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J Affect Disord. 2017 Mar 1;210:294-302. doi: 10.1016/j.jad.2016.12.035. Epub 2016 Dec 24.

The effectiveness of suicide prevention delivered by GPs: A systematic review and meta-analysis.

Author information

1
Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Work, Health and Wellbeing Unit, Population Health Research Centre, School of Health & Social Development, Deakin University, Melbourne, Australia. Electronic address: Allison.milner@unimelb.edu.au.
2
Turning Point, Monash University, Melbourne, Australia.
3
Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
4
Orygen National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia.
5
Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia.
6
Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.

Abstract

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.

KEYWORDS:

Doctor suicide prevention; General practice; Self-harm; Suicide attempt; Suicide ideation; Suicide prevention

PMID:
28068618
DOI:
10.1016/j.jad.2016.12.035
[Indexed for MEDLINE]

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