Excerpt

Suicide is the tenth leading cause of death in the United States (US), with nearly 100 suicides occurring each day and over 36,000 dying by suicide each year. Among Veterans and current military, suicide is a national public health concern. Recent estimates suggest current or former military represent 20 percent of all known suicides in the US and the rate of suicides among Veterans utilizing Veterans Health Administration (VHA) services is estimated to be higher than the general population. The enormity of the problem has led to several major public health initiatives and a growth in research funding for suicide prevention.

Despite recent suicide prevention efforts, the suicide rate in the US has changed relatively little over the past 100 years. The body of research on suicide prevention approaches has been reviewed previously by Gaynes and colleagues, and Mann and colleagues, and recent, similar work exists in the form of draft self-harm guidelines from the National Institute for Health and Clinical Excellence (NICE) in 2011. As requested by the Veterans Affairs (VA)/Department of Defense (DoD) Evidence Based Practice Working Group (EBPWG) on suicide prevention, we examined recent research on suicidal self-directed violence as defined by Crosby et al. 2011. We update the work of Gaynes et al. and Mann et al. by systematically reviewing relevant literature that was not included in either report, and was published in 2005 through November 18, 2011. Though the focus of the report is on suicide prevention, we include as outcomes any type of suicidal self-directed violence, defined as “Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. There is evidence, whether implicit or explicit, of suicidal intent.”

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • DATA SYNTHESIS
  • PEER REVIEW
  • RESULTS
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION #1 What is the effectiveness of specific interventions for reducing rates of suicidal self-directed violence in military and/or Veteran populations?
  • KEY QUESTION #2 What lessons can be learned from self-directed violence prevention intervention research conducted outside of VA or military settings that can be applied to Veteran and/or military populations?
  • KEY QUESTION #3 What is the effectiveness of referral and follow-up services (e.g., strategies designed to provide referrals, improve referral follow-through and attendance, etc.) for reducing rates of suicidal self-directed violence in military and/or Veteran populations?
  • KEY QUESTION #4 What lessons can be learned from research on self-directed violence referral and follow-up services conducted outside of VA or military settings that can be applied to Veteran and/or military populations?
• SUMMARY AND DISCUSSION
  • LIMITATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGIES
• APPENDIX B STUDY SELECTION FORM
• APPENDIX C CRITERIA USED IN QUALITY ASSESSMENT OF SYSTEMATIC REVIEWS
• APPENDIX D CRITERIA USED IN QUALITY ASSESSMENT OF RANDOMIZED CONTROLLED TRIALS
• APPENDIX E CRITERIA USED TO ASSESS STRENGTH OF EVIDENCE
• APPENDIX F QUALITY RATING OF SYSTEMATIC REVIEWS RELATED TO PHARMACOTHERAPY USING OXMAN AND GUYATT CRITERIA
• APPENDIX G DATA ABSTRACTION OF PRIMARY STUDIES OBTAINED FROM GOOD QUALITY SYSTEMATIC REVIEWS RELATED TO PHARMACOTHERAPY
• APPENDIX H SUMMARY OF SYSTEMATIC REVIEW RESULTS RELATED TO PHARMACOTHERAPY FROM GAYNES ET AL., MANN ET AL., AND NICE REVIEWS
• APPENDIX I DESCRIPTION OF PRIMARY OUTCOMES AND INTENT TO TREAT SUICIDAL SELF-DIRECTED VIOLENCE FOR PHARMACOTHERAPY STUDIES
• APPENDIX J DATA ABSTRACTION FOR PRIMARY STUDIES RELATED TO PHARMACOTHERAPY
• APPENDIX K RISK OF BIAS RATINGS FOR PRIMARY STUDIES RELATED TO PHARMACOTHERAPY
• APPENDIX L STRENGTH OF EVIDENCE RATINGS FOR PRIMARY STUDIES RELATED TO PHARMACOTHERAPY
• APPENDIX M QUALITY RATING OF SYSTEMATIC REVIEWS RELATED TO PSYCHOTHERAPY USING OXMAN AND GUYATT CRITERIA
• APPENDIX N DATA ABSTRACTION OF PRIMARY STUDIES OBTAINED FROM GOOD QUALITY SYSTEMATIC REVIEWS RELATED TO PSYCHOTHERAPY
• APPENDIX O SUMMARY OF SYSTEMATIC REVIEW RESULTS RELATED TO PSYCHOTHERAPY FROM GAYNES ET AL., MANN ET AL., AND NICE REVIEWS
• APPENDIX P DESCRIPTION OF PRIMARY OUTCOMES AND INTENT TO TREAT SUICIDAL SELF-DIRECTED VIOLENCE FOR PSYCHOTHERAPY STUDIES
• APPENDIX Q DATA ABSTRACTION FOR PRIMARY STUDIES RELATED TO PSYCHOTHERAPY
• APPENDIX R RISK OF BIAS RATINGS FOR PRIMARY STUDIES RELATED TO PSYCHOTHERAPY
• APPENDIX S STRENGTH OF EVIDENCE RATINGS FOR PRIMARY STUDIES RELATED TO PSYCHOTHERAPY
• APPENDIX T QUALITY RATING OF SYSTEMATIC REVIEWS RELATED TO REFERRAL/FOLLOW-UP SERVICES USING OXMAN AND GUYATT CRITERIA
• APPENDIX U DATA ABSTRACTION OF PRIMARY STUDIES OBTAINED FROM GOOD QUALITY SYSTEMATIC REVIEWS RELATED TO REFERRAL/FOLLOW-UP SERVICES
• APPENDIX V SUMMARY OF SYSTEMATIC REVIEW RESULTS RELATED TO REFERRAL AND FOLLOW-UP SERVICES FROM GAYNES ET AL., MANN ET AL., AND NICE REVIEWS
• APPENDIX W DESCRIPTION OF PRIMARY OUTCOMES AND INTENT TO TREAT SUICIDAL SELF-DIRECTED VIOLENCE FOR STUDIES RELATED TO REFERRAL AND FOLLOW-UP SERVICES
• APPENDIX X DATA ABSTRACTION FOR PRIMARY STUDIES RELATED TO REFERRAL/FOLLOW-UP SERVICES
• APPENDIX Y RISK OF BIAS RATINGS FOR PRIMARY STUDIES RELATED TO REFERRAL/FOLLOW-UP SERVICES
• APPENDIX Z STRENGTH OF EVIDENCE RATINGS FOR PRIMARY STUDIES RELATED TO REFERRAL/FOLLOW-UP SERVICES
• APPENDIX AA PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX BB ABBREVIATIONS
• APPENDIX CC EXCLUDED STUDIES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Portland VA Medical Center, Portland, OR, Devan Kansagara, M.D., M.C.R., Director

Suggested citation:

O'Neil ME, Peterson K, Low A, Carson S, Denneson LM, Haney E, Shiroma P and Kansagara D. Suicide Prevention Interventions and Referral/Follow-up Services: A Systematic Review. VA-ESP Project #05-225; 2012.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Portland VA Medical Center, Portland OR funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.