TY - JOUR
T1 - The effectiveness of suicide prevention delivered by GPs : a systematic review and meta-analysis
AU - Milner, Allison
AU - Witt, Katrina
AU - Pirkis, Jane
AU - Hetrick, Sarah
AU - Robinson, Jo
AU - Currier, Dianne
AU - Spittal, Matthew J.
AU - Page, Andrew
AU - Carter, Gregory L.
PY - 2017
Y1 - 2017
N2 - Background: The aim of this review was to assess whether suicide prevention provided in the primary health care setting and delivered by GPs results in fewer suicide deaths, episodes of self-harm, attempts and lower frequency of thoughts about suicide. Methods: We conducted a systematic review and meta-analysis using PRIMSA guidelines. Eligible studies: 1) evaluated an intervention provided by GPs; 2) assessed suicide, self-harm, attempted suicide or suicide ideation as outcomes, and; 3) used a quasi-experimental observational or trial design. Study specific effect sizes were combined using the random effects meta-analysis, with effects transformed into relative risk (RR). Results: We extracted data from 14 studies for quantitative meta-analysis. The RR for suicide death in quasi-experimental observational studies comparing an intervention region against another region acting as a “control” was 1.26 (95% CI 0.58, 2.74). When suicide in the intervention region was compared before and after the GP program, the RR was 0.78 (95% CI 0.62, 0.97). There was no evidence of a treatment effect for GP training on rates of suicide death in one cRCT (RR 1.07, 95% CI 0.79, 1.45). There was no evidence of effect for the most other outcomes studied. Limitations: All of the studies included in this review are likely to have a high level of bias. It is also possible that we excluded or missed relevant studies in our review process Conclusions: Interventions have produced equivocal results, which varied by study design and outcome. Given these results, we cannot recommend the roll out of GP suicide prevention initiatives.
AB - Background: The aim of this review was to assess whether suicide prevention provided in the primary health care setting and delivered by GPs results in fewer suicide deaths, episodes of self-harm, attempts and lower frequency of thoughts about suicide. Methods: We conducted a systematic review and meta-analysis using PRIMSA guidelines. Eligible studies: 1) evaluated an intervention provided by GPs; 2) assessed suicide, self-harm, attempted suicide or suicide ideation as outcomes, and; 3) used a quasi-experimental observational or trial design. Study specific effect sizes were combined using the random effects meta-analysis, with effects transformed into relative risk (RR). Results: We extracted data from 14 studies for quantitative meta-analysis. The RR for suicide death in quasi-experimental observational studies comparing an intervention region against another region acting as a “control” was 1.26 (95% CI 0.58, 2.74). When suicide in the intervention region was compared before and after the GP program, the RR was 0.78 (95% CI 0.62, 0.97). There was no evidence of a treatment effect for GP training on rates of suicide death in one cRCT (RR 1.07, 95% CI 0.79, 1.45). There was no evidence of effect for the most other outcomes studied. Limitations: All of the studies included in this review are likely to have a high level of bias. It is also possible that we excluded or missed relevant studies in our review process Conclusions: Interventions have produced equivocal results, which varied by study design and outcome. Given these results, we cannot recommend the roll out of GP suicide prevention initiatives.
KW - parasuicide
KW - physicians (general practice)
KW - self-mutilation
KW - suicide prevention
KW - systematic reviews (medical research)
UR - http://handle.westernsydney.edu.au:8081/1959.7/uws:39184
U2 - 10.1016/j.jad.2016.12.035
DO - 10.1016/j.jad.2016.12.035
M3 - Article
VL - 210
SP - 294
EP - 302
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -