Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review

In the paper

“SSRIs target serotonin, and appeared more effective than noradrenergic drugs for suicidal ideation.(59, 61)”

What the sources say

• Partly supported

  The Discussion (page not provided) reports an exploratory finding that patients with more severe baseline suicidal ideation improved more on the SSRI paroxetine than on bupropion. It also says the primary treatment effects were not significant. The claim omits those limits and generalizes a comparison of two drugs to SSRIs and noradrenergic drugs as classes. (LLM, conf=0.86)

  cites [59] sourceExperimental — accuracy not yet measured
• Disputed

  The Discussion reports that suicidal ideation decreased with both escitalopram (an SSRI) and nortriptyline, with no overall difference between them. It identifies a narrower exception: men taking nortriptyline had higher rates of treatment-emergent or worsening suicidal ideation. That does not support the unqualified claim that SSRIs appeared more effective. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  cites [61] sourceExperimental — accuracy not yet measured

In the paper

“One systematic review of antidepressants in pediatric populations found SSRIs increased odds of a suicide attempt,(53) but most subsequent meta-analyses and epidemiological studies in both pediatric(48),(50) and adult populations(49, 52, 66, 67, 86) reported a more favorable risk-benefit ratio than the FDA analyses,(51, 87) including benefits for suicidal behavior.”

What the sources say

• Disputed

  The Results (Suicide-related outcomes; page unavailable) found no significant difference in suicide-related risk between SNRIs and placebo in children and adolescents, not a benefit for suicidal behavior. The Results (Acceptability outcomes; page unavailable) also report significantly more discontinuations for adverse effects with SNRIs. This paper does not support the favorable pediatric risk-benefit finding attributed to it; it does not assess adult populations or compare its findings directly with the FDA analyses. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  cites [48] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [50] source
• Partly supported

  The Discussion reports antidepressant benefits in youth and adults and says the findings should prompt reconsideration of the risk–benefit equation behind the warning about suicidal thinking in children. It does not report a benefit for suicidal behavior or establish what most subsequent meta-analyses and epidemiological studies found; this paper analyzes trial data for fluoxetine and venlafaxine. (LLM, conf=0.85)

  cites [49] sourceExperimental — accuracy not yet measured
• Partly supported

  The COMMENT section reports significantly lower suicide-risk measures with antidepressant treatment in adult and geriatric patients. But it says those adult findings largely agree with the FDA’s, rather than showing a more favorable result, and that the study could not analyze suicidal behavior separately from ideation. It therefore supports an adult suicide-risk benefit, not the full comparison or a distinct benefit for suicidal behavior. (LLM, conf=0.86)

  cites [52] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [66] source
• ?Not checked — no full text of the sourcecites [67] source
• ?Not checked — no full text of the sourcecites [86] source

In the paper

“Both pediatric and adult studies of antidepressant effects on suicidal behavior show reductions in suicidal behavior in meta-analyses, more readily than in individual RCTs, probably because the low base rate of suicide attempts requires larger sample sizes.”

What the sources say

• Disputed

  The Results (Suicide-related outcomes; page unavailable) report no significant reduction in suicide-related outcomes with SNRIs versus placebo in the pooled pediatric trials (RR=1.09; 95% CI=0.60–1.99). The paper does not examine adult trials, so it cannot support that part of the claim either. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  cites [48] sourceExperimental — accuracy not yet measured
• ?Could not verify

  The Discussion (page unavailable) reports improved depression response and remission in youth and adults, but does not report reductions in suicidal behavior. A separate Discussion passage mentions the pediatric warning about suicidal thinking; neither it nor the Methods passages establish the claimed comparison between meta-analyses and individual RCTs. Searches for suicidal behavior, suicide attempts, and the proposed low-base-rate explanation found no supporting passage. (LLM, conf=0.76)

  cites [49] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [50] source
• Partly supported

  The COMMENT reports significant reductions in suicide-risk measures for treated adults in an analysis combining trial data, and the METHODS notes that suicide attempts and deaths were too few for well-powered comparisons. But the RESULTS > YOUTH FLUOXETINE STUDIES found no significant treatment effect in youths. The paper also says it lacked power to analyze suicidal behavior separately from ideation, so it does not establish the claimed reduction in suicidal behavior for both age groups or directly compare meta-analyses with individual RCTs. Page numbers are unavailable in our copy. (LLM, conf=0.88)

  cites [52] sourceExperimental — accuracy not yet measured
• Disputed

  The Results report the opposite direction for the paper’s pooled analysis: SSRIs significantly increased suicide attempts compared with placebo, rather than reducing them. The Introduction notes that rare events can make differences hard to detect in individual studies, but its mention of an earlier reduction concerns suicidal ideation, not suicidal behavior. (LLM, conf=0.91)

  Checked by a reasoning model — may be wrong.

  cites [53] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [54] source
• ?Not checked — no full text of the sourcecites [66] source
• ?Not checked — no full text of the sourcecites [67] source
• ?Not checked — no full text of the sourcecites [86] source

In the paper

“The decline in suicide rates was observed in the study sample of 19,248 suicides who were in treatment within 12 months of death studied 1997–2012.”

