Golden Gate Bridge Suicide Net Plan Gets Boost

Didge wrote:

Irn Bru wrote:

Didge wrote:



PMSL

The link is within the link I provided, so now you cannot admit you were wrong and I do not have to do anything or are you abusing your position as a moderator trying to tell me how I should post now when you are not capable of going to a link within a link. That is your failing not mine, you do not make the rules either

I'm not telling you how to post Didge. You can post in anyway you like but I really would have expected you to quote the actual link and not a link that contained the link but that's your choice.
It's just that you didn't quote all the additional evidence that was in there that showed that the evidence presented was not the conclusive proof that you were making it out to be.

That's true, isn't it?

Why should I need to post the link when the link to the actual report is found within the link I posted, sorry you are being pedantic over a non issue to the debate, as the report is found within the link, it is not my fault you did not realise that, the issue is with yourself

lovedust wrote:

Didge wrote:

Sorry but you are taking the piss now lovedust, answer my points all the ones I have given you and answer them, you keep avoiding them and just think that you can getaway without responding, then I will answer your points, that is how debates work

Try again

What is the basis of your claim Didge, that the experts from 15 countries were biased?

Irn Bru wrote:

Didge wrote:


Why should I need to post the link when the link to the actual report is found within the link I posted, sorry you are being pedantic over a non issue to the debate, as the report is found within the link, it is not my fault you did not realise that, the issue is with yourself

I did realise that Didge and that's why I quoted the extracts that I did.

And you did try to present the evidence as the conclusive proof that you were making it out to be when the report never made it out to be that at all and clearly said that other factors had to be considered.

Didge wrote:

Irn Bru wrote:

Didge wrote:


Why should I need to post the link when the link to the actual report is found within the link I posted, sorry you are being pedantic over a non issue to the debate, as the report is found within the link, it is not my fault you did not realise that, the issue is with yourself

I did realise that Didge and that's why I quoted the extracts that I did.

And you did try to present the evidence as the conclusive proof that you were making it out to be when the report never made it out to be that at all and clearly said that other factors had to be considered.

No you claimed there was no link, so that is now a complete lie, when there was a link.

The evidence does very well to show there is no evidence the nets will deter people from suicide.

Didge wrote:

lovedust wrote:

What is the basis of your claim Didge, that the experts from 15 countries were biased?

I answered this already, again where factors have been discounted, like levels of depression, levels or bullying, economic, poverty, media peer pressure, social websites etc, if they have failed to take these into account and are seeking to to find this link it can cloud judgement on a fair report as stated.

 I suggest you read back and then answer mine, because you are one of the worst for answering points, 

Try again

Irn Bru wrote:

Didge wrote:



No you claimed there was no link, so that is now a complete lie, when there was a link.

The evidence does very well to show there is no evidence the nets will deter people from suicide.

No I didn't. Of course there was a link - just that you didn't cite  the primary link and that the overall evidence was contained within another link.

And you did try to present the evidence as the conclusive proof that you were making it out to be when the report never made it out to be that at all and clearly said that other factors had to be considered.

So were you lying or just mistaken and you hadn't read the link within the link yourself. If you had you surely would have presented all the evidence and not just accepted what was in the media link as conclusive proof when it wasn't.

lovedust wrote:

Didge wrote:



I answered this already, again where factors have been discounted, like levels of depression, levels or bullying, economic, poverty, media peer pressure, social websites etc, if they have failed to take these into account and are seeking to to find this link it can cloud judgement on a fair report as stated.

 I suggest you read back and then answer mine, because you are one of the worst for answering points, 

Try again

I don't think they did discount  those things - they gave a very detailed account of their methodology in their abstract. I don't know if you'vehad chance to read it yet.

But you started out saying they found a link because through bias they wanted to find it.

1) A link to what and 2) what makes you think they were biased toward finding it?

lovedust wrote:

So you don't have a specific reason to assume the Salzburg expertsfrom15countries in their review of 93 studies were biased per se... more that there's an ncbi write-up of a completely different study limited to 15 self-harm trials, where the reviewers concluded they didn't know how big a factor bias had played. Much different?

Nice talking to you didge. Goodnight

Didge wrote:

Irn Bru wrote:

Didge wrote:



No you claimed there was no link, so that is now a complete lie, when there was a link.

The evidence does very well to show there is no evidence the nets will deter people from suicide.

No I didn't. Of course there was a link - just that you didn't cite  the primary link and that the overall evidence was contained within another link.

And you did try to present the evidence as the conclusive proof that you were making it out to be when the report never made it out to be that at all and clearly said that other factors had to be considered.

So were you lying or just mistaken and you hadn't read the link within the link yourself. If you had you surely would have presented all the evidence and not just accepted what was in the media link as conclusive proof when it wasn't.

You claimed there was no link, read back you state;

The actual BMJ link isn't there, is it?

Rumbled again

http://www.newsfixboard.com/t5448p600-golden-gate-bridge-suicide-net-plan-gets-boost


The evidence has backed my points throughout and as seen you are just being pedantic on points as if it garners you more credibility to your points when as seen it does not, It clearly as shown shows how on other bridges the level increases and your claims to me lying are just all waffle to detract fro the debate, because you fucked up. I presented the evidence on two news links, one that has the link to the report, so all your claims is both childish and absurd, based more on the fact this study shows that there is no evidence that nets deter suicides in an area 

I am enjoying watching you struggle, it is most amusing

Irn Bru wrote:

Didge wrote:



You claimed there was no link, read back you state;

The actual BMJ link isn't there, is it?

Rumbled again

http://www.newsfixboard.com/t5448p600-golden-gate-bridge-suicide-net-plan-gets-boost


The evidence has backed my points throughout and as seen you are just being pedantic on points as if it garners you more credibility to your points when as seen it does not, It clearly as shown shows how on other bridges the level increases and your claims to me lying are just all waffle to detract fro the debate, because you fucked up. I presented the evidence on two news links, one that has the link to the report, so all your claims is both childish and absurd, based more on the fact this study shows that there is no evidence that nets deter suicides in an area 

I am enjoying watching you struggle, it is most amusing

Sorry about the delay there, Didge - penalty shoot out  great stuff.

