Education And Debate

Prevention of suicide: aspirations and evidence

BMJ 1994; 308 doi: http://dx.doi.org/10.1136/bmj.308.6938.1227 (Published 07 May 1994) Cite this as: BMJ 1994;308:1227
  1. D Gunnell,
  2. S Frankel
  1. Health Care Evaluation Unit, Department of Epidemiology and Public Health Medicine, Bristol BS8 2PR
  1. Correspondence to: Dr Gunnell.
  • Accepted 3 February 1994

The Health of the Nation white paper set a target for 15% reduction in overall suicide rates by the year 2000. If the targets are to be achieved interventions must be identified which are of proved effectiveness. This paper examines the evidence on the available interventions and points of access to the population at risk. No single intervention has been shown in a well conducted randomised controlled trial to reduce suicide. The greatest potential seems to arise from limiting the availability of methods. In particular it is likely that the introduction of the catalytic convertor will lead to reduced lethality of car exhausts and reductions in suicide using this method. General practitioner education programmes, the effectiveness of lithium and maintenance antidepressants, and limits on the quantity of medicines available over the counter or on prescription should all be evaluated. Particular high risk groups include people recently discharged from psychiatric hospitals and those with a history of parasuicide. Many social processes affect suicide rates and these rather than specific interventions may help or hinder the ability to realise the Health of the Nation targets. Well conducted trials are essential to distinguish complex social processes from the effects of specific interventions for suicide prevention. This review of the available evidence offers little support for the aspiration that the posited targets can be achieved on the basis of current knowledge and current policy.

Suicide is a rare event, but because it occurs among young people it is the third most important contributor to life years lost, after coronary heart disease and cancer. For this reason suicide reduction is included as a key target area in the Health of the Nation strategy.1,2 Suicide reduction appears as the only quantified target in the area of psychiatric illness, where the overall purpose is to “reduce …

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