Brown C Hendricks, Wyman Peter A, Brinales Joseph M, Gibbons Robert D
Prevention Science and Methodology Group, Department of Epidemiology and Biostatistics, University of South Florida, Tampa 33612, USA.
Int Rev Psychiatry. 2007 Dec;19(6):617-31. doi: 10.1080/09540260701797779.
Epidemiological considerations point to a small handful of prevention strategies that have the potential for dramatically reducing suicide rates. Nearly all of those prevention approaches involve population-based strategies to either find an increased number of individuals at high risk for suicide or to reduce the prevalence of risk factors in members of a population that, as a whole, has a relatively low rate of suicide. Few of these approaches have been evaluated in rigorous trials. We argue that there are rigorous randomized trial designs that are both feasible and ethical and can be used to test both programmes and implementation strategies for population-based suicide prevention. We review existing suicide prevention trials and introduce two new randomized trial designs that are likely to achieve sufficient statistical power. The 'dynamic wait-listed design' randomizes across different time periods and is now being used to test a gatekeeper training programme in 32 schools. It could also be used to examine suicide prevention programmes in rural areas. The multi-trial follow-up study builds on the large number of successful population-based preventive interventions aimed at reducing known risk factors for suicide in youths to see whether these also cause a reduction in rates of completed suicide.
流行病学方面的考量指向了一小部分有可能大幅降低自杀率的预防策略。几乎所有这些预防方法都涉及基于人群的策略，要么是找出更多有高自杀风险的个体，要么是降低在总体自杀率相对较低的人群中危险因素的流行率。这些方法很少在严格的试验中得到评估。我们认为，存在既可行又符合伦理的严格随机试验设计，可用于测试基于人群的自杀预防计划和实施策略。我们回顾了现有的自杀预防试验，并介绍了两种可能具有足够统计效力的新随机试验设计。“动态等待列表设计”在不同时间段进行随机分组，目前正用于在32所学校测试一项守门人培训计划。它也可用于研究农村地区的自杀预防计划。多项试验随访研究建立在大量成功的基于人群的预防性干预措施之上，这些干预措施旨在降低青少年已知的自杀危险因素，以观察这些措施是否也能降低自杀既遂率。
