental health service recommendations over time. Unsurprisingly, the investigators showed that as more service recommendations were implemented, suicide rates in the target populations of service users with mental illness declined. From 2004 onwards, there were fewer suicides in services in which seven to nine recommendations had been implemented (10· 80 suicides per 10 000 in 2004, 95% CI 9· 99–11· 65) than in those where zero to six recommendations were implemented (12· 63, 11· 70–13· 61). Removal of ligature points on inpatient wards was associated with reduction in overall psychiatric inpatient suicide rates (11· 98 suicides per 10 000 per year [95% CI 10· 92–13· 11] vs 15· 66 [14· 65–16· 73]), and implementation of an assertive outreach policy was associated with decreased rates in the subgroup of the patient population that was non-compliant with care (1· 26 suicides per 10 000 per year [95% CI 1· 16–1· 37] vs 1· 77 [1· 65–1· 89]). These and other reported results might seem obvious, but even the obvious can go unseen and, therefore, unfunded. While and colleagues1 do a great service to mental health systems, their providers, and patients by lending strong support to the contention that existing recommendations are effective.
