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A systematic review of interventions to prevent suicidal behaviors and reduce suicidal ideation in older people

Published online by Cambridge University Press:  02 August 2017

Chukwudi Okolie Open the ORCID record for Chukwudi Okolie [Opens in a new window] ,
Michael Dennis ,
Emily Simon Thomas  and
Ann John
Chukwudi Okolie
Affiliation:
Swansea University Medical School, Swansea, UK Public Health Wales, Swansea, UK
Michael Dennis
Affiliation:
Swansea University Medical School, Swansea, UK
Emily Simon Thomas
Affiliation:
Swansea University Medical School, Swansea, UK
Ann John*
Affiliation:
Swansea University Medical School, Swansea, UK Public Health Wales, Swansea, UK
*
Correspondence should be addressed to: Ann John, Professor, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK. Phone: +44 (0)1792 602568. Email: [email protected].
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Abstract

Background:

Older people have a high risk of suicide but research in this area has been largely neglected. Unlike for younger age groups, it remains unclear what strategies for prevention exist for older adults. This systematic review assesses the effectiveness of interventions to prevent suicidal behavior and reduce suicidal ideation in this age group.

Methods:

MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant publications from their dates of inception until 1 April 2016. Studies included in this review report effectiveness data about interventions delivered to older adults to prevent suicidal behavior (suicide, attempted suicide, and self-harm without suicidal intent) or reduce suicidal ideation. A narrative synthesis approach was used to analyze data and present findings.

Results:

Twenty one studies met the criteria for inclusion in the study. Most programs addressed risk predictors, specifically depression. Effective interventions were multifaceted primary care-based depression screening and management programs; treatment interventions (pharmacotherapy and psychotherapy); telephone counseling for vulnerable older adults; and community-based programs incorporating education, gatekeeper training, depression screening, group activities, and referral for treatment. Most of the studies were of low quality apart from the primary care-based randomized controlled trials.

Conclusions:

Multifaceted interventions directed at primary care physicians and populations, and at-risk elderly individuals in the community may be effective at preventing suicidal behavior and reducing suicidal ideation in older adults. However, more high quality trials are needed to demonstrate successful interventions.

