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#10 - Suicide et STRATÉGIES NATIONALES EN PRÉVENTION DU SUICIDE - 21 Février 2012

La 22e Semaine de prévention du suicide qui s’est tenue du 5 au 11 février 2012 nous rappelle que, même si les taux de suicide ont diminué depuis une décennie au Québec, les efforts, les actions et les ressources déployés pour la prévention doivent être constants pour continuer à sauver des vies. Il en va de même pour l’implication des gouvernements en matière de prévention et d’intervention. Plusieurs pays, au cours des quinze dernières années, se sont dotés de stratégie nationale en prévention du suicide.

Même si quelques provinces canadiennes ont développé leur propre stratégie, le Canada n’en possède toujours pas une qui lui soit propre. L’Association canadienne pour la prévention du suicide (ACPS) avait déjà proposé en 2004 un avant-projet de stratégie nationale (lire la version éditée – en anglais) et récemment, elle a pressé le gouvernement fédéral de faire preuve «de leadership et de coordonner une réponse à ce problème de santé publique» (lire le communiqué de presse). Le 15 février dernier, un ambitieux projet de loi (C300) concernant l'établissement d'un cadre fédéral de prévention du suicide a été adopté en deuxième lecture par les membres de la chambre des Communes (consulter le projet de loi). Maintenant, il ne reste plus qu’à savoir si le Canada fera partie de la liste des pays ayant une stratégie nationale en prévention du suicide.
Dans la présente liste, vous trouverez quelques nouveaux documents portant sur ces stratégies à travers le monde.


Pour vous abonner à notre liste d'envoi, complétez le formulaire en-ligne.

Hadlaczky, G., Wasserman, D., Hoven, C. W., Mandell, D. J., & Wasserman, C. (2011). Suicide prevention strategies: Case studies from across the Globe. In R. C. O'Connor, S. Platt & J. Gordon (Eds.), International Handbook of Suicide Prevention: Research, Policy and Practice (pp. 473-485). Chichester, UK: John Wiley & Sons, Ltd.
Résumé:In the light of the more than 1.5 million annual suicide deaths worldwide projected for 2020, suicide prevention is clearly a high priority.  Moreover, the goal of suicide prevention is achievable. This chapter describes theoretical aspects such as the familiar primary, secondary, and tertiary model of suicide prevention, and compares it with the US Institute of Medicine model which adopts universal, selective, and indicated approaches. Suicide preventive efforts of inter-governmental bodies, such as the World Health Organisation (WHO) and European Union (EU), and area-specific programmes in Sweden, Uganda, Hong Kong, and Japan are also discussed as examples. Systematic inter-governmental collaboration, between policy planners, relevant decision-makers, clinicians, professional organizations, as well as researchers is a prerequisite in the successful prevention of suicides.

Matsubayashi, T., & Ueda, M. (2011). The effect of national suicide prevention programs on suicide rates in 21 OECD nations. Social Science and Medicine, 73(9), 1395-1400.
Résumé: Suicide has become a serious and growing public health problem in many countries. To address the problem of suicide, some countries have developed comprehensive suicide prevention programs as a collective political effort. However, no prior research has offered a systematic test of their effectiveness using cross-national data. This paper evaluates whether the national suicide prevention programs in twenty-one OECD nations had the anticipated effect of reducing suicide rates. By analyzing data between 1980 and 2004 with a fixed-effect estimator, we test whether there is a statistically meaningful difference in the suicide rates before and after the implementation of national suicide prevention programs. Our panel data analysis shows that the overall suicide rates decreased after nationwide suicide prevention programs were introduced. These government-led suicide prevention programs are most effective in preventing suicides among the elderly and young populations. By contrast, the suicide rates of working-age groups, regardless of gender, do not seem to respond to the introduction of national prevention programs. Our findings suggest that the presence of a national strategy can be effective in reducing suicide rates.
http://dx.doi.org/10.1016/j.socscimed.2011.08.022

WHO Western Pacific Region (2010). Towards Evidence-based Suicide Prevention Programmes. Geneva: World Health Organization.
Résumé: The monograph attempts to set out the basic framework for suicide prevention strategies and it provides details in formulating and evaluating suicide prevention programmes. Included are also details of some well-established suicide prevention programmes worldwide and in the Western Pacific Region that have been shown effective in reducing the number of suicides and/or associated outcome indicators.
http://www.wpro.who.int/publications/PUB_9789290614623.htm

Links, P. S. (2011). The role of physicians in advocating for a national strategy for suicide prevention. CMAJ, 183(7), 1987-1990.
Résumé: Many Canadian physicians, policy-makers and politicians have not been adequately updated by experts in the field that suicide is preventable. As a result, physicians in particular may not be aware of their important role in suicide prevention. In this article, I examine the arguments for and against the need for a national strategy for suicide prevention and selectively review some of the evidence of effective strategies that may influence physicians' practices.
http://dx.doi.org/10.1503/cmaj.111008