What the sources say

• Supported

  The Results (p. 5) report 19,248 patient suicides in England during 1997–2012 and a decrease in suicide rates in the patient population. The Suicide data section (p. 2) defines the patients as people who had contact with mental health services within 12 months of death; it does not say they were in treatment throughout those 12 months. (LLM, conf=0.90)

  cites [34] source

In the paper

“Targeting high school students prevented student suicide attempts (29, 30) whereas targeting teachers (29) and all but one parent study (Table S1), did not find benefit.”

What the sources say

• ?Not checked — no full text of the sourcecites [29] source
• Supported

  The Discussion reports significantly fewer suicide attempts among high school students receiving SOS than among untreated controls three months after the intervention. The Conclusion describes a reduction in self-reported attempts; the evidence supports prevention in the sense of reducing attempts, not eliminating them. (LLM, conf=0.92)

  cites [30] source

In the paper

“One study in the United Kingdom (34) found benefit for an array of clinical service changes including improved depression management, continuity of care from adolescent patient services to adult patient services, improved community services and lower staff turnover and found reduced suicide rates with incident rate ratios of .71–.79.”

What the sources say

• Partly supported

  The Summary (p. 1) reports incidence rate ratios of 0.71–0.79 for service changes, and the Results (p. 5) identify depression guidance, community treatment teams, and transitions to adult services among changes associated with lower suicide rates. The paper treats low staff turnover separately as an organisational factor that strengthened the association between service changes and reduced suicide rates (Results, p. 6), not as a clinical service change with an incidence rate ratio in that range. (LLM, conf=0.88)

  cites [34] sourceExperimental — accuracy not yet measured

In the paper

“Training primary care doctors and nurses at the local and state level to better screen and treat depression with supplemental help available from psychiatrists, lowered suicide rates,(12–19) nonfatal suicide attempts(20, 21) and ideation(22) (Table 2).”

What the sources say

• Partly supported

  The Results (General effect on suicidal acts; page unavailable) report fewer attempted suicides relative to controls in Portugal, but no overall reduction across the four countries. The implementation findings describe GP training, not a demonstrated effect of training doctors and nurses with supplemental psychiatric help; the Discussion says the contribution of any single intervention measure cannot be isolated. (LLM, conf=0.88)

  cites [20] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [21] source

In the paper

“In the second study, 4,133 high students were randomized to a mental health and suicide education program or control group. Less suicidal behavior was observed in the active intervention group relative to the control group over the next year.”

What the sources say

• Partly supported

  The Abstract (Methods) reports 4,133 high school students assigned to intervention and control groups, and the Discussion reports significantly fewer suicide attempts in the intervention group. But the outcome was measured approximately three months after the program, not over the next year. (LLM, conf=0.92)

  cites [30] sourceExperimental — accuracy not yet measured

In the paper

“Doctors in primary care and other non-psychiatric care settings see 45% of future suicide decedents in the 30 days prior to suicide, and 77% within 12 months of suicide,(11) about double the rate consulting mental health professionals.”

What the sources say

• Partly supported

  The Results report approximately 45% contact with primary care providers within one month and 77% within one year, versus 19% and 32% contact with mental health services—roughly twice as high. These figures concern primary care providers; the paper does not establish the same rates for other non-psychiatric care settings. (LLM, conf=0.85)

  cites [11] sourceExperimental — accuracy not yet measured

In the paper

“Repeated education sessions reduced suicide rates progressively for years.(12, 21)”

What the sources say

• Partly supported

  The Intervention Training section documents repeated education sessions, and the Primary Outcome section reports a lower mean annual suicide rate during the five intervention years than during the five preceding years. The paper does not establish that rates fell progressively year by year; the Comment section also says it cannot determine whether education, additional resources, or both accounted for the change. (LLM, conf=0.89)

  cites [12] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [21] source

In the paper

“Conversely, a study of 40 primary care medical practices in the Netherlands found a drop in depression recognition from 65% to 44% was associated with higher suicide attempt rates in men.(28)”

What the sources say

• Partly supported

  The Abstract’s Setting identifies 40 Dutch general practices, and its Results report both a rise in male suicide attempts and a decline from 65% to 44% in reported depression history. But those percentages concern all patients who died by suicide, not men who attempted suicide. The Results section on suicidal behaviour after 2007 gives different figures for male suicide decedents (60% to 46%); the paper does not establish an association between declining depression recognition and male attempt rates. (LLM, conf=0.88)

  cites [28] sourceExperimental — accuracy not yet measured

In the paper

“In contrast, a single day training session produced no benefit for suicide deaths over 3-years.(27)”

What the sources say

• Partly supported

  The Education program section describes a four-hour training program, and Table 4 compares suicide deaths over the three years before and after it. The Results report a 12% decrease in intervention regions versus 4% in the control region, but the difference was not statistically significant. Thus the paper supports no demonstrated benefit for suicide deaths, not the categorical claim that the training produced no benefit. (LLM, conf=0.87)

  cites [27] sourceExperimental — accuracy not yet measured

In the paper

“Training primary care doctors and nurses at the local and state level to better screen and treat depression with supplemental help available from psychiatrists, lowered suicide rates,(12–19) nonfatal suicide attempts(20, 21) and ideation(22) (Table 2).”

