Review explores suicide prevention during disasters and emergencies

Suicide prevention during disasters and public health emergencies: a systematic review

by Lennart Reifels, Karolina Krysinska and Karl Andriessen

Published 6 February 2024

What's the issue?

Suicide is a complex public health concern that is influenced by distress.

Experiencing disasters and public health emergencies can contribute to a person’s distress, as well as having widespread impacts communities. Disasters and public health emergencies can be recognised as adverse life events for many, with the impacts including but not limited to financial stress, social isolation or reduced social support and access to healthcare.

Little is known about the outcomes of suicide prevention initiatives implemented through periods of disaster and public health emergencies.

What was done?

Researchers conducted a systematic review to examine the outcomes of suicide prevention strategies implemented in the context of disasters and public health emergencies. The review included research publications that were:

• Peer-reviewed and in English;
• Contained research relating to populations affected by disasters or public health emergencies such as epidemics, pandemic, and infectious disease outbreaks;
• Had a focus on suicide prevention; and
• Contained information about changes in suicide or self-harm.

Qualitative studies were excluded in this review.

From the search results, a two-stage record screening and study selection process was undertaken by two researchers.

From the search results, 11 reports relating to 10 studies were included in the systematic review.

What was found?

While this review examined a small number of studies (n=10), there is a great deal of variance among them in terms of study quality, focus interventions, diversity of intentions, contexts and scope of published evidence.

Based on the outcomes of each study, conclusive evidence for intervention effectiveness is limited. Despite the limitations, some findings of this systematic review can provide valuable insights for suicide prevention practice within increasingly challenging contexts such as disasters and public health emergencies.

For example, the potentially mitigating effects of urban parks and green spaces were noted in two studies of moderate quality, while another found that distribution of video enabled tablets to veterans (in the United States) during a pandemic improved mental health service engagement and reduced suicidal behaviour.

Increased economic security measures related to local government spending were associated with decreased rates of suicide among men in two cohort studies. The same studies also found volunteer delivered mental health support was associated with decreased suicide attempts among bereaved survivors. The authors emphasise that the studies analysed largely focused on generic suicide prevention interventions and lacked reference to suicide prevention interventions specifically used in disaster or public health crisis contexts. They theorised that generic suicide prevention measures that have been more comprehensively determined as effective in everyday contexts may have the best chance of being effective during times of disaster or public health emergencies. However, given the disruption to services in times of disaster and emergency the authors highlight that this conclusion may also be problematic.

Why are findings important?

• Prevention strategies that addressed known risk and protective factors for suicide appeared to have the best outcomes in prevention of suicide.
• Universal interventions may have just as much impact as disaster or public health emergency focused interventions.
• The review highlighted the difficulty in gathering evidence during emergency situations and often does not capture the impact of secondary exposure or other factors contributing to suicide risk or acting as a protective factor outside of the intervention in focus.