50

Appendix A. Data Collection Forms
51

Article ID: 

Reviewer: 

 Date: 

Population (check all that apply)

 Men 

 Women

 Veterans

 Military

 Age (complete all that are reported)

Mean: _____________

Median: ___________

Range: ____________

Setting (check all)

 Primary Care

 Hospital

 Psychiatric

 Population Based

 Other

 Not stated / Not reported / 

Not applicable

References to Retrieve: _____ _____ ______

_____ _____ ______

 _____ _____ ______

 

Country (check one)

  US

  UK/New Zealand/Canada/Australia

  Other

Interventions (check all that apply)

  Physician

  Patient

  Population Based

 

  Organizational

  Not stated / Not reported / 

 Not applicable

Outcome (check all)

  Attempters

  Completers

  SI

Design (check one)

  Experimental 

  Observational

 

Intervention Codes

_____ _____ _____

Study Design: _____________

Final 06/25/08

VA ESP – SUICIDE PREVENTION

PRE SCREENER
52

Article ID

Reviewer: Steven Bagley Assigned on:

1. Was the study:

 (Check all

that apply)

Outpatient...............................q

Inpatient ....................................q

Emergency Dept/ Crisis Services....q

Not reported/Not applicable............q

 2. What was the sample size: (NR for not reported)

F/Up Duration Units Enrolled

Time 0 _________

 

F/Up 1 ________ ________ ________

F/Up 2 ________ ________ ________

F/Up 3 ________ ________ ________

F/Up 4 ________ ________ ________

3. Eligibility Criteria

4. The intervention consisted of:

Quality Measurement (only interventions)

1. Was the study described as randomized?

 Yes...........................q

 No............................q

 Don’t know..............q

2. Treatment Allocation 

 a. Was a method of randomization performed? 

 Yes...........................q

 No............................q

 Don’t know..............q

 b. Was the treatment allocation concealed? 

 Yes...........................q

 No............................q

 Don’t know..............q

3. Were the groups similar at baseline regarding the most 

important prognostic indicators?

 Yes...........................q

 No............................q

 Don’t know..............q

 

VA-ESP Suicide Prevention

Detail Intervention & Quality Review Form

4. Were the eligibility criteria specified?

 Yes...........................q

 No............................q

 Don’t know..............q

5. Was the outcome assessor blinded?

 Yes...........................q

 No............................q

 Don’t know..............q

6. Was the care provider blinded?

 Yes...........................q

 No............................q

 Don’t know..............q

7. Were subjects blinded?

 Yes...........................q

 No............................q

 Don’t know..............q

8. Were point estimates and measures of variability presented for the primary outcome measures?

 Yes...........................q

 No............................q

 Don’t know..............q

9. Were all randomized participants analyzed in the group 

to which they were allocated?

 Yes...........................q

 No............................q

 Don’t know..............q

10. Were co-interventions avoided or similar?

 Yes...........................q

 No............................q

 Don’t know..............q

11. Was the compliance acceptable in all groups?

 Yes...........................q

 No............................q

 Don’t know..............q

12. Was the drop-out rate described and acceptable?

 Yes...........................q

 No............................q

 Don’t know..............q

13. Was the timing of the outcome assessment in all groups 

similar?

 Yes...........................q

 No............................q

 Don’t know..............q

Units

1. Days 

2. Weeks

3. Months

4. Years

5. NR
53

Appendix B. Excluded Studies

Excluded after Initial Review

No Intervention

Cooper, S. L. ; Lezotte, D.; Jacobellis, J., and Diguiseppi, C. Does availability of mental health 

resources prevent recurrent suicidal behavior? An ecological analysis. Suicide Life Threat 

Behav. 2006; 36(4):409-17.

Ettlinger, RW. Suicides in a groupd of patients who had previously attempted suicide. Acta Psychiatr Scand. 1964; 40:363-78.

Greer, S. and Lee, H. A. Subsequent progress of potentially lethal attempted suicides. Acta Psychiatr Scand. 1967; 43(4):361-71.

Kessel, N. and McCulloch, W. Repeated acts of self-poisoning and self-injury. Proc R Soc Med. 

1966 Feb; 59(2):89-92.

Shah, A. and Bhat, R. Are elderly suicide rates improved by increased provision of mental health 

service resources? A cross-national study. Int Psychogeriatr. 2008; 1-8.

Foreign Language

Nielsen, A. S. and Nielsen, B. Pattern of choice in preparation of attempted suicide by poisoning--with particular reference to changes in the pattern of prescriptions. Ugeskr Laeger. 

1992 Jul 6; 154(28):1972-6.

Rueegsegger, P. Attempted suicide. Clinical statistically and catamnestic studies of 132 attempted 

suicide patients in Basle University Psychiatric Clinic. 1963;146:81-104. 

Duplicate Data

Bateman, A. and Fonagy, P. Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry. 2001 Jan; 

158(1):36-42.

McMain, S. Dialectic behaviour therapy reduces suicide attempts compared with non-behavioural psychotherapy in women with borderline personality disorder. Evid Based Ment 

Health . 2007; 10(1):18.

World Health Organization (WHO). For which strategies of suicide prevention is there evidence 

of effectiveness? World Health Organitzation: Health Evidence Network; 2004.
54

Review or Meta-analysis

Althaus, D. and Hegerl, U. The evaluation of suicide prevention activities: state of the art. World 

J Biol Psychiatry. 2003 Oct; 4(4):156-65.

Anderson, M. and Jenkins, R. The challenge of suicide prevention - an overview of national 

strategies. Disease Management & Health Outcomes. 2005; 13245-53.

Baldessarini, R. J.; Tondo, L.; Davis, P.; Pompili, M.; Goodwin, F. K., and Hennen, J. Decreased 

risk of suicides and attempts during long-term lithium treatment: a meta-analytic review. 

Bipolar Disord. 2006; 8(5 Pt 2):625-39.

Baldessarini, R. J.; Tondo, L.; Strombom, I. M.; Dominguez, S.; Fawcett, J.; Licinio, J.; Oquendo, M. A.; Tollefson, G. D.; Valuck, R. J., and Tohen, M. Ecological studies of antidepressant treatment and suicidal risks. Harv Rev Psychiatry. 2007; 15(4):133-45.

Beautrais, A. ; Fergusson, D.; Coggan, C.; Collings, C.; Doughty, C.; Ellis, P.; Hatcher, S.; 

Horwood, J.; Merry, S.; Mulder, R.; Poulton, R., and Surgenor, L. Effective strategies 

for suicide prevention in New Zealand: a review of the evidence. N Z Med J. 2007; 

120(1251):U2459 .

Boscarino, J. A. External-cause mortality after psychologic trauma: the effects of stress exposure 

and predisposition. Compr Psychiatry. 2006; 47(6):503-14.

Chan, J.; Draper, B., and Banerjee, S. Deliberate self-harm in older adults: a review of the literature from 1995 to 2004. Int J Geriatr Psychiatry. 2007; 22(8):720-32.

Cipriani, A.; Pretty, H.; Hawton, K., and Geddes, J. R. Lithium in the prevention of suicidal 

behavior and all-cause mortality in patients with mood disorders: a systematic review of 

randomized trials. Am J Psychiatry. 2005; 162(10):1805-19.

Conwell, Y. and Thompson, C. Suicidal behavior in elders. Psychiatr Clin North Am. 2008; 

31(2):333-56.

Crawford, M. J.; Thomas, O.; Khan, N., and Kulinskaya, E. Psychosocial interventions following 

self-harm: systematic review of their efficacy in preventing suicide. Br J Psychiatry. 2007 

Jan; 190:11-7.

Daigle, M. S. Suicide prevention through means restriction: assessing the risk of substitution. A 

critical review and synthesis. Accid Anal Prev. 2005; 37(4):625-32.

Dew, M. A.; Bromet, E. J.; Brent, D., and Greenhouse, J. B. A quantitative literature review 

of the effectiveness of suicide prevention centers. J Consult Clin Psychol. 1987 Apr; 

55(2):239-44.

Diekstra R.F.W. The prevention of suicidal behaviour: evidence for the efficacy of clinical and 

community based programs. Int J Ment Health. 1992; 21(3):69-87.
55

Gaynes, B. N.; West, S. L.; Ford, C. A.; Frame, P.; Klein, J., and Lohr, K. N. Screening for 

suicide risk in adults: a summary of the evidence for the U.S. Preventive Services Task 

Force. Ann Intern Med. 2004 May 18; 140(10):822-35.

Goldney, R. D. Suicide prevention is possible: a review of recent studies. Archives of Suicide 

Research. 1998; 4:329-339.

Gunnel, D. and Frankel, S. Prevention of suicide: aspirations and evidence. BMJ. 1994; 

308:1227-1233.

Guo, B.; Scott, A., and Bowkers, S. Suicide Prevention Strategies: Evidence from Systematic 

Reviews. Alberta Heritage Foundation for Medical Research Health Technology Assessment. 

Guzzetta, F. ; Tondo, L.; Centorrino, F., and Baldessarini, R. J. Lithium treatment reduces suicide 

risk in recurrent major depressive disorder. J Clin Psychiatry. 2007; 68(3):380-3.

Hawkins, L. C.; Edwards, J. N., and Dargan, P. I. Impact of restricting paracetamol pack sizes on 

paracetamol poisoning in the United Kingdom: a review of the literature. Drug Saf. 2007; 

30(6):465-79.

Hawton, K.; Townsend, E.; Arensman, E.; Gunnell, D.; Hazell, P., and House, A. et al. Psychosocial and pharmacological treatments for deliberate self harm (Cochrane Review). The 

Cochran Library, Issue 3, 2002. Oxford: Update Software; 2002.

Heisel, M. J. Suicide and its prevention among older adults. Can J Psychiatry. 2006; 51(3):143-

54.

Hirsch, J. K. A review of the literature on rural suicide: risk and protective factors, incidence, and 

prevention. Crisis. 2006; 27(4):189-99.

Hirsch, S. R.; Walsh, C., and Draper, R. Parasuicide. A review of treatment interventions. J Affect Disord. 1982 Dec; 4(4):299-311.

Isacsson, G. and Rich, C. L. Antidepressant drug use and suicide prevention. Int Rev Psychiatry. 

2005; 17(3):153-62.

