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Canadian Journal of Public Health

, Volume 102, Issue 1, pp 18–19 | Cite as

Post-suicide Intervention Programs: A Systematic Review

  • Magdalena Szumilas
  • Stan Kutcher
Systematic Review

Abstract

Objective

The purposes of this study were: 1) to determine the effectiveness of suicide postvention programs on suicide attempts and suicide as well as grief symptoms, mental distress, and mental health broadly defined; and 2) to investigate their cost-effectiveness.

Methods

Computerized database searches (PubMed, PsycINFO, Cinahl, Cochrane Database, Crisis and Suicide & Life-Threatening Behavior) were performed in September 2009 to obtain evaluations of suicide postvention programs and in February 2010 (Centre for Research and Dissemination Database, Cochrane Database of Systematic Reviews, PubMed, PsycINFO, and Cinahl) to obtain cost-effectiveness analyses of bereavement programs. Hand searches of relevant articles and reviews were also conducted. Publications were included in the analysis if they described an evaluation/costeffectiveness analysis of a suicide postvention program, provided data, and were published in English-language peer-reviewed journals. There was no restriction on publication date. Studies were excluded if they were narrative systematic reviews or dissertations or if they described a postvention program but provided no evaluation. Because very few cost-effectiveness analyses were identified, articles describing “costs” of bereavement programs were also included. Studies were evaluated for quality using Centres for Evidence-Based Medicine Levels of Evidence, and for program effectiveness using Office of Justice Programs “What Works Repository” Analytic Framework.

Results

Of the 49 studies of suicide postvention programs retrieved, 16 met inclusion criteria for evaluation of study quality and evidence of effectiveness. Three target populations for postvention programs were identified: school-based, family-focused, and community-based. No protective effect of any postvention program could be determined for number of suicide deaths or suicide attempts from the available studies. Few positive effects of school-based postvention programs were found. One study reported negative effects of a suicide postvention. Gatekeeper training for proactive postvention was effective in increasing knowledge pertaining to crisis intervention among school personnel. Outreach at the scene of suicide was found to be helpful in encouraging survivors to attend a support group at a crisis centre and seek help in dealing with their loss. Contact with a counseling postvention for familial survivors (spouses, parents, children) of suicide generally helped reduce psychological distress in the short term. There was no statistical analysis of community-based suicide postvention programs; however media guidelines for reporting of suicide and suicide attempts have been adopted by mental health organizations in numerous countries. No analyses of cost-effectiveness of suicide postvention programs were found.

Conclusion

Recommendations to provide guidance to policy-makers, administrators and clinicians are presented and directions for future research are outlined.

Key words

Suicide bereavement tertiary prevention program evaluation cost review 

Résumé

Objectifs

Cette étude visait à: 1) déterminer l’efficacité des programmes de « postvention » du suicide sur les tentatives de suicide et sur le suicide ainsi que sur les symptômes de tristesse, la détresse mentale et la santé mentale en général; et 2) examiner leur rapport coûtefficacité.

Méthode

En septembre 2009, nous avons interrogé des bases de données informatisées (PubMed, PsycINFO, Cinahl, base de données Cochrane, Crisis, Suicide and Life-Threatening Behavior) pour trouver des évaluations de programmes de prévention du suicide, et en février 2010, nous avons fait d’autres recherches (dans la base de données du Centre for Reviews and Dissemination, la base de données des examens systématiques du groupe Cochrane, PubMed, PsycINFO et Cinahl) pour trouver des analyses coût-efficacité de programmes de deuil. Nous avons aussi cherché manuellement des revues de la littérature et des articles pertinents. Ont été inclues dans notre analyse les publications qui décrivaient l’évaluation ou l’analyse coût-efficacité d’un programme de postvention du suicide, qui fournissaient des données et qui avaient été publiées dans des revues de langue anglaise avec comité de lecture. Nous n’avons pas tenu compte de leur date de publication. Nous avons exclu les examens systématiques descriptifs, les thèses de doctorat et les études qui décrivaient un programme de postvention sans en faire l’évaluation. N’ayant trouvé que très peu d’analyses coût-efficacité, nous avons aussi inclus les articles décrivant les « coûts » des programmes de deuil. Nous avons évalué la qualité de ces études à l’aide de la hiérarchie des preuves du CEBM (Centre for Evidence-Based Medicine), et l’efficacité des programmes à l’aide du cadre d’analyse « What Works Repository » de l’OJP (Office of Justice Programs).

Résultats

Sur les 49 études de programmes de postvention du suicide récupérées, 16 répondaient à nos critères d’inclusion pour l’évaluation de la qualité et des preuves d’efficacité. Nous avons défini trois populations cibles pour les programmes de postvention: l’école, la famille et la communauté. D’après les études disponibles, les programmes de postvention n’ont aucun effet protecteur sur le nombre de décès par suicide ou de tentatives de suicide, et les programmes de postvention en milieu scolaire ont peu d’effets positifs. Une étude fait même état des effets néfastes d’une initiative de postvention du suicide. La formation sentinelle, comme mesure de postvention proactive, est efficace pour accroître les connaissances sur l’intervention de crise parmi le personnel enseignant. L’accompagnement de proximité sur les lieux du suicide est utile pour inciter les survivants à participer à un groupe d’entraide dans un centre d’écoute et à trouver de l’aide pour composer avec leur perte. Le contact avec un service de counseling postvention aide en général à atténuer la détresse psychologique de la famille du défunt (conjoint, parents, enfants) dans l’immédiat. Nous n’avons trouvé aucune analyse statistique de programmes communautaires de postvention du suicide; cependant, les organismes de santé mentale de nombreux pays ont adopté les lignes directrices des médias pour parler des suicides et des tentatives de suicide. Nous n’avons trouvé aucune analyse du rapport coût-efficacité de programmes de postvention du suicide.

Conclusion

Nous présentons des recommandations pour encadrer la démarche des responsables des politiques, des administrateurs et des cliniciens, et nous proposons des pistes de recherche.

Mots clés

deuil (perte) prévention tertiaire évaluation de programme coûts et analyse des coûts revue de la literature 

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Copyright information

© The Canadian Public Health Association 2011

Authors and Affiliations

  1. 1.Dalhousie University & IWK Health CentreHalifaxCanada

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