The current review highlights those groups for whom the evidence indicates elevated risk of suicide, and those interventions for which the most evidence of effectiveness exists.
While the identification of population subgroups at increased risk of suicide varies according to method, it is clear that targeting these groups most at-risk (as well as relevant 'gatekeepers') forms an important component of a broad-spectrum, multi-faceted approach to suicide prevention, particularly on a national scale.
There is some evidence to suggest that national suicide prevention strategies have the ability to lead to reductions in suicide rates,112 in particular among certain subsets of the population (namely elderly and young people).113 However, it is harder to determine exactly which components of national strategies are the most effective. From this review it can be concluded that the interventions for which the best evidence exists are reducing access to means of suicide, educating general practitioners to better recognise and treat depressive disorders, and gatekeeper training programs. There is also some evidence to suggest that the implementation of media guidelines, screening programs and CBT may be promising.
A lack of relevant data and variations in study design and quality mean that the evidence in this area is often insufficient to prescriptively inform future suicide prevention initiatives. This is particularly true for interventions specifically targeting Indigenous populations.
However, an absence of evidence does not equate to evidence of absence. This observation is supported by the LIFE Framework itself, which identifies the need for an expansion of the evidence base regarding suicide prevention. The Senate Inquiry into Suicide in Australia88 and the Parliamentary Inquiry into Youth Suicide89 both also called for a national program of funding for research into suicide prevention, including detailed evaluation of suicide prevention interventions and the development of a coordinated and targeted program of research into this area respectively. A specific program of research that can develop and test interventions designed to reduce suicide risk among Australia's Indigenous population, and using culturally appropriate methodologies, is also clearly warranted.
For all of these reasons, and because suicide is multi-faceted and complex, it is widely agreed that suicide prevention activities need to be broad-based, reflecting the full spectrum of approaches, including universal, selective and indicated interventions.57,58,59,60 The evaluation of the NSPP, informed in part by this literature review, will be a key process in ensuring that future national suicide prevention strategies are based, as far as possible, on evidence of effectiveness for individual components and the strategy as a whole.