Recent data suggest that the rates of suicides in the United States dropped slightly in 2020 (Psychiatric News). Underlying this positive news is that even with this drop, more than 40,000 people still lost their lives to suicide last year, and many of these deaths could have been prevented. Further reducing deaths by suicide requires broader implementation of effective intervention programs. But which suicide interventions work best on a large scale?

To answer this question, J. John Mann, M.D., the Paul Janssen Professor of Translational Neuroscience (in Psychiatry and Radiology) at Columbia University, and colleagues turned to studies published between 2005 and 2019 that explored interventions aimed at reducing suicides or suicidal behavior. As the researchers described in a review in the American Journal of Psychiatry, educating primary care physicians on depression management, increasing awareness about mental illness and suicide among high school students, and restricting access to firearms are all effective and scalable solutions for preventing suicide.

Mann had conducted a similar review that was published in 2005 but noted that there has been a huge uptick in suicide intervention research since then. “I think the field was ready for a proper update,” he told Psychiatric News.

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The analysis by Mann, along with Columbia colleagues Christina Michel, M.A., and Randy Auerbach, Ph.D., involved data from 97 randomized clinical trials and 30 population-level studies. The studies focused on a variety of suicide prevention strategies, including education campaigns, screening tools, medication, psychotherapy, follow-up contact with people who had attempted suicide, and restricting access to lethal means such as firearms.

Mann said that a key aspect of this analysis is that it assessed scalability in addition to effectiveness. “It’s great if an intervention prevents suicide attempts, but how quickly and reliably can we push it out to a state or national level?” he asked.

The following four interventions showed good evidence of effectiveness—that is, most individual studies indicated that the people who received the intervention had less suicidal behavior than those who did not:

• Educating youth about suicidal behaviors

• Restricting access to firearms

• Educating primary care doctors about depression

• Following up with psychiatric patients after hospital discharge or suicide-related crisis

All four of these interventions were also identified by the authors as prevention methods that can be scaled up to city, county, state, and national levels.

Education for primary care physicians “could be tremendously impactful,” Mann said. As he and colleagues noted in their article, 45% of people who go on to die by suicide visit a primary care physician or other nonpsychiatrist in the 30 days prior to suicide, which is double the rate that they visit mental health professionals.

“You do not even have to mention the word suicide,” Mann continued. He believes a standardized course on recognizing and treating depression—like the national effort to educate physicians about opioids—would save numerous lives.

Educating middle and high school students about mental health could also reduce suicides, Mann said. Pushing out mental health messages to students over videoconference, for instance, can be readily accomplished on a large scale, he said.

“When all else fails, this study also confirms that if we can at least make it harder for a suicidal person to gain hold of a firearm, then many attempts will be averted,” Mann said. “We can do a lot by just focusing on gun safety—educating people about the importance of locking guns away and maybe encouraging research into smart gun technology.”

Speaking of technology, Mann said that he believes that digital tools such as mobile health and machine learning software will become important players in the suicide prevention landscape in the coming decade, though right now evidence is still preliminary. He noted that Auerbach, one of the co-authors on the review, is conducting studies looking at whether passive data gathered in iPhones—such as movement, keystroke activity, or even facial expressions in selfies—might help predict suicidal ideation.

This study was supported in part by grants from the National Institute of Mental Health. ■