***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Universal screening for mental health problems and suicide risk is at the forefront of the national agenda for youth suicide prevention , yet no study has directly addressed the potential harm of suicide screening . OBJECTIVE To examine whether asking about suicidal ideation or behavior during a screening program creates distress or increases suicidal ideation among high school students generally or among high-risk students reporting depressive symptoms , substance use problems , or suicide attempts . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled study conducted within the context of a 2-day screening strategy . Participants were 2342 students in 6 high schools in New York State in 2002 - 2004 . Classes were r and omized to an experimental group ( n = 1172 ) , which received the first survey with suicide questions , or to a control group ( n = 1170 ) , which did not receive suicide questions . MAIN OUTCOME MEASURES Distress measured at the end of the first survey and at the beginning of the second survey 2 days after the first measured on the Profile of Mood States adolescent version ( POMS-A ) instrument . Suicidal ideation assessed in the second survey . RESULTS Experimental and control groups did not differ on distress levels immediately after the first survey ( mean [ SD ] POMS-A score , 5.5 [ 9.7 ] in the experimental group and 5.1 [ 10.0 ] in the control group ; P = .66 ) or 2 days later ( mean [ SD ] POMS-A score , 4.3 [ 9.0 ] in the experimental group and 3.9 [ 9.4 ] in the control group ; P = .41 ) , nor did rates of depressive feelings differ ( 13.3 % and 11.0 % , respectively ; P = .19 ) . Students exposed to suicide questions were no more likely to report suicidal ideation after the survey than unexposed students ( 4.7 % and 3.9 % , respectively ; P = .49 ) . High-risk students ( defined as those with depression symptoms , substance use problems , or any previous suicide attempt ) in the experimental group were neither more suicidal nor distressed than high-risk youth in the control group ; on the contrary , depressed students and previous suicide attempters in the experimental group appeared less distressed ( P = .01 ) and suicidal ( P = .02 ) , respectively , than high-risk control students . CONCLUSIONS No evidence of iatrogenic effects of suicide screening emerged . Screening in high schools is a safe component of youth suicide prevention efforts BACKGROUND All follow-up studies of causes of death in affective disordered patients have found they have markedly elevated suicide rates and a less reproducible increased mortality from other causes . The reported rates by gender , disorder type and treatment are more variable . METHODS Hospitalised affective disordered patients ( n=406 ) were followed prospect ively for 22 years or more . Later , mortality was assessed for 99 % of them at which time 76 % had died . RESULTS St and ardised Mortality Rates ( observed deaths/expected deaths ) for patients were elevated especially for suicide and circulatory disorders in both men and women . Women actually had higher suicide rates but that did not take into account the twofold increase in general population rates for men . Unipolar patients had significantly higher rates of suicide than bipolar Is or IIs . In all groups long term medication treatment with antidepressants alone or with a neuroleptic , or with lithium in combination with antidepressants and /or neuroleptics significantly lowered suicide rates even though the treated were more severely ill . Although at the age of onset the suicide rates were most elevated , from ages 30 to 70 the rates were remarkably constant despite the different courses of illness . LIMITATIONS The patients were identified as in patients and followed prospect ively . The treatments were uncontrolled and are not quantifiable but were documented during the follow-up . CONCLUSIONS Men and women hospitalised for affective disorders have elevated mortality rates from suicide and circulatory disorders . Unipolars have higher suicide rates than bipolar Is or IIs . Long term medication treatment lowers the suicide rates , despite the fact that it was the more severely ill who were treated We carried out a r and omized controlled trial to determine whether an intensive intervention after a suicide attempt could decrease by half the risk of a repeat attempt in the following two years . After initial assessment and r and omization , experimental subjects attended 18 therapy appointments over one year  , including one home visit , and measures to improve attendance .  Control subjects received the usual care . Of 63 experimental subjects , 35 % made a repeat attempt , and so did 30 % of 63 control subjects . The study had a 99 % power to detect the desired decrease of risk ( 30 % to 15 % ) . Clearly , the intervention did not achieve its objective OBJECTIVES This study evaluated the efficacy of 2 indicated preventive interventions , postintervention and at 9-month follow-up . METHODS Drawn from a pool of potential high school dropouts , 460 youths were identified as being at risk for suicide and participated in 1 of 3 conditions r and omly assigned by school : ( 1 ) Counselors CARE ( C-CARE ) ( n = 150 ) , a brief one-to-one assessment and crisis intervention ; ( 2 ) Coping and Support Training ( CAST ) ( n = 155 ) , a small-group skills-building and social support intervention delivered with C-CARE ; and ( 3 ) usual-care control ( n = 155 ) . Survey instruments were administered pre-intervention , following C-CARE ( 4 weeks ) , following CAST ( 10 weeks ) , and at a 9-month follow-up . RESULTS Growth curve analyses showed significant rates of decline in attitude toward suicide and suicidal ideation associated with the experimental interventions . C-CARE and CAST , compared with usual care , also were effective in reducing depression and hopelessness . Among females , reductions in anxiety and anger were greater in response to the experimental programs . CAST was most effective in enhancing and sustaining personal control and problem-solving coping for males and females . CONCLUSIONS School-based , indicated prevention approaches are feasible and effective for reducing suicidal behaviors and related emotional distress and for enhancing protective factors OBJECTIVE This study tested the hypothesis that professionals ' maintenance of long-term contact with persons who are at risk of suicide can exert a suicide-prevention influence . This influence was hypothesized to result from