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Suicide Prevention by Limiting Access to Methods a Review of Theory and Practice

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Commonage efforts to reduce the incidence of suicide

This article is about chief prevention of suicides. For secondary prevention and intervention, see Suicide intervention.

Suicide prevention measures suggested by the CDC[1]

Suicide prevention is a collection of efforts to reduce the risk of suicide.[ii] Suicide is frequently preventable,[three] and the efforts to forestall it may occur at the individual, relationship, customs, and society level.[2] Suicide is a serious public wellness trouble that can take long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide tin exist prevented past learning the warning signs, promoting prevention and resilience, and a committing to social change. [4]

Beyond directly interventions to end an impending suicide, methods may include:

  • treating mental illness
  • improving coping strategies of people who are at risk
  • reducing risk factors for suicide, such as poverty and social vulnerability
  • giving people hope for a amend life after electric current problems are resolved
  • calling a suicide hotline number

General efforts include measures within the realms of medicine, mental health, and public wellness. Because protective factors[5] such as social back up and social engagement—besides as environmental gamble factors such as admission to lethal means— play a function in suicide, suicide is not solely a medical or mental-health issue.[six]

Interventions [edit]

Lethal-means reduction [edit]

Means reduction ⁠— ⁠reducing the odds that a suicide attempter volition use highly lethal means ⁠— ⁠is an important component of suicide prevention.[seven] This practice is also called "means restriction". It has been demonstrated that restricting lethal means tin can aid reduce suicide rates, as delaying action until the want to die has passed.[8] In general, strong evidence supports the effectiveness of means brake in preventing suicides.[ix] [ten] [11] [12] There is as well potent evidence that restricted admission at and so-chosen suicide hotspots, such equally bridges and cliffs, reduces suicides, whereas other interventions such as placing signs or increasing surveillance at these sites appears less constructive.[13]

I of the most famous historical examples of means reduction is that of coal gas in the United Kingdom. Until the 1950s, the nearly common means of suicide in the UK was poisoning by gas inhalation. In 1958, natural gas (virtually gratis of carbon monoxide) was introduced, and over the next decade, comprised over l% of gas used. Equally carbon monoxide in gas decreased, suicides also decreased. The decrease was driven entirely by dramatic decreases in the number of suicides by carbon monoxide poisoning.[14] [15] A 2020 Cochrane review on means restrictions for jumping found tentative evidence of reductions in frequency.[16]

In the United States, firearm access is associated with increased suicide completion.[17] About 85% of suicide attempts with a gun outcome in death, while most other widely used suicide attempt methods result in death less than 5% of the fourth dimension.[18] [xix] Matthew Miller, M.D., Sc.D. conducted inquiry comparing the number of suicides in states with the highest rates of gun ownership, to the number of suicides in states with the lowest rates of gun ownership. He establish that men were iii.7 times more than likely to die past firearm suicide and women were 7.9 times more than likely to die by firearm suicide living in states with high rates of gun buying. There was no divergence in non-firearm suicides.[20] Although restrictions on access to firearms have reduced firearm suicide rates in other countries, such restrictions are hard in the U.s. because the 2nd Amendment to the United States Constitution limits restrictions on weapons.[21]

Crises hotline [edit]

As a suicide prevention initiative, signs on the Golden Gate Bridge promote special telephones that connect to a crisis hotline, as well equally a 24/7 crisis text line.

Crisis hotlines connect a person in distress to either a volunteer or staff fellow member.[3] This may occur via telephone, online conversation, or in person.[three] Even though crisis hotlines are common, they have not been well studied.[22] [23] One report institute a subtract in psychological pain, hopelessness, and want to die from the first of the call through the next few weeks; however, the want to dice did non decrease long term.[3]

[edit]

In the United states of america, the 2012 National Strategy for Suicide Prevention promotes various specific suicide prevention efforts including:[24]