Keywords

elderlysuicidesuicidal ideationpreventioninterventionsystematic review
Type
Review Article
Information
International Psychogeriatrics , Volume 29 , Issue 11 , November 2017 , pp. 1801 - 1824
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Aizenberg, D., Olmer, A. and Barak, Y. (2006). Suicide attempts amongst elderly bipolar patients. Journal of Affective Disorders, 91, 91–94.Google Scholar
Alexopoulos, G. S. et al. (2009). Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. American Journal of Psychiatry, 166, 882–890.Google Scholar
Almeida, O. P. et al. (2012). A randomized trial to reduce the prevalence of depression and self-harm behavior in older primary care patients. Annals of Family Medicine, 10, 347–356.CrossRefGoogle ScholarPubMed
Barak, Y., Olmer, A. and Aizenberg, D. (2006). Antidepressants reduce the risk of suicide among elderly depressed patients. Neuropsychopharmacology, 31, 178–181.Google Scholar
Bebbington, P. et al. (2010). Suicidal ideation, self-harm and attempted suicide: results from the British Psychiatric Morbidity Survey 2000. European Psychiatry, 25, 427–431.Google Scholar
Bruce, M. L. et al. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients – a randomized controlled trial. JAMA, 291, 1081–1091.CrossRefGoogle ScholarPubMed
Centre for Addiction and Mental Health (2010). Best Practice Guidelines for Mental Health Promotion Programs: Older Adults 55+. Canada: Centre for Addiction and Mental Health.Google Scholar
Chan, S. S. et al. (2011). Outcomes of a two-tiered multifaceted elderly suicide prevention program in a Hong Kong Chinese community. American Journal of Geriatric Psychiatry, 19, 185–196.Google Scholar
Ciulla, L. et al. (2014). Suicide risk in the elderly: data from Brazilian public health care program. Journal of Affective Disorders, 152–154, 513–516.Google Scholar
Conwell, Y. (2014). Suicide later in life: challenges and priorities for prevention. American Journal of Preventive Medicine, 47, S244–S250.Google Scholar
Conwell, Y., Duberstein, P. R. and Caine, E. D. (2002). Risk factors for suicide in later life. Biological Psychiatry, 52, 193–204.Google Scholar
Conwell, Y., Duberstein, P., Cox, C., Herrman, J., Forbes, N., Caine, E. (1998). Age differences in behaviours leading to completed suicide. American Journal of Geriatric Psychiatry, 6, 122–126.Google Scholar
Cougnard, A., Verdoux, H., Grolleau, A., Moride, Y., Begaud, B. and Tournier, M. (2009). Impact of antidepressants on the risk of suicide in patients with depression in real-life conditions: a decision analysis model. Psychological Medicine, 39, 1307–1315.Google Scholar
De Leo, D., Buono, M. D. and Dwyer, J. (2002). Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy. British Journal of Psychiatry, 181, 226–229.CrossRefGoogle ScholarPubMed
De Leo, D., Carollo, G. and Dello Buono, M. (1995). Lower suicide rates associated with a Tele-Help/Tele-Check service for the elderly at home. American Journal of Psychiatry, 152, 632–634.Google Scholar
Dennis, M. (2009). Suicide and self-harm in older people. Quality in Ageing and Older Adults, 10, 16–23.Google Scholar
Dong, X., Chang, E.-S., Zeng, P. and Simon, M. A. (2015). Suicide in the global Chinese aging population: a review of risk and protective factors, consequences, and interventions. Aging and Disease, 6, 121–130.Google Scholar
Erlangsen, A. et al. (2011). Key considerations for preventing suicide in older adults consensus opinions of an expert panel. Crisis-the Journal of Crisis Intervention and Suicide Prevention, 32, 106–109.Google Scholar
Fiske, A. and Arbore, P. (2000). Future directions in late life suicide prevention. Omega-Journal of Death and Dying, 42, 37–53.CrossRefGoogle Scholar
Gustavson, K. A., Alexopoulos, G. S., Niu, G. C., Mcculloch, C., Meade, T. and Arean, P. A. (2016). Problem-solving therapy reduces suicidal ideation in depressed older adults with executive dysfunction. American Journal of Geriatric Psychiatry, 24, 11–17.Google Scholar
Harrod, C. S., Goss, C. W., Stallones, L. and Diguiseppi, C. (2014). Interventions for primary prevention of suicide in university and other post-secondary educational settings. Cochrane Database of Systematic Reviews.Google Scholar
Hawton, K. et al. (2015a). Pharmacological interventions for self-harm in adults. Cochrane Database of Systematic Reviews, Issue 7. Art. No. CD011777. doi:10.1002/14651858.CD011777.Google Scholar
Hawton, K. et al. (2015b). Interventions for self-harm in children and adolescents. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD012013. doi:10.1002/14651858.CD012013.Google Scholar
Heikkinen, M. E., Isometsa, E. T., Aro, H. M., Sarna, S. J. and Lonnqvist, J. K. (1995). Age-related variation in recent life events preceding suicide. Journal of Nervous and Mental Disease, 183, 325–331.Google Scholar
Heisel, M. J., Duberstein, P. R., Talbot, N. L., King, D. A. and Tu, X. M. (2009). Adapting interpersonal psychotherapy for older adults at risk for suicide: preliminary findings. Professional Psychology-Research and Practice, 40, 156–164.Google Scholar
Higgins, J. P. T. and Green, S. (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. Available at: http://handbook.cochrane.org.Google Scholar
Jinks, A., Cotton, A. and Rylance, R. (2011). Obesity interventions for people with a learning disability: an integrative literature review. Journal of Advanced Nursing, 67, 460–471.Google Scholar