Chen, Y.-Y., Wu, K. C.-C., & Yip, P. S. F. (2011). Suicide prevention through restricting access to suicide means and hotspots. In R. C. O'Connor, S. Platt & J. Gordon (Eds.), International Handbook of Suicide Prevention: Research, Policy and Practice (pp. 545-560). Chichester, UK: John Wiley & Sons, Ltd.
Résumé: Restricting access to suicide means and locations is a component in prevention strategies of almost all prevention centres worldwide.  In this review, we describe the rationale underpinning such approaches in general, as well as for specific methods of suicide.  We review the age, sex, and country distribution of several common methods of suicide, including medication overdose, pesticide poisoning, gas poisoning, jumping, firearms, and hanging.  Current evidence supporting policies to restrict access to suicide means and hotspots is summarized.  In the case of suicides involving self-poisoning and firearms, direct restrictions on selling/purchasing of these lethal or highly toxic means (e.g. guns, pesticides, pills) through regulatory controls is generally effective in reducing suicide.  For suicide by self-poisoning, prevention approaches can also involve reducing the toxicity of substances used.  Current evidence indicates the effectiveness of erecting barriers at jumping hotspots in reducing suicidal leaps.  As ligature points and ligatures are universally available, restricting access to these suicide means is not a reasonable prevention strategy except in certain controlled environments such as psychiatric hospitals and prisons.  Despite the limited opportunities in relation to hanging, restricting access to suicide means and hotspots are effective and feasible strategies in preventing suicide.

Nordentoft, M. (2010). Crucial elements in suicide prevention strategies. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35(4), 848-853.
Résumé: Ways of conceptualizing suicide prevention are reviewed briefly, and the preventive model: Universal, Selected, and Indicated prevention (USI) is chosen as the structure for the literature review, and the discussion. Universal preventive interventions are directed toward entire population; selective interventions are directed toward individuals who are at greater risk for suicidal behaviour; and indicated preventions are targeted at individuals who have already begun self-destructive behaviour. On the universal prevention level, an overview of the literature is presented with focus on restrictions in firearms and carbon monoxide gas. At the selective prevention level, a review of risk of suicide in homelessness and schizophrenia and risk factors for suicide in schizophrenia is conducted and possible interventions are mentioned together with the evidence for their effect. Suicide rate and preventive measures in affective disorder are also touched upon. At the indicated prevention level, studies of fatal and non-fatal suicide acts after suicide attempt are mentioned. The evidence of preventive measures to reduce repetition rates is presented. Finally, the state of the art is discussed with regard to prevention at the universal, the selected and the indicated level and clinical and research implications are outlined.
http://dx.doi.org/10.1016/j.pnpbp.2010.11.038

Pearson, J. L. (2011). Challenges in US suicide prevention public awareness programmes. In R. C. O'Connor, S. Platt & J. Gordon (Eds.), International Handbook of Suicide Prevention: Research, Policy and Practice (pp. 577-590). Chichester, UK: John Wiley & Sons, Ltd.
Résumé: Awareness is considered the initial step in suicide prevention efforts in the United Sates and many nations around the world.  Yet there is limited research to guide effective approaches to increasing awareness.  A recent review by Dumesnil and Verger (2009) provides a helpful overview of international suicide prevention awareness efforts and called for expert consensus on approaches.  An edited book by Hornik (2002) is another comprehensive summary of successful public health communication efforts across the world, with examples of efforts that were more or less successful.  Using lessons learned from these reviews, this chapter considers some specific targeted campaign efforts in the United States.  Included are efforts aimed at federal and state policy-makers; the news media and entertainment media; and two US demographic groups: high school youth and military veterans.  It reviews the goals and intended outcomes for these awareness programmes and highlights opportunities for research for these particular target audiences.  Safety issues unique to suicide prevention efforts are considered.  With these conclusions in mind, the chapter considers some current research challenges: efficient means of assessing awareness needs in target groups; and how to work with cultural values withing target groups, using an example that harnesses new media.