What the sources say

• Supported

  The INTERVENTION Training section describes education for GPs and their nurses, and Improving Access to Depression Treatment describes screening guidance and telephone consultation with local psychiatrists. The PRIMARY OUTCOME section reports that suicide rates fell during the intervention. The paper notes that the decline was comparable to the local control region’s, so it does not establish which component of the program drove the reduction. (LLM, conf=0.88)

  cites [12] source
• ?Not checked — no full text of the sourcecites [13] source
• Partly supported

  The Introduction (page not specified) describes depression screening by trained public health nurses, and the Discussion reports a 74% reduction in suicide risk among elderly women in the intervention area, but not among men. The intervention also included psychoeducation and group activities; the Discussion says it cannot determine which component accounted for the reduction. The paper does not describe training primary care doctors to screen and treat depression, although it records occasional referrals to psychiatrists. (LLM, conf=0.89)

  cites [14] sourceExperimental — accuracy not yet measured
• Partly supported

  The Discussion reports that the suicide rate fell among elderly females following the intervention. But it describes the intervention as group activities, psychoeducation, and self-assessment of depression—not training primary care doctors and nurses to screen and treat depression. The Self-assessment section explicitly says the questionnaire was used to recommend assessment, “but not to screen.” (LLM, conf=0.88)

  cites [15] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [16] source
• ?Not checked — no full text of the sourcecites [17] source
• ?Not checked — no full text of the sourcecites [18] source
• ?Not checked — no full text of the sourcecites [19] source

In the paper

“Screening for suicide risk to identify otherwise undetected at-risk individuals,(30, 37) if coupled with effective referral for evaluation and treatment, was found by some studies to prevent suicidal behavior.(15–17, 37, 38)”

What the sources say

• Partly supported

  The Introduction (page unavailable) reports that earlier programs combining depression screening with psychiatric follow-up reduced suicide rates among older adults. It does not establish that screening specifically for suicide risk, coupled with effective referral, produced that result; the paper says its own group intervention was not a screening program. (LLM, conf=0.85)

  cites [15] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [16] source
• ?Not checked — no full text of the sourcecites [17] source
• Partly supported

  The Discussion (page unavailable) recommends asking about suicidal ideation and describes assessment that can guide treatment, follow-up, or referral. But it says the degree to which suicide is preventable remains uncertain; it does not report that studies found screening coupled with referral prevented suicidal behavior. (LLM, conf=0.86)

  cites [37] Dube P, 2010, Prim Care Companion J Clin Psychiatry sourceExperimental — accuracy not yet measured
• ?Could not verify

  The Methods and Clinical implications sections describe screening and limited follow-up assistance, but do not evaluate screening coupled with effective referral and treatment as a way to prevent suicidal behavior. The Strengths and limitations section says the trial lacked sufficient power to detect differences in self-harm; its conclusion concerns whether screening induced suicidal thoughts, not whether it prevented suicidal behavior. (LLM, conf=0.76)

  cites [38] sourceExperimental — accuracy not yet measured

In the paper

“Areas with suicide rates 3–10 times higher than the U.S., have shown that screening for depression combined with referral for depression treatment by a primary care doctor or psychiatrist lowered suicide rates relative to a contemporaneous geographic control.(12, 15–17)”

What the sources say

• Partly supported

  The Improving Access to Depression Treatment section describes GP depression screening and referral to a depression clinic. The Primary Outcome section reports a greater decline in suicide rates than in the surrounding county, but no overall difference in the change relative to the nearby local control region; the rural-women comparison was a trend (P=.07). The claim overstates the result if “contemporaneous geographic control” means that local control region. (LLM, conf=0.88)

  cites [12] sourceExperimental — accuracy not yet measured
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [15] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [16] source
• ?Not checked — no full text of the sourcecites [17] source

In the paper

“We focused on suicidal behavior as an outcome and not suicidal ideation, because there is closer a relationship between suicide deaths and nonfatal suicide attempts than there is between suicidal ideation and suicide deaths.(7)”

What the sources say

• ?Could not verify

  The Prevalence and Characteristics of suicidal behaviours as risk factors sections report attempts among people with suicidal ideation and transitions from ideation to attempts. The Background calls ideation, plans and attempts precursors to suicide, but no passage compares how closely attempts and ideation are related to suicide deaths (searched: suicide deaths, nonfatal attempts, completed suicide). (LLM, conf=0.76)

  cites [7] sourceExperimental — accuracy not yet measured

In the paper

“More promisingly, antidepressants reduced suicidal ideation in 9/12 studies that reported effects on suicidal ideation.(55, 57, 59–65)”

What the sources say

• ?Not checked — no full text of the sourcecites [55] source
• ?Not checked — no full text of the sourcecites [57] source
• Partly supported

  The Discussion reports exploratory evidence of greater improvement in suicidal ideation with paroxetine than bupropion among patients with more severe baseline ideation. The Introduction summarizes 10 studies comparing antidepressant classes, but neither section reports that antidepressants reduced ideation in 9 of 12 studies. No page numbers are available in our copy. (LLM, conf=0.82)

  cites [59] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [60] source
• Partly supported

  The Discussion and Conclusion (pages unavailable in our copy) report that suicidal ideation decreased during treatment with escitalopram or nortriptyline in the GENDEP trial. This supports the paper as one example of a study finding a reduction, but it does not establish the citing sentence’s count of 9 out of 12 studies. (LLM, conf=0.86)

  cites [61] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [62] source
• Partly supported

  The Efficacy Results (p. 625) report reduced suicidal thoughts with esketamine versus placebo at 4 hours, so this paper supports one instance of the claimed effect. It is a single trial, however, and does not report that antidepressants reduced suicidal ideation in 9 of 12 studies. (LLM, conf=0.88)

  cites [63] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [64] source
• ?Not checked — no full text of the sourcecites [65] source

