Effectiveness of a Multimodal Community Intervention Program to Prevent Suicide and Suicide Attempts: A Quasi-Experimental StudyReport as inadecuate




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Background

Multilevel and multimodal interventions have been suggested for suicide prevention. However, few studies have reported the outcomes of such interventions for suicidal behaviours.

Methods

We examined the effectiveness of a community-based multimodal intervention for suicide prevention in rural areas with high suicide rates, compared with a parallel prevention-as-usual control group, covering a total of 631,133 persons. The effectiveness was also examined in highly populated areas near metropolitan cities 1,319,972 persons. The intervention started in July 2006, and continued for 3.5 years. The primary outcome was the incidence of composite outcome, consisting of completed suicides and suicide attempts requiring admission to an emergency ward for critical care. We compared the rate ratios RRs of the outcomes adjusted by sex, age group, region, period and interaction terms. Analyses were performed on an intention-to-treat basis and stratified by sex and age groups.

Findings

In the rural areas, the overall median adherence of the intervention was significantly higher. The RR of the composite outcome in the intervention group decreased 7% compared with that of the control group. Subgroup analyses demonstrated heterogeneous effects among subpopulations: the RR of the composite outcome in the intervention group was significantly lower in males RR = 0.77, 95% CI 0.59–0.998, p = 0.0485 and the RR of suicide attempts was significantly lower in males RR = 0.39, 95% CI 0.22–0.68, p = 0.001 and the elderly RR = 0.35, 95% CI 0.17–0.71, p = 0.004. The intervention had no effect on the RR of the composite outcome in the highly populated areas.

Interpretation

Our findings suggest that this community-based multimodal intervention for suicide prevention could be implemented in rural areas, but not in highly populated areas. The effectiveness of the intervention was shown for males and for the elderly in rural areas.

Trial Registration

ClinicalTrials.gov NCT00737165 UMIN Clinical Trials Registry UMIN000000460



Author: Yutaka Ono , Akio Sakai, Kotaro Otsuka, Hidenori Uda, Hirofumi Oyama, Naoki Ishizuka, Shuichi Awata, Yasushi Ishida, Hiroto Iwasa

Source: http://plos.srce.hr/



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