Lester, D. The effectiveness of suicide prevention centers: a review. Suicide Life Threat Behav. 

1997 Fall; 27(3):304-10.

Links, P. S. and Hoffman, B. Preventing suicidal behaviour in a general hospital psychiatric 

service: priorities for programming. Can J Psychiatry. 2005; 50( 8):490-6.

Mackenzie, M.; Blamey, A.; Halliday, E.; Maxwell, M.; McCollam, A.; McDaid, D.; MacLean, 

J.; Woodhouse, A., and Platt, S. Measuring the tail of the dog that doesn’t bark in the 

night: the case of the national evaluation of Choose Life (the national strategy and action 

plan to prevent suicide in Scotland). BMC Public Health. 2007; 7146.
56

Mann, J. J.; Apter, A.; Bertolote, J.; Beautrais, A.; Currier, D.; Haas, A.; Hegerl, U.; Lonnqvist, 

J.; Malone, K.; Marusic, A.; Mehlum, L.; Patton, G.; Phillips, M.; Rutz, W.; Rihmer, Z.; 

Schmidtke, A.; Shaffer, D.; Silverman, M.; Takahashi, Y.; Varnik, A.; Wasserman, D.; 

Yip, P., and Hendin, H. Suicide prevention strategies: a systematic review. JAMA. 2005 

Oct 26; 294(16):2064-74.

Moller, H. J. Evidence for beneficial effects of antidepressants on suicidality in depressive patients: a systematic review. Eur Arch Psychiatry Clin Neurosci. 2006; 256(6):329-43.

Morgan, O. and Majeed, A. Restricting paracetamol in the United Kingdom to reduce poisoning: 

a systematic review. J Public Health (Oxf). 2005 Mar; 27(1):12-8.

NHS Centre for Reviews and Dissemination. Deliberate self-harm. Effective Health Care. 1998; 

4(6 ):1-12.

Pignone, M. P.; Gaynes, B. N.; Rushton, J. L.; Burchell, C. M.; Orleans, C. T.; Mulrow, C. D., 

and Lohr, K. N. Screening for depression in adults: a summary of the evidence for the 

U.S. Preventive Services Task Force. Ann Intern Med. 2002 May 21; 136(10):765-76.

Pinkis, J.; Blood, W., and Beautrais, A. et al. Media guidelines on the reporting of suicide. Crisis 

. 2006; 27(2):82-7.

Rehkopf, D. H. and Buka, S. L. The association between suicide and the socio-economic characteristics of geographical areas: a systematic review. Psychol Med. 2006; 36(2):145-57.

Ritchie, E. C.; Keppler, W. C., and Rothberg, J. M. Suicidal admissions in the United States military. Mil Med. 2003 Mar; 168(3):177-81.

Rodgers, P. L.; Sudak, H. S.; Silverman, M. M., and Litts, D. A. Evidence-based practices project 

for suicide prevention. Suicide Life Threat Behav. 2007 Apr; 37(2):154-64.

Safer, D. J. and Zito, J. M. Do antidepressants reduce suicide rates? Public Health. 2007; 

121(4):274-7.

Seguin, M.; Lesage, A. D.; Turecki, G., and et al. Research project on deaths by suicide in New 

Brunswick between April 2002 and May 2003. Douglas Hospital Research Centre and 

New Brunswick Department of Health; 2005.

Staal, M. A. The assessment and prevention of suicide for the 21st century: the Air Force’s community awareness training model. Mil Med. 2001 Mar; 166(3):195-8.

Stander, V. A.; Hilton, S. M.; Kennedy, K. R., and Robbins, D. L. Surveillance of completed suicide in the Department of the Navy. Mil Med. 2004 Apr; 169(4):301-6.

van der Sande, R.; Buskens, E.; Allart, E.; van der Graaf, Y., and van Engeland, H. Psychosocial 

intervention following suicide attempt: a systematic review of treatment interventions. 

Acta Psychiatr Scand. 1997 Jul; 96(1):43-50.

No Outcome of Interest or Usable Outcome

Preventing patient suicide. Healthc Hazard Manage Monit. 2007; 21(1):1-8.
57

S-kit Suicide prevention local implementation framework: A strategic multi-agency toolkit aimed 

at saving lives. National Institute for Mental Health in England, Care Services Improvement Partnership.

Aguilar, E. J. and Siris, S. G. Do antipsychotic drugs influence suicidal behavior in schizophrenia? Psychopharmacol Bull. 2007; 40(3):128-42.

Akroyd, S. and Wyllie, J. Impacts of National Media Campaign to Counter Stigma and Discriminantion Associated with Mental Illness: Survey 4. Wellington, New Zealand: New 

Zealand Ministry of Health; 2002; Publication 9-20-0004. 

Anderson, M. and Jenkins, R. The national suicide prevention strategy for England: the reality 

of a national strategy for the nursing profession. J Psychiatr Ment Health Nurs. 2006; 

13(6):641-50.

Bateman, D. N.; Bain, M.; Gorman, D., and Murphy, D. Changes in paracetamol, antidepressants 

and opioid poisoning in Scotland during the 1990s. QJM. 2003 Feb; 96(2):125-32.

Beautrais, A. L. Subsequent mortality in medically serious suicide attempts: a 5 year follow-up. 

Aust N Z J Psychiatry. 2003 Oct; 37(5):595-9.

Bodner, E.; Ben-Artzi, E., and Kaplan, Z. Soldiers who kill themselves: the contribution of dispositional and situational factors. Arch Suicide Res. 2006; 10(1):29-43.

Brent, D. A. and Mann, J. J. Family genetic studies, suicide, and suicidal behavior. Am J Med 

Genet C Semin Med Genet. 2005 Feb 15; 133(1):13-24.

Bridges, F. S. and Kunselman, J. C. Gun availability and use of guns for suicide, homicide, and 

murder in Canada. Percept Mot Skills. 2004 Apr; 98(2):594-8.

Burgess, P.; Pirkis, J.; Jolley, D.; Whiteford, H., and Saxena, S. Do nations’ mental health policies, programs and legislation influence their suicide rates? An ecological study of 100 

countries. Aust N Z J Psychiatry. 2004 Nov-2004 Dec 31; 38(11-12):933-9.

Carrington, P. Gender, gun control, suicide, and homicide in Canada. Archives of Suicide Research. 1999; 5:71-75.

Chan, T. Y. Improvements in the packaging of drugs and chemicals may reduce the likelihood of 

severe intentional poisonings in adults. Hum Exp Toxicol. 2000 Jul; 19(7):387-91.

Copley, G. B. Epidemiologica risk factors for suicide and attempted suicide in the U.S. Air 

Force: using administrative data systems and multiple case of death information to improve prevention policy. Diss Abst Int B Sci Eng. 2001; 62807.

Crane, C.; Hawton, K.; Simkin, S., and Coulter, P. Suicide and the media: pitfalls and prevention. 

Report on a meeting organized by the Reuters Foundation Program at Green College and 

University of Oxford Centre for Suicide Research at Green College, Oxford, UK, November 18, 2003. Crisis. 2005; 26(1):42-7.

Crome, P. The toxicity of drugs used for suicide. Acta Psychiatr Scand Suppl. 1993; 371:33-7.
58

Dargan, P. and Jones, A. Effects of legislation restricting pack sizes of paracetamol on self poisoning. It’s too early to tell yet. BMJ. 2001 Sep 15; 323(7313):633.

Deutsch, S. and Alt, F. The effect of Massachusetts’ gun control law on gun-related crimes in the 

city of Boston. Evaluation Quarterly. 1977; 1:543-568.

Eaton, K. M. ; Messer, S. C.; Garvey Wilson, A. L., and Hoge, C. W. Strengthening the validity of population-based suicide rate comparisons: an illustration using U.S. military and 

civilian data. Suicide Life Threat Behav. 2006; 36(2):182-91.

 Feightner J and Canadian Task Force on the Periodic Health Examination. Canadian Guide to 

Clinical Preventitive Health Care. Ottawa, Ontario: Health Canada; 1994.

Florkowski, A.; Gruszczynski, W., and Wawrzyniak, Z. Evaluation of psychopathological factors and origins of suicides committed by soldiers, 1989 to 1998. Mil Med. 2001 Jan; 

166(1):44-7.

Gibbons, R. D.; Hur, K.; Bhaumik, D. K., and Mann, J. J. The relationship between antidepressant medication use and rate of suicide. Arch Gen Psychiatry. 2005 Feb; 62(2):165-72.

Gilbody, S.; Whitty, P.; Grimshaw, J., and Thomas, R. Educational and organizational interventions to improve the management of depression in primary care: a systematic review. 

JAMA. 2003 Jun 18; 289(23):3145-51.

Giles-Sims, J. and Lockhart, C. Explaining cross-state differences in elderly suicide rates and 

identifying state-level public policy responses that reduce rates. Suicide Life Threat Behav. 2006; 36(6):694-708.

Goldney, R. D.; Fisher, L. J., and Wilson, D. H. Mental health literacy: an impediment to the 

optimum treatment of major depression in the community. J Affect Disord. 2001 May; 

64(2-3):277-84.

Greer, S. and Bagley, C. Effect of psychiatric intervention in attempted suicide: a controlled 

study. Br Med J. 1971 Feb 6; 1(5744):310-2.

Grossman, D. C.; Mueller, B. A.; Riedy, C.; Dowd, M. D.; Villaveces, A.; Prodzinski, J.; Nakagawara, J.; Howard, J.; Thiersch, N., and Harruff, R. Gun storage practices and risk of 

youth suicide and unintentional firearm injuries. JAMA. 2005 Feb 9; 293(6):707-14.

Gunnell, D.; Middleton, N., and Frankel, S. Method availability and the prevention of suicide--a 

re-analysis of secular trends in England and Wales 1950-1975. Soc Psychiatry Psychiatr 

Epidemiol. 2000 Oct; 35(10):437-43.

Hannaford, P. C.; Thompson, C., and Simpson, M. Evaluation of an educational programme to 

improve the recognition of psychological illness by general practitioners. Br J Gen Pract. 

