Bennett Kathryn, Rhodes Anne E, Duda Stephanie, Cheung Amy H, Manassis Katharina, Links Paul, Mushquash Christopher, Braunberger Peter, Newton Amanda S, Kutcher Stanley, Bridge Jeffrey A, Santos Robert G, Manion Ian G, Mclennan John D, Bagnell Alexa, Lipman Ellen, Rice Maureen, Szatmari Peter
Professor, McMaster University, Hamilton, Ontario.
Research Scientist, St Michael's Hospital, Toronto, Ontario; Associate Professor, University of Toronto, Toronto, Ontario.
Can J Psychiatry. 2015 Jun;60(6):245-57. doi: 10.1177/070674371506000603.
We conducted an expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based strategies and nonschool-based interventions designed to prevent repeat attempts.
Systematic review of review methods were applied. Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations derived from the findings.
No included review addressing school-based prevention (n = 7) reported decreased suicide death rates based on randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts (n = 14) found the following: emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness. Consensus on 6 recommendations ranged from 73% to 100%.
Our EKS facilitates decision maker access to what is known about effective youth suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention.
我们开展了一项快速知识综合(EKS),以促进有关青少年自杀预防的循证决策,特别是旨在预防再次自杀企图的校本策略和非校本干预措施。
应用系统综述的综述方法。纳入标准如下:系统综述或荟萃分析;针对0至24岁青少年的预防;经同行评审的英文文献。使用AMSTAR(一种评估系统综述的测量工具)确定综述质量。名义群体法对从研究结果得出的建议的共识进行量化。
纳入的关于校本预防的综述(n = 7)中,没有基于随机对照试验(RCT)或对照队列研究(CCS)报告自杀死亡率降低,但报告了自杀企图、自杀意念以及自杀风险替代指标有所降低(基于RCT和CCS)。纳入的关于预防再次自杀企图的综述(n = 14)发现:急诊科过渡项目可能降低自杀死亡、住院率和治疗不依从性(基于RCT和CCS);培训初级保健提供者进行抑郁症治疗可能减少再次自杀企图(基于一项RCT);抗抑郁药可能增加某些患者的短期自杀风险(基于RCT和荟萃分析);总体上,与青少年抑郁症的抗抑郁药治疗相关的自杀率下降抵消了这种增加(基于观察性研究);心理社会干预预防措施需要进一步评估。没有综述系统地探讨性别差异、原住民青少年这一特殊人群、危害或成本效益。对6项建议的共识率在73%至100%之间。
我们的EKS有助于决策者了解有效的青少年自杀预防干预措施。建议建立一个将研究人员和决策者联系起来的全国性研究到实践网络,以实施和评估有前景的干预措施;消除无效或有害干预措施的使用;并阐明预防干预措施对自杀死亡、自杀企图和自杀意念的影响。这样一个网络可以使加拿大成为青少年自杀预防的领导者。