Anyway, as you have just confirmed the link to the actual report isn't one of the two that you gave me in Irrelevant your post and that the real report that you hadn't read was contained within it. I had read this report last night, you are just making unfounded claims, as it was easy for me to post the link for you where you have failed to see it That's why you didn't quote any of the information poor unfounded assumption again, a media report is better sometimes where it highlights main points for easy reading for people, where it still contains the main link if they wish to read it, so you are again way off the mark with again unfounded assumptions that I did because if you had read it you would never have made out that the report was absolutely the conclusive evidence that you made it out, it is very conclusive in that is shows there is no evidence to support a view that safety nets deter suicides within an area, that is very conclusive, the point you keep missing. As you have now seen with what I gave you that the report never was conclusive evidence and that is supported in the report that clearly states that other factors were involved and could not be discounted. As seen it is very conclusive on the nets not deterring
That's the facts Didge and you should  just be man enough to admit that you screwed up big time by trying to present the evidence contained only in the media report as the full result of this study.
I'm sorry but there is no other conclusion to explain why you would do that.

Irn Bru wrote:

Didge wrote:



You claimed there was no link, read back you state;

The actual BMJ link isn't there, is it?

Rumbled again

http://www.newsfixboard.com/t5448p600-golden-gate-bridge-suicide-net-plan-gets-boost


The evidence has backed my points throughout and as seen you are just being pedantic on points as if it garners you more credibility to your points when as seen it does not, It clearly as shown shows how on other bridges the level increases and your claims to me lying are just all waffle to detract fro the debate, because you fucked up. I presented the evidence on two news links, one that has the link to the report, so all your claims is both childish and absurd, based more on the fact this study shows that there is no evidence that nets deter suicides in an area 

I am enjoying watching you struggle, it is most amusing

Sorry about the delay there, Didge - penalty shoot out  great stuff.

Anyway, as you have just confirmed the link to the actual report isn't one of the two that you gave me in Irrelevant your post and that the real report that you hadn't read was contained within it. I had read this report last night, you are just making unfounded claims, as it was easy for me to post the link for you where you have failed to see it That's why you didn't quote any of the information poor unfounded assumption again, a media report is better sometimes where it highlights main points for easy reading for people, where it still contains the main link if they wish to read it, so you are again way off the mark with again unfounded assumptions  that I did because if you had read it you would never have made out that the report was absolutely the conclusive evidence that you made it out, it is very conclusive in that is shows there is no evidence to support a view that safety nets deter suicides within an area, that is very conclusive, the point you keep missing. As you have now seen with what I gave you that the report never was conclusive evidence and that is supported in the report that clearly states that other factors were involved and could not be discounted. As seen it is very conclusive on the nets not deterring
That's the facts Didge and you should  just be man enough to admit that you screwed up big time by trying to present the evidence contained only in the media report as the full result of this study.
I'm sorry but there is no other conclusion to explain why you would do that.

Irn Bru wrote:I've got some bedtime reading for you Didge when you eventually turn in. Let me have your comments on this please.

The effectiveness of structural interventions at suicide hotspots: a meta-analysis

Key Messages

Sites which gain a reputation for suicides by jumping are a priority for preventive activities because of the fact that suicide attempts from these sites are often fatal, can have a devastating effect on witnesses and may promote copycat acts.

Various structural interventions—usually in the form of barriers—have been put in place at some of these sites, but these interventions have not always been well received.

Naysayers argue that such interventions are futile, because they simply shift the problem to other sites.

Our study provided convincing evidence that these sorts of interventions not only reduce suicides by jumping at the sites in question, but also lead to an overall reduction in jumping deaths in the area.


It includes the data from the Bloor Street viaduct in Canada.

http://ije.oxfordjournals.org/content/42/2/541.full

Didge wrote:

Irn Bru wrote:

Didge wrote:



You claimed there was no link, read back you state;

The actual BMJ link isn't there, is it?

Rumbled again

http://www.newsfixboard.com/t5448p600-golden-gate-bridge-suicide-net-plan-gets-boost


The evidence has backed my points throughout and as seen you are just being pedantic on points as if it garners you more credibility to your points when as seen it does not, It clearly as shown shows how on other bridges the level increases and your claims to me lying are just all waffle to detract fro the debate, because you fucked up. I presented the evidence on two news links, one that has the link to the report, so all your claims is both childish and absurd, based more on the fact this study shows that there is no evidence that nets deter suicides in an area 

I am enjoying watching you struggle, it is most amusing

Sorry about the delay there, Didge - penalty shoot out  great stuff.

Anyway, as you have just confirmed the link to the actual report isn't one of the two that you gave me in Irrelevant your post and that the real report that you hadn't read was contained within it. I had read this report last night, you are just making unfounded claims, as it was easy for me to post the link for you where you have failed to see it That's why you didn't quote any of the information poor unfounded assumption again, a media report is better sometimes where it highlights main points for easy reading for people, where it still contains the main link if they wish to read it, so you are again way off the mark with again unfounded assumptions  that I did because if you had read it you would never have made out that the report was absolutely the conclusive evidence that you made it out, it is very conclusive in that is shows there is no evidence to support a view that safety nets deter suicides within an area, that is very conclusive, the point you keep missing. As you have now seen with what I gave you that the report never was conclusive evidence and that is supported in the report that clearly states that other factors were involved and could not be discounted. As seen it is very conclusive on the nets not deterring
That's the facts Didge and you should  just be man enough to admit that you screwed up big time by trying to present the evidence contained only in the media report as the full result of this study.
I'm sorry but there is no other conclusion to explain why you would do that.