1996 Jun; 46(407):333-7.

Hartl, T. L. ; Rosen, C.; Drescher, K.; Lee, T. T., and Gusman, F. Predicting high-risk behaviors 

in veterans with posttraumatic stress disorder. J Nerv Ment Dis. 2005; 193(7):464-72.
59

Hawton, K.; Simkin, S., and Deeks, J. Co-proxamol and suicide: a study of national mortality 

statistics and local non-fatal self poisonings. BMJ. 2003 May 10; 326(7397):1006-8.

Hegerl, U.; Althaus, D., and Stefanek, J. Public attitudes towards treatment of depression: effects 

of an information campaign. Pharmacopsychiatry. 2003 Nov; 36(6):288-91.

Henkel, V.; Mergl, R.; Kohnen, R.; Maier, W.; Moller, H. J., and Hegerl, U. Identifying depression in primary care: a comparison of different methods in a prospective cohort study. 

BMJ. 2003 Jan 25; 326(7382):200-1.

Hirschfeld, R. M.; Keller, M. B.; Panico, S.; Arons, B. S.; Barlow, D.; Davidoff, F.; Endicott, 

J.; Froom, J.; Goldstein, M.; Gorman, J. M.; Marek, R. G.; Maurer, T. A.; Meyer, R.; 

Phillips, K.; Ross, J.; Schwenk, T. L.; Sharfstein, S. S.; Thase, M. E., and Wyatt, R. J. 

The National Depressive and Manic-Depressive Association consensus statement on the 

undertreatment of depression. JAMA. 1997 Jan 22-1997 Jan 29; 277(4):333-40.

Isbister, G. and Balit, C. Effects of legislation restricting pack sizes of paracetamol on self 

poisoning. Authors did not look at effects on all deliberate and accidental self poisoning. 

BMJ. 2001 Sep 15; 323(7313):633-4.

Jorm, A. F.; Christensen, H., and Griffiths, K. M. The impact of beyondblue: the national depression initiative on the Australian public’s recognition of depression and beliefs about treatments. Aust N Z J Psychiatry. 2005 Apr; 39(4):248-54.

Kaleveld, L. and English, B. Evaluating a suicide prevention program: a question of impact. 

Health Promot J Austr. 2005 Aug; 16(2):129-33.

Kapur, S.; Mieczkowski, T., and Mann, J. J. Antidepressant medications and the relative risk of 

suicide attempt and suicide. JAMA. 1992 Dec 23-1992 Dec 30; 268(24):3441-5.

Kelly, C. The effects of depression awareness seminars on general practitioners knowledge of 

depressive illness. Ulster Med J. 1998 May; 67(1):33-5.

Kelly, S. and Bunting, J. Trends in suicide in England and Wales, 1982-96. Popul Trends. 1998 

Summer; (92):29-41.

Kennedy, P. Efficacy of a regional poisoning treatment centre in preventing further suicidal behaviour. Br Med J. 1972 Nov 4; 4(5835):255-7.

Laing, W.; Gordon, L.; Lee, D.; Good, A., and Bateman, D. Have the new pack size regulations 

impacted on UK paracetamol overdose? J Toxicol Clin Toxicol. 2001; 39:301.

Lester, D. Firearm availability and use of firearms for suicide and homicide. Perceptual and Motor Skills. 2000; 91:758.

Lin, E. H.; Simon, G. E.; Katzelnick, D. J., and Pearson, S. D. Does physician education on 

depression management improve treatment in primary care? J Gen Intern Med. 2001 Sep; 

16(9):614-9.
60

Luoma, J. B.; Martin, C. E., and Pearson, J. L. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002 Jun; 159(6):909-

16.

Mahon, M. J. ; Tobin, J. P.; Cusack, D. A.; Kelleher, C., and Malone, K. M. Suicide among 

regular-duty military personnel: a retrospective case-control study of occupation-specific 

risk factors for workplace suicide. Am J Psychiatry. 2005; 162(9):1688-96.

Marzuk, P. M.; Leon, A. C.; Tardiff, K.; Morgan, E. B.; Stajic, M., and Mann, J. J. The effect 

of access to lethal methods of injury on suicide rates. Arch Gen Psychiatry. 1992 Jun; 

49(6):451-8.

McClure, G. M. Changes in suicide in England and Wales, 1960-1997. Br J Psychiatry. 2000 Jan; 

176:64-7.

McLeavey, B. C.; Daly, R. J.; Ludgate, J. W., and Murray, C. M. Interpersonal problem-solving 

skills training in the treatment of self-poisoning patients. Suicide Life Threat Behav. 1994 

Winter; 24(4):382-94.

Miller, M.; Hemenway, D., and Azrael, D. Firearms and suicide in the northeast. J Trauma. 2004 

Sep; 57(3):626-32.

Mills, P. D. ; Neily, J.; Luan, D.; Osborne, A., and Howard, K. Actions and implementation strategies to reduce suicidal events in the Veterans Health Administration. Jt Comm J Qual 

Patient Saf. 2006; 32( 3):130-41.

Ministry of Health. Suicide and the Media: The Reporting and Portrayal of suicide in the Media. 

Wellington: Ministry of Health; 1999.

Mundt, R. J. Gun control and rates of firearms violence in Canada and the United States. Canadian Journal of Criminology. 1990; 32:137-154.

Naismith, S. L.; Hickie, I. B.; Scott, E. M., and Davenport, T. A. Effects of mental health training and clinical audit on general practitioners’ management of common mental disorders. 

Med J Aust. 2001 Jul 16; 175 Suppl:S42-7.

Paykel, E. S.; Hart, D., and Priest, R. G. Changes in public attitudes to depression during the 

Defeat Depression Campaign. Br J Psychiatry. 1998 Dec; 173:519-22.

Pettit, J. W.; Paukert, A. L.; Joiner, T. E. Jr., and Rudd, M. D. Pilot sample of very early onset 

bipolar disorder in a military population moderates the association of negative life events 

and non-fatal suicide attempt. Bipolar Disord. 2006; 8(5 Pt 1):475-84.

Pfaff, J. J.; Acres, J. G., and McKelvey, R. S. Training general practitioners to recognise and respond to psychological distress and suicidal ideation in young people. Med J Aust. 2001 

Mar 5; 174(5):222-6.
61

Platt, S.; McLean, J.; McCollam, A.; Blamey, A.; Mackenzie, M.; McDaid, D.; Maxwell, M.; 

Halliday, E., and Woodhouse, A. Evaluation of the first phase of Choose Life: the National Strategy and Action Plan to Prevent Suicide in Scotland 2006. Edinburgh: Scottish 

Executive Social Research.

Rabasca, L. Military suicide-prevention program reduces the stigma of seeking help. Am Psychol 

Assoc Monitor. 1999; 30(9):8.

Rihmer, Z.; Belso, N., and Kalmar, S. Antidepressants and suicide prevention in Hungary. Acta 

Psychiatr Scand. 2001 Mar; 103(3):238-9.

Sakinofsky, I. The current evidence base for the clinical care of suicidal patients: strengths and 

weaknesses. Can J Psychiatry. 2007; 52(6 Suppl 1):7S-20S.

Sakinofsky, I. Treating suicidality in depressive illness. Part 2: does treatment cure or cause suicidality? Can J Psychiatry. 2007; 52(6 Suppl 1):85S-101S.

Saunders, K. and Hawton, K. Suicide prevention and audit. Br J Hosp Med (Lond). 2005; 

66(11):627-30.

Scarff, E. Evaluation of the Canadian gun control legislation: final report. Ottawa: Canadian 

Government Publishing Centre; 1983.

Scoville, S. L.; Gubata, M. E.; Potter, R. N.; White, M. J., and Pearse, L. A. Deaths attributed 

to suicide among enlisted U.S. Armed Forces recruits, 1980-2004. Mil Med. 2007; 

172(10):1024-31.

Sheen, C. and Dillon, J. The effect on toxicity and healthcare costs on reducing the size of available acetaminophen pack sizes in the Tayside region of Scotland. Gastroenterology. 2001; 

120(Suppl. 1):A-228.

Sheen, C. L.; Dillon, J. F.; Bateman, D. N.; Simpson, K., and MacDonald, T. M. The effect on 

toxicity on reducing the size of available paracetamol pack sizes. Gut. 2001; 48((Suppl 

1)):A105.

Sheen, C. L.; Dillon, J. F.; Bateman, D. N.; Simpson, K. J., and MacDonald, T. M. Paracetamol pack size restriction: the impact on paracetamol poisoning and the over-the-counter 

supply of paracetamol, aspirin and ibuprofen. Pharmacoepidemiol Drug Saf. 2002 Jun; 

11(4):329-31.

Shenassa, E. D.; Rogers, M. L.; Spalding, K. L., and Roberts, M. B. Safer storage of firearms 

at home and risk of suicide: a study of protective factors in a nationally representative 

sample. J Epidemiol Community Health. 2004 Oct; 58(10):841-8.

Sloan, J. H.; Rivara, F. P.; Reay, D. T.; Ferris, J. A., and Kellermann, A. L. Firearm regulations 

and rates of suicide. A comparison of two metropolitan areas. N Engl J Med. 1990 Feb 8; 

322(6):369-73.

Sorenson, S. B. and Vittes, K. A. Mental health and firearms in community-based surveys: implications for suicide prevention. Eval Rev. 2008; 32(3):239-56.
62

Stuart, H. Fighting stigma and discrimination is fighting for mental health. Canadian Public 

Policy. 2005; S21-S28.

Thoresen, S. and Mehlum, L. Suicide in peacekeepers: risk factors for suicide versus accidental 

death. Suicide Life Threat Behav. 2006; 36(4):432-42.

Thoresen, S. ; Mehlum, L.; Roysamb, E., and Tonnessen, A. Risk factors for completed suicide 

in veterans of peacekeeping: repatriation, negative life events, and marital status. Arch 

Suicide Res. 2006; 10(4):353-63.

Tiet, Q. Q.; Finney, J. W., and Moos, R. H. Recent sexual abuse, physical abuse, and suicide 

attempts among male veterans seeking psychiatric treatment. Psychiatr Serv. 2006; 

57(1):107-13.

Tiet, Q. Q.; Ilgen, M. A.; Byrnes, H. F., and Moos, R. H. Suicide attempts among substance use 

disorder patients: an initial step toward a decision tree for suicide management. Alcohol 

Clin Exp Res. 2006; 30(6):998-1005.