  • Developing groups led by professionally trained individuals for wide-based back up for suicide prevention.
  • Promoting community-based suicide prevention programs.
  • Screening and reducing at-hazard behavior through psychological resilience programs that promotes optimism and connectedness.
  • Education about suicide, including risk factors, alert signs, stigma related bug and the availability of aid through social campaigns.
  • Increasing the proficiency of health and welfare services at responding to people in need. eastward.1000., sponsored training for helping professionals, increased access to community linkages, employing crisis counseling organizations.
  • Reducing domestic violence and substance abuse through legal and empowerment means are long-term strategies.
  • Reducing access to convenient means of suicide and methods of self-harm. due east.g., toxic substances, poisons, handguns.
  • Reducing the quantity of dosages supplied in packages of non-prescription medicines due east.g., aspirin.
  • School-based competency promoting and skill enhancing programs.
  • Interventions and usage of ethical surveillance systems targeted at high-risk groups.
  • Improving reporting and portrayals of negative behavior, suicidal behavior, mental affliction and substance abuse in the entertainment and news media.
  • Research on protective factors & development of effective clinical and professional person practices.

Media guidelines [edit]

Recommendations around media reporting of suicide include not sensationalizing the event or attributing it to a unmarried cause.[3] It is also recommended that media messages include suicide prevention messages such as stories of promise and links to further resource.[3] [25] Particular care is recommended when the person who died is famous.[26] Specific details of the method or the location are not recommended.[26]

There is trivial bear witness, however, regarding the benefit of providing resources for those looking for assist and the evidence for media guidelines mostly is mixed at all-time.[27]

Tv shows and news media may also be able to help foreclose suicide by linking suicide with negative outcomes such as pain for the person who has attempted suicide and their survivors, conveying that the majority of people cull something other than suicide in lodge to solve their problems, avoiding mentioning suicide epidemics, and fugitive presenting authorities or sympathetic, ordinary people every bit spokespersons for the reasonableness of suicide.[28]

Medication [edit]

The medication lithium may be useful in certain situations to reduce the risk of suicide.[29] Specifically it is effective at lowering the risk of suicide in those with bipolar disorder and major depressive disorder.[29] [30] Some antidepressant medications may increase suicidal ideation in some patients under certain atmospheric condition.[31]

Counseling [edit]

There are multiple talk therapies that reduce suicidal thoughts and behaviors including dialectical behavior therapy (DBT).[32] [33] Cognitive behavior therapy for suicide prevention (CBT-SP) is a class of DBT adapted for adolescents at high risk for repeated suicide attempts.[34] [35] The brief intervention and contact technique developed by the Globe Health Organization also has shown benefit.[36]

The Earth Health Organization recommends "specific skills should be available in the instruction system to prevent bullying and violence in and effectually the schoolhouse".[37]

Coping planning [edit]

Coping planning is a strengths-based intervention that aims to come across the needs of people who ask for aid, including those experiencing suicidal ideation.[38] By addressing why someone asks for help, the take chances cess and direction stays on what the person needs, and the needs assessment focuses on the individual needs of each person.[39] [twoscore] The coping planning approach to suicide prevention draws on the health-focused theory of coping. Coping is normalized every bit a normal and universal man response to unpleasant emotions, and interventions are considered a change continuum of low intensity (due east.g., cocky-soothing) to high intensity support (eastward.thousand. professional help). Past planning for coping, it supports people who are distressed and provides a sense of belongingness and resilience in handling of illness.[41] [42] The proactive coping planning approach overcomes implications of ironic process theory.[43] The biopsychosocial[44] strategy of grooming people in good for you coping improves emotional regulation and decreases memories of unpleasant emotions.[45] A skilful coping planning strategically reduces the inattentional incomprehension for a person while developing resilience and regulation strengths.[41]

Strategies [edit]

A United states Army suicide prevention affiche

The traditional arroyo has been to place the run a risk factors that increase suicide or self-impairment, though meta-analysis studies suggest that suicide run a risk assessment might not be useful and recommend immediate hospitalization of the person with suicidal feelings as the good for you choice.[46] In 2001, the U.S. Department of Wellness and Human Services, published the National Strategy for Suicide Prevention, establishing a framework for suicide prevention in the U.South. The document, and its 2012 revision, calls for a public health arroyo to suicide prevention, focusing on identifying patterns of suicide and suicidal ideation throughout a grouping or population (every bit opposed to exploring the history and health conditions that could lead to suicide in a single private).[47] The power to recognize warning signs of suicide allows individuals who may be concerned almost someone they know to direct them to help.[48]

Suicide gesture and suicidal desire (a vague wish for death without whatsoever bodily intent to kill oneself) are potentially cocky-injurious behaviors that a person may utilise to attain some other ends, like to seek assistance, punish others, or to receive attention. This behavior has the potential to aid an private's capability for suicide and can exist considered as a suicide warning, when the person shows intent through verbal and behavioral signs.[49]

Specific strategies [edit]

Suicide prevention strategies focus on reducing the risk factors and intervening strategically to reduce the level of take a chance. Hazard and protective factors unique to the individual can exist assessed by a qualified mental health professional person.

