Effective programs and strategies on suicide prevention: combination of review of systematic reviews with expert opinions

Abstract

Abstract Background Suicide is a complex and ongoing public health crisis which is a misinterpreted course of death that strongly affects communities’ and individuals’ mental health and quality of life. Health managers often do not have adequate information for decision making on what strategy makes an effective impact on suicide prevention. Despite the availability of global Suicide Prevention Programs (SPP) around the world, no previous investigation has developed combinations of a review of systematic reviews with expert opinions. The present study was aimed to identify effective community-based strategies for suicide prevention. Methods We used two methods for selecting the best and effective SPP. 1) review of systematic reviews: we systematically searched to find relevant review studies through Medline, Cochrane Library, PsycINFO, and grey literatures, from January 1, 2011, and December 30, 2014. 2) Expert panel opinions: effective strategies identified from the previous step were combined with field and academic expert views via the Hanlon method. Then the strategies have been rated based on the following five criteria: feasibility, importance, cost-effectiveness, timeliness, acceptability. Results Of the total of 489 identified records, 9 reviews included in the review of systematic reviews. A total of 12 effective SPP were found. Expert panel then prioritized strategies based on Hanlon method as following: 1) case management of attempters to prevent future attempts, 2) identification and treatment of depression, 3) improving registry for suicide, 4) identification and investigation of suicidal behaviors’ risk factors, 5) public education campaigns in hotspots, 6) gatekeepers’ training, 7) conducting research, 8) school-based training 9) improving knowledge and attitudes, 10) restricting access to means of suicide, 11) screening of suicide ideation and at-risk people, and 12) mass media role, respectively. Conclusion Management of suicide attempters, developing a registry for suicide, and treatment of depression were three priority and basic interventions suggested after evidence combined with the expert panel. Suicide is a multifaceted phenomenon that is strongly affected by local beliefs. Effective management of suicide requires up-to-date information through a combination of evidence with expert views at the local level where SPP are implemented.