No facts just you being poorly pedantic make absurd loony claims, but hey ho is funny to me, it shows our desperation to detract from the debate where you still have not admitted to your fuck up, where you claimed there was no link within the link I gave, when there was, you are now trying to get out of jail free, for fucking up trying to twist this back with as seen the most idiotic assumptions on your part

It shows you clutching at straws and am very happy to see people get their comeuppance when they poorly start a thread with intent as you and sassy did to attack a poster. Maybe next time you will learn


Night Irn

Irn Bru wrote:

Didge wrote:

No facts just you being poorly pedantic make absurd loony claims, but hey ho is funny to me, it shows our desperation to detract from the debate where you still have not admitted to your fuck up, where you claimed there was no link within the link I gave, when there was, you are now trying to get out of jail free, for fucking up trying to twist this back with as seen the most idiotic assumptions on your part

It shows you clutching at straws and am very happy to see people get their comeuppance when they poorly start a thread with intent as you and sassy did to attack a poster. Maybe next time you will learn


Night Irn

Balderdash Didge. The report never ever was the conclusive proof that you made it out to be - Fact.

Goodnight anyway and I won't say you are running away because I'm not that childish.

CYA tomorrow pal.

Didge wrote:

Irn Bru wrote:

Didge wrote:

No facts just you being poorly pedantic make absurd loony claims, but hey ho is funny to me, it shows our desperation to detract from the debate where you still have not admitted to your fuck up, where you claimed there was no link within the link I gave, when there was, you are now trying to get out of jail free, for fucking up trying to twist this back with as seen the most idiotic assumptions on your part

It shows you clutching at straws and am very happy to see people get their comeuppance when they poorly start a thread with intent as you and sassy did to attack a poster. Maybe next time you will learn


Night Irn

Balderdash Didge. The report never ever was the conclusive proof that you made it out to be - Fact.

Goodnight anyway and I won't say you are running away because I'm not that childish.

CYA tomorrow pal.

The report is utterly flawed and I will show you why:

Results Following the interventions, there was an 86% reduction in jumping suicides per year at the sites in question (95% CI 79% to 91%). There was a 44% increase in jumping suicides per year at nearby sites (95% CI 15% to 81%), but the net gain was a 28% reduction in all jumping suicides per year in the study cities (95% CI 13% to 40%).


What about other methods of suicide and if any of these increase?


Now do you see why such a report is utterly flawed, it fails to take into account all suicides within an area, it only goes off jumping, thus we cannot see if other methods increase also. It certain shows jumping increases elsewhere, and if they cannot provide data on all methods, then their conclusions are utterly flawed

Irn Bru wrote:

Didge wrote:


The report is utterly flawed and I will show you why:

Results Following the interventions, there was an 86% reduction in jumping suicides per year at the sites in question (95% CI 79% to 91%). There was a 44% increase in jumping suicides per year at nearby sites (95% CI 15% to 81%), but the net gain was a 28% reduction in all jumping suicides per year in the study cities (95% CI 13% to 40%).


What about other methods of suicide and if any of these increase?


Now do you see why such a report is utterly flawed, it fails to take into account all suicides within an area, it only goes off jumping, thus we cannot see if other methods increase also. It certain shows jumping increases elsewhere, and if they cannot provide data on all methods, then their conclusions are utterly flawed

Results Following the interventions, there was an 86% reduction in jumping suicides per year at the sites in question (95% CI 79% to 91%). There was a 44% increase in jumping suicides per year at nearby sites (95% CI 15% to 81%), but the net gain was a 28% reduction in all jumping suicides per year in the study cities (95% CI 13% to 40%).

Thanks for highlighting the very part that shows that.  It's jumping that is being discussed - the subject of the debate and the subject you were so keen to focus on  with the Toronto results.

Complete turnabout there Didge but not entirely unexpected.

Goodnight again.

Irn Bru wrote:Contained in the coal study report already discussed is the conclusion shown below

There is no shortage of exits from this life; it would seem that that anyone bent on self-destruction must eventually succeed, yet it is also quite possible that , given the ambivalence (or multivalence) of many suicides that a failed attempt serves as a catharis leading to profound psychological change. For others it may be that the scenario of suicide specifies the use of a particular method, and if that method is not available actual suicide is then less likely. Virtually nothing is known about these questions.

Something for you consider in the morning

Didge wrote:

Irn Bru wrote:

Didge wrote:


The report is utterly flawed and I will show you why:

Results Following the interventions, there was an 86% reduction in jumping suicides per year at the sites in question (95% CI 79% to 91%). There was a 44% increase in jumping suicides per year at nearby sites (95% CI 15% to 81%), but the net gain was a 28% reduction in all jumping suicides per year in the study cities (95% CI 13% to 40%).


What about other methods of suicide and if any of these increase?


Now do you see why such a report is utterly flawed, it fails to take into account all suicides within an area, it only goes off jumping, thus we cannot see if other methods increase also. It certain shows jumping increases elsewhere, and if they cannot provide data on all methods, then their conclusions are utterly flawed

Results Following the interventions, there was an 86% reduction in jumping suicides per year at the sites in question (95% CI 79% to 91%). There was a 44% increase in jumping suicides per year at nearby sites (95% CI 15% to 81%), but the net gain was a 28% reduction in all jumping suicides per year in the study cities (95% CI 13% to 40%).

Thanks for highlighting the very part that shows that.  It's jumping that is being discussed - the subject of the debate and the subject you were so keen to focus on  with the Toronto results.

Complete turnabout there Didge but not entirely unexpected.

Goodnight again.

No its suicide that is being discussed, that is just one method, again a method only around 2-5% use, but then you never seem to understand the real problem.

So again even the report eludes to many problems itself:


This meta-analysis had five main limitations, and these should be taken into account in interpreting the findings. Firstly, our search strategy may have missed some studies. Secondly, positive findings about the effects of restricting access to jumping sites may have been more likely to be published than negative findings. (hence bias again) Thirdly, the restriction measures described in some studies may have been accompanied by other activities (e.g. telephone crisis lines), and the impact of these additional strategies is unmeasured.

Fourthly, there was some evidence of heterogeneity across studies. This highlights the differences between the individual studies both in terms of the study designs (number of deaths and study duration), the underlying population sizes and, more substantially, differences in the jump sites themselves. The structural interventions included the use of barriers, blocking road access to jump sites or the installation of a safety net below the jump site. Nonetheless, the fact that the findings hold despite these differences points to the generalizability of the findings to other settings.