Some of the specific strategies used to address are:

  • Crisis intervention.
  • Structured counseling and psychotherapy.
  • Hospitalization for those with low adherence to collaboration for help and those who crave monitoring and secondary symptom treatment.
  • Supportive therapy similar substance abuse treatment, Psychotropic medication, Family unit psychoeducation and Access to emergency telephone telephone call care with emergency rooms, suicide prevention hotlines, etc.
  • Restricting access to lethality of suicide means through policies and laws.
  • Creating and using crunch cards, an easy-to-read uncluttered carte that describes a list of activities one should follow in crisis until the positive behavior responses settles in the personality.
  • Person-centered life skills grooming. due east.one thousand., Problem solving.
  • Registering with support groups like Alcoholics Anonymous, Suicide Bereavement Back up Grouping, a religious grouping with period rituals, etc.
  • Therapeutic recreational therapy that improves mood.
  • Motivating cocky-care activities like physical exercises and meditative relaxation.

Psychotherapies that have shown well-nigh successful or testify based are dialectical behavior therapy (DBT), which has shown to be helpful in reducing suicide attempts and reducing hospitalizations for suicidal ideation[50] and cerebral behavioral therapy (CBT), which has shown to amend problem-solving and coping abilities.[51]

After a suicide [edit]

Postvention is for people affected by an individual'southward suicide. This intervention facilitates grieving, guides to reduce guilt, guides to reduce anxiety and depression, and helps to subtract the furnishings of trauma. Bereavement is ruled out and promoted for catharsis and supporting their adaptive capacities before intervening depression and any psychiatric disorders. Postvention is also provided to minimize the risk of imitative or copycat suicides, merely there is a lack of evidence based standard protocol. The general goal of the mental wellness practitioner is to decrease the likelihood of others identifying with the suicidal behavior of the deceased as a coping strategy in dealing with adversity.[52]

Adventure assessment [edit]

A photo analogy produced by the Defense force Media Agency on suicide prevention

Warning signs [edit]

Warning signs of suicide can permit individuals to straight people who may exist considering suicide to become assistance.[53]

Behaviors that may exist warning signs include:[54]

  1. Talking near wanting to die or wanting to kill themselves
  2. Suicidal ideation: thinking, talking, or writing about suicide, planning for suicide
  3. Substance abuse
  4. Feelings of purposelessness
  5. Anxiety, agitation, beingness unable to sleep, or sleeping all the time
  6. Feelings of existence trapped
  7. Feelings of hopelessness
  8. Social withdrawal
  9. Displaying extreme mood swings, suddenly changing from sad to very at-home or happy
  10. Recklessness or impulsiveness, taking risks that could lead to expiry, such as driving extremely fast
  11. Mood changes including depression
  12. Feelings of uselessness
  13. Settling outstanding affairs, giving away prized or valuable possessions, or making apology when they are otherwise not expected to dice (every bit an example, this behavior would be typical in a terminal cancer patient but not a healthy young adult)
  14. Strong feelings of pain, either emotional or physical
  15. Because oneself burdensome
  16. Increased use of drugs or alcohol

Additionally, the National Institute for Mental Health includes feeling crushing, and stiff feelings of pain—either emotional or physical—as alarm signs that someone may attempt suicide.[53]

Straight talks [edit]