Troister, T. ; Links, P. S., and Cutcliffe, J. Review of predictors of suicide within 1 year of discharge from a psychiatric hospital. Curr Psychiatry Rep. 2008; 10(1):60-5.

Unutzer, J.; Katon, W.; Callahan, C. M.; Williams, J. W. Jr; Hunkeler, E.; Harpole, L.; Hoffing, M.; Della Penna, R. D.; Noel, P. H.; Lin, E. H.; Arean, P. A.; Hegel, M. T.; Tang, 

L.; Belin, T. R.; Oishi, S., and Langston, C. Collaborative care management of late-life 

depression in the primary care setting: a randomized controlled trial. JAMA. 2002 Dec 

11; 288(22):2836-45.

Valentini, W.; Levav, I.; Kohn, R.; Miranda, C. T.; Mello, A. A.; Mello, M. F., and Ramos, C. P. 

[An educational training program for physicians for diagnosis and treatment of depression]. Rev Saude Publica. 2004 Aug; 38(4):522-8.

Voaklander, D. C.; Rowe, B. H.; Dryden, D. M.; Pahal, J.; Saar, P., and Kelly, K. D. Medical illness, medication use and suicide in seniors: a population-based case-control study. Epidemiol Community Health. 2008; 62(2):138-46.

Vuorilehto, M. S.; Melartin, T. K., and Isometsa, E. T. Suicidal behaviour among primary-care 

patients with depressive disorders. Psychol Med. 2006; 36(2):203-10.

Zivin, K.; Kim, H. M.; McCarthy, J. F.; Austin, K. L.; Hoggatt, K. J.; Walters, H., and Valenstein, 

M. Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: associations with patient and treatment setting characteristics. 

Am J Public Health. 2007; 97(12):2193-8.

Adolescent

Rotheram-Borus, M. J.; Piacentini, J.; Cantwell, C.; Belin, T. R., and Song, J. The 18-month 

impact of an emergency room intervention for adolescent female suicide attempters. J 

Consult Clin Psychol. 2000 Dec; 68(6):1081-93.
63

Design- Other

Appleby, L. and Sherratt, J. Good clinical practice on suicide and suicide prevention. Psychiatr 

Bull R Coll Psychiatr. 2001; 2541-42.

Excluded at Further Review (n=49)

Country

Apter, A.; King, R. A.; Bleich, A.; Fluck, A.; Kotler, M., and Kron, S. Fatal and non-fatal suicidal 

behavior in Israeli adolescent males. Arch Suicide Res. 2008; 12(1):20-9.

Bellanger, M. M.; Jourdain, A., and Batt-Moillo, A. Might the decrease in the suicide rates in 

France be due to regional prevention programmes? Soc Sci Med. 2007; 65(3):431-41.

Bradvik, L. and Berglund, M. Long-term treatment and suicidal behavior in severe depression: 

ECT and antidepressant pharmacotherapy may have different effects on the occurrence 

and seriousness of suicide attempts. Depress Anxiety. 2006; 23(1):34-41.

Cedereke, M.; Monti, K., and Ojehagen, A. Telephone contact with patients in the year after a 

suicide attempt: does it affect treatment attendance and outcome? A randomised controlled study. Eur Psychiatry. 2002 Apr; 17(2):82-91.

De Leo, D.; Dello Buono, M., and Dwyer, J. Suicide among the elderly: the long-term impact of 

a telephone support and assessment intervention in northern Italy. Br J Psychiatry. 2002 

Sep; 181:226-9.

Dieserud, G.; Loeb, M., and Ekeberg, O. Suicidal behavior in the municipality of Baerum, Norway: a 12-year prospective study of parasuicide and suicide. Suicide Life Threat Behav. 

2000 Spring; 30(1):61-73.

Gunnell, D.; Fernando, R.; Hewagama, M.; Priyangika, W. D.; Konradsen, F., and Eddleston, M. 

The impact of pesticide regulations on suicide in Sri Lanka. Int J Epidemiol. 2007.

Hegerl, U.; Althaus, D.; Schmidtke, A., and Niklewski, G. The alliance against depression: 

2-year evaluation of a community-based intervention to reduce suicidality. Psychol Med. 

2006 Sep; 36(9):1225-33.

Kapusta, N. D.; Etzersdorfer, E.; Krall, C., and Sonneck, G. Firearm legislation reform in the 

European Union: impact on firearm availability, firearm suicide and homicide rates in 

Austria. Br J Psychiatry. 2007; 191 253-7.

Matakas, F. and Rohrbach, E. Suicide prevention in the psychiatric hospital. Suicide Life Threat 

Behav. 2007; 37(5):507-17.
64

Ohberg, A.; Lonnqvist, J.; Sarna, S.; Vuori, E., and Penttila, A. Trends and availability of suicide methods in Finland. Proposals for restrictive measures. Br J Psychiatry. 1995 Jan; 

166(1):35-43.

Oyama, H.; Fujita, M.; Goto, M.; Shibuya, H., and Sakashita, T. Outcomes of community-based 

screening for depression and suicide prevention among Japanese elders. Gerontologist. 

2006 Dec; 46(6):821-6.

Oyama, H.; Goto, M.; Fujita, M.; Shibuya, H., and Sakashita, T. Preventing elderly suicide 

through primary care by community-based screening for depression in rural Japan. Crisis. 

2006; 27(2):58-65.

Oyama, H.; Koida, J.; Sakashita, T., and Kudo, K. Community-based prevention for suicide in 

elderly by depression screening and follow-up. Community Ment Health J. 2004 Jun; 

40(3):249-63.

Oyama, H.; Ono, Y.; Watanabe, N.; Tanaka, E.; Kudoh, S.; Sakashita, T.; Sakamoto, S.; Neichi, 

K.; Satoh, K.; Nakamura, K., and Yoshimura, K. Local community intervention through 

depression screening and group activity for elderly suicide prevention. Psychiatry Clin 

Neurosci. 2006; 60(1):110-4.

Oyama, H.; Watanabe, N.; Ono, Y.; Sakashita, T.; Takenoshita, Y.; Taguchi, M.; Takizawa, T.; 

Miura, R., and Kumagai, K. Community-based suicide prevention through group activity for the elderly successfully reduced the high suicide rate for females. Psychiatry Clin 

Neurosci. 2005; 59(3):337-44.

Raj, M. A. J.; Kumaraiah, V., and Bhide, A. V. Cognitive-behavioural intervention in deliberate 

self-harm. Acta Psychiatr Scand. 2001; 104:340-5.

Rutz, W.; von Knorring, L., and Walinder, J. Frequency of suicide on Gotland after systematic postgraduate education of general practitioners. Acta Psychiatr Scand. 1989 Aug; 

80(2):151-4.

Szanto, K.; Kalmar, S.; Hendin, H.; Rihmer, Z., and Mann, J. J. A suicide prevention program in 

a region with a very high suicide rate. Arch Gen Psychiatry. 2007; 64(8):914-20.

Torhorst, A.; Moller, H. J.; Burk, F.; Kurz, A.; Wachtler, C., and Lauter, H. The psychiatric management of parasuicide patients: a controlled clinical study comparing different strategies 

of outpatient treatment. Crisis. 1987 Mar; 8(1):53-61.

Torhorst, A.; Moller, H. J., and Schimid-Bode, K. W. Comparing a 3-month and a 12-month outpatient aftercare program for parasuicide repeaters. Current Issues of SuicidologyBerlin, 

Germany: Springer-Verlag; 1988; pp. 19-24.

Vaiva, G.; Vaiva, G.; Ducrocq, F.; Meyer, P.; Mathieu, D.; Philippe, A.; Libersa, C., and Goudemand, M. Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: randomised controlled study. Bmj. 2006; 

332(7552):1241-5.
65

van den Bosch, L. M.; Koeter, M. W.; Stijnen, T. ; Verheul, R., and van den Brink, W. Sustained 

efficacy of dialectical behaviour therapy for borderline personality disorder. Behav Res 

Ther. 2005; 43(9):1231-41.

van der Sande, R.; van Rooijen, L.; Buskens, E.; Allart, E.; Hawton, K.; van der Graaf, Y., and 

van Engeland, H. Intensive in-patient and community intervention versus routine care 

after attempted suicide. A randomised controlled intervention study. Br J Psychiatry. 1997 

Jul; 171:35-41.

Van Heeringen, C.; Jannes, S.; Buylaert, W.; Henderick, H.; De Bacquer, D., and Van Remoortel, J. The management of non-compliance with referral to out-patient after-care among 

attempted suicide patients: a controlled intervention study. Psychol Med. 1995 Sep; 

25(5):963-70.

Varnik, A.; Kolves, K.; Vali, M.; Tooding, L. M., and Wasserman, D. Do alcohol restrictions 

reduce suicide mortality? Addiction. 2007; 102(2):251-6.

Verkes, R. J.; Van der Mast, R. C.; Hengeveld, M. W.; Tuyl, J. P.; Zwinderman, A. H., and Van 

Kempen, G. M. Reduction by paroxetine of suicidal behavior in patients with repeated 

suicide attempts but not major depression. Am J Psychiatry. 1998 Apr; 155(4):543-7.

Zonda, T. and Lester, D. Preventing suicide by educating general practitioners. Omega (Westport). 2006; 54( 1):53-7.

Pharmacotherapy

Battaglia, J.; Wolff, T. K.; Wagner-Johnson, D. S.; Rush, A. J.; Carmody, T. J., and Basco, M. R. 

Structured diagnostic assessment and depot fluphenazine treatment of multiple suicide attempters in the emergency department. Int Clin Psychopharmacol. 1999 Nov; 14(6):361-

72.

Coryell, W.; Arndt, S.; Turvey, C.; Endicott, J.; Solomon, D.; Mueller, T.; Leon, A. C., and 

Keller, M. Lithium and suicidal behavior in major affective disorder: a case-control study. 

Acta Psychiatr Scand. 2001 Sep; 104(3):193-7.

Ludwig, J.; Marcotte, D. E., and Norberg, K. Anti-Depressants and Suicide. 2007 Feb.

Montgomery, D. B.; Roberts, A.; Green, M.; Bullock, T.; Baldwin, D., and Montgomery, S. A. 

Lack of efficacy of fluoxetine in recurrent brief depression and suicidal attempts. Eur 

Arch Psychiatry Clin Neurosci. 1994; 244(4):211-5.