Finally, we acknowledge that the original studies were limited in terms of their capacity to examine substitution. Most examined jumping behaviour at nearby sites, which is clearly superior to ignoring the potential for substitution, but is still somewhat crude. Notwithstanding our earlier point about absolute reductions in the overall suicide rate not being the only arbiter of success, it should still be noted that the studies could not capture the extent to which individuals who were prevented from jumping by barriers and other structural measures may have travelled outside the area to jump, or may have adopted other methods.


So as seen it admits bias, it fails to show all levels of sucice, which is the main argument point being made if such nets just push the problem elsewhere, in other words to other methods, it clearly shows increases to jumps elsewhere an indication it moves the problem and we have no data on other suicides.


Thus utterly flawed study

Didge wrote:

Irn Bru wrote:Contained in the coal study report already discussed is the conclusion shown below

There is no shortage of exits from this life; it would seem that that anyone bent on self-destruction must eventually succeed, yet it is also quite possible that , given the ambivalence (or multivalence) of many suicides that a failed attempt serves as a catharis leading to profound psychological change. For others it may be that the scenario of suicide specifies the use of a particular method, and if that method is not available actual suicide is then less likely. Virtually nothing is known about these questions.

Something for you consider in the morning

Already debated this point and you need to read back

Sassy wrote:No Didge, by everyone else but you, it was JUMPING OFF BRIDGES AND HOW TO STOP IT that was being discussed, but as usual, you couldn't do that.

Irn Bru wrote:

Didge wrote:

No its suicide that is being discussed, that is just one method, again a method only around 2-5% use, but then you never seem to understand the real problem.

So again even the report eludes to many problems itself:


This meta-analysis had five main limitations, and these should be taken into account in interpreting the findings. Firstly, our search strategy may have missed some studies. Secondly, positive findings about the effects of restricting access to jumping sites may have been more likely to be published than negative findings. (hence bias again) Thirdly, the restriction measures described in some studies may have been accompanied by other activities (e.g. telephone crisis lines), and the impact of these additional strategies is unmeasured.

Fourthly, there was some evidence of heterogeneity across studies. This highlights the differences between the individual studies both in terms of the study designs (number of deaths and study duration), the underlying population sizes and, more substantially, differences in the jump sites themselves. The structural interventions included the use of barriers, blocking road access to jump sites or the installation of a safety net below the jump site. Nonetheless, the fact that the findings hold despite these differences points to the generalizability of the findings to other settings.

Finally, we acknowledge that the original studies were limited in terms of their capacity to examine substitution. Most examined jumping behaviour at nearby sites, which is clearly superior to ignoring the potential for substitution, but is still somewhat crude. Notwithstanding our earlier point about absolute reductions in the overall suicide rate not being the only arbiter of success, it should still be noted that the studies could not capture the extent to which individuals who were prevented from jumping by barriers and other structural measures may have travelled outside the area to jump, or may have adopted other methods.


So as seen it admits bias, it fails to show all levels of sucice, which is the main argument point being made if such nets just push the problem elsewhere, in other words to other methods, it clearly shows increases to jumps elsewhere an indication it moves the problem and we have no data on other suicides.


Thus utterly flawed study

No more flawed than the study you tried to report as the conclusive evidence that you tried to make out it to be with the Bloor Street study which never ever was the conclusive evidence that you were making it out to be.

You see Didge, you want it all your own way in that the evidence that is presented to you is flawed but the evidence you present is fact when it isn't and never was the report for the Bloor Street says so in that other factors could not be discounted.

You're all the place with this and it shows.

Anyway - goodnight again.

Irn Bru wrote:

Didge wrote:


Already debated this point and you need to read back

I did and that's why I added that.

Didge wrote:

Irn Bru wrote:

Didge wrote:

No its suicide that is being discussed, that is just one method, again a method only around 2-5% use, but then you never seem to understand the real problem.

So again even the report eludes to many problems itself:


This meta-analysis had five main limitations, and these should be taken into account in interpreting the findings. Firstly, our search strategy may have missed some studies. Secondly, positive findings about the effects of restricting access to jumping sites may have been more likely to be published than negative findings. (hence bias again) Thirdly, the restriction measures described in some studies may have been accompanied by other activities (e.g. telephone crisis lines), and the impact of these additional strategies is unmeasured.

Fourthly, there was some evidence of heterogeneity across studies. This highlights the differences between the individual studies both in terms of the study designs (number of deaths and study duration), the underlying population sizes and, more substantially, differences in the jump sites themselves. The structural interventions included the use of barriers, blocking road access to jump sites or the installation of a safety net below the jump site. Nonetheless, the fact that the findings hold despite these differences points to the generalizability of the findings to other settings.

Finally, we acknowledge that the original studies were limited in terms of their capacity to examine substitution. Most examined jumping behaviour at nearby sites, which is clearly superior to ignoring the potential for substitution, but is still somewhat crude. Notwithstanding our earlier point about absolute reductions in the overall suicide rate not being the only arbiter of success, it should still be noted that the studies could not capture the extent to which individuals who were prevented from jumping by barriers and other structural measures may have travelled outside the area to jump, or may have adopted other methods.


So as seen it admits bias, it fails to show all levels of sucice, which is the main argument point being made if such nets just push the problem elsewhere, in other words to other methods, it clearly shows increases to jumps elsewhere an indication it moves the problem and we have no data on other suicides.


Thus utterly flawed study

No more flawed than the study you tried to report as the conclusive evidence that you tried to make out it to be with the Bloor Street study which never ever was the conclusive evidence that you were making it out to be.

You see Didge, you want it all your own way in that the evidence that is presented to you is flawed but the evidence you present is fact when it isn't and never was the report for the Bloor Street says so in that other factors could not be discounted.

You're all the place with this and it shows.

Anyway - goodnight again.

I do not mind that you see mine with flaws, but it has facts within it showing people moved elsewhere to commit suicide, these facts are indisputable Irn and again it seems your only argument is to discuss me, showing again your childish attempts which was exposed from the start with collusion with sassy to attack Quill with this thread, you were exposed and do not like the fact everyone sees that.