Solin, P., & Nikander, P. (2011). Targeting suicide—Qualitative analysis of suicide prevention strategy documents in England and Finland. Mental Health Review Journal, 16(1), 5-14.
Résumé: Suicide as a stigmatising issue presents a huge challenge for prevention policy. Also, policy itself is often difficult to turn into action. This research describes the interpretative repertoires found in the suicide prevention strategies of England and Finland, and explores their potential functions and audiences. It was found that the political repertoire was formed from four sub-repertoires: the public health epidemiology, the everyday, the preventive action and the reflective repertoires. This paper discusses the polyphonic and multilayered nature of these policy documents and how different repertoires may be used for various functions. The polyphonic nature of policy documents is necessary to reach a wide readership and to capture suicide as a controversial phenomenon. However, the downside is that the argumentative style may also undermine some of the measures and actions recommended.
http://dx.doi.org/10.5042/mhrj.2011.0175

Flavin, P., & Radcliff, B. (2009). Public policies and suicide rates in the American states. Social Indicators Research, 90(2), 195-209.
Résumé: We are interested in the relationship between public policies and outcomes measuring quality of life. There is no outcome more final than the ending of one's own life. Accordingly, we test the relationship between public policy regimes and suicide rates in the American states. Controlling for other relevant factors (most notably a state's stock of social capital), we find that states with higher per capita public assistance expenditures tend to have lower suicide rates. This relationship is of significant magnitude when translated into potential lives saved each year. We also find that general state policy liberalism and the governing ideologies of state governments are linked to suicide rates. In response to a growing literature on the importance of non-political factors such as social connectedness in determining quality of life, these findings demonstrate that government policies remain important determinates as well.
http://dx.doi.org/10.1007/s11205-008-9252-5

Page, A., Taylor, R., Gunnell, D., Carter, G., Morrell, S., & Martin, G. (2011). Effectiveness of Australian youth suicide prevention initiatives. British Journal of Psychiatry, 199(5), 423-429.
Résumé: BACKGROUND: After an epidemic rise in Australian young male suicide rates over the 1970s to 1990s, the period following the implementation of the original National Youth Suicide Prevention Strategy (NYSPS) in 1995 saw substantial declines in suicide in young men. AIMS: To investigate whether areas with locally targeted suicide prevention activity implemented after 1995 experienced lower rates of young adult suicide, compared with areas without such activity. METHOD: Localities with or without identified suicide prevention activity were compared during the period of the NYSPS implementation (1995-1998) and a period subsequent to implementation (1999-2002) to establish whether annual average suicide rates were lower and declined more quickly in areas with suicide prevention activity over the period 1995-2002. RESULTS: Male suicide rates were lower in areas with targeted suicide prevention activity (and higher levels of funding) compared with areas receiving no activity both during and after implementation, with rates declining faster in areas with targeted activity than in those without (13% v. 10% decline). However, these differences were reduced and were no longer statistically significant following adjustment for sociodemographic variables. There was no difference in female suicide rates between areas with or without targeted suicide prevention activity. CONCLUSIONS: There was little discernible impact on suicide rates in areas receiving locally targeted suicide prevention activities in the period following the NYSPS.
http://dx.doi.org/10.1192/bjp.bp.111.093856

Thomas, B. (2011). Organizations, corporate governance and risk management. In R. Whittington & C. Logan (Eds.), Self-harm and violence: Towards best practice in managing risk in mental health services. (pp. 163-185): Wiley-Blackwell.
Résumé: Government policy initiatives relating to harmful behaviour by the users of mental health services, including the National Suicide Strategy, have been developed. Implementation of these 'top-level' initiatives is the responsibility of the organizations that make up the NHS. It is also the responsibility of these organizations to manage risk, provide safe care, and to protect people who use their services and staff from harm. In addition, it is widely acknowledged that errors and adverse events that result in harm are much more likely to result from systems failures within an organization rather than the poor performance of an individual. This chapter will be of interest not only to NHS managers, but also practising clinicians as it explains the organizational responsibilities involved in the management of risk, providing safer mental health services, and managing harmful behaviour. These responsibilities include compliance with legislation, the provision of a safe environment, adequate staffing levels, competent staff, and well maintained equipment. It also includes an effective risk management system, incorporating complaints procedures, litigation, claims handling, and financial risk. While the policy framework described here is that which operates in England, many of the issues will be relevant to organizations and individuals in other countries. In addition to legislative requirements, there are extensive national policies and guidance available to help organizations ensure service users are treated and cared for in high quality services that respect and promote users' safety, privacy, and dignity. This chapter examines how such policies and guidance are translated and implemented locally. It recognizes that knowing what to do does not always translate into doing the right thing. The chapter explores the ways in which organizations can support staff in making the best decisions around risk and thus drive up standards across the board. In doing so, the chapter also describes the work of other organizations, particularly independent agencies and the 'arm's lengths' bodies of the Department of Health, in supporting policy implementation, decision-making and monitoring services. These organizations include the NHS Litigation Authority (NHSLA), the CQC, including the Mental Health Act Commission, and the National Patient Safety Agency (NPSA).

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Les opinions exprimées dans ces documents sont celles des auteurs et elles ne représentent pas nécessairement celles des membres du CRISE. Ces titres sont fournis à titre informatif seulement et cette liste ne se veut pas être exhaustive. Le CRISE ne se tient aucunement responsable de l'utilisation de l'information contenue à l'intérieur de ces documents.

 
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UQAM - Université du Québec à Montréal  ›  Mise à jour : février 2006