Abstract

Evaluations of the effectiveness of multifaceted suicide prevention programmes often focus exclusively on primary outcome measures, such as suicide and non-fatal suicidal acts. In order to build the evidence for the effectiveness of suicide prevention programmes it is therefore important to also include intermediate outcome measures, which is the focus of the review presented. Intermediate outcome measures are defined as proximal effect indicators of single interventions of multi-level programmes and are directly linked to the objectives and content of each intervention. A review of the literature was conducted of suicide prevention studies including intermediate outcome measures and papers addressing psychometric characteristics of the measures used. Specific psychometric issues related to measuring change including content validity, construct validity, test-retest reliability and internal consistency were examined. 18 commonly used instruments were selected for the psychometric analysis. Intermediate outcome measures used in previous suicide prevention studies included instruments to measure changes in awareness of depression and suicidal behaviour, changes in attitude towards depression and/or suicide, attitudes towards help-seeking, stigma surrounding depression and/or suicide, acquisition of relevant skills, confidence in dealing with suicidal or depressed patients, and changes in antidepressant prescription rates. Few of the instruments reached an acceptable standard on all of the predefined quality dimensions. Although intermediate outcome criteria are more common in recent studies evaluating the effectiveness of suicide prevention programmes, most measures lack sufficient psychometric quality. Researchers in the area of suicide prevention should ensure evidence-based decisions when defining and measuring changes in intermediate outcome measures.