So you need to grow up, stop having childish grudges with Quill and debate the points

Goo luck

Irn Bru wrote:

Didge wrote:


I do not mind that you see mine with flaws, but it has facts within it showing people moved elsewhere to commit suicide, these facts are indisputable Irn and again it seems your only argument is to discuss me, showing again your childish attempts which was exposed from the start with collusion with sassy to attack Quill with this thread, you were exposed and do not like the fact everyone sees that.

So you need to grow up, stop having childish grudges with Quill and debate the points

Goo luck

Back to the Quill stuff - diversion alert. You've run out of gas and it shows.

Goodnight - and for real.

CYA tomorrow.

Sassy wrote:I wondered whether you were talking sense, i hoped you might be talking sense, I realised you can't.   You can't stop all suicides, you can try and stop them in places where they happen on a regular basis.  If we could stop all suicides we'd be Gods, not people.   And this thread was about stopping people jumping off the bridge and the trauma it caused others.

Now for fuck sakes, when you say good night, mean it, and don't do what you did last night, stay up all bloody night because you couldn't let KD have the last word.

Sassy wrote:Simply observation of pathological tendencies, amazing how many people have noticed them, especially after this thread.   Goodnight didge, hope you get help in the morning, you really need it.    I have no grudge against you, I pity you, I really do.  

Didge wrote:

lovedust wrote:

So you don't have a specific reason to assume the Salzburg expertsfrom15countries in their review of 93 studies were biased per se... more that there's an ncbi write-up of a completely different study limited to 15 self-harm trials, where the reviewers concluded they didn't know how big a factor bias had played. Much different?

Nice talking to you didge. Goodnight

I gave you specific reasons Lovedust, you ignored them.

I gave also evidence to show such studies are flawed.


Night then and as always a pleasure to talk to you too

lovedust wrote:

Didge wrote:


I gave you specific reasons Lovedust, you ignored them.

I gave also evidence to show such studies are flawed.


Night then and as always a pleasure to talk to you too

Which points did I ignore, didge? Do you mean where you said the Salzburg review will be biased because it doesn't take into account things like financial situation and whether the subjects were being bullied at the time?

lovedust wrote:Didge, there's really no need to take that tone. We can all complain we've been making the same points over and over... You've just told me I'm "taking the piss" by ignoring your points and "one of the worst" for failing to address points, and while I disagree, I'm asking you in good faith so you could stand to give a polite answer:

Which points of yours have I failed to address?

lovedust wrote:Here is the report of the Salzburg 2004 consultation between Suicide Prevention Experts from 15 different countries. It was published in the Journal of the American Medical Association in 2005.

Suicide Prevention Strategies: A Systematic Review

J. John Mann, MD; Alan Apter, MD; Jose Bertolote, MD; Annette Beautrais, PhD; Dianne Currier, PhD; Ann Haas, PhD; Ulrich Hegerl, MD; Jouko Lonnqvist, MD; Kevin Malone, MD; Andrej Marusic, MD, PhD; Lars Mehlum, MD; George Patton, MD; Michael Phillips, MD; Wolfgang Rutz, MD; Zoltan Rihmer, MD, PhD, DSc; Armin Schmidtke, MD, PhD; David Shaffer, MD; Morton Silverman, MD; Yoshitomo Takahashi, MD; Airi Varnik, MD; Danuta Wasserman, MD; Paul Yip, PhD; Herbert Hendin, MD

Author Affiliations: New York State Psychiatric Institute, Division of Neuroscience (Drs Mann and Currier) and Division of Child psychiatry (Dr Schaffer), Department of Psychiatry, Columbia University, New York; Department of Psychiatry, Schneiders Childrens Medical Center of Israel (Dr Apter); Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland (Dr Bertolote); Canterbury Suicide Project, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand (Dr Beautrais); American Foundation for Suicide Prevention, New York, NY (Drs Haas and Hendin); Department of Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany (Dr Hegerl); Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland (Dr Lonnqvist); Department of Psychiatry & Mental Health Research, St Vincents University Hospital, Dublin, Ireland (Dr Malone); Institute of Public Health of the Republic of Slovenia, Ljubjana, Slovenia (Dr Marusic); Suicide Research and Prevention Unit, University of Oslo, Oslo, Norway (Dr Mehlum); Centre for Adolescent Health, University of Melbourne, Melbourne, Australia (Dr Patton); Beijing Suicide Research and Prevention Center, Beijing, China (Dr Phillips); Division of Psychiatry, Unit for Social Psychiatry and Health Promotion, Academic University Hospital, Uppsala, Sweden (Dr Rutz); National Institute for Psychiatry and Neurology, Budapest, Hungary (Dr Rihmer); Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany (Dr Schmidtke); National Suicide Prevention Technical Resource Center, Centers for Disease Prevention and Control, Newton, Mass (Dr Silverman); Division of Behavior Sciences, National Defense Medical College Research Institute, Tokyo, Japan (Dr Takahashi); Estonian-Swedish Suicidology Institute, Center Behavior and Health Science, Tallinn, Estonia (Dr Varnik); Department of Public Health Sciences at Karolinska Institute, Swedish National Centre for Suicide Research and Prevention of Mental Ill-Health, Stockholm, Sweden (Dr Wasserman); and Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China (Dr Yip).

ABSTRACT.

Context In 2002, an estimated 877 000 lives were lost worldwide through suicide. Some developed nations have implemented national suicide prevention plans. Although these plans generally propose multiple interventions, their effectiveness is rarely evaluated.

Objectives To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research.

Data Sources and Study Selection Relevant publications were identified via electronic searches of MEDLINE, the Cochrane Library, and PsychINFO databases using multiple search terms related to suicide prevention. Studies, published between 1966 and June 2005, included those that evaluated preventative interventions in major domains; education and awareness for the general public and for professionals; screening tools for at-risk individuals; treatment of psychiatric disorders; restricting access to lethal means; and responsible media reporting of suicide.

Data Extraction Data were extracted on primary outcomes of interest: suicidal behavior (completion, attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification of at-risk individuals, antidepressant prescription/use rates, referrals), or both. Experts from 15 countries reviewed all studies. Included articles were those that reported on completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates. We included 3 major types of studies for which the research question was clearly defined: systematic reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies (n = 41). Heterogeneity of study populations and methodology did not permit formal meta-analysis; thus, a narrative synthesis is presented.

