The report is a product of the VA/HSR Evidence Synthesis Program.

Systematic Review: Population and Community-based Interventions to Prevent Suicide

In the United States, suicide is a national public health problem and a top-10 leading cause of death. In 2018, Veterans represented 8% of the US adult population but accounted for 14% of suicide deaths; thus, suicide prevention is a top priority for VA. Many VA initiatives focus on identifying and treating Veterans at elevated risk for suicidal behaviors. These initiatives may account for reduced suicide rates among Veterans who use VA healthcare; however, two-thirds of Veterans do not use VA healthcare. Community-based approaches to suicide prevention outside of VA healthcare may provide opportunities to reach all Veterans. This approach aligns with the National Strategy for Suicide Prevention, released by the Surgeon General’s Office, and the National Action Alliance for Suicide Prevention’s call for a public health approach to suicide prevention that potentially provides greater benefit to a larger number of people.

This systematic review examined the published literature on the effectiveness and harms of community-based or population-level strategies aimed at preventing suicide. Investigators from VA’s Evidence Synthesis Program (ESP) Center in Minneapolis, MN searched the literature, including MEDLINE, Embase, PsycINFO, Sociological Abstracts, and the Cochrane Database of Systematic Reviews from January 2010 through November 2020. After reviewing 4,499 titles and abstracts – 692 for full text review – investigators included 56 publications that described 47 unique studies in this systematic review. The studies were grouped based on suicide prevention approaches outlined in the Centers for Disease Control and Prevention’s (CDC) guidebook Preventing Suicide: A Technical Package of Policy, Programs, and Practices, and also if they were single-strategy interventions or multi-strategy interventions targeting specific populations.

Summary of Findings

Findings of this systematic review suggest:

• Reducing access to lethal means, implementing programs that influence organizational policies and culture in workplace settings (police), and screening for depression in the community may reduce deaths by suicide.
• Among high school students, social-emotional learning programs, gatekeeper training, and screening for at-risk individuals may reduce suicide attempts, but it is unclear if these interventions reduce suicides.
• There was uncertain or no evidence for reducing suicide deaths for other single-strategy interventions, including public awareness and education campaigns, crisis hotlines, and gatekeeper training.
• Evidence was inconsistent for community-based, multi-strategy interventions. The most promising multi-strategy intervention was the European Alliance Against Depression. This intervention included educational workshops for primary care physicians (to improve detection and treatment of depression), public relations campaign, training of community facilitators (policeman, pharmacists, nurses, teachers, and hotline workers), support for high-risk groups, and restricting access to lethal means.

Implications for VA

The community-based approaches to suicide prevention reviewed here  may provide opportunities to reach more Veterans at risk of suicide outside of VA healthcare settings.  

Research Gaps/Future Research

Future studies using randomized designs or observational studies with concurrent controls and appropriate adjustment for confounders are needed given the large number of potential risk factors. Studies examining interventions’ acceptability, feasibility, effectiveness, and sustainability in US Veterans also are needed, particularly those targeting suicide means relevant to Veterans, such as firearms, poisoning, and suffocation. Finally, more evidence is required to see if the success of suicide interventions is population-specific—and if specific combinations of interventions are more successful than others.

A Cyberseminar titled “Population and Community-Based Interventions to Prevent Suicide” will be held on May 25, 2021 from 3:00pm – 4:00pm ET. Register here.

Sultan S, Linskens E, Gustavson A, Sayer N, Murdoch M, MacDonald R, McKenzie L, Ullman K, Venables N, Wilt T. Population and community-based interventions to prevent suicide: A systematic review. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-009; 2021.

To view the full report, go to
vaww.hsrd.research.va.gov/publications/esp/suicide-prevention.cfm (Intranet only, copy and paste URL into your browser if you have network access.)

ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.

This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of VA/HSR&D's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.

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