The effectiveness of suicide prevention delivered by GPs

A systematic review and meta-analysis

Allison Milner, Katrina Witt, Jane Pirkis, Sarah Hetrick, Jo Robinson, Dianne Currier, Matthew J Spittal, Andew Page, Gregory Carter

Research output: Contribution to journalReview ArticleResearchpeer-review

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.
Original languageEnglish
Pages (from-to)294-302
Number of pages9
JournalJournal of Affective Disorders
Volume210
DOIs
Publication statusPublished - Mar 2017

Keywords

  • general practice
  • suicide prevention
  • self-harm
  • suicide attempt
  • suicide ideation
  • doctor suicide prevention

Cite this

Milner, A., Witt, K., Pirkis, J., Hetrick, S., Robinson, J., Currier, D., ... Carter, G. (2017). The effectiveness of suicide prevention delivered by GPs: A systematic review and meta-analysis. Journal of Affective Disorders, 210, 294-302. https://doi.org/10.1016/j.jad.2016.12.035
Milner, Allison ; Witt, Katrina ; Pirkis, Jane ; Hetrick, Sarah ; Robinson, Jo ; Currier, Dianne ; Spittal, Matthew J ; Page, Andew ; Carter, Gregory. / The effectiveness of suicide prevention delivered by GPs : A systematic review and meta-analysis. In: Journal of Affective Disorders. 2017 ; Vol. 210. pp. 294-302.
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Milner, A, Witt, K, Pirkis, J, Hetrick, S, Robinson, J, Currier, D, Spittal, MJ, Page, A & Carter, G 2017, 'The effectiveness of suicide prevention delivered by GPs: A systematic review and meta-analysis', Journal of Affective Disorders, vol. 210, pp. 294-302. https://doi.org/10.1016/j.jad.2016.12.035

The effectiveness of suicide prevention delivered by GPs : A systematic review and meta-analysis. / Milner, Allison; Witt, Katrina; Pirkis, Jane; Hetrick, Sarah; Robinson, Jo; Currier, Dianne; Spittal, Matthew J; Page, Andew; Carter, Gregory.

In: Journal of Affective Disorders, Vol. 210, 03.2017, p. 294-302.

Research output: Contribution to journalReview ArticleResearchpeer-review

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T1 - The effectiveness of suicide prevention delivered by GPs

T2 - 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, Andew

AU - Carter, Gregory

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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 processConclusions: 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 processConclusions: 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 - general practice

KW - suicide prevention

KW - self-harm

KW - suicide attempt

KW - suicide ideation

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DO - 10.1016/j.jad.2016.12.035

M3 - Review Article

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JO - Journal of Affective Disorders

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ER -