Data Synthesis Education of physicians and restricting access to lethal means were found to prevent suicide. Other methods including public education, screening programs, and media education need more testing.

Conclusions Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates. Other interventions need more evidence of efficacy. Ascertaining which components of suicide prevention programs are effective in reducing rates of suicide and suicide attempt is essential in order to optimize use of limited resources.

Suicide is a significant public health issue. In 2002, an estimated 877 000 lives were lost worldwide through suicide, representing 1.5% of the global burden of disease or more than 20 million disability-adjusted life-years (years of healthy life lost through premature death or disability).1 The highest annual rates are in Eastern Europe, where 10 countries report more than 27 suicides per 100 000 persons. Latin American and Muslim countries report the lowest rates, fewer than 6.5 per 100 000.2 In the United States, in 2002, suicide accounted for 31 655 deaths, a rate of 11.0 per 100 000 per year,3 and general population surveys document a suicide attempt rate of 0.6% and a suicide ideation rate of 3.3%,4 representing a huge human tragedy and an estimated $11.8 billion in lost income.5

Suicidal behavior has multiple causes that are broadly divided into proximal stressors or triggers and predisposition.6 Psychiatric illness is a major contributing factor, and more than 90% of suicides have a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric illness,7- 13 with some exceptions, such as in China.14Mood disorders, principally major depressive disorder and bipolar disorder, are associated with about 60% of suicides.7,8,10,15,16 Other contributory factors include availability of lethal means, alcohol and drug abuse, access to psychiatric treatment, attitudes to suicide, help-seeking behavior, physical illness, marital status, age, and sex.6 To address these causes, suicide prevention involves a multifaceted approach with particular attention to mental health. The Figure illustrates the multiple factors involved in suicidal behavior6 and indicates where specific preventive interventions are being directed. Suicide prevention is possible because up to 83% of suicides have had contact with a primary care physician within a year of their death and up to 66% within a month.17,18 Thus, a key prevention strategy is improved screening of depressed patients by primary care physicians and better treatment of major depression. This review considers what is known about this and other prevention strategies to permit integration into a comprehensive prevention strategy.

Suicide experts from 15 countries met in Salzburg, Austria, in August 2004 to review efficacy of suicide prevention interventions. The 5-day workshop identified 5 major areas of prevention: education and awareness programs for the general public and professionals; screening methods for high-risk persons; treatment of psychiatric disorders; restricting access to lethal means; and media reporting of suicide.

DATA SOURCES.

An electronic literature search of all articles published between 1966 and June 2005 was conducted via MEDLINE, the Cochrane Library, and PsychINFO to identify reports evaluating suicide prevention interventions. An initial search used the MEDLINE identifier suicide (including the subheading suicide, attempted) and the subheading prevention and control, following that suicide was combined with the following identifiers: depression, health education, health promotion, public opinion, mass screening, family physicians, medical education, primary health care, antidepressive agents, psychotherapy, schools, adolescents, methods, firearms, overdose, poisoning, gas poisoning, and mass media. We identified 5020 articles, which were not bound by the 5 major areas identified during the workshop. Abstracts were reviewed and full-text articles that met inclusion criteria were retrieved. All reports were reviewed by at least 2 authors.

Study Selection

Studies were included if they reported on either the primary outcomes of interest, namely completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates.

We included 3 major types of studies for which the research question was clearly defined as assessment of efficacy or effectiveness of prevention programs in terms of the above primary or secondary outcomes; (1) systematic reviews and meta-analyses (n = 10) for which the search strategy was comprehensive and the methodological quality of primary studies was critically appraised; (2) quantitative studies, either randomized controlled trials (n = 18), or cohort studies (n = 24); and (3) ecological or population based studies (n = 41). Table 1 and Table 2 detail study type, study population, and preventive intervention tested and rate the studies according to the scheme proposed by the Oxford Centre for Evidence Based Medicine.112 Randomized controlled trials provide the most compelling evidence of efficacy while findings of naturalistic studies are largely correlational, indicating that their outcomes need further testing.


DATA SYNTHESIS.

Heterogeneity in study methodology and populations limited formal meta-analysis, thus we present a narrative synthesis of the results for the key domains of suicide prevention interventions.

Awareness and Education

General Public. Public education campaigns are aimed at improving recognition of suicide risk and help seeking through improved understanding of the causes and risk factors for suicidal behavior, particularly mental illness. Public education also seeks to reduce stigmatization of mental illness and suicide and challenges the acceptance of suicide as inevitable, as a national character trait, or as an appropriate solution to life problems, including serious medical illness. Despite their popularity as a public health intervention, the effectiveness of public awareness and education campaigns in reducing suicidal behavior has seldom been systematically evaluated.

Studies in Germany,55 the United Kingdom,57 Australia,56 and New Zealand58 suggest modest effects of public education campaigns on attitudes regarding the causes and treatment of depression. Such public education and awareness campaigns, largely about depression, have no detectable effect on primary outcomes of decreasing suicidal acts or on intermediate measures, such as more treatment seeking or increased antidepressant use.57,58,113 The German study showed an 18% decrease in suicide attempts in an intervention region after 9 months of a depression awareness campaign.59 However, the decline in suicide attempts occurred without a greater improvement in attitudes in the intervention region compared with the control region.55

Other specific education strategies are aimed at youth, including school and community-based programs.114,115 Few such programs are evidence-based, reflect the current state of knowledge in suicide prevention, or evaluate effectiveness and safety for preventing suicidal behavior.114 A systematic review of studies published from 1980-1995 found that knowledge about suicide improved but there were both beneficial and harmful effects in terms of help-seeking, attitudes, and peer support.22 A later review of studies published from 1990-2002 also found that curriculum-based programs increase knowledge and improve attitudes to mental illness and suicide but found insufficient evidence for prevention of suicidal behavior.23 A subsequent controlled trial reported lower suicide attempt rates, greater knowledge, and more adaptive attitudes about depression and suicide in the intervention group compared with in the 3 months after the intervention, but no significant benefits for rates of suicide ideation or help-seeking.29 In adolescents, several studies found that improving problem solving, coping with stress, and increasing resilience enhance hypothesized protective factors but effects on suicidal behavior were unevaluated.43- 45

Primary Care Physicians. Depression and other psychiatric disorders are underrecognized and undertreated in the primary care setting.116,117 Prevention is possible because most suicides have had contact with a primary care physician within a month of death.17,18 Primary care physicians’ lack of knowledge about or failure to screen patients for depression may contribute to nontreatment seen in most suicides. Therefore, improving physician recognition of depression and suicide risk evaluation is a component of suicide prevention.

