Evaluation of the Effectiveness of Suicide Prevention Programs: A Methodological Perspective

Abstract

Many studies that attempt to evaluate the effectiveness of treatment programs for suicidal patients are methodologically deficient in one or more areas. This paper outlines six criteria that should be met in designing such investigations: Patients should be randomly assigned to groups; at least 80% of the subjects who were initially enrolled should be followed up; the results should be both statistically significant and clinically important; all clinically relevant outcomes should be reported; the patients must be adequately described; and the new intervention should be feasible in other settings. It is shown that these criteria are both necessary and achievable.

Which Helper Behaviors and Intervention Styles are Related to Better Short‐Term Outcomes in Telephone Crisis Intervention? Results from a Silent Monitoring Study of Calls to the U.S. 1–800‐SUICIDE Network

“…We have not come across a study in which clients were asked to rate their satisfaction with helpline services that did not show highly positive results. When clients are asked to rate their satisfaction or perceived helpfulness, between 60% and 80% give positive responses (e.g., Apsler & Hoople, 1976; King, 1977; McKenna, Nelson, Chatterson, Koperno & Brown, 1975; Motto, 1971; Rogers & Rogers, 1978; Stein & Cotler, 1973; Stein & Lambert, 1984; Streiner & Adam, 1987; Tekavcic‐Grad & Zavasnik, 1987; Wold, 1973). One of the reasons satisfaction studies may always get positive results is the fact that response rates in satisfaction studies are generally poor; that is, those who were satisfied are more likely to respond to follow‐up than those who were not.…”

Intensive Follow‐up Does Not Decrease the Risk of Repeat Suicide Attempts

“…Most other studies of interventions to decrease the frequency of repeat suicide attempts have also obtained negative results. We believe that our study clarifies the issue, because it paid close attention to recommended methodological criteria in this field (Streiner & Adam, 1987).…”

“…The methodological aspects of studies of the effectiveness of suicide prevention programs have been well discussed (Streiner & Adam, 1987). Many of the studies we reviewed contained remediable flaws, notably a nonconcurrent comparison group, ill-designed or ill-described randomization procedures, and/or short follow-up (often no longer than the intervention itself).…”

Evaluation Strategy for Finland's Suicide Prevention Project

“…There is a widely recognized need for program evaluation in suicide prevention [see Tierney, 1994], and an even greater deficit in large-scale, multi-focused evaluation studies. Typically, suicide prevention evaluation studies have had a limited scope and an epidemiological or clinical approach focusing on the outcome of one specific treatment or intervention – usually the effect on the risk of further suicide attempts [Streiner & Adam, 1987]. Naturally, the rarity of national or other large-scale strategic suicide prevention programs explains the lack of comprehensive evaluation studies.…”