In the paper

“Ketamine, an NMDA glutamate receptor antagonist, reduced suicidal ideation within 1–4 hours in major depression(71–75) and bipolar disorder.(76, 77)”

What the sources say

• Partly supported

  The Introduction reports earlier findings suggesting that ketamine can reduce suicidal ideation within 40 minutes, including in treatment-resistant depression. This trial studied patients with treatment-resistant unipolar major depression but measured its suicidal-ideation outcome at 24 hours, not at 1–4 hours; the claimed interval is therefore not established by this trial. (LLM, conf=0.80)

  cites [71] sourceExperimental — accuracy not yet measured
• Supported

  The Secondary Outcome Measures section reports a greater reduction in suicidal ideation with ketamine than with midazolam at 230 minutes after infusion—about 3 hours and 50 minutes—in patients with major depressive disorder. That assessment falls within the claimed 1–4-hour window; the paper does not establish an effect specifically at 1 hour. (LLM, conf=0.92)

  cites [72] source
• Partly supported

  The Results section reports significantly lower suicidal-ideation scores after ketamine, but the measurements were on days 1 and 3 in patients with newly diagnosed cancer. The Discussion mentions antidepressant effects as soon as 40 minutes in depressed patients; it does not establish reduced suicidal ideation within 1–4 hours in major depression. (LLM, conf=0.88)

  cites [73] sourceExperimental — accuracy not yet measured
• Partly supported

  The Suicidal ideation results (section 3.2; page unavailable) report that ketamine alleviated suicidal ideation 90–180 minutes after infusion, within the claimed 1–4-hour window. But the Participants section (2.1; page unavailable) includes major depression alongside bipolar depression, depression NOS, and dysthymia; the reported effect is for the combined group, not specifically for patients with major depression. (LLM, conf=0.83)

  cites [74] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [75] source

In the paper

“Screening in the U.S. military(42) indicated current ideation added predictive power to a history of a previous suicide attempt.”

What the sources say

• Partly supported

  The Results table lists both prior suicide attempts and the frequency of outpatient visits recording suicidal ideation as predictors in a model for soldiers with prior psychiatric hospitalization. It does not report that screening for current ideation added predictive power beyond a history of attempts; its ideation measures concern visits in the preceding three or twelve months. The Abstract says clinician-evaluated suicide-risk information might improve a future model. (LLM, conf=0.82)

  cites [42] sourceExperimental — accuracy not yet measured

In the paper

“A meta-analysis of RCTs in bipolar disorder found no data on lithium’s effect on suicide prevention(81), however a meta-analysis of non-randomized studies suggested that risk of attempts and suicide was 5 times less with lithium treatment.(82)”

What the sources say

• Partly supported

  The Meta-analysis: all suicide acts section reports a 4.91-fold lower risk of suicide or attempts during lithium treatment, supporting the approximate five-fold figure. But that estimate pools 31 studies, including five RCTs, so describing it as a meta-analysis of non-randomized studies alone is inaccurate. (LLM, conf=0.86)

  cites [82] sourceExperimental — accuracy not yet measured

In the paper

“Ketamine, an NMDA glutamate receptor antagonist, reduced suicidal ideation within 1–4 hours in major depression(71–75) and bipolar disorder.(76, 77)”

What the sources say

• Supported

  The Results section reports lower suicidal-ideation scores after ketamine than after placebo in patients with bipolar depression, beginning at 40 minutes and continuing across later measurements. This supports a reduction within 1–4 hours. (LLM, conf=0.94)

  cites [76] source
• ?Not checked — no full text of the sourcecites [77] source

In the paper

“More complex EMR-based screening, bypassing gatekeepers, may improve identification of higher risk patients.(43–47)”

What the sources say

• Partly supported

  The Historical Administrative Data Study section (page unavailable) describes using soldiers’ administrative records to study predictors of suicide risk, and the Discussion (page unavailable) proposes adding more detailed predictors. The paper does not evaluate EMR-based screening, show that it improves identification of high-risk patients, or discuss bypassing gatekeepers. (LLM, conf=0.79)

  cites [43] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [44] source
• Partly supported

  The Discussion (page not provided) reports that an algorithm using Army/DoD administrative data identified a highest-risk group containing 52.9% of post-hospital suicides. It does not say the approach bypasses gatekeepers; instead, it describes the algorithm as a component of, not a substitute for, clinical assessment. (LLM, conf=0.85)

  cites [45] sourceExperimental — accuracy not yet measured
• Partly supported

  The Discussion (page unavailable) says that considering additional patient characteristics would improve risk prediction and help identify patients at highest risk. The Methods (page unavailable) describe using electronic health records, but the study does not say that screening bypasses gatekeepers or evaluate that approach. (LLM, conf=0.83)

  cites [46] sourceExperimental — accuracy not yet measured
• Partly supported

  The Introduction (Background and Significance; page not provided) describes EHR-based machine learning as a way to address limitations of clinician-administered risk assessments. The Discussion (Conclusions; page not provided) says better algorithms could improve follow-up for patients at risk, but it does not establish that screening bypasses clinical gatekeepers or improves identification in practice. (LLM, conf=0.83)

  cites [47] sourceExperimental — accuracy not yet measured

In the paper

“Brief screening tools like the P4, that assesses the 4P’s (past suicide attempt, suicide plan, probability of completing suicide and preventive factors), or the Columbia Suicide Severity Rating Scale (C-SSRS), that assesses severity of previous suicidal behavior and current suicidal ideation, may improve triage.(37, 39)”

