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Reducing Suicide: A National Imperative
Universal, selective, and indicated prevention programs that provide skills training show promise in increasing coping skills and to reducing hopelessness. School-based programs have been shown to enhance social support, self-efficacy, and self-esteem and may reduce depression, substance abuse, and suicidality. Training gatekeepers including responsible school staff or primary care physicians may be effective for identifying individuals at risk and obtaining assistance. Placing depression care managers in primary care practices may prove to be of benefit in reducing suicidal behaviors. The value of intervention programs, however, is frequently difficult to assess because of their short duration, often inadequate control populations, and limited long-term follow-up.
School-based intervention programs at the universal, selective, and indicated levels can help to limit suicide among youths and should be pursued. Efforts should provide skills training, gatekeeper training, a crisis response plan, and screening for youth at risk. Evidence-based programs, especially longer-term approaches couched in a broader context of teaching skills and establishing appropriate follow-through and services appear the most effective against suicide. Brief, didactic suicide prevention programs with no connection to services should be avoided.
Some suicide prevention programs targeting special populations have shown promise. Such models can inform national efforts regarding specific strategies for implementing effective programs in high-risk or special populations, such as policemen, indigenous peoples, and the elderly.
Comprehensive, integrated state and national suicide prevention strategies that target suicide risk and barriers to treatment across levels and domains appear to reduce suicide. Evaluation of such programs remains challenging given the multitude of variables on the individual and aggregate level that interact to affect suicide rates. Lack of adequate planning and funding for evaluation have seriously hampered prevention efforts.
Prevention and intervention trials must be carefully designed with appropriate controls and rigorously evaluated with long-term follow-up in order to know what works. Furthermore, it is critical that these interventions be assessed to determine if they can be applied to populations other than those in the original test and to define the characteristics that make a program generally effective.