Mental health policies and strategies
| Study | Design | Study time period | Country (region) | Intervention | Results | Direction of association |
| Ohberg et al 1997S81 | Time series | 1980–1995 | Finland | In 1990, a national suicide prevention project was implemented. | There was a significant decline in suicide rates among men aged >15 years from 61.7 deaths per 100 000 in 1990 to 54.1 in 1995, with the largest impact occurring in youth aged 15–24 years. The decline in suicide rates among women was not significant. | Male 15–24 years: -- 25–34 years: - 35–64 years: - >65 years: - Female 15–24 years: - 25–34 years: + 35–64 years: - >65 years: - |
| Bellanger et al 2006S82 | Quasi-experimental | 1988–2001 | France | Since 1994, a new suicide prevention policy has been introduced in France. | Following the implementation of the new policy, the decrease in suicide rates was significantly greater in the exposed group (−12.7%) compared with the non-exposed group (−7.6%), after adjusting for sex and initial death rates. | Total: -- |
| Nakanishi et al 2020S83 | Interrupted Time series | 1996–2016 | Japan | In 2006, the Basic Act for Suicide Prevention implemented, which included nine initiatives that covered almost all aspects of suicide prevention, with the exception of policies to reduce harmful alcohol use. | After the 2006 implementation of the Act, there was a reduction in suicide mortality across most age and sex groups (April 2006–February 2011), but none of the reductions were considered statistically significant. | Total: - Male: - Female: + ≤19 years: - 20–39 years: - 40–59 years: - >60 years: + |
| Lee et al 2018S84 | Time series | 1993–2016 | South Korea | In the early 2000s (first: year 2004; second: year 2009), South Korea implemented the national suicide prevention programme, which included different suicide prevention policies for both high-risk groups, and the general population. | From 1993 to 2010, the national suicide mortality rate increased by an annual percent change of 5.6% (95% CI 4.4% to 6.9%). After 2010, the suicide mortality rate declined by an annual percent change of 5.5% (95% CI −10.3% to −0.5%) until 2016. | Total: -- Male: - Female: -- |
| Baran et al 2015S85 | Pre–post with no control group | 2002–2014 | Sweden | In 2008, the Swedish government approved a national programme for suicide prevention that recommended nine strategies. Specific details on the programme are not provided. | Before the implementation of the national programme, the suicide rate in Sweden was 12.9 per 100 000 (2002–2007), which declined to 12.33 per 100 000 following the implementation (2009–2014). The overall slope of the regression was not significant, suggesting that the programme had a minimal impact on suicide rates. The programme may have only reduced suicide rates in older men age >65 years (2.41 suicide rate reduction, p=0.02). | Male 0–24 years: + 25–44 years: - 45–64 years: - >65 years: -- Female 0–24 years: + 25–44 years: - 45–64 years: - >65 years: - |
| Lang, 2013S86 | Pre–post, with control group | 1990–2004 | USA | States began enacting mental health insurance laws between the mid-1990s and early 2000s. By 2002, 45 states had enacted some type of mental health insurance law. | Following the enactment of mental health insurance laws that were at parity physical health insurance laws in 29 states, the state-level suicide rate was 10.24 per 100 000. If these laws were not enacted the suicide rate would have been 10.61 per 100,000, which equates to approximately 592 suicide deaths prevented per year. | Total: -- |
| Matsubayashi et al 2011S87 | Pre−post, with no control group | 1980–2004 | 11 high-income OECD countries | Between 1995 and 2003, 11 high-income OECD countries had implemented a nationwide suicide prevention programme. These programmes varied by country, were multifaceted and include a variety of activities, some of which constituted universal interventions. | Following the implementation of a national suicide prevention programme, the national suicide rate per 100 000 declined by 1.38 (SE=0.5, p<0.05). The effect was larger in men (suicide rate=−1.43, SE=0.513, p<0.05) than women (suicide rate=−0.37, SE=0.51, not significant). | Male 0–24 years: -- 25–64 years: - >65 years: -- Female 0–24 years: -- 25–64 years: + >65 years: -- |
+, not statistically significant increase; -, not statistically significant reduction; --, statistically significant reduction; ++, statistically significant increase; OECD, Organisation for Economic Co-operation and Development; SE, SE error.