An effective way to assess suicidal thoughts is to talk with the person direct, to inquire about low, and appraise suicide plans as to how and when it might be attempted.[55] Contrary to popular misconceptions, talking with people near suicide does not constitute the idea in their heads.[55] However, such discussions and questions should be asked with care, concern and compassion.[55] The tactic is to reduce sadness and provide assurance that other people care. The WHO advises to not say everything volition be all right nor make the trouble seem trivial, nor requite false assurances about serious issues.[55] The discussions should be gradual and specifically executed when the person is comfy nigh discussing their feelings. ICARE (Identify the thought, connect with it, Appraise prove for it, Restructure the thought in positive calorie-free, Express or provide room for expressing feelings from the restructured thought) is a model of arroyo used here.[55]

Screening [edit]

The U.South. Surgeon General has suggested that screening to detect those at take a chance of suicide may be one of the most effective means of preventing suicide in children and adolescents.[56] There are diverse screening tools in the form of self-report questionnaires to help identify those at run a risk such every bit the Beck Hopelessness Scale and Is Path Warm?. A number of these self-report questionnaires accept been tested and institute to be constructive for use amongst adolescents and young adults.[57] In that location is all the same a high rate of faux-positive identification and those accounted to exist at risk should ideally have a follow-up clinical interview.[58] The predictive quality of these screening questionnaires has non been conclusively validated and then it is non possible to decide if those identified at risk of suicide will really die by suicide.[59] Asking about or screening for suicide does not create or increase the risk.[60]

In approximately 75 per centum of suicides, the individuals had seen a physician within the yr before their death, including 45 to 66 per centum inside the prior month. Approximately 33 to 41 pct of those who died past suicide had contact with mental health services in the prior year, including twenty pct within the prior month. These studies suggest an increased need for effective screening.[61] [62] [63] [64] [65] Many suicide chance cess measures are not sufficiently validated, and exercise not include all three core suicidality attributes (i.e., suicidal affect, beliefs, and knowledge).[66] A study published by the Academy of New Southward Wales has concluded that asking well-nigh suicidal thoughts cannot exist used as a reliable predictor of suicide risk.[67]

Underlying condition [edit]

The conservative estimate is that x% of individuals with psychiatric disorders may have an undiagnosed medical status causing their symptoms,[68] with some estimates stating that upwards of fifty% may have an undiagnosed medical condition which, if not causing, is exacerbating their psychiatric symptoms.[69] [seventy] Illegal drugs and prescribed medications may also produce psychiatric symptoms.[71] Constructive diagnosis and, if necessary, medical testing, which may include neuroimaging[72] to diagnose and treat whatever such medical conditions or medication side effects, may reduce the risk of suicidal ideation as a result of psychiatric symptoms. Most often including low, which are present in upwards to xc–95% of cases.[73]

Risk factors [edit]

All people tin can be at chance of suicide. Chance factors that contribute to someone feeling suicidal or making a suicide effort may include:

  • Depression, other mental disorders, or substance abuse disorder
  • Certain medical conditions
  • Chronic pain[74]
  • A prior suicide attempt
  • Family history of a mental disorder or substance abuse
  • Family unit history of suicide
  • Family violence, including physical or sexual abuse
  • Having guns or other firearms in the abode
  • Having recently been released from prison or jail
  • Being exposed to others' suicidal beliefs, such equally that of family members, peers, or celebrities[54]
  • Being male[75]

Legislation [edit]

 Suicide and assisted suicide illegal

 Suicide legal, assisted suicide illegal

 Suicide and assisted suicide legal

Suicide is a crime in some parts of the world.[76] However, while suicide has been decriminalized in many western countries, the act is stigmatized and discouraged. In other contexts, suicide could be utilized equally an farthermost expression of liberty, every bit is exemplified by its usage as an expression of devout dissent towards perceived tyranny or injustice which occurred occasionally in cultures similar aboriginal Rome, medieval Nihon, or today'south Chinese Tibet.

While a person who has died of suicide is across the reach of the law, there can yet be legal consequences in relation to handling of the corpse or the fate of the person's property or family members. The associated matters of assisting a suicide and attempting suicide take likewise been dealt with by the laws of some jurisdictions. Some countries criminalise suicide attempts.

