Declines in the Lethality of Suicide Attempts Explain the Decline in Suicide Deaths in Australia

Background: To investigate the epidemiology of a steep decrease in the incidence of suicide deaths in Australia. Methods: National data on suicide deaths and deliberate self-harm for the period 1994–2007 were obtained from the Australian Institute of Health and Welfare. We calculated attempt and death rates for five major methods and the lethality of these methods. Negative binomial regression was used to estimate the size and significance of method-specific time-trends in attempts and lethality. Results: Hanging, motor vehicle exhaust and firearms were the most lethal methods, and together accounted for 72% of all deaths. The lethality of motor vehicle exhaust attempts decreased sharply (RR = 0.94 per year, 95% CI 0.93–0.95) while the motor vehicle exhaust attempt rate changed little; this combination of motor vehicle exhaust trends explained nearly half of the overall decline in suicide deaths. Hanging lethality also decreased sharply (RR = 0.96 per year, 95% CI 0.956–0.965) but large increases in hanging attempts negated the effect on death rates. Firearm lethality changed little while attempts decreased. Conclusion: Declines in the lethality of suicide attempts–especially attempts by motor vehicle exhaust and hanging–explain the remarkable decline in deaths by suicide in Australia since 1997

Understanding service demand for mental health among Australians aged 16 to 64 years according to their possible need for treatment

Background: To inform decisions about mental health resource allocation, planners require reliable estimates of people who report service demand (i.e. people who use or want mental health services) according to their level of possible need. Methods: Using data on 6915 adults aged 16-64 years in Australia's 2007 National Survey of Mental Health and Wellbeing, we examined past-year service demand among respondents grouped into four levels of possible need: (a) 12-month mental disorder; (b) lifetime but no 12-month mental disorder; (c) any other indicator of possible need (12-month symptoms or reaction to stressful event, or lifetime hospitalisation); (d) no indicator of possible need. Multivariate logistic regression analyses examined correlates of service demand, separately for respondents in each of levels 1-3. Results: Sixteen per cent of Australian adults reported service demand, of whom one-third did not meet criteria for a 12-month mental disorder (equivalent to 5.7% of the adult population). Treatment patterns tended to follow a gradient defined by level of possible need. For example, service users with a 12-month disorder received, on average, 1.6-3.9 times more consultations than their counterparts in other levels of possible need, and had 1.9-2.2 times higher rates of psychologist consultation. Service users with a lifetime but not 12-month disorder or any other indicator of need consumed a similar average number of services to people with mild 12-month mental disorders, but received relatively fewer services involving the mental health sector. Service demand was associated with increased suicidality and psychological distress in all levels of possible need examined, and with poorer clinical and functional status for those with 12-month or lifetime disorders. Conclusions: Many Australians reporting service demand do not meet criteria for a current mental disorder, but may require services to maintain recovery following a past episode or because they are experiencing symptoms and significant psychological distress

Interventions to reduce suicides at suicide hotspots: a systematic review

Background: 'Suicide hotspots' include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention. Methods. We searched Medline for studies that could inform the following question: 'What interventions are available to reduce suicides at hotspots, and are they effective?'. Results: There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise. Conclusions: More well-designed intervention studies are needed to strengthen this evidence base. © 2013 Cox et al.; licensee BioMed Central Ltd.published_or_final_versio

Suicide and suicide prevention in Asia

Access the book via http://www.who.int/mental_health/resources/suicide_prevention_asia.pd

Optimising the primary mental health care workforce: how can effective psychological treatments for common mental disorders best be delivered in primary health care?

The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Responding to Young People's Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing.

OBJECTIVE: To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians' detection of health risks and patients' risk taking behaviour, compared to a didactic seminar on young people's health. DESIGN: Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. SETTING: General practices in metropolitan and rural Victoria, Australia. PARTICIPANTS: General practices with at least one interested clinician (general practitioner or nurse) and their 14-24 year old patients. INTERVENTION: This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients' risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. OUTCOME MEASURES: Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients' sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. RESULTS: 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524 patients) practices. 69% of patients in both intervention (260) and comparison (360) arms completed the 12 month follow-up. Intervention clinicians discussed more health risks per patient (59.7%) than comparison clinicians (52.7%) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours (38.4% vs 26.7%, risk difference [RD] 11.6%, Confidence Interval [CI] 2.93% to 20.3%; adjusted odds ratio [OR] 1.7, CI 1.1 to 2.5). Patients reported less illicit drug use (RD -6.0, CI -11 to -1.2; OR 0.52, CI 0.28 to 0.96), and less risk for STI (RD -5.4, CI -11 to 0.2; OR 0.66, CI 0.46 to 0.96) at three months in the intervention relative to the comparison arm, and for unplanned pregnancy at 12 months (RD -4.4; CI -8.7 to -0.1; OR 0.40, CI 0.20 to 0.80). No differences were detected between arms on other health risks. There were no differences on secondary outcomes, apart from a greater detection of abuse (OR 13.8, CI 1.71 to 111). There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool. CONCLUSIONS: A complex intervention, compared to a simple educational seminar for practices, improved detection of health risk behaviours in young people. Impact on health outcomes was inconclusive. Technology enabling more efficient, systematic health-risk screening may allow providers to target counselling toward higher risk individuals. Further trials require more power to confirm health benefits. TRIAL REGISTRATION: ISRCTN.com ISRCTN16059206

Interventions to reduce suicides at suicide hotspots: a systematic review

BACKGROUND: 'Suicide hotspots' include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention. METHODS: We searched Medline for studies that could inform the following question: 'What interventions are available to reduce suicides at hotspots, and are they effective?' RESULTS: There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise. CONCLUSIONS: More well-designed intervention studies are needed to strengthen this evidence base.Australian Government Department of Health and AgeingUK National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the Southwest Peninsul

Suicide is a complex problem that requires a range of prevention initiatives and methods of evaluation

A range of factors can contribute to suicide, which means that a multifactorial approach to suicide prevention is necessary. Whereas randomised controlled trials may be suitable for evaluation of some interventions, others require different approaches for assessment of their impact. Also, suicide itself will not always be the most feasible outcome measure