Implementation research: community intervention to prevent repeated suicide attempts in Ningxia China and Nunavut Canada

Background

Suicide is the most serious outcome of a wide variety of mental illnesses, including depression, bipolar disorder, schizophrenia, eating disorders and substance abuse. Several recent milestones highlight the increasing international recognition of the global importance of suicide to health: in 2010 the World Health Organization’s (WHO) Mental Health Gap Action Programme to promote mental health in non-specialized health settings included suicide prevention as one of its main targets; in 2013 the first global mental health plan approved by all WHO member countries, the Global Mental Health Action Plan, included the goal of reducing suicide mortality by 10% by 2020.

The most important risk factor for death by suicide is having made a prior suicide attempt, so monitoring attempted suicides and reducing repeated suicidal behavior in this high-risk group of individuals is a fundamental part of the global effort to reduce suicide mortality. A recent meta analysis comparing different interventions to prevent repeated suicidal behavior in individuals who have made a recent suicide attempt concluded that ‘active contact and follow-up’ approaches are effective in reducing recidivism while other common interventions such as psychotherapy and pharmacotherapy are not effective. However, most of these ‘active contact and follow-up’ interventions have been conducted in high-income settings where mental health professionals are readily available, so they are of limited usefulness in low-resource setting.

Aims

This 5-year implementation science project will develop methods for adapting the WH0 SUPRE-MISS intervention for suicide attempters in parallel projects in Ningxia, China, and among Inuit in Nunavut, Canada. These methods for adapting SUPRE-MISS will then be promulgated in Inuit and other indigenous populations, other parts of China, other low- and middle-income countries, and other low-resourced settings in high-income countries.

Project plan

• PHASE 1. Conduct focus groups with local stakeholders to identify local factors that need to be considered when developing a location-specific version of SUPRE-MISS that provides a brief educational intervention about suicide prevention to individuals who have recently made a suicide attempt and periodic social support and access to emergency services to these high-risk individuals.

• PHASE 2. Pilot-test the adapted intervention in a small number of settings for one year.

• PHASE 3. Revise and then scale-up the intervention to more settings for 30 months and continuously collect outcome measures, process measures, and resource utilization measures (for cost-effectiveness assessment).

• PHASE 4. Conduct post-intervention focus groups with stakeholders to identify the strengths and weaknesses of the intervention. Integrate these qualitative results with the quantitative results (e.g., rates of repeated suicidal behavior) to prepare a report on the process of implementing the SUPRE-MISS intervention in low-resource settings. Work with administrators and policy makers in China, Nunavut, and other locations to develop policies that will widely promulgate the use of this approach to suicide prevention.

EXPECTED OUTCOMES: This project will develop methods that can be widely disseminated to help achieve the United Nation’s ambitious goal of reducing suicide mortality by 1/3 by 2030. Combining findings from parallel projects in a low-middle-income country with those from a low-resource setting in a high-income country will provide a unique case example of how implementation science can be used to address complex mental health problems in different low-resource settings.

Principal investigators

Team members

Funding organisations

• 
•