Historically, many laws against suicide and mercy killing accept developed at to the lowest degree in part from religious doctrine: for example, the claim that only God has the right to decide when a person will die.[ citation needed ]

Support organizations [edit]

Sign promoting Samaritans near a payphone about Beachy Head, a major suicide spot in the Britain

A sign at a railroad crossing in the Netherlands promoting a suicide crisis line (113)

Many not-profit organizations exist, such as the American Foundation for Suicide Prevention in the United states, which serve equally crunch hotlines; it has benefited from at to the lowest degree 1 crowd-sourced campaign.[77] The first documented program aimed at preventing suicide was initiated in 1906 in both New York, the National Save-A-Life League, and in London, the Suicide Prevention Department of the Salvation Ground forces.[78]

Suicide prevention interventions autumn into two broad categories: prevention targeted at the level of the individual and prevention targeted at the level of the population.[79] To identify, review, and disseminate information about best practices to accost specific objectives of the National Strategy Best Practices Registry (BPR) was initiated. The Best Practices Registry of Suicide Prevention Resource Eye is a registry of diverse suicide intervention programs maintained past the American Association of Suicide Prevention. The programs are divided, with those in Section I listing bear witness-based programs: interventions which have been subjected to in depth review and for which evidence has demonstrated positive outcomes. Section III programs accept been subjected to review.[80] [81]

If you or someone yous know displays sign or symptoms of suicidal thoughts or actions these prevention organizations are available:

  • Befrienders Worldwide
  • American Foundation for Suicide Prevention
  • Campaign Against Living Miserably
  • Crisis Text Line
  • International Association for Suicide Prevention
  • The Jed Foundation
  • National Suicide Prevention Lifeline
  • Samaritans
  • Suicide Prevention Action Network USA
  • The Trevor Project
  • Trans Lifeline

Economics [edit]

Although in that location are lasting emotional effects on families due to suicide, the economic effects are contagious. In the United States it is estimated that an episode of suicide results in costs of most $1.3 million.[82] 97 percent of these costs are due to the loss in career productivity from the deceased individual besides every bit the later on-consequence toll on families. Likewise, the remaining 3 percent of the expenses were contributed from medical expenses. Money spending on appropriated interventions is estimated to result in a decrease in economic losses that are 2.5-fold greater than the corporeality spent. Therefore, declaring the need for increased deportment in intervention and prevention to aid uphold individuals, families, and the economy.[82]

See also [edit]

  • Advocacy of suicide
  • Coping (psychology)
  • Coping planning
  • Crisis intervention
  • Euthanasia
  • Gatekeeping (education)
  • List of suicide crisis lines
  • Living Is For Anybody
  • Social skills
  • Suicide prevention contract
  • World Suicide Prevention Twenty-four hour period
  • Suicide awareness

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Further reading [edit]

  • Suicide prevention and assessment handbook, Centre for Addiction and Mental Health, 2011.
  • Nancy Boyd-Franklin; Elizabeth N. Cleek; Matt Wofsy; Brian Mundy (2013). "Adventure Assessment and Suicide Prevention". Therapy in the Existent World: Effective Treatments for Challenging Problems. Guilford Press. p. 341. ISBN978-1-4625-1034-iv.
  • Van Orden, Kimberly A.; Witte, Tracy One thousand.; Cukrowicz, Kelly C.; Braithwaite, Scott R.; Selby, Edward A.; Joiner, Thomas Eastward. (2010). "The interpersonal theory of suicide". Psychological Review. 117 (two): 575–600. doi:10.1037/a0018697. PMC3130348. PMID 20438238.

External links [edit]

  • CDC website on Suicide Prevention
  • The Suicide Prevention Resource Center (SPRC) provides prevention back up, training, and resource to assist organizations and individuals to develop suicide prevention programs, interventions and policies, and to accelerate the National Strategy for Suicide Prevention.
  • Centre for Suicide Prevention (CSP), Canada
  • Suicide Prevention:Effectiveness and Evaluation A 32-page guide from Span United states, the National Center for Injury Prevention and Control, and Education Development Heart, Inc.
  • International Clan for Suicide Prevention Organization co-sponsors Earth Suicide Prevention Mean solar day on September 10 every year with the Globe Health Organization (WHO).
  • U.South. Surgeon General – Suicide Prevention
  • Suicide Risk Assessment Guide – VA Reference Transmission
  • Practice Guidelines for Suicide prevention, APA

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Source: https://en.wikipedia.org/wiki/Suicide_prevention

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