If you thwart a means of suicide, do patients just switch to a different method? Received wisdom in the UK is that the answer is no - take away the means and the suicide rate drops. The main evidence for this comes from time trends following the change in coal gas in the 1960s, and more recently from changes in packaging of paracetamol to prevent people swallowing a whole bottleful - it can only be sold in blister packs which forces the person to pop each tablet out individually.
But here is a less optimistic study from Toronto: putting jump barriers on one bridge did not lower the city-wide suicide rate. The accompanying editorial provides useful context to this finding.
Perhaps the answer lies in another paper in the same BMJ: the method chosen may predict outcome. The person who chooses a violent method such as jumping may be different, and more determined, than the person who chooses gas or drugs.
Here is an interesting and meticulous study from Karachi. Community health workers delivered advice on diet and lifestyle, and in so doing averted much (diastolic) or all (systolic) of the normal rise in blood pressure with age. An important study because this is the first time it's been proved to work.
My main resevation is that the age of participants stretched from 5 to 39 years (mean 19years) - I'd have thought that effects in children should be presented separately (though I'm no expert in this field).
As usual the actual differences in mean blood pressure are very small - less than 2mm Hg - but conventional wisdom is that this will make a big difference at population level. You also need an epidemiologists' viewpoint to regard the participants as being in need of blood pressure control - mean blood pressure at the start of the intervention was 114 / 74. Note also the huge attention to detail needed in measuring blood pressure in this type of study.
I'm impressed by this report of a successful campaign to reduce suicide: 9 consecutive quarters with no suicides in a population of 200 000 (compared to about 40 per quarter
beforehand). It's a report not a paper so there isn't much scientific detail. For example the trend graph only shows one data point before the intervention. This always raises doubts about whether we have simply seen a natural rise and fall, with the intervention somewhat irrelevant.
Also, because the population is served by a US health organisation, I can't work out whether it is an all-age, general population or a group specifically served because of mental health problems. Finally, it would be nice to know if the baseline suicide rate is stonkingly high by international standards or in the middle of the pack.
But all that aside, we should congratulate them.
The write-up gives a very good feel for what it takes to deliver success on this scale. Foremost: the will to succeed. As the director of the programme said:
'If we were to provide perfect depression care, nobody would kill themselves. Such a 'perfection' goal was very controversial at the start, but if zero isn't the right number, what is?'
The first health strategy for England 'Health of the Nation' set a target to reduce suicides. At the time there wasn't much evidence that this could be done. The only real evidence in the literature were reports from the small Danish island of Gotland, which raised questions about whether this educational initiative for doctors could generalise to large health systems.
Here's another trial that provides a startling result. Well actually, this result isn't so startling - but read the introduction, because all the other trials of this issue have produced startling results. So this one is startling by virtue of being as expected!
The issue is whether giving old people spectacles reduces falls. Seems commonsense, doesn't it? Old people can't see trip hazards, so helping them to see better must reduce falls. Now read on...