Reducing youth suicide: systems modelling and simulation to guide targeted investments across the determinants
Jo-An Occhipinti, Adam Skinner, Frank Iorfino, Kenny Lawson, Julie Sturgess, Warren Burgess, Tracey Davenport, Danica Hudson & Ian Hickie
BMC Medicine
volume 19, Article number: 61 (2021)
Affiliations
Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia : Jo-An Occhipinti, Adam Skinner, Frank Iorfino, Tracey Davenport & Ian Hickie
Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia Jo-An Occhipinti
Menzies Centre for Health Policy, University of Sydney, Sydney, Australia : Jo-An Occhipinti & Adam Skinner
Translational Health Research Institute, Western Sydney University, Penrith, Australia Jo-An Occhipinti & Kenny Lawson
Hunter Medical Research Institute, Newcastle, Australia
Kenny Lawson North Coast Primary Health Network, Ballina, Australia Julie Sturgess, Warren Burgess & Danica Hudson
Abstract
Background
Reducing suicidal behaviour (SB) is a critical public health issue globally. The complex interplay of social determinants, service system factors, population demographics, and behavioural dynamics makes it extraordinarily difficult for decision makers to determine the nature and balance of investments required to have the greatest impacts on SB. Real-world experimentation to establish the optimal targeting, timing, scale, frequency, and intensity of investments required across the determinants is unfeasible. Therefore, this study harnesses systems modelling and simulation to guide population-level decision making that represent best strategic allocation of limited resources.
Methods
Using a participatory approach, and informed by a range of national, state, and local datasets, a system dynamics model was developed, tested, and validated for a regional population catchment. The model incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and SB. Intervention scenarios were investigated to forecast their impact on SB over a 20-year period.
Results
A combination of social connectedness programs, technology-enabled coordinated care, post-attempt assertive aftercare, reductions in childhood adversity, and increasing youth employment projected the greatest impacts on SB, particularly in a youth population, reducing self-harm hospitalisations (suicide attempts) by 28.5% (95% interval 26.3–30.8%) and suicide deaths by 29.3% (95% interval 27.1–31.5%). Introducing additional interventions beyond the best performing suite of interventions produced only marginal improvement in population level impacts, highlighting that ‘more is not necessarily better.’
Conclusion
Results
indicate that targeted investments in addressing the social
determinants and in mental health services provides the best opportunity
to reduce SB and suicide. Systems modelling and simulation offers a
robust approach to leveraging best available research, data, and expert
knowledge in a way that helps decision makers respond to the unique
characteristics and drivers of SB in their catchments and more
effectively focus limited health resources.
lire l'etude : https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-01935-4#author-information