Montgomery, S.; Cronholm, B.; Asberg, M., and Montgomery, D. B. Differential effects on suicidal ideation of mianserin, maprotiline and amitriptyline. Br J Clin Pharmacol. 1978; 5 

Suppl 1:77S-80S.

Montgomery, S. A.; Roy, D., and Montgomery, D. B. The prevention of recurrent suicidal acts. 

Br J Clin Pharmacol. 1983; 15 Suppl 2:183S-188S.
66

Verkes, R. J.; Van der Mast, R. C.; Hengeveld, M. W.; Tuyl, J. P.; Zwinderman, A. H., and Van 

Kempen, G. M. Reduction by paroxetine of suicidal behavior in patients with repeated 

suicide attempts but not major depression. Am J Psychiatry. 1998 Apr; 155(4):543-7.

Psychotherapy

Bateman, A. and Fonagy, P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry. 1999 Oct; 

156(10):1563-9.

Blum, N.; St John, D.; Pfohl, B.; Stuart, S.; McCormick, B.; Allen, J.; Arndt, S., and Black, D. 

W. Systems Training for Emotional Predictability and Problem Solving (STEPPS) for 

outpatients with borderline personality disorder: a randomized controlled trial and 1-year 

follow-up. Am J Psychiatry. 2008; 165(4):468-78.

Bradvik, L. and Berglund, M. Long-term treatment and suicidal behavior in severe depression: 

ECT and antidepressant pharmacotherapy may have different effects on the occurrence 

and seriousness of suicide attempts. Depress Anxiety. 2006; 23(1):34-41.

Evans, K.; Tyrer, P.; Catalan, J.; Schmidt, U.; Davidson, K.; Dent, J.; Tata, P.; Thornton, S.; 

Barber, J., and Thompson, S. Manual-assisted cognitive-behaviour therapy (MACT): a 

randomized controlled trial of a brief intervention with bibliotherapy in the treatment of 

recurrent deliberate self-harm. Psychol Med. 1999 Jan; 29(1):19-25.

Liberman, R. P. and Eckman, T. Behavior therapy vs insight-oriented therapy for repeated suicide 

attempters. Arch Gen Psychiatry. 1981 Oct; 38(10):1126-30.

Linehan, M. M.; Armstrong, H. E.; Suarez, A.; Allmon, D., and Heard, H. L. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991 

Dec; 48(12):1060-4.

Linehan, M. M.; Comtois, K. A.; Murray, A. M.; Brown, M. Z.; Gallop, R. J.; Heard, H. L.; 

Korslund, K. E.; Tutek, D. A.; Reynolds, S. K., and Lindenboim, N. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts 

for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006; 

63(7):757-66.

Matakas, F. and Rohrbach, E. Suicide prevention in the psychiatric hospital. Suicide Life Threat 

Behav. 2007; 37(5):507-17.

Patsiokas, A. T. and Clum, G. A. Effects of psychotherapeutic strategies in the treatment of suicide attempters. Journal of Psychotherapy. 1985; 22(281).

Raj, M. A. J.; Kumaraiah, V., and Bhide, A. V. Cognitive-behavioural intervention in deliberate 

self-harm. Acta Psychiatr Scand. 2001; 104:340-5.

Rudd, M. D.; Rajab, M. H.; Orman, D. T.; Joiner, T.; Stulman, D. A., and Dixon, W. Effectiveness of an outpatient intervention targeting suicidal young adults: preliminary results. J 

Consult Clin Psychol. 1996 Feb; 64(1):179-90.
67

Salkovskis, P. M.; Atha, C., and Storer, D. Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide. A controlled trial. Br J Psychiatry. 1990 

Dec; 157:871-6.

Tarrier, N.; Haddock, G.; Lewis, S.; Drake, R., and Gregg, L. Suicide behaviour over 18 months 

in recent onset schizophrenic patients: the effects of CBT. Schizophr Res. 2006; 83(1):15-

27.

Torhorst, A.; Moller, H. J.; Burk, F.; Kurz, A.; Wachtler, C., and Lauter, H. The psychiatric management of parasuicide patients: a controlled clinical study comparing different strategies 

of outpatient treatment. Crisis. 1987 Mar; 8(1):53-61.

Tyrer, P.; Thompson, S.; Schmidt, U.; Jones, V.; Knapp, M.; Davidson, K.; Catalan, J.; Airlie, 

J.; Baxter, S.; Byford, S.; Byrne, G.; Cameron, S.; Caplan, R.; Cooper, S.; Ferguson, B.; 

Freeman, C.; Frost, S.; Godley, J.; Greenshields, J.; Henderson, J.; Holden, N.; Keech, P.; 

Kim, L.; Logan, K.; Manley, C.; MacLeod, A.; Murphy, R.; Patience, L.; Ramsay, L.; De 

Munroz, S.; Scott, J.; Seivewright, H.; Sivakumar, K.; Tata, P.; Thornton, S.; Ukoumunne, 

O. C., and Wessely, S. Randomized controlled trial of brief cognitive behaviour therapy 

versus treatment as usual in recurrent deliberate self-harm: the POPMACT study. Psychol 

Med. 2003 Aug; 33(6):969-76.

van den Bosch, L. M.; Koeter, M. W.; Stijnen, T. ; Verheul, R., and van den Brink, W. Sustained 

efficacy of dialectical behaviour therapy for borderline personality disorder. Behav Res 

Ther. 2005; 43(9):1231-41.

Weinberg, I.; Gunderson, J. G.; Hennen, J., and Cutter, C. J. Jr. Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients. J Personal Disord. 2006; 20(5):482-92.

Suicidal Ideation

Bruce, M. L.; Ten Have, T. R.; Reynolds, C. F. 3rd; Katz, I. I.; Schulberg, H. C.; Mulsant, B. H.; 

Brown, G. K.; McAvay, G. J.; Pearson, J. L., and Alexopoulos, G. S. Reducing suicidal 

ideation and depressive symptoms in depressed older primary care patients: a randomized 

controlled trial. JAMA. 2004 Mar 3; 291(9):1081-91.

Montgomery, S.; Cronholm, B.; Asberg, M., and Montgomery, D. B. Differential effects on suicidal ideation of mianserin, maprotiline and amitriptyline. Br J Clin Pharmacol. 1978; 5 

Suppl 1:77S-80S.

Patsiokas, A. T. and Clum, G. A. Effects of psychotherapeutic strategies in the treatment of suicide attempters. Journal of Psychotherapy. 1985; 22(281).

Raj, M. A. J.; Kumaraiah, V., and Bhide, A. V. Cognitive-behavioural intervention in deliberate 

self-harm. Acta Psychiatr Scand. 2001; 104:340-5.
68

vidence Tables

es Describing Suicide Prevention Interventions in Military Personnel and Veterans

Country / 

Setting

Veteran 

/ Military Outcome Intervention Detailed Intervention Results

US / Population & Other No / Yes Completers Population / Organizational

25th Infantry Division (Light) Suicide Prevention Program implementation beginning in 1992. This program incorporated warning signs and risk factors along with community education.

In the two years following complete implementation (1994) the suicide rate decreased to 3.

US / Other No / Yes Attempters & SI Organizational

This two year retrospective study examines a suicide prevention program at the training command center aimed at the instructors. The classes, provided in 1986 and then again from June 1987-January 1988, were targeted at informing instructors on how to recognize signs of distress and students at risk. 

The average number of suicide attempts was 9.4 per 100,000 per month. The number of instructors who received training was negatively correlated (-0.65, p<0.001) with number of suicide attempts per month.

US / Population No / Yes Completers Population / Organizational

To assess the impact of the US Air Force suicide prevention program implemented in 1996, this study looked at 5,260,292 air force personnel. The program aimed to reduce risk factors for suicide and enhance protective factors as well as increasing understanding of mental health and policies while decreasing the stigma of seeking mental health assistance. 

The relative risk for suicide when comparing the pre-implementation population and post-implementation population was 0.67(95% CI: 0.57, 0.80). There was a 33% relative risk reduction for those in the post implementation group. 

US / Population No / Yes Completers Population

Existing resources (education in suicide awareness and life skills training, counseling, post-suicide interventions, and suicide incident reporting) were augmented with new training video using positive role models to increase detection and referral.

For Navy, suicide rate dropped to 9.2/100000, the lowest rate in 10 years. For the Marine Corps, the rate was 15.6/100000.

US / Other No / Yes Attempters Patient

This is a one year follow up on a gambling treatment program implemented in January 2003 as a part of the Substance Abuse Rehabilitation Program at the US Naval Hospital in Okinawa, Japan. There was 35 participants. 

Prior to treatment 7 participants expressed suicidal ideation and 3 (8.5%) made suicide attempts related to their gambling. Post-implementation, no participants expressed suicidal ideation or attempted suicide. 

Ukraine / Population No / Yes Completers

Population / Organizational

This two year suicide prevention program, implemented in 2000, used training seminars for soldiers, professional officers, and commanders that spanned the course of one year. Brochures on suicide prevention were distributed to more than 2000 soldiers. 

The average number of suicides per year between 1988 and 1999 was 32.6per 100,000. In 1999 the suicide rate was 74.7per 100,000. During the first year of the program there was no reported suicides and in the 2nd year there were 16.7 per 100,000 reported suicides.

Serbia & Montenegro / Other No / Yes Completers Organizational

Two year follow up on a Suicide Prevention Program, based on the U.S. Air force suicide prevention program, that was implemented in 2003. The program focused on early prevention and identification of those at increased risk of committing suicide. The long-term objective was modifying military-specific risk factors for suicide. The program was applied by selection, education, and motivation.

Suicides decreased from 15 in 2003 (pre-implementation) to 9 in 2004 and 7 in 2005. After one year of implementation, suicides decreased from 13 per 100,000 of military personnel to 5 per 100,000 military personnel. 

UC / Psychiatric Yes / No Attempters & SI Patient

Dialectical behavior therapy (DBT) in with borderline personality disorder. 28 women veterans were randomized to DBT or usual care groups. 20 patients (10 in each group) completed the treatment. 

Patients in the DBT reported significantly greater decrease in depression (as measured by the BDI), suicidal ideation, and hopelessness than usual care patients. 

