Research Associate, Sun Life Financial Chair in Adolescent Mental Health, Dalhousie University & IWK Health Centre, Halifax, NS.
Can J Public Health. 2011 Jan-Feb;102(1):18-29. doi: 10.1007/BF03404872.
The purposes of this study were: 1) to determine the effectiveness of suicide postvention programs on suicide attempts and suicide as well as grief symptoms, mental distress, and mental health broadly defined; and 2) to investigate their cost-effectiveness.
Computerized database searches (PubMed, PsycINFO, Cinahl, Cochrane Database, Crisis and Suicide & Life-Threatening Behavior) were performed in September 2009 to obtain evaluations of suicide postvention programs and in February 2010 (Centre for Research and Dissemination Database, Cochrane Database of Systematic Reviews, PubMed, PsycINFO, and Cinahl) to obtain cost-effectiveness analyses of bereavement programs. Hand searches of relevant articles and reviews were also conducted. Publications were included in the analysis if they described an evaluation/cost-effectiveness analysis of a suicide postvention program, provided data, and were published in English-language peer-reviewed journals. There was no restriction on publication date. Studies were excluded if they were narrative systematic reviews or dissertations or if they described a postvention program but provided no evaluation. Because very few cost-effectiveness analyses were identified, articles describing "costs" of bereavement programs were also included. Studies were evaluated for quality using Centres for Evidence-Based Medicine Levels of Evidence, and for program effectiveness using Office of Justice Programs "What Works Repository" Analytic Framework.
Of the 49 studies of suicide postvention programs retrieved, 16 met inclusion criteria for evaluation of study quality and evidence of effectiveness. Three target populations for postvention programs were identified: school-based, family-focused, and community-based. No protective effect of any postvention program could be determined for number of suicide deaths or suicide attempts from the available studies. Few positive effects of school-based postvention programs were found. One study reported negative effects of a suicide postvention. Gatekeeper training for proactive postvention was effective in increasing knowledge pertaining to crisis intervention among school personnel. Outreach at the scene of suicide was found to be helpful in encouraging survivors to attend a support group at a crisis centre and seek help in dealing with their loss. Contact with a counseling postvention for familial survivors (spouses, parents, children) of suicide generally helped reduce psychological distress in the short term. There was no statistical analysis of community-based suicide postvention programs; however media guidelines for reporting of suicide and suicide attempts have been adopted by mental health organizations in numerous countries. No analyses of cost-effectiveness of suicide postvention programs were found.
Recommendations to provide guidance to policy-makers, administrators and clinicians are presented and directions for future research are outlined.
本研究的目的是：1）确定自杀预防计划在自杀未遂和自杀以及广义的悲伤症状、精神困扰和心理健康方面的有效性；2）研究其成本效益。
2009 年 9 月，我们通过计算机数据库检索（PubMed、PsycINFO、Cinahl、Cochrane 数据库、危机与自杀和危及生命的行为）获取自杀预防计划的评估结果，2010 年 2 月（研究与传播数据库、Cochrane 系统评价数据库、PubMed、PsycINFO 和 Cinahl）获取丧亲计划成本效益分析结果。我们还进行了相关文章和综述的手工检索。如果研究描述了自杀预防计划的评估/成本效益分析、提供了数据且发表在同行评议的英文期刊上，则将其纳入分析。未对发表日期进行限制。如果研究是叙述性系统评价或论文，或者描述了预防计划但未提供评估，则将其排除。由于很少有成本效益分析，因此还纳入了描述丧亲计划“成本”的文章。使用循证医学中心的证据水平评估研究质量，使用司法项目“有效措施”分析框架评估计划效果。
在检索到的 49 项自杀预防计划研究中，有 16 项符合评估研究质量和有效性证据的标准。确定了三种预防计划的目标人群：学校、家庭为重点和社区为基础。从现有研究中，没有发现任何预防计划能对自杀死亡或自杀未遂的数量产生保护作用。学校预防计划的积极效果很少。一项研究报告了预防自杀的负面影响。危机干预方面的预防自杀培训可有效提高学校工作人员的危机干预知识。自杀现场的外展工作有助于鼓励幸存者参加危机中心的支持小组，并寻求帮助以应对他们的损失。与自杀家庭幸存者（配偶、父母、子女）联系一般可在短期内帮助减轻心理困扰。没有对社区预防自杀的成本效益进行统计分析；然而，许多国家的心理健康组织已经采用了媒体自杀和自杀未遂报告指南。没有找到预防自杀的成本效益分析。
提出了为决策者、管理人员和临床医生提供指导的建议，并概述了未来研究的方向。