Some studies in the United Kingdom,61 Australia,60 the United States,24 and Northern Ireland,49 showed that programs aimed at educating primary care physicians improved detection and increased treatment of depression, but that was not shown in other studies in the United States,62 Brazil,63 and the United Kingdom.30 Nurse case management, collaborative care, or quality improvement initiatives can further improve the recognition and management of depression27 and has application where education alone may be insufficient.

A controlled trial comparing a treatment algorithm plus depression care management with treatment as usual for late-life depression in primary care in the United States demonstrated greater improvement in patient suicidal ideation and a more favorable course of illness in the intervention group compared with the treatment-as-usual group.31 An adolescent depression treatment quality improvement intervention with care managers supporting primary care physicians resulted in a 50% decrease in suicide attempts in the intervention group that was not statistically different from the control group (18%) due to the low base rate.42 An Australian program that trained primary care physicians to recognize and respond to psychological distress and suicidal ideation in young people increased identification of suicidal patients by 130% (determined by the Depressive Symptom Inventory–Suicidality Subscale score), without changes in treatment or management strategies.64 Studies examining suicidal behavior in response to primary care physician education programs, mostly targeting depression recognition and treatment, in specific regions in Sweden,66,118 Hungary,47 Japan,65 and Slovenia48 have all reported increased prescription rate for antidepressants and often substantial declines in suicide rates and represent the most striking known example of a therapeutic intervention lowering suicide rates.

Gatekeepers. Suicide prevention includes a range of interventions focused on community or organizational gatekeepers whose contact with potentially vulnerable populations provides an opportunity to identify at-risk individuals and direct them to appropriate assessment and treatment.5Gatekeepers include clergy, first responders, pharmacists, geriatric caregivers, personnel staff, and those employed in institutional settings, such as schools, prisons, and the military. Education covered awareness of risk factors, policy changes to encourage help-seeking, availability of resources, and efforts to reduce stigma associated with help-seeking. In addition to gatekeeper training, these programs also promoted organization-wide awareness of mental health and suicide and facilitated access to mental health services.

To date, systematic evaluation of impact on suicidal behavior has largely been limited to multilevel programs conducted in institutional settings, such as the military where programs in the Norwegian Army67 and the US Air Force52 have reported success in lowering suicide rates.

Screening

Screening aims to identify at-risk individuals and direct them to treatment. The focus may be on suicidal behavior directly or risk factors, such as depression or substance abuse. Screening instruments for depression, suicidal ideation, or suicidal acts administered to high school students,119 juvenile offenders,120 and youth in general121 have reliability and validity in identifying individuals at increased risk for suicidal behavior and are reported to double the number of known at-risk individuals.122 There is no evidence that screening youth for suicide induces suicidal thinking or behavior.123 Acceptance of the need for treatment by identified at-risk youth and actual treatment implementation are understudied as potential barriers to the effectiveness of screening programs.

The US Preventive Services Task Force (USPSTF) review of studies of depression screening in adults in primary health care settings found a 10% to 47% increase in rates of detection and diagnosis of depression with the use of screening tools.24 The effect on treatment was mixed, due to differences in study methodology. In contrast, a Canadian review of depression screening studies did not find routine screening in primary care to improve depression care.25 Neither report commented on effects on suicidal behavior. In contrast, screening in localized geographic areas results in more treatment of depression and lower suicide rates.50,51,66 The 2004 USPSTF26 review of evidence on screening for suicide risk, as opposed to depression, found no published studies in English evaluating the effectiveness of screening for suicide risk in primary care.

Treatment Interventions

Pharmacotherapy. Psychiatric disorders are present in at least 90% of suicides and more than 80% are untreated at time of death.124,125 Depression is untreated or undertreated in general,116,126 even after suicide attempt.127 Thus, treating mood and other psychiatric disorders is a central component of suicide prevention.5

Antidepressant medications alleviate depression and other psychiatric disorders.128 However meta-analyses of RCTs have generally not detected benefit for suicide or suicide attempts in studies of antidepressants in mood and other psychiatric disorders,19- 21 perhaps due to the low base rate of suicidal behavior and insufficient systematic screening for suicidal behavior since reliance on spontaneous reporting underestimates rates of suicidal behavior.129 Randomized controlled trials can be informative when higher-risk patients are studied and indicate an antisuicidal effect for lithium in major mood disorders34 and clozapine in schizophrenia.32,33 Few studies prospectively identified suicidal behavior as an outcome measure and systematically assessed it throughout the RCT.

Higher prescription rates of antidepressants correlate with decreasing suicide rates in adults or youth in Hungary,47 Sweden,89 Australia,93 and the United States.91,92 Geographic regions or demographic groups with the highest selective serotonin reuptake inhibitor prescription rates have the lowest suicide rates in the United States91 and Australia.93 Although Iceland,94 Japan,95 and Italy96 do not show such correlations, potential reasons include lack of compliance; pre-existing low-suicide rate, resulting in a floor effect; and high rates of alcoholism that may elevate suicide rates or the effect may be confined to women because too few men seek and comply with treatment with antidepressants. Suicide rates in 27 countries fell most markedly in countries that had the greatest increase in selective serotonin reuptake inhibitor prescriptions.99 Patient population studies report lower suicide attempt rates in adults treated with antidepressant medication97 and in adolescents after 6 months of antidepressant treatment compared with less than two months of treatment.98 The risk of an ecological fallacy, that is, inferring causality from group correlations, prevents attributing decreases in suicide rates solely to antidepressant use. Nevertheless, there is a striking correlation and plausible mechanism linking antidepressant use to declining rates of untreated major depression and therefore suicide.