US / Primary Care & Psychiatric Yes / No Attempters Patient

Comparison of 226,866 patients in a VHA data set who were diagnosed with depression and had one of the following treatments: no antidepressant, SSRI, non-SSRI, tricyclic or combinations.

Odds ratio for comparing the SSRI treatment to the no antidepressant, non-SSRI and tricycle categories was 0.34 (95% CI: 0.31 to 0.38, p<0.0001). 

US / Psychiatric Yes / No Attempters Patient

This study followed 3733 veterans entering either a residential or outpatint substance abuse program. Data on suicide attempts were collected for 12 months prior to entry, during treatment and 12 months after entry.

During treatment, residential treatment was associated with a lower rate of suicide attempts than outpatient treatment. Predicting suicide attempts after drug abuse treatment was not significant for either setting. 
69

CTs Describing Suicide Interventions

Follow Up Time 

Points

/ Follow Up

Veterans / 

Military 

Country

/ Mean Age

Eligibility Criteria

Quality Measurements

Intervention

Duration of Treatment Outcome Adverse Events

Described as Randomized

Eligibility Criteria Specified

Point estimates & measures of variability for primary outcomes variable

Co-interventions avoided

Method of 

Randomization

Outcome Assessor Blinded

Compliance acceptable

Allocation Concealment

Care provider blinded

Randomized patients analyzed in group they were allocated to

Drop-out rate described

Similarity at Baseline between groups

Patients Blinded

Timing of Outcome Assessment Similar

3 mths / NR 6 mths/ 20 Yes / No US / 35

Female veterans with borderline personality disorder

Yes Yes

Yes

Yes

dialectical behavior therapy (DBT) and treatment as usual (TAU)

weekly meetings of 90 minutes each?

Attempters & SI

30% in DBT, 20% in TAU at post treatment reported self harm

Don’t Know Yes Yes

Don’t Know No

Yes

Yes

Yes No Yes

4 mths / 119 No / No US / 29

 ED contact for suicide attempt 

Yes Yes

Yes

Don’t 

Know

follow up outreach program by therapists

4 month follow up outreach program Attempters

at 4 months there were 3 repeated attempts in experimental group & 9 in control

Yes

Don’t 

Know Yes

Don’t Know No

Yes

Yes

Don’t Know No Yes

3 mths / 128 No / No

Canada / NR

ER presentation for suicide attempt

No Yes

Yes

Don’t 

Know 1. Mental health 

follow up 2. Phone follow up 3. Reassessment at 3 mths. 4. assessment at 3 mths. 12 weeks Attempters

Reattempt rate, 1: 2.2%, 2: 6.1%, 3: 22%, 4: 11.1%

No No

Don’t 

Know

No No

Yes

No

Don’t Know No Yes

12 mths/ NR 18 mths/ NR 24 mths/ 126 No / No

Canada / NR

Seen in ED after suicide attempt

Yes Yes

Yes

Don’t 

Know a treatment plan, 

follow up visits, one home visit, 

reminder for missed appointments. Treatment could include meds or therapy

18 therapy sessions & a home visit over 1 year

Attempters & Completers

3 suicides in experimental & 1 

in control

Don’t Know

Don’t 

Know Yes

Don’t Know No

Yes

Yes

Yes No Yes
70

CCTs Describing Suicide Interventions Continued

Follow Up Time 

Points / 

Follow Up

Veterans / Military 

Country

/ Mean Age

Eligibility Criteria

Quality Measurements

Intervention

Duration of Treatment Outcome Adverse Events

Described as Randomized

Eligibility Criteria Specified

Point estimates & measures of variability for primary outcomes variable

Co-interventions avoided

Method of 

Randomization

Outcome Assessor Blinded

Compliance acceptable

Allocation Concealment

Care provider blinded Randomized patients 

analyzed in group they were allocated to

Drop-out rate described

Similarity at Baseline between groups

Patients Blinded

Timing of Outcome Assessment Similar

6 mths/ NR No / No UK / NR

Hospital contact for deliberate self harm for repeat patients

No Yes

Yes

Don’t Know

outpatient clinic, home visits, telephone hotline

6 months from discharge Attempters

24% acts of parasuicide in treatment & 23% in control

No

Don’t 

Know Don’t Know

Don’t Know No

No

Yes

Yes No Yes

1 yr / 273 No / No UK / NR

Patient admitted to hospital for self poisoning

Yes Yes

Yes

Don’t Know

Inpatient assessment by medical vs. psychiatric team

Not reported. Assessment during following year.

Attempters & Completers

10% repeat attempts for medical team, 13% repeat attempts for psychiatrist. 0% suicide for medical team, 0.4% for psychiatrist.

Yes Yes Yes

Don’t Know No

Yes

Yes

Don’t Know No Yes

1 yr/ 400 No / No UK / NR

ED contact for deliberate self poisoning, not requiring immediate psychiatric treatment

Yes Yes

Yes

Don’t Know

social worker to assist with task oriented problem solving

Not reported. Assessment at one year. Attempters

13.5 repeated self poisoning in treatment group & 14.5 in control

Don’t Know

Don’t 

Know Don’t Know

Don’t Know No

Yes

Yes

Don’t Know No Yes

1 yr/ 96 No / No

UK / 25.2

Hospitalization for deliberate self poisoning

Yes Yes

Yes

Don’t Know

outpatient vs. home based therapy

Maximum of 3 months, 1st 2 as frequent as needed

Attempters & SI

10% repeated attempts in homebased, 15% in outpatiients.

Yes Yes NoYes No

Yes

Yes

Yes No Yes
71

CCTs Describing Suicide Interventions Continued

Follow Up Time Points / Follow Up

Veterans / Military 

Country / Mean Age

Eligibility Criteria

Quality Measurements

Intervention

Duration of Treatment Outcome Adverse Events

Described as Randomized

Eligibility Criteria Specified

Point estimates & measures of variability for primary outcomes variable

Co-interventions 

avoided

Method of 

Randomization

Outcome Assessor Blinded

Compliance acceptable

Allocation Concealment

Care provider blinded Randomized patients 

analyzed in group they were allocated to

Drop-out rate described

Similarity at Baseline between groups

Patients Blinded

Timing of Outcome Assessment Similar

9 mths / 65 No / No

UK / 29.3

Hospitalized for overdose, not in need of formal psychiatric care

Yes Yes

Yes

Don’t Know

brief problem oriented counseling

Not 

reported. 

Assessment 

at one year.

Attempters & Completers

1 patient in counseling group committed suicide, 15.4% in general practitioner group repeated, 

7.3% in counseling repeated 

Don’t Know Yes YesDon’t Know No

Yes

Yes

Yes No Yes

6 mths/ 95 No / No

UK / 31.2

ED contact for deliberate self poisoning

Yes Yes

Yes

Don’t Know

four sessions of psychodynamic interpersonal therapy in patient’s home

4 weekly at home sessions

Attempters & Completers & SI

9% repeated self-harm in intervention & 28% in control, no completers

Yes Yes Yes

Don’t Know No

Yes

Yes

Yes No Yes

12 mths/ 1932 No / No

UK / 32.6

Seen in ED for deliberate self harm

Yes Yes

Yes

Don’t Know

letter from GP, use of guidelines for GP to use

1 year after first self harm episode Attempters

211repeat self-harm in intervention group & 189 in the control

Don’t Know Yes Don’t Know

Don’t Know No

Yes

Yes

Don’t Know No Yes

12 mths/ 467 No / No UK / 33

ED contact for deliberate self harm

Yes Yes

Yes

Don’t Know

case management led by nurse practitioner

1 year follow up after first admission Attempters

19 readmitted in treatment & 25 in control

Yes

Don’t 

Know Yes

Yes No

Yes

Yes

Yes No Yes
72

CCTs Describing Suicide Interventions Continued

llow 

 

me 

ints 

ol

w 

Veterans / Military 

Country / Mean Age

Eligibility Criteria

Quality Measurements

Intervention

Duration of Treatment Outcome Adverse Events

Described as Randomized

Eligibility Criteria Specified

Point estimates & measures of variability for primary outcomes variable

Co-interventions avoided

Method of 

Randomization

Outcome Assessor Blinded

Compliance acceptable

Allocation Concealment

Care provider blinded

Randomized patients analyzed in group they were allocated to

Drop-out rate described

Similarity at Baseline between groups

Patients Blinded

Timing of Outcome Assessment Similar

r/ 

3 

rs/ 

3 

yrs/ 

3 No / No US / NR

Hospitalized for depression or suicidality

Yes Yes

Yes

Don’t Know

follow up letter

15 years from discharge Completers

after 15 years there were 25 suicides in the contact group, & 26 in the no contact group

Don’t Know

Don’t 

Know Don’t Know

Don’t Know No

Yes

No

Don’t Know No Yes

r/ 

2 No / No

UK / 30.1

Admission follow up episode of deliberate self harm

Yes Yes

Yes

Don’t Know

“green card” offering easy access to psychiatrist on call

1 year follow up after first admission

Attempters & Completers

No suicides occurred; 5 repeated self harm (serious threats) in experiment & 15 in control

Yes

Don’t 

Know Don’t Know

Don’t Know No

Yes

Yes

Yes No Yes

hs/ 

7 No / No

UK / 33.3

Hospitalization for deliberate self harm

Yes Yes

Yes

Don’t Know

“green card” offering 24 hr crisis phone consultation

6 months following discharge Attempters

2 suicides in “green card” group & 1 in control

Yes Yes Don’t Know

Don’t Know No

Yes

Yes

Yes No Yes

hs/ 

2 No / No

Australia / NR

ED contact for deliberate self poisoning

Yes Yes

Yes

Don’t Know

postcard sent at 1,2,3,4,6,8,10,12 months after discharge 12 months Attempters

57 repeat self harm in intervention & 68 in control

Yes Yes YesYes NA

Yes

Yes

Yes No Yes
73

nd CCTs Describing Suicide Interventions Continued

Follow Up Time Points / Follow Up

Veterans / Military 

Country / Mean Age

Eligibility Criteria

Quality Measurements

Intervention

Duration of Treatment Outcome Adverse Events

Described as Randomized

Eligibility Criteria Specified

Point estimates & measures of variability for primary outcomes variable

Co-interventions 

avoided

Method of 

Randomization

Outcome Assessor Blinded

Compliance acceptable

Allocation Concealment

Care provider blinded

Randomized patients analyzed in group they were allocated to

Drop-out rate described

Similarity at Baseline between groups

Patients Blinded

Timing of Outcome Assessment Similar

1 wk/ NR 16 wk/ NR No / No UK / NR

ED contact for parasuicidal act by self poisoning

Yes Yes

Yes

Don’t Know

hospitalization 16 months

Attempters & SI

at 16 weeks a total of 3 admitted & 4 discharged patients repeated parasuicide

Yes No Don’t Know

Don’t Know No

Yes

Don’t Know

Yes No Yes

2 yrs/ NR Yes / No

US / 71.2

Elderly with depression

Yes Yes

Yes

Don’t Know

collaborative care program, including a depression case manager in primary care clinic 12 months

Completers & SI

No completed suicides during 2 year follow up

Yes Yes Don’t KnowYes No

Yes

Don’t Know

Yes No Yes

2 mths/ 120 6 mths/ 120 No / No

Canada / NR

Family friend (of suicidal men) who called suicide hotline

No Yes

Yes

Don’t Know family friend 

of suicidal men were assigned to one of four programs

post test after 2 months with 6 month follow up Attempters

22.0% attempt rate at entry, 10.6% at 2 mo., 2.7% at 6 mo.