Joffe, P. (2008). An empirically supported program to prevent suicide in a college student population. Suicide and Life-Threatening Behavior, 38, 87–103.Google Scholar
Kiosses, D. N., Rosenberg, P. B., Mcgovern, A., Fonzetti, P., Zaydens, H. and Alexopoulos, G. S. (2015). Depression and suicidal ideation during two psychosocial treatments in older adults with major depression and dementia. Journal of Alzheimer's Disease, 48, 453–462.Google Scholar
Konradt, B., Hirsch, R. D., Jonitz, M. F. and Junglas, K. (2013). Evaluation of a standardized humor group in a clinical setting: a feasibility study for older patients with depression. International Journal of Geriatric Psychiatry, 28, 850–857.Google Scholar
Lapierre, S. et al. (2011). A systematic review of elderly suicide prevention programs. Crisis-the Journal of Crisis Intervention and Suicide Prevention, 32, 88–98.Google Scholar
Mann, J. J. et al. (2005). Suicide prevention strategies: a systematic review. JAMA, 294, 2064–2074.Google Scholar
Mcmanus, S., Hassiotis, A., Jenkins, R., Dennis, M., Aznar, C. and Appleby, L. (2016). Chapter 12: suicidal thoughts, suicide attempts and self-harm. In McManus, S., Bebbington, P., Jenkins, R. and Brugha, T. (eds.), Mental Health and Wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital.Google Scholar
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G. and Grp, P. (2010). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. International Journal of Surgery, 8, 336–341.Google Scholar
Murphy, E. et al. (2012). Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study. British Journal of Psychiatry, 200, 399–404.Google Scholar
National Research Council and Institute of Medicine (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities, Washington, DC: The National Academies Press.Google Scholar
Nock, M. et al. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry. 192, 98–105.CrossRefGoogle ScholarPubMed
O'Connell, H., Chin, A.-V., Cunningham, C. and Lawlor, B. A. (2004). Recent developments: suicide in older people. BMJ, 329, 895–899.Google Scholar
Ono, Y. et al. (2013). Effectiveness of a multimodal community intervention program to prevent suicide and suicide attempts: a quasi-experimental study. PLoS ONE [Electronic Resource], 8, e74902.Google Scholar
Owens, D., Wood, C., Greenwood, D. C., Hughes, T. and Dennis, M. (2005). Mortality and suicide after non-fatal self-poisoning: 16-year outcome study. The British Journal of Psychiatry, 187, 470–475.CrossRefGoogle ScholarPubMed
Oyama, H. et al. (2005). Community-based suicide prevention through group activity for the elderly successfully reduced the high suicide rate for females. Psychiatry and Clinical Neurosciences, 59, 337–344.Google Scholar
Oyama, H. et al. (2006c). Local community intervention through depression screening and group activity for elderly suicide prevention. Psychiatry and Clinical Neurosciences, 60, 110–114.CrossRefGoogle ScholarPubMed
Oyama, H. et al. (2010). A community-based survey and screening for depression in the elderly: the short-term effect on suicide risk in Japan. Crisis, 31, 100–108.Google Scholar
Oyama, H., Fujita, M., Goto, M., Shibuya, H. and Sakashita, T. (2006a). Outcomes of community-based screening for depression and suicide prevention among Japanese elders. Gerontologist, 46, 821–826.Google Scholar
Oyama, H., Goto, M., Fujita, M., Shibuya, H. and Sakashita, T. (2006b). Preventing elderly suicide through primary care by community-based screening for depression in Rural Japan. Crisis, 27, 58–65.Google Scholar
Oyama, H., Koida, J., Sakashita, T. and Kudo, K. (2004). Community-based prevention for suicide in elderly by depression screening and follow-up. Community Mental Health Journal, 40, 249–263.CrossRefGoogle ScholarPubMed
Oyama, H., Sakashita, T., Ono, Y., Goto, M., Fujita, M. and Koida, J. (2008). Effect of community-based intervention using depression screening on elderly suicide risk: a meta-analysis of the evidence from Japan. Community Mental Health Journal, 44, 311–320.CrossRefGoogle Scholar
Pearson, J. L. and Brown, G. K. (2000). Suicide prevention in late life: directions for science and practice. Clinical Psychology Review, 20, 685–705.Google Scholar
Popay, J. et al. (2006). Guidance on the Conduct of Narrative Synthesis in Systematic Reviews: A Product From the ESRC Methods Programme. Lancaster: Institute of Health Research.Google Scholar
Royal College of Psychiatrists (2005). Who Cares Wins: Improving the Outcome for Older People Admitted to the General Hospital: Guidelines for the Development of Liaison Mental Health Services for Older People. London: Royal College of Psychiatrists.Google Scholar
Tarrier, N., Taylor, K. and Gooding, P. (2008). Cognitive-behavioral interventions to reduce suicide behavior: a systematic review and meta-analysis. Behavior Modification, 32, 77–108.Google Scholar
Unutzer, J. et al. (2006). Reducing suicidal ideation in depressed older primary care patients. Journal of the American Geriatrics Society, 54, 1550–1556.Google Scholar
World Health Organization (1999). Ageing: Exploding the Myths. Geneva, Switzerland: Ageing and Health Programme, World Health Organization Google Scholar
World Health Organization (2014). Preventing Suicide - A Global Imperative Geneva. Switzerland: World Health Organization.Google Scholar