Sakashita Tomoe, Oyama Hirofumi
Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan.
Front Psychiatry. 2019 Mar 26;10:161. doi: 10.3389/fpsyt.2019.00161. eCollection 2019.
Suicide prevention is an increasingly important issue, especially among older people. Recent work on improving its effectiveness has focused on developing a framework aligning interventions with key risk factors and stages of the suicide process. We have developed this further, by integrating psycho-behavioral components associated with suicide, existing guidelines for identifying critical points of intervention, and the previous preventive strategies framework. Our schematic diagram shows the relationship between the suicide process and prevention strategies, combined with initiatives for linking different types of strategies, from universal strategies at population level, through selective strategies focusing on groups at risk, to indicated strategies, aimed at specific high-risk individuals. We tested our framework using previous studies assessing the impact of suicide prevention interventions on suicide rates in older adults. It was possible to place all identified interventions within the framework. Examining effectiveness within the framework suggests that some interventions may be more successful in reducing suicide rates because they developed systematic linkages between universal, selective, and indicated prevention interventions. Other studies, however, show that interventions can be successful without these linkages, so other factors may also be important. The main weakness of our framework is a lack of evidence about critical intervention points within the suicide process, which may limit its practical application. However, the framework may help to improve the linkages between types of interventions, and support practitioners in developing a wide range of strategies across different areas and stages of the suicide process.
预防自杀是一个日益重要的问题，在老年人中尤为如此。近期关于提高预防自杀有效性的工作主要集中在制定一个框架，使干预措施与自杀过程的关键风险因素和阶段相匹配。我们在此基础上进一步发展，整合了与自杀相关的心理行为因素、现有的干预关键点识别指南以及先前的预防策略框架。我们的示意图展示了自杀过程与预防策略之间的关系，并结合了将不同类型策略联系起来的举措，从针对全体人群的普遍策略，到针对高危群体的选择性策略，再到针对特定高危个体的指示性策略。我们利用之前评估预防自杀干预措施对老年人自杀率影响的研究来测试我们的框架。可以将所有已识别的干预措施纳入该框架。在框架内审视有效性表明，一些干预措施在降低自杀率方面可能更成功，因为它们在普遍、选择性和指示性预防干预措施之间建立了系统联系。然而，其他研究表明，即使没有这些联系，干预措施也可能取得成功，所以其他因素可能也很重要。我们框架的主要弱点是缺乏关于自杀过程中关键干预点的证据，这可能会限制其实际应用。然而，该框架可能有助于改善不同类型干预措施之间的联系，并支持从业者在自杀过程的不同领域和阶段制定广泛的策略。
