TY  - JOUR
PY  - 2013//
TI  - Effectiveness of a multimodal community intervention program to prevent suicide and suicide attempts: A quasi-experimental study
JO  - PLoS one
A1  - Ono, Yutaka
A1  - Sakai, Akio
A1  - Otsuka, Kotaro
A1  - Uda, Hidenori
A1  - Oyama, Hirofumi
A1  - Ishizuka, Naoki
A1  - Awata, Shuichi
A1  - Ishida, Yasushi
A1  - Iwasa, Hiroto
A1  - Kamei, Yuichi
A1  - Motohashi, Yutaka
A1  - Nakamura, Jun
A1  - Nishi, Nobuyuki
A1  - Watanabe, Norimichi
A1  - Yotsumoto, Toshihiko
A1  - Nakagawa, Atsuo
A1  - Suzuki, Yuriko
A1  - Tajima, Miyuki
A1  - Tanaka, Eriko
A1  - Sakai, Hironori
A1  - Yonemoto, Naohiro
SP  - e74902
EP  - e74902
VL  - 8
IS  - 10
N2  - BACKGROUND: Multilevel and multimodal interventions have been suggested for suicide prevention. However, few studies have reported the outcomes of such interventions for suicidal behaviours. METHODS: We examined the effectiveness of a community-based multimodal intervention for suicide prevention in rural areas with high suicide rates, compared with a parallel prevention-as-usual control group, covering a total of 631,133 persons. The effectiveness was also examined in highly populated areas near metropolitan cities (1,319,972 persons). The intervention started in July 2006, and continued for 3.5 years. The primary outcome was the incidence of composite outcome, consisting of completed suicides and suicide attempts requiring admission to an emergency ward for critical care. We compared the rate ratios (RRs) of the outcomes adjusted by sex, age group, region, period and interaction terms. Analyses were performed on an intention-to-treat basis and stratified by sex and age groups. FINDINGS: In the rural areas, the overall median adherence of the intervention was significantly higher. The RR of the composite outcome in the intervention group decreased 7% compared with that of the control group. Subgroup analyses demonstrated heterogeneous effects among subpopulations: the RR of the composite outcome in the intervention group was significantly lower in males (RR = 0.77, 95% CI 0.59-0.998, p = 0.0485) and the RR of suicide attempts was significantly lower in males (RR = 0.39, 95% CI 0.22-0.68, p = 0.001) and the elderly (RR = 0.35, 95% CI 0.17-0.71, p = 0.004). The intervention had no effect on the RR of the composite outcome in the highly populated areas. INTERPRETATION: Our findings suggest that this community-based multimodal intervention for suicide prevention could be implemented in rural areas, but not in highly populated areas. The effectiveness of the intervention was shown for males and for the elderly in rural areas. TRIAL REGISTRATION: ClinicalTrials.gov NCT00737165 UMIN Clinical Trials Registry UMIN000000460.<p />  <p>Language: en</p>
LA  - en
SN  - 1932-6203
UR  - http://dx.doi.org/10.1371/journal.pone.0074902
ID  - ref1
ER  -