No No Yes

Don’t Know No

Don’t Know

Yes

Don’t Know No Yes
74

es Describing Interventions Restricting the Access to Firearms

ountry / 

Setting

Veteran 

/ Military Legislation Study Period Outcome Results

S / 

opulaon No / No

District of Columbia’s Firearms Control Regulations Act 1976 1968-1987

Mean number of suicides per month

Suicides using firearms decreased from 2.6 per month to 2.0 per month (p=.005). Non-firearm related suicides did not experience a decrease of similar magnitude. 

S / 

opulaon No / No Brady Handgun Violence Prevention Act, 1994 1985-1997

Total suicide rates per 100,000 of population for adults (≥21 years and ≥55 years) controlling for age, race, poverty and income levels, urban residence, and alcohol consumption, the effected states (32 states where Brady handgun act was implemented)

Firearm suicide rates declined by 0.32 (95% CI: -0.73, 0.20) for adults over 21 years old. For adults 55 or older suicide rates declined by 0.92 (95% CI: -1.43, -0.42, p<.05).

S / 

opulaon No / No

State Safe-Storage laws passed between October 1,1989 through January 1,1996 1979-1996

Comparison of suicide rates, accidental deaths and crimes in states with and without SafeStorage laws

Regression estimates were not statistically significant from 0 or from each other with and without including control variables. Thus the gun laws did not seem to have a statistically significant effect on suicide rates.

S / 

opulaon No / No

Multi-State: “Shall issue” (concealed weapons), minimum age of private purchase 21, minimum age of private possession 21, on gun per month, Junk gun ban 1979-1998

A cross sectional time series study of firearm suicides and homicides 

None of the 5 laws were associated with a statistically significant change in firearm suicide rates. 

S / 

opulaon No / No

State and federal Child Access Prevention laws (requiring safe storage) 1976-2001

Number of total suicides per 100,000 and methods used for youth between 14 to 20 years old. 

Of the 63,954 suicides between 1976-2001, 62% were committed with firearms. Firearm suicides increased from 2.6 in 1976 to a high of 5.7 in 1994. They quickly decreased to 2.5 in 2001. For youth between 14-17 child access prevention laws at the state level are associated with a 10.8% decrease in firearm suicides (RR, 0.89; 95% CI: 0.83-0.96). For adults between 18-20 state child access prevention laws are associated with a 11.1% decrease 

in suicides from firearms (RR, 0.89; 95% CI: 0.85-0.93). 

anada 

 US / 

opulaon No / No 1978 Criminal Code of Canada 1973-1983

Number of suicides in Ontario and Toronto and method of suicide for Toronto

The mean percent of suicides by firearms decreased significantly after the legislation went into effect (23.2% to 16.2%, difference 7%, p<0.0001). The total number of suicides did not significantly decrease.

anada / 

opulaon No / No 1978 Criminal Code of Canada 1965-1977 Mean suicide rates per 100,000 and trends. 

The suicide rate did not change significantly from the 5 years before and the 5 years after the 1978 gun control law (13.5 to 12.8, p=0.12). Regression analysis found no slope for the 5 years following the legislation.

anada / 

opulaon No / No

Canada’s Criminal Law Amendment Act of 1977 (Bill C-51) 1969-1985

Annual suicide rates per 100,000 by all methods.

Suicide by firearm rates decreased after Bill C-51 (4.27 to 2.09, p=0.05). But the total suicide rate increased, suggesting that people turned to other methods. 

anada 

 US / 

opulaon No / No

Comment on assertion that Bill C-51 did not lessen suicide rates 1969-1991

Change in suicide rates for the period following the 1977 Bill C-51.

Before the passage of Bill C-51, firearm suicide rate was increasing (simple linear regression slope, b= 0.608, p=0.01), as were the total suicide rate and suicide rate from other methods. From 1978 to 1985 the overall suicide rate did not change and the rate by other methods did not change. The percentage of suicides by firearms did decrease (b= -0.574, p=0.03).
75

es Describing Interventions Restricting the Access to Firearms, Continued

Country / 

Setting

Veteran / 

Military Legislation Study Period Outcome Results

Canada / Popula

ion No / No

Canada’s Criminal Law Amendment Act of 1977 (Bill C-51) 1969-1985

Suicide rates before (1969-1976) and after (1978-1985) the enactment of Bill C-51

Suicide rates by firearms decreased significantly (p<0.05) after the passage of Bill C-51. Also the percentage of suicides by firearms also significantly decreased. 

Canada / Popula

ion No / No

Canada’s Criminal Law Amendment Act of 1977 (Bill C-51) 1970-1995

Firearm suicide and homicide rates per 100,000

The correlation between year and the percentage of suicides and homicides by firearms is -0.86 (one-tailed p<0.001).

Canada / Popula

ion No / No

Canada’s Criminal Law Amendment Act of 1977 (Bill C-51) 1969-1985

Suicide and homicide rates per 100,000 before and after Bill C-51 was passed

The mean annual number suicides decreased for those in the following age groups 15-24 (p<0.001), 35-64 (p<0.05), and 75 and over (p<0.01). Prior to the law the rate of suicides was increasing (regression line slope = 0.16) where as after the law went into effect the rate began to decrease (regression line slope = -0.13).

Canada / Popula

ion No / No

Canada’s Criminal Law Amendment Act of 1977 (Bill C-51) 1969-1985

Suicide rates compared from before and after the 1977 Bill C-51. 

Least squares regression showed that the introduction of the Bill had no statistically significant increase or decrease in the rate of suicides, overall or by firearms. However the Bill had a negative effect on the slope of the line, thus the Bill decreased the trend in suicide rates. 

Canada / Popula

ion No / No Canadian Bill C-17 1984-1998

Total suicide and homicide rates per 100,000, as well as methods, before and after Bill C-17.

The mean annual number of suicides significantly decreased from the first 7 year period to the 7 years following instatement of the Bill (4.09 to 3.17, p=.001). The rates by other methods increased significantly (9.02 to 9.76, p=.01). The total average number of suicides did not significantly differ between the 2 study periods (13.11 to 12.93).

Canada / Popula

ion No / No Canadian Bill C-17 1979-1999

Suicide rates and methods for youth between the ages of 15-19 before and after Bill C-17.

The percent of suicide by firearms decreased from 55% in 1979 to 25% in 1999. Death by other means increased 

during this time. The overall rate of suicides did not decrease. 

Australia / Popula

ion No / No Several? 1968-1989

Suicide rates per 100,000 by gender, State, age and residence.

The mean rate of firearm suicides was 6.13 for men and 0.43 for women (p<0.005). 

Australia / Popula

ion No / No

1996 gun law reform, following the 1996 firearm massacre in Tasmania 1979-2003

Changes in trends of total firearm suicides and suicides per 100,000 of population 

Before 1996, annual average of 491.7 firearm suicides. From 1997 to 2003, annual average of 246.6 firearm suicides. 

Australia / Popula

ion No / No Weapons Act 1990 (Qld) 1990-1993

Firearm suicide mean annual rates per 100,000 and method for different geographical areas two years before and two years after the legislation went into effect 

Suicide rates decreased in metropolitan (3.6 to 2.3) and provincial areas (5.2 to 3.1) (p<0.05). The mean annual rate per 100,000 for rural areas was about double that of metropolitan and provincial areas. This rate did not decrease after the legislation. There was also a significant decrease in suicide rates among men and adults between 15 and 29 years old. 

Australia / Popula

ion No / No Victoria Response (1988) and Firearms Act of 1996 1979-2000

Following gun control regulations, death rates, trends, and ownership in Victoria and Australia. 

The overall death rate decreased for Australia (-3.9%; 95% CI: -4.8% ro -3.1%) and Victoria(-4.9% 95% CI: -5.9, -3.9) from 1979 - 2000. Significant decreases in firearm related suicides were seen in Victoria. Suicides by firearms dropped by 54.5% from 1979 to 2000.

New Zealand / Popula

ion No / No Amendment to the Arms Act, 1992 1985-2002

Age-specific suicide rates per 100,000 of population for firearm and Non-firearm related suicides

For youths (15-24years), firearm suicides were reduced by 39% in the 3 year implementation period and decreased 66% in the 5 year post-implementation period. For adults (25+ years) firearm suicides decreased by 25% in the 3 year implementation period and decreased by 39% in the 5 year post-implementation period. 
76

Peer Review Comments

view Comments

Comment Change

me information was collected for only three categories: 

mpters, Completers, SI.” The synthesis project does not ad

ny literature demonstrating if suicide prevention strategies 

: a) the need for hospitalization, b) number of ER visits, c)  and provider satisfaction, etc. 

The scope of the report was set in consultation with the ESP Advisory Committee and the outcomes were restricted to the ones included in this report. These additional outcomes could be included in an update or new ESP report

erature review was detailed but narrative, and it would be 

 to see the summation in a data table. It’s very difficult 

the “take home messages” amidst all the detail. There 

ntly were data collection forms in Appendix D. Would like 

data tables for the data collected in these forms to better 

tand the results of the synthesis project.