What the sources say

• Supported

  The Figure 1 caption identifies the P4 as a brief screener asking about the four listed factors. The Discussion says an efficient suicide-risk assessment could help distinguish patients needing urgent evaluation from those suitable for follow-up or referral, and the Conclusions cautiously suggest the P4 may be useful. This supports the P4 portion of the sentence; this source is not being used to substantiate the C-SSRS description. (LLM, conf=0.90)

  cites [37] Dube P, 2010, Prim Care Companion J Clin Psychiatry source
• Supported

  The Method section reports use of the C-SSRS at initial screening, and the Conclusions describe it as assessing the severity of suicidal ideation and behavior. The Discussion says its severity thresholds could inform clinical referral and facilitate clinical management, supporting the hedged claim that it may improve triage. This source supports the C-SSRS portion of the sentence, not the separately cited P4. (LLM, conf=0.86)

  cites [39] source

In the paper

“A meta-analysis of all FDA-registered randomized placebo-controlled studies of fluoxetine and venlafaxine found these medications decreased suicidal ideation and behavior.(49, 52)”

What the sources say

• Partly supported

  The Discussion (page unavailable) says the paper analyzed sponsor-conducted, placebo-controlled trials of fluoxetine and venlafaxine. Its reported benefits concern depressive symptoms, response, and remission—not a decrease in suicidal ideation or behavior. The passage also does not establish that the trials were all FDA-registered. (LLM, conf=0.88)

  cites [49] sourceExperimental — accuracy not yet measured
• Partly supported

  The Study Selection section describes sponsor-conducted randomized trials of fluoxetine and venlafaxine, and the Conclusions report decreased suicidal thoughts and behavior in adult and geriatric patients. The claim omits the important qualifier that no significant treatment effect was found in youths. Our copy also describes the trials as sponsor-conducted, rather than establishing that they were all FDA-registered. (LLM, conf=0.88)

  cites [52] sourceExperimental — accuracy not yet measured

In the paper

“The C-SSRS predicted suicide attempts with an OR of 4.8 (95% CI 2.23–10.32, p<.001) in adolescents and young adults following an emergency psychiatric evaluation.(41)”

What the sources say

• Partly supported

  The Discussion says several C-SSRS items predicted future attempts in adolescents and emerging adults seeking psychiatric emergency services. But Table 3, Model 1 (Future Attempter Index Visit Clinical Characteristics; page unavailable) assigns OR 4.80 (95% CI 2.23–10.32, p<.001) specifically to a lifetime history of suicide attempt, not to the C-SSRS overall. (LLM, conf=0.91)

  cites [41] sourceExperimental — accuracy not yet measured

In the paper

“Two of four RCTs showed benefit for suicidal behavior with lithium compared with various other medications.(55, 58, 79, 80)”

What the sources say

• ?Not checked — no full text of the sourcecites [55] source
• ?Not checked — no full text of the sourcecites [58] source
• Partly supported

  The Methods and Lithium efficacy sections identify this as a randomized trial of lithium plus usual care versus usual care alone, with self-harm and suicide outcomes. The Lithium efficacy section reports no significant difference between arms (p = 0.676). This paper can serve as an example of a relevant RCT, but it does not establish that two of four RCTs showed benefit or that its comparator was another medication. (LLM, conf=0.86)

  cites [79] sourceExperimental — accuracy not yet measured
• Partly supported

  The Conclusions report that this paper is an RCT comparing lithium with valproate and found no difference in suicidal outcomes, so it can serve as one of the trials counted. Our copy does not establish that two of four RCTs found a benefit for lithium over other medications; the Discussion’s reference to three of four studies concerns comparisons using other methodologies. (LLM, conf=0.83)

  cites [80] sourceExperimental — accuracy not yet measured

In the paper

“Contrary to earlier FDA findings, SSRIs may work without increasing risk of treatment-emergent suicidal ideation or behavior, even in youth.(67–69)”

What the sources say

• ?Not checked — no full text of the sourcecites [67] source
• Partly supported

  The Results and Discussion report no significant increase in suicidal ideation or behavior with vilazodone versus placebo among younger adults aged 18–24. That supports a narrower version of the claim, but the paper does not establish the same result for SSRIs generally or for children and adolescents; its Introduction recounts the FDA finding of increased risk in pediatric patients. Page numbers are not available in our copy. (LLM, conf=0.86)

  cites [68] sourceExperimental — accuracy not yet measured
• Partly supported

  In “Suicidality in levomilnacipran ER MDD trials” (p. 479), the authors report no greater risk of suicidal ideation or behavior with levomilnacipran ER than placebo among younger adults, while cautioning that the subgroup was small. This supports the possibility that an antidepressant need not increase that risk, but the trials studied levomilnacipran ER, not SSRIs, and enrolled adults aged 18–80, not children or adolescents. The Introduction also describes the FDA warning based on pediatric and young-adult trials rather than establishing that the warning was wrong. (LLM, conf=0.88)

  cites [69] sourceExperimental — accuracy not yet measured

In the paper

“Internet CBT, with or without phone follow-up, was not more effective compared with waitlist controls for reducing suicidal ideation.(121, 125)”