Concerns about higher rates of suicide-related adverse event reports in depressed children and adolescents taking selective serotonin reuptake inhibitors compared with placebo in RCTs have prompted regulatory bodies in the United States, the United Kingdom, and Europe to issue warnings urging clinicians to monitor suicide risk and adverse effects carefully when prescribing antidepressants to youth. Such concerns need to be weighed against the risk of untreated depression because suicide is the third leading cause of death in youth and more than 90% of suicides in depressed youth are untreated at the time of death.130

Psychotherapy. Promising results in reducing repetition of suicidal behavior and improving treatment adherence exist for cognitive therapy,35 problem-solving therapy,28 intensive care plus outreach,28 and interpersonal psychotherapy,36 compared with standard aftercare. Cognitive therapy halved the reattempt rate in suicide attempters compared with those receiving usual care.35 In borderline personality disorder, dialectical behavioral therapy28 and psychoanalytically oriented partial hospitalization37 improved treatment adherence and reduced suicidal behavior compared with standard after care. Intermediate outcomes such as hopelessness and depressive symptoms improve with problem solving therapy, and suicidal ideation is decreased with interpersonal psychotherapy, cognitive behavior therapy, and dialectical behavioral therapy.26

Follow-up Care After Suicide Attempts. Many psychiatric disorders, including depression, are chronic and recurrent131 and compliance with maintenance medication is often poor. Interventions for depression provided by primary care physicians are more effective when a case manager follows up with patients who miss appointments or need prescription renewals.132 Many depressed patients who survive a suicide attempt will make further suicide attempts,133 particularly in the period shortly following psychiatric hospitalization134,135 or during future major depressive episodes.136 Thus, improved acute, continuation, and maintenance care, including psychiatric hospitalization, where necessary, of those with recurrent or chronic psychiatric disorders,137- 139 particularly patients who attempt suicide with mood disorders, has potential for prevention. Reduction of the number of psychiatric inpatient beds in Norway as part of a program of deinstitutionalization of psychiatric inpatients resulted in an increased suicide rate in the year after discharge with a standardized mortality ratio of 133(95% confidence interval, 90.1-190.7) in men and 208.5 (95% confidence interval, 121.5-333.9) in women.140

The Norwegian multidisciplinary chain-of-care networks provide follow-up care after hospital care to those who attempt suicide. Regions with chain-of-care programs have lower treatment dropout rates and fewer repeat attempts.68 Intervention studies of those who attempt suicide to prevent future suicidal behavior have produced mixed results, including fewer suicides compared with a control group after regular mailings,38 and fewer suicide attempts after issuing an emergency contact green card41) or use of a suicide intervention counselor to coordinate assessment and long-term treatment.69 Other interventions for those who attempt suicide, including telephone follow-up, intensive psychosocial follow-up, and video education plus family therapy, resulted in no difference between standard aftercare and intervention groups in rate of reattempt or reemergent suicidal ideation.39,40,70

Means Restriction

Suicide attempts using highly lethal means, such as firearms in US men, or pesticides in rural China, India, and Sri Lanka, result in higher rates of death. Suicides by such methods have decreased after firearm control legislation,54,72- 75,100 restrictions on pesticides,76,77 detoxification of domestic gas,79- 81,101- 103 restrictions on the prescription and sale of barbiturates,82- 84,101,105- 107 changing the packaging of analgesics to blister packets,85 mandatory use of catalytic converters in motor vehicles,86- 88,108 construction of barriers at jumping sites,90 and the use of new lower toxicity antidepressants.91,109

Where the method is common, restriction of means has led to lower overall suicide rates: firearms in Canada78 and Washington, DC,54 barbiturate restriction in Australia,105 domestic gas detoxification in Switzerland80 and the United Kingdom,79 and vehicle emissions in England.87 Restrictions on access to alcohol have coincided with decreases in overall suicide rates in the former Union of Soviet Socialists Republics110 and Iceland.111

Substitution of method may obscure a change in overall suicide rates, as has been observed for domestic gas detoxification among men in the United Kingdom,81 in Germany,103 and in the United States104 and for banning the pesticide parathion in Finland.76 Despite unresolved questions about method substitution, these studies demonstrate the life-saving potential of restricting lethal means. Gauging the extent to which declining overall suicide rates are directly attributable to restriction in access to particular means requires consideration of long-term trends and confounding factors such as increased antidepressant use.

Media

The media can help or hinder suicide prevention efforts by being an avenue for public education or by exacerbating suicide risk by glamorizing suicide or promoting it as a solution to life’s problems. The latter may encourage vulnerable individuals to attempt suicide or to be attracted to suicide hot spots portrayed in the media as discussed by Pirkis et al141,142 and Gould.143 Media blackouts on reporting suicide have coincided with decreases in suicide rates.53 A 1987 campaign to decrease media coverage of subway suicides in Austria cut subway suicides by 80%.71 The Internet is of increasing concern, particularly the effects of suicide chat rooms, the provision of instruction in methods for suicide, and the active solicitation of suicide-pact partners.

Educating journalists and establishing media guidelines for reporting suicide have had mixed results.144 The American Foundation for Suicide Prevention and Annenberg Public Policy Center,145 and The Centers for Disease Control and Prevention146 in the United States have produced guidelines for the responsible reporting of suicide; however, no published studies have evaluated their impact.

Conclusions and Future Directions
National suicide prevention strategies have been proposed despite knowledge deficits about the effectiveness of some common key components. The relative impact of different strategies on national suicide rates is important for planning but difficult to estimate. Table 3 summarizes estimates of impact of different interventions on national suicide rates showing that the most promising interventions are physician education, means restriction, and gatekeeper education. Many universal or targeted educational interventions are multifaceted, and it is not known which components produce the desired outcome, or there may be longer-term trends in suicide rates that are not captured by the studies.


http://jama.jamanetwork.com/article.aspx?articleid=201761