Suicide Prevention Strategies for Improving Population Health

Many suicide prevention programs are listed on the National Registry of Evidence based Programs and Practices but very few have demonstrated evidence of effectiveness from randomized trials. Nearly all widely used programs aim to identify youth after they have already developed identifiable symptoms or after a suicidal crisis has already started, which is an approach that is unlikely to reduce rates of youth suicide in the general population significantly. For most youth who die by suicide, there are opportunities for intervention before imminent risk and problems develop. Effective prevention programs have been identified that reduce the occurrence and severity of mental, emotional, and behavioral problems that increase risk for suicidal behavior, many offered through schools; however, the impact of these programs on reducing suicidal behaviors is unknown at present because evaluators of these interventions have rarely included suicidal behavior in their outcome measures. Identifying the impact of these programs is underway as part of the National Institutes of Health Pathways to Prevention program. To advance upstream suicide prevention, we also recommend identifying other promising intervention settings and strategies. Social media has been in the spotlight owing to rapidly expanding Internet-networked communication, concerns about cyberbullying, and the tendency of vulnerable youth to seek peers on social media instead of help in person. In 2011, Facebook added a feature to report suicidal content, which has been recently updated to pass information to the National Suicide Prevention Lifeline. Owing to social media's wide reach to youth isolated from adults and its ability to provide extensive real-time data, this setting has great potential for suicide prevention. We also recommend suicide prevention approaches that integrate the physical and behavioral health domains. As pointed out by Brent and Brown, for suicide risk screening or GKT to reduce suicides, detection has to be accurate, students and their parents need to follow through with referrals and the treatment has to be effective. Because a national survey indicates that community treatment for suicidal young people has not established consistent effectiveness,interventions such as the GBG or YAM, which build skills, and Sources of Strength, which builds communication ties to adults, seem to be wise suicide prevention investments. Replication and cost-effectiveness studies of these primary prevention approaches are needed. A greater investment is required to build infrastructure to support financing and sustaining large-scale, coordinated suicide prevention efforts and research.