What the sources say

• Partly supported

  The Discussion reports that suicidal ideation declined across intervention conditions, with no consistent overall effect by condition. However, the Method identifies the comparator as treatment as usual—participants could contact the helpline if needed—not a waitlist control. (LLM, conf=0.90)

  cites [121] sourceExperimental — accuracy not yet measured
• Partly supported

  The Results (Original article; page unavailable) report no statistically significant difference in suicidal ideation between Reframe-IT and the control group (p=0.593). But the Methods (Abstract and interventions; page unavailable) identify the comparison as internet CBT plus treatment as usual versus treatment as usual alone, not a waitlist; the paper does not test a separate phone-follow-up condition. (LLM, conf=0.90)

  cites [125] sourceExperimental — accuracy not yet measured

In the paper

“A cohort comparison study of safety planning interventions, administered in ED with follow-up telephone contact produced a 45% reduction in suicidal behaviors vs. TAU.(115)”

What the sources say

• Partly supported

  The Suicidal Behavior Report Outcomes section reports 45% fewer suicidal behaviors over six months among patients receiving ED safety planning with telephone follow-up than among those receiving usual care. The paper describes this as an association in a cohort comparison study; saying the intervention “produced” the reduction implies a causal conclusion the study does not establish. (LLM, conf=0.86)

  cites [115] sourceExperimental — accuracy not yet measured

In the paper

“The greatest risk of suicidal behavior is after discharge from the emergency room (ER) or hospital inpatient units.(110–112)”

What the sources say

• ?Not checked — no full text of the sourcecites [110] source
• ?Could not verify

  The Treatment Modalities and Discussion passages address depression treatment and psychological distress, not suicidal behavior after discharge. Searches for suicide, emergency-room discharge, and inpatient discharge found no passage in our copy addressing when suicidal-behavior risk is greatest; page numbers were unavailable. (LLM, conf=0.76)

  cites [111] sourceExperimental — accuracy not yet measured
• Partly supported

  The Results (page not supplied) report that 27 of 33 survivors who later died by suicide did so within a year of their initial attempt. The Conclusions also discuss protective follow-up appointments scheduled at discharge from an emergency department or inpatient service. The paper does not establish that risk of suicidal behavior is greatest immediately after discharge; its timing finding concerns deaths after an initial attempt, not time since discharge or all suicidal behavior. (LLM, conf=0.84)

  cites [112] sourceExperimental — accuracy not yet measured

In the paper

“Another study used a similar approach by sending caring text messages over one year to active military personnel who had reported a suicide attempt (50%) or suicidal ideation, but not in the context of discharge from hospital or ED. The intervention lowered subsequent suicide attempts by almost half.(114)”

What the sources say

• Partly supported

  The Primary Outcomes section (page unavailable) reports 48% lower odds of at least one suicide attempt during follow-up with caring texts (9.0% vs 14.9%), supporting the main finding. The Participant Characteristics section reports that 44.3%, not 50%, had a lifetime suicide attempt and that 53.0% were referred from an inpatient unit. The paper does not establish the citing sentence’s categorical description that the intervention was outside the context of hospital discharge. (LLM, conf=0.84)

  cites [114] sourceExperimental — accuracy not yet measured

In the paper

“Surprisingly, faced with no access to their chosen method, most individuals do not turn to alternative means for suicide, as shown for coal and gas(156) or firearm restriction.(127)”

What the sources say

• Partly supported

  The ‘Domestic Gas and Other Modes of Death in Suicide’ section reports that the fall in coal-gas suicides was large enough to lower total suicide rates despite increases in deaths by other means in some groups. But ‘Some Implications’ treats whether individuals switched methods as an open question and says virtually nothing is known about it. The paper therefore supports an aggregate decline, not the claim that most individuals did not turn to alternative means; the firearm citation is separate. (LLM, conf=0.88)

  cites [156] Kreitman N, 1976, Br J Prev Soc Med sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [127] source

In the paper

“Although it does not induce subsequent suicidal ideation,(38, 147) screening a non-help-seeking population for suicidal ideation and nonfatal suicide attempts, beyond screening for major depression, remains a debated approach.(40)”

What the sources say

• Partly supported

  The Conclusions report that screening among primary-care patients with signs of depression “does not appear to induce” feelings that life is not worth living. The Clinical implications also report no apparent increase in subsequent suicidal ideation over the short follow-up. The citing clause states this more definitively and without the study’s population and time limits; the nearby discussion of a non-help-seeking population is not established by this trial. (LLM, conf=0.86)

  cites [38] sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [147] source

In the paper

“Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention.”

In the paper

“Education of gatekeepers about youth suicidal behavior lacks effectiveness.”

In the paper

“Educating youth regarding depression and suicidal behavior, and active outreach of psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior.”

In the paper

“Educating youth regarding depression and suicidal behavior, and active outreach of psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior.”

In the paper

“Training primary care physicians in depression recognition and treatment prevents suicide.”

In the paper

“Meta-analyses find antidepressants prevent suicide attempts, but individual RCTs appear under-powered.”

In the paper

“Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression.”

In the paper

“No RCTs are reported for gatekeeper training for adult suicidal behavior prevention.”

In the paper

“Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention.”

In the paper

“YAM prevented suicidal behavior relative to the control condition, but the screening intervention and educating teachers/staff gatekeepers did not.”

