d'apres article European College of Neuropsychopharmacology. "Suicide prevention strategies revisited: A 10-year systematic review." ScienceDaily. ScienceDaily, 8 June 2016* .
Un examen de la revue internationale sur la prévention du suicide a confirmé que certaines méthodes fonctionnent pour réduire les suicides, alors que d'autres actuellement utilisés ont encore peu d'efficacité prouvée.
Dans le monde entier, il y a plus de 800.000 suicides chaque année, bien que pour chaque suicide, il y a environ 30 tentatives. Plus de personnes sont tuées par le suicide que par la guerre et les homicides réunis. Chez les jeunes (15-29 ans), le suicide est la deuxième cause principale de décès. L'Information sur la prévention du suicide est urgente. Une nouvelle étude majeure de l' Expert Platform on Mental Health, Focus on Depression, et the European College of Neuropsychopharmacology (ECNP), a évalué les stratégies de prévention du suicide. Le document est publié dans Lancet Psychiatry.
L'une des principales conclusions est que la restriction de l'accès facile aux moyens de prendre sa propre vie est un élément clé, comme le montre la baisse des suicides dans les pays qui diminuent le nombre de pilules dans des paquets d'analgésiques. D'autres mesures efficaces comprennent des obstacles physiques érigés à des endroits de suicide connus tels que des ponts élevés. Le rapport conclut que si une tentative de suicide impulsif est dissuadée, souvent, ces mesures sont suffisantes pour sauver une vie.
Certains traitements médicaux se sont révélés être efficaces dans certaines populations. Par exemple, les médicaments lithium et clozapine ont prouvé des avantages dans certaines populations. Les médicaments pour la dépression ont été montré pour réduire les suicides chez les plus de 75. Chez les enfants et les adolescents la medication de la sérotonine a le potentiel d'accroître les pensées suicidaires, bien qu'il n'y ait aucune preuve que les suicides effectifs augmentent (le papier note que la dépression non traitée chez les enfants est aussi un risque, et ainsi que des médicaments pour la dépression peuvent être considérées pour l'usage, avec une surveillance étroite).
D'autres stratégies comprennent le Gatekeeper Training, une formation spéciale des médecins, des professionnels dans les écoles et les lieux de travail pour reconnaître les comportements à risque, se sont également avérées utiles, mais seulement si intégrées à d'autres méthodes de prévention du suicide. Le Suivi des personnes qui ont tenté de se suicider est fortement recommandé.
Le Professeur Joseph Zohar (Tel Aviv), l'un des auteurs de l'article dit: "Nous avons examiné près de 1800 articles scientifiques sur le suicide publiés entre 2005 et 2015. Nous avons constaté qu'il n'y a pas une seule façon de prévenir le suicide, mais la mise en œuvre des méthodes probantes de prises en charge décrites dans cette étude, y compris l'education et la sensibilisation du public et des médecins conjointement avec une législation appropriée, a le potentiel de modifier les stratégies de santé publique dans les plans de prévention du suicide. avec ces mesures, nous pouvons réduire considérablement le nombre de décès dus au suicide ».
www.sciencedaily.com/releases/2016/06/160608212150.htm
L'article cité : Suicide prevention strategies revisited: 10-year systematic review
Gil Zalsman, a, b, , ,Keith Hawton, c,Danuta Wasserman, d,Kees van Heeringen, e, Ella Arensman, f, Marco Sarchiapone, g, Vladimir Carli, d, Cyril Höschl, h, Ran Barzilay, a, Judit Balazs, i, György Purebl, j, Jean Pierre Kahn, k,Pilar Alejandra Sáiz, l, Cendrine Bursztein Lipsicas, m,
Julio Bobes, l, Doina Cozman, n, Ulrich Hegerl, o, Joseph Zohar, p
a Geha Mental Health Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
b Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA
c Centre for Suicide Research, University of Oxford, Oxford, UK
d National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
e Unit for Suicide Research, Ghent University, Ghent, Belgium
f National Suicide Research Foundation, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
g Department of Medicine and Health Science, University of Molise, Via De Santis Campobasso and National Institute for Health, Migration and Poverty, Roma, Italy
h National Institute of Mental Health, Klecany, Czech Republic
i Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
j Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
k Université de Lorraine, Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy-Laxou, Nancy-Laxou, France
l Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, Spain
m Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
n Department of Clinical Psychology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
o Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
p Psychiatry Department, Sheba Health Center and Sackler School of Medicine, Tel Aviv University, Tel Avis, Israel
Summary
Background
Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide prevention interventions since 2005.
Methods
We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis.
Findings
We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0·45, 95% CI 0·24–0·85; p=0·014) and suicidal ideation (0·5, 0·27–0·92; p=0·025). The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions.
Interpretation
In the quest for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs.
Funding
The Expert Platform on Mental Health, Focus on Depression, and the European College of Neuropsychopharmacology.
Correspondence to: Gil Zalsman, Geha Mental Health Center and Psychiatry Department, Tel Aviv University, Petach Tiqwa 49100, Israel
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30030-X/abstract
Julio Bobes, l, Doina Cozman, n, Ulrich Hegerl, o, Joseph Zohar, p
a Geha Mental Health Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
b Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA
c Centre for Suicide Research, University of Oxford, Oxford, UK
d National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
e Unit for Suicide Research, Ghent University, Ghent, Belgium
f National Suicide Research Foundation, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
g Department of Medicine and Health Science, University of Molise, Via De Santis Campobasso and National Institute for Health, Migration and Poverty, Roma, Italy
h National Institute of Mental Health, Klecany, Czech Republic
i Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
j Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
k Université de Lorraine, Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy-Laxou, Nancy-Laxou, France
l Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, Spain
m Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
n Department of Clinical Psychology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
o Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
p Psychiatry Department, Sheba Health Center and Sackler School of Medicine, Tel Aviv University, Tel Avis, Israel
Summary
Background
Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide prevention interventions since 2005.
Methods
We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis.
Findings
We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0·45, 95% CI 0·24–0·85; p=0·014) and suicidal ideation (0·5, 0·27–0·92; p=0·025). The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions.
Interpretation
In the quest for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs.
Funding
The Expert Platform on Mental Health, Focus on Depression, and the European College of Neuropsychopharmacology.
Correspondence to: Gil Zalsman, Geha Mental Health Center and Psychiatry Department, Tel Aviv University, Petach Tiqwa 49100, Israel
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30030-X/abstract
