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Evidence-based Approaches to Suicide Preventon: Exemplars in Reducing Risk and Increasing Protection in Community and Military Settings
Transcript of Evidence-based Approaches to Suicide Preventon: Exemplars in Reducing Risk and Increasing Protection in Community and Military Settings
Mental Health Intervention Spectrum
Complexity can confound prevention efforts.
Centers for Disease Control and Prevention
Measurement can confound research
Suicide has multiple contributing factors
Suicide "Prevention" Programs
Programs for clinicians
Programs for Communities
Programs for EDs
Programs for Schools
Programs for families
Although NSSP 1.0 espoused a “public health approach,” many interpreted this as equivalent to case finding of imminently suicidal individuals through deploying screening programs and gatekeeper training programs in high schools and universities—although neither has ever demonstrated any impact on rates of suicide or attempted suicide.
Evidence-based Approaches to Suicide Prevention: Exemplars in Reducing Risk & Increasing Protection in Community & Military Settings
The Good Behavior Game...
Service use for emotional, behavioral, drug, or alcohol problems.
Poduska et al. (2008)
The Good Behavior Game in short:
The class is divided into two teams.
The teams compete for fewest disruptions.
At the end of the week one or both teams win.
Disruptive behavior markedly decreased because of the Good Behavior Game.
Donaldson et al. (2011)
Drug abuse or
Kellam et al. (2008)
Anti-social Personality Disorders, but...
Anti-social personality disorder for those who were highly disruptive/ aggressive in 1st grade.
Kellam et al. (2008)
Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates. Other interventions need more evidence of efficacy.
What is the state of knowledge?
The challenge in identifying best practices for suicide prevention is the lack of data on the effectiveness of programs. A best practice for suicide prevention would be one supported by empirical evidence showing that it causally reduced suicides. Currently, only a handful of programs would meet this definition.
The US Air Force Program
Perfect Depression Care Initiative
Assessment & evaluation
Availability of services/support
Within Henry Ford Behavioral Health System
Dealing with suicide through professional military education
Guidelines for commanders: use of mental health services
Community preventive services
Community education and training
Investigative interview policy
Critical incident stress management (CISM)
Integrated delivery system (IDS) for human services prevention, chartered as a standing subcommittee of
Limited patient privilege
Behavioural health survey
Suicide event surveillance system
Knox, Litts, Talcott, Catalano, & Caine (2003) Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: Cohort study. BMJ, 327.
Hampton. (2010). Depression care effort brings dramatic drop in large HMO population's suicide rate. JAMA, 303(19), 1903-1905.
We have "Little data about what really works in the real world."
Sources of Strength
David Rudd's 5 Elements of effective suicide prevention psychotherapies.
1. Easy to understand treatment model
2. Focus on treatment compliance
3. Focus on skill-building
4. Take personal responsibility
5. Provide easy access to treatment and crisis services
--Crisis management/safety plan
Langford, Litts, & Pearson. (2012). Using science to mprove communications about suicide among military veteran populations: Looking for a few good messages. American Journal of Public Health.
Motto & Bostrom (2001). A randomized controlled trail of postcrisis suicide prevention. Psychiatric Services, 51(6).
Current suicide prevention: Lots of action--but weak measurement of lethal or near lethal outcomes (attempts, deaths)
Source: David Knesper, University of Michigan
It is incomprehensible that, in many states, a teacher is now required to have more training on suicide warning signs and risk factors than the mental health professionals to whom he or she is directing potentially suicidal students.
Schmitz, Allen, Feldman, Gutin et al. (2012). Preventing Suicide through Improved Training in Suicide Risk Assessment and Care: An American Association of Suicidology Task Force Report Addressing Serious Gaps in U.S. Mental Health Training. Suicide and Life-Threatening Behavior 42(3) June 2012.
Expanding the Paradigm
Caine, E. (2013). Forging an agenda for suicide prevention in the United States. American Journal of Public Health, 103(5), 822-829.
As a result of our difficulty in measuring suicide, we often use proxy variables or surrogate endpoints to measure program "effectiveness". This confounds the term effective or evidence-based.
For every difficult problem, there is a simple answer...that is wrong.
Psychotherapies for Suicide Prevention