Summarizing the results of disparate studies is always a challenge. We have included Evidence Tables summarizing most of the data from the included studies in Appendix C. Each report section then also has a narrative summary, as does the report’s conclusion.

ere any studies on suicide prevention related to this report 

e have overlooked?: The use of telemedicine for suicide 

tion 

We reported all studies identified as of the search date. We found no studies reporting outcomes from telemedicine interventions.

A National Center for Suicide Prevention and the MIRECC 

ver may have at least some published data describing the 

 of the recent VA national suicide prevention hotline. This 

obviously be the most relevant information, yet there was 

ntion of this in the project synthesis. It would be helpful if 

cument states explicitly one way or another if there is any 

data to be factored from either of these VA suicide preven

nters, either in the literature, in press or otherwise.

We used standard search techniques to find published literature, and did not attempt to identify unpublished or not yet published results. We’ll check with VA to see if there 

is anything published abpout the impact of the VA hotline.

n this brief summary, it would be useful to list the inclu

itieria yielding studies below, e.g., interventions, controlled 

, outcomes limited to attempts, completed suicides?))

We have added a list of the search criteria in the executive summary.

n contains much useful information; some statements 

benefit from references, to guide the interested reader—

hat is known or theorized about media-induced imitation or ion?

We have added a reference to a recent review on mediainduced imitation.

xclusion makes sense but doesn’t seem to be consistently 

ed. I’ll note examples below. If interional, maybe further 

ation of the exclusion here would be useful

Our original description in Study Selection was imprecise. We have added text to clarify the search criteria, 

especially with respect to exclusion of mental health interventions.
77

view Comments Continued

have missed it, but it’s not clear to me where these quanti

nstructions are applied to the studies in this report. If in an 

dix, might be useful to steer the reader to it here.

The quality assessment of individual articles appears in tables in Appendix C. The GRADE ratings were applied to sets of evidence taken together, and appear in the text of the results section.

these studies are quite well described. This one, though, 

 with a question. Did the study employ a chaplain to de

secular counseling/educational intervention? Or was there 

ous component to the education? Seems basic to under

ng the study/

The article in question does not provide enough detail to allow us to accurately answer this question.

ng to Koons et al. This study would seem to be excluded 

mental health intervention only”. Its foundational efficacy 

 specifically addressed suicide. If there’s a reason to in

t, consider clarifying critera?

See answer to item 8

ng to Ilgen Also would seem to be excluded as a “mental 

intervention only”. If SUD or ‘program’ features set it 

consider clarifying criteria?

See answer to item 8

ng to Gibbons Would seem to be excluded as a “mental 

intervention only”. If reason is that the study addresses an 

on effect rather than a treatment effect, consider clarifying 

See answer to item 8

ng to Webster et al. Not sure I understand, because it’s not 

o me how representative any one state is (of the country?) 

der listing states and characteristics, e.g., more rural, higher 

ence of alcoholism, etc.? 

We have re-written the description of this study’s results to avoid the question of “representativeness.”

re the authors know more about this than I do; I thought 

ork consistutes a ‘systematic review’ and that a ‘meta

s’ would be distinguished from this review by the pooling 

 across studies.

This comment is correct, this synthesis is not a meta-analysis and we have changed the text to reflect that.

about access to and treatment of mental health or sud dis

 does that reduce suicide – addiction treatment, clozapine, 

See answer to item 8

s a major statement here on defining terms is needed – this 

y a problem in the literature. Define gesture, attempt, 

n, death ideation etc.

We have added more text highlighting the critical nature of such terminology for advancing the field.
78

view Comments Continued

ol and drug use isn’t listed as a factor involved in behavior 

eems like an oversight

We have added a comment about the role of substance abuse and other factors not explcitly appearing in the Mann conceptual model to the introduction.

er target might be social situation – homelessness, employ

there is a strong correlation in the jobless rate and suicde 

so programs like CWT or Supported employment might be 

ant to mention.

Same answer as item 18.

bout those in mh care See answer to item 8

ion from inpatient to outpatient care – I believe there is 

n a critical time intervention by lisa dixon on this issue

We found no study by Dixon reporting a direct effect on suicide attempts or completions.

 clear what this means: “ were rejected at title review as 

 irrelevant to the project”

If the title clearly indicated that the study did not report an outcome relevant to our search, then it was rejected. This is standard practice in systematic reviews and metaanalyses.

ospect study (M Bruce showed a reduction in suicide ide

when treating depression in primary care, should these type 

not be included?

We did not consider studies reporting changes in rates of suicidal ideation, only studies that reported direct effects on suicide attempts or completions.

ly worth saying in the summary: “Our review did not 

on purely menthal health interventions. These have been the 

 of other reviews. Perhaps somewhat surprisingly given the 

 depressive disorders as significant risk factors for suicide, 

dence in support of the use of antidepressants is rather 

See answer to item 8

ver, I am at a loss to explain why the IMPACT study was 

sed but the PROSPECT study was noted as excluded given 

remely similar study designs (perhaps because IMPACT 

ed some VA sites?). 

If the study reported including veterans, then it was included, but not otherwise. See item 8.

anuscript is still at a developmental stage so I delineate 

hich I would like to see in a final version more than provid

eer review per se [interspersed with other editorial obser

s roughly in order of appearance]:

No reply needed.

ial discussion of known correlates of suicide and suicidal

anuscript leads off suggesting the primary one is substance 

 and/or conceptual framework for approaching this topic

In the Introduction, we described the Mann review’s conceptual model in moderate detail, because we used its search strategy. Our goal was not to review existing conceptual frameworks or to develop new ones.
79

view Comments Continued

r connection and discussion to policy issues and programs; 

ent it is a very dry list of vignettes from research papers

The results section lists in a narrative format the results of our search. The summary section contains some comments related to research and policy development.

ary of strategies for key question #1 is largely absent Questions 1 and 2 were answered together.

c data from the quality review are not presented The quality data appear in Appendix C for the RCTs and 

CCTs.

numbers end partway into the manuscript This problem has been fixed.

editing for consistency of tone and some substitution of 

uial or inappropriate word choices [e.g., ‘repertoire’, ‘more 

had’] 

These phrases have been rewritten.

0, penultimate paragraph: would revise to “similar...pro

 the antemortem profiles of suicide completers.” We have made the suggested change.

4, first paragraph: consider “nonclinician gatekeepers,” 

s “medical clerks, chaplains, or military unit commanders,” 

ducation programs may provide gatekeeper education to 

 medical facilities

We have made the suggested change.

4, last paragraph: brief summaries miss some elements 

m purchase background checks and waiting periods; drug 

e configurations not just sizes) 

We have made the suggested change.

ais study: should describe the nature of the additional data; ads now it is not clear what distinction is being made in the 

ntence 

We have added a brief description of the additional data to clarify this point.

jectives of the report are not clear. Why was this report 

ssioned? In response to what pressures? Several key ques

were developed following a conference call (page 14). It is 

ar who commissioned the Office of R&D for the Evidence 

sis Project; why were these topics (i.e suicide screening) 

d. What were the “key questions” responding to? Why 

key question formulated but not addressed at all in the 

?? Therefore, in my opinion additional background might 

pful to better delineate whether the objectives and scope of 

ort were appropriate. On the other hand, the methods are 

 described. 

As noted in the report, this topic was nominated by Office of Research and Development to the ESP Advisory Committee, and the Key Questions were developed by these two groups working together. The pressures leading to the nomination of this topic, other than VA’s concern for the mental health of the veteran population, are outside our scope.
80

view Comments Continued

mpressed with the objectivity of the report. Studies are 

ted without bias. The strengths and weaknesses of the 

 are briefly but clearly described. After each topic, the 

 of the relevant studies pertaining to that topic are summa

These are strengths of the review. 

No changes needed.

ere any studies on suicide prevention related to this report 

e have overlooked?: No to my knowledge. Critical stud

t have influenced national VHA policy regarding suicide 

ng and intervention have been included. One possible 

m is that studies that have been pivotal should be identified 

h and perhaps discussed more fully. An example might be 

 Air Force Study from the BMJ (Knox et al, reference #14). 

We agree the methodological advantages of the Knox study and have added extra detail about it.

port is well constructed, well written and very helpful. It 

arizes a broad range of studies, providing brief commentary 

form of summary statements. The report stops short of 

ting national guidelines or policy based upon the available 

e. evidence based recommendations), potentially a limita

 the authors are probably particularly well poised to do 

r this thorough review. In fact, Key Question #1 directly 

is question and is left unanswered. The responses to Key 

ons #1 and #2 are tentative and very general. For example, 

ponse to Key Question #3 suggests that preliminary data be 

ed from the computerized medical record (page 8), without 

sing any specific thoughts or recommendations as to what 

ould be collected and how. The use of the computer to 

ddress Key Question #2 is not mentioned although the 

to track patients and ensure that they receive appropriate 

ntions is a very well recognized use of this resource.

The purpose of the report was to conduct a literature review, not report a policy analysis. We included a few general recommendations in the conclusion. Key Questions 1 and 2 were answered together.

 suggest choosing another word than “Rare” in first sen

Current debate in Congress, press, and email is why rates high for veterans. It might be the wrong tone to set. 

We have removed that word and simplified the statement.
81

view Comments Continued

ere any studies on suicide prevention related to this report 

e have overlooked?: Is there any work from VISN19 MI

 which was designed to focus on suicide issues that might 

with this analysis?

We used standard search techniques to find published literature. We’ll check with the MIRECC to see if there is anything additional we might have missed.

view demonstrated an embarrassing lack of evidence for 

ns in this critical and highly publicized topic. Research $$ 

 be directed toward remedying this. Perhaps a combination 

currently funded VISN 19 MIRECC and new studies?

No changes needed.

eading this review and the synthesis review on depression, 

eems a consistent theme in those studies having positive 

 of additional or directed staff who build a “relationship” 

e patient that plays the role of support and intervention as 

 providing social contact for discussion, venting of issues, 

vice. Perhaps the social isolation component should be 

d as a variable that might have predictive value?

We agree that such factors are likely to be important. We have added a comment about this in the conclusion.

der studies involving telebuddy type devices, web access 

ponse, etc.

No studies of such interventions were identified.