September 2020
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Full text: Tracy, D., Joyce, D., Albertson, D., & Shergill, S. (2020). Kaleidoscope. The British Journal of Psychiatry, 217(3), 532-533. doi:10.1192/bjp.2020.145
Read the full September 2020 Kaleidoscope column in BJPsych for free
We're all familiar with the mantra that while self-harm is common, suicide is ‘rare’ and prediction ‘difficult’. Can we at least have confidence in suicide-prevention interventions? A meta-analysis examined subsequent suicide attempts following a brief, single-encounter, suicide-prevention intervention in 14 studies covering 4270 individuals.1 The majority of interventions were multi-aspect, typically including care coordination, safety planning, short-term follow-up contacts and a brief therapeutic intervention. The specific therapeutic component varied between studies, but included techniques informed variously by motivational interviewing, problem-solving and increasing likelihood of engaging with mental health services. The interventions did reduce subsequent suicide attempts, with a pooled odds ratio of 0.69; this equates to about 78 fewer suicide attempts in 2241 patients. There was increased linkage to clinical engagement with a 22.5% increase in attending follow-up, but interestingly, no association with any reduction in depressive symptoms. The findings are heartening, and we are reminded how a very significant number of people who die by suicide have contact with services in the days and weeks prior to their death. These findings encourage wider roll-out of such specific interventions across clinical services, and a need for clarification of the aspects that work best and in whom.