What the sources say

• ?Not checked — no full text of the sourcecites [29] source

In the paper

“Follow-up found the benefit faded once programming stopped regardless of years it was implemented.”

What the sources say

• ?Not checked — no full text of the sourcecites [32] source

In the paper

“The intervention counties exhibited a decline in youth suicide rates that did not extend to other causes of death in youth or to adult suicide rates, compared with 969 demographical and sociologically comparable counties where this program was not implemented.”

What the sources say

• ?Not checked — no full text of the sourcecites [32] source

In the paper

“Targeting high school students prevented student suicide attempts (29, 30) whereas targeting teachers (29) and all but one parent study (Table S1), did not find benefit.”

In the paper

“Training primary care doctors and nurses at the local and state level to better screen and treat depression with supplemental help available from psychiatrists, lowered suicide rates,(12–19) nonfatal suicide attempts(20, 21) and ideation(22) (Table 2).”

What the sources say

• ?Not checked — no full text of the sourcecites [22] source

In the paper

“Algorithm-driven electronic health records (EHR) screening, internet-based screening and smartphone passive monitoring to identify high-risk patients are under-studied.”

In the paper

“Means restriction, including firearms, prevents suicide, but is rarely employed in the U.S., even though firearms are used in half of all U.S. suicides.”

In the paper

“Depression-management education of doctors lowers adult suicide rates (Table 2), but extending the education to other gatekeepers and the general public is not proven to further lower nonfatal and fatal suicide attempt rates.(31)”

In the paper

“Targeting high school students prevented student suicide attempts (29, 30) whereas targeting teachers (29) and all but one parent study (Table S1), did not find benefit.”

What the sources say

• ?Not checked — no full text of the sourcecites [29] source

In the paper

“This study did not control for changes in the secular suicide rate, and there was no randomization of the intervention, despite the fact that the poorest districts where the interventions were deployed had the greatest declines in suicide rates.(35)”

What the sources say

• ?Not checked — no full text of the sourcecites [35] source

In the paper

“YAM prevented suicidal behavior relative to the control condition, but the screening intervention and educating teachers/staff gatekeepers did not.”

What the sources say

• ?Not checked — no full text of the sourcecites [29] source

In the paper

“A U.S. study examined the effect of staff education and frequent screening of suicide risk in all psychiatric patients in the Henry Ford Health System that resulted in 9 consecutive quarters without a suicide compared with 80/100,000 suicides in 2000.”

In the paper

“Depression-management education of doctors lowers adult suicide rates (Table 2), but extending the education to other gatekeepers and the general public is not proven to further lower nonfatal and fatal suicide attempt rates.(31)”

What the sources say

• ?Not checked — no full text of the sourcecites [31] source

In the paper

“Although 4/9 prevention studies in youth reported less suicidal behavior (Table S1), 7/9 found less ideation (Table S1).”

In the paper

“YAM prevented suicidal behavior relative to the control condition, but the screening intervention and educating teachers/staff gatekeepers did not.”

What the sources say

• ?Not checked — no full text of the sourcecites [29] source

In the paper

“System-wide health care changes have not been tested in a randomized study but promising results have emerged from opportunistic before and after studies.(33)”

In the paper

“The program ran from 2001–2007, and the rate declined to zero in the period 2008–2010, inspiring the notion of zero suicide as a goal for health care systems.”

In the paper

“Although 4/9 prevention studies in youth reported less suicidal behavior (Table S1), 7/9 found less ideation (Table S1).”

In the paper

“There are no controlled trials of targeted gatekeeper education in adults.”

In the paper

“System-wide health care changes have not been tested in a randomized study but promising results have emerged from opportunistic before and after studies.(33)”

What the sources say

• ?Not checked — no full text of the sourcecites [33] source

In the paper

“Although one study found no correlation between bipolar disorder and many other psychiatric disorders with lithium levels in drinking water (83), 11/16 ecological studies report these levels were linked to lower suicide rates.(84)”

What the sources say

• ?Not checked — no full text of the sourcecites [84] source

In the paper

“Used adjunctively with other psychotropic medications, one RCT found ketamine’s benefit for suicidal ideation persisted for weeks,(72) but its effect on suicidal behavior has never been evaluated.”

In the paper

“An FDA meta-analysis found antidepressants lowered risk of suicidal behavior in older age groups, but subsequent pharmaco-epidemiological studies found SSRIs reduced suicidal behavior more broadly, including in young adults.(66, 67)”

What the sources say

• ?Not checked — no full text of the sourcecites [66] source
• ?Not checked — no full text of the sourcecites [67] source

In the paper

“Medications reduced suicidal behavior in 4/12 adult studies,(55–58) but those effective medications belonged to pharmacologically diverse classes.”

What the sources say

• ?Not checked — no full text of the sourcecites [55] source
• ?Not checked — no full text of the sourcecites [56] source
• ?Not checked — no full text of the sourcecites [57] source
• ?Not checked — no full text of the sourcecites [58] source

In the paper

“Meta-analyses of RCT data show more impressive benefit for suicidal behavior than individual RCTs.”

In the paper

“Medications reduced suicidal behavior in 4/12 adult studies,(55–58) but those effective medications belonged to pharmacologically diverse classes.”

What the sources say

• ?Not checked — no full text of the sourcecites [55] source
• ?Not checked — no full text of the sourcecites [56] source
• ?Not checked — no full text of the sourcecites [57] source
• ?Not checked — no full text of the sourcecites [58] source

In the paper

“Longitudinal pharmaco-epidemiologic studies in adolescents, young adults and older adults indicated that the greatest risk for a suicide attempt was in the month before antidepressant medication began, and after the medication was initiated, the risk declined progressively over months.(66, 67, 70)”

What the sources say

• ?Not checked — no full text of the sourcecites [66] source
• ?Not checked — no full text of the sourcecites [67] source
• ?Not checked — no full text of the sourcecites [70] source

In the paper

“An FDA meta-analysis found antidepressants lowered risk of suicidal behavior in older age groups, but subsequent pharmaco-epidemiological studies found SSRIs reduced suicidal behavior more broadly, including in young adults.(66, 67)”

What the sources say

• ?Not checked — no full text of the sourcecites [51] source

In the paper

“However, other studies did not finding screening and referral of at-risk high school students to be effective.(29)”

What the sources say

• ?Not checked — no full text of the sourcecites [29] source

In the paper

“Longitudinal pharmaco-epidemiologic studies in adolescents, young adults and older adults indicated that the greatest risk for a suicide attempt was in the month before antidepressant medication began, and after the medication was initiated, the risk declined progressively over months.(66, 67, 70)”

What the sources say

• ?Not checked — no full text of the sourcecites [66] source
• ?Not checked — no full text of the sourcecites [67] source
• ?Not checked — no full text of the sourcecites [70] source

In the paper

“Psychodynamic psychotherapies for BPD prevent suicidal or self-harm behavior in most controlled studies (Table S3a).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites Table S3a

In the paper

“Educating non-psychiatrist primary care physicians to better diagnose and treat major depression prevents suicide and non-fatal suicide attempts (Table 2).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites Table 2

In the paper

“Given efficacy evidence for pharmacotherapy and psychotherapy separately, combinations of both showed no advantage for suicidal behavior (Table S3b).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites Table S3b

In the paper

“No brain stimulation therapies have demonstrated suicide behavior prevention.”

In the paper

“Determination of imminent risk has evolved towards continuous monitoring via mobile devices.(148, 149)”

What the sources say

• ?Not checked — no full text of the sourcecites [148] source
• ?Not checked — no full text of the sourcecites [149] source

In the paper

“Meta-analyses find antidepressants prevent suicide attempts, but individual RCTs appear under-powered.”

In the paper

“A key factor appears to be the population targeted for education.”

In the paper

“Suicide risk can be understood in terms of a stress diathesis model (8) (Figure 1) where stress results from an internal stressor, usually a psychiatric illness, present in about 90% of all suicides and most commonly major depression, and/or an external stressor involving life events.”

What the sources say

• ?Not checked — no full text of the sourcecites [8] source

In the paper

“The diathesis moderates suicide risk, and that risk can be influenced by acute alcohol or drug abuse adversely via mood or disinhibition (Figure 1).”

What the sources say

• ?Not checked — no full text of the sourcecites [8] source

In the paper

“Therefore, educating non-psychiatrist physicians may prevent far more suicides than further training for psychiatrists.”

In the paper

“Suicide risk can be understood in terms of a stress diathesis model (8) (Figure 1) where stress results from an internal stressor, usually a psychiatric illness, present in about 90% of all suicides and most commonly major depression, and/or an external stressor involving life events.”

What the sources say

• ?Not checked — no full text of the sourcecites [8] source

In the paper

“The diathesis moderates suicide risk, and that risk can be influenced by acute alcohol or drug abuse adversely via mood or disinhibition (Figure 1).”

What the sources say

• ?Not checked — no full text of the sourcecites [8] source

In the paper

“These findings indicate the benefit for suicide was found in the intervention counties and confined to the demographic group targeted by the intervention.”

What the sources say

• ?Not checked — no full text of the sourcecites [32] source

In the paper

“Suicide risk can be understood in terms of a stress diathesis model (8) (Figure 1) where stress results from an internal stressor, usually a psychiatric illness, present in about 90% of all suicides and most commonly major depression, and/or an external stressor involving life events.”

What the sources say

• ?Not checked — no full text of the sourcecites [8] source

In the paper

“Combination approaches in healthcare systems show promise in reducing suicide in U.K., Denmark and U.S., but evaluating benefit attributable to each component is essential.”

In the paper

“Such an approach lacks the capacity to measure the separate effect of each intervention component.”

In the paper

“A system-level approach shows promise in lowering suicide risk and involves applying a combination of education, training and screening.”

In the paper

“The 2014 United States Preventative Services Task Force report concluded there is insufficient evidence that screening, specifically for suicide risk in primary care, identified new cases beyond screening for a psychiatric disorder, distress or a past suicide attempt.(40)”

What the sources say

• ?Not checked — no full text of the sourcecites [40] source

In the paper

“Even if psychotherapies were effective, only CBT appears to be scalable (Table 2).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites Table 2

In the paper

“Education of primary care physicians, and potentially internists and obstetricians, in the diagnosis and treatment of depression is a robust suicide prevention approach.”

In the paper

“Within strategies there is heterogeneity of study populations in terms of psychiatric illness, proportion of higher risk patients such as those with a history of a past suicide attempt, age, ethnicity and proportion of males (because males have 3–4 times the suicide rate of females).”

In the paper

“The major limitation of this review is the uneven quality and quantity of data available for different suicide prevention strategies.”