the development of a feeling of connectedness and to be most pertinent to high-risk individuals who refuse to remain in the health care system . METHODS A total of 3,005 persons hospitalized because of a depressive or suicidal state , population s known to be at risk of subsequent suicide , were contacted 30 days after discharge about follow-up treatment . A total of 843 patients who had refused ongoing care were r and omly divided into two groups ; persons in one group were contacted by letter at least four times a year for five years . The other group-the control group-received no further contact . A follow-up procedure identified patients who died during the five-year contact period and during the subsequent ten years . Suicide rates in the contact and no-contact groups were compared . RESULTS Patients in the contact group had a lower suicide rate in all five years of the study . Formal survival analyses revealed a significantly lower rate in the contact group ( p=.04 ) for the first two years ; differences in the rates gradually diminished , and by year 14 no differences between groups were observed . CONCLUSIONS A systematic program of contact with persons who are at risk of suicide and who refuse to remain in the health care system appears to exert a significant preventive influence for at least two years . Diminution of the frequency of contact and discontinuation of contact appear to reduce and eventually eliminate this preventive influence OBJECTIVES We examined the effectiveness of the Signs of Suicide ( SOS ) prevention program in reducing suicidal behavior . METHODS Twenty-one hundred students in 5 high schools in Columbus , Ga , and Hartford , Conn , were r and omly assigned to intervention and control groups . Self-administered question naires were completed by students in both groups approximately 3 months after program implementation . RESULTS Significantly lower rates of suicide attempts and greater knowledge and more adaptive attitudes about depression and suicide were observed among students in the intervention group . The modest changes in knowledge and attitudes partially explained the beneficial effects of the program . CONCLUSIONS SOS is the first school-based suicide prevention program to demonstrate significant reductions in self-reported suicide attempts CONTEXT Suicide attempts constitute a major risk factor for completed suicide , yet few interventions specifically design ed to prevent suicide attempts have been evaluated . OBJECTIVE To determine the effectiveness of a 10-session cognitive therapy intervention design ed to prevent repeat suicide attempts in adults who recently attempted suicide . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial of adults ( N = 120 ) who attempted suicide and were evaluated at a hospital emergency department within 48 hours of the attempt . Potential participants ( N = 350 ) were consecutively recruited from October 1999 to September 2002 ; 66 refused to participate and 164 were ineligible . Participants were followed up for 18 months . INTERVENTION Cognitive therapy or enhanced usual care with tracking and referral services . MAIN OUTCOME MEASURES Incidence of repeat suicide attempts and number of days until a repeat suicide attempt . Suicide ideation ( dichotomized ) , hopelessness , and depression severity at 1 , 3 , 6 , 12 , and 18 months . RESULTS From baseline to the 18-month assessment , 13 participants ( 24.1 % ) in the cognitive therapy group and 23 participants ( 41.6 % ) in the usual care group made at least 1 subsequent suicide attempt ( asymptotic z score , 1.97 ; P = .049 ) . Using the Kaplan-Meier method , the estimated 18-month reattempt-free probability in the cognitive therapy group was 0.76 ( 95 % confidence interval [ CI ] , 0.62 - 0.85 ) and in the usual care group was 0.58 ( 95 % CI , 0.44 - 0.70 ) . Participants in the cognitive therapy group had a significantly lower reattempt rate ( Wald chi2(1 ) = 3.9 ; P = .049 ) and were 50 % less likely to reattempt suicide than participants in the usual care group ( hazard ratio , 0.51 ; 95 % CI , 0.26 - 0.997 ) . The severity of self-reported depression was significantly lower for the cognitive therapy group than for the usual care group at 6 months ( P= .02 ) , 12 months ( P = .009 ) , and 18 months ( P = .046 ) . The cognitive therapy group reported significantly less hopelessness than the usual care group at 6 months ( P = .045 ) . There were no significant differences between groups based on rates of suicide ideation at any assessment point . CONCLUSION Cognitive therapy was effective in preventing suicide attempts for adults who recently attempted suicide BACKGROUND Approximately 50 % of patients with schizophrenia or schizoaffective disorder attempt suicide , and approximately 10 % die of suicide . Study results suggest that clozapine therapy significantly reduces suicidal behavior in these patients . METHODS A multicenter , r and omized , international , 2-year study comparing the risk for suicidal behavior in patients treated with clozapine vs olanzapine was conducted in 980 patients with schizophrenia or schizoaffective disorder , 26.8 % of whom were refractory to previous treatment , who were considered at high risk for suicide because of previous suicide attempts or current suicidal ideation . To equalize clinical contact across treatments , all patients were seen weekly for 6 months and then biweekly for 18 months . Subsequent to r and omization , unmasked clinicians at each site could make any interventions necessary to prevent the occurrence of suicide attempts . Suicidal behavior was assessed at each visit . Primary end points included suicide attempts ( including those that led to death ) , hospitalizations to prevent suicide , and a rating of " much worsening of suicidality " from baseline . Masked raters , including an independent suicide monitoring board , determined when end point criteria were achieved . RESULTS Suicidal behavior was significantly less in patients treated with clozapine vs olanzapine ( hazard ratio , 0.76 ; 95 % confidence interval , 0.58 - 0.97 ; P = .03 ) . Fewer clozapine-treated patients attempted suicide ( 34 vs 55 ; P = .03 ) , required hospitalizations ( 82 vs 107 ; P = .05 ) or rescue interventions ( 118 vs 155 ; P = .01 ) to prevent suicide , or required concomitant treatment with antidepressants ( 221 vs 258 ; P = .01 ) or anxiolytics or soporifics ( 301 vs 331 ; P = .03 ) . Overall , few of these high-risk patients died of suicide during the study ( 5 clozapine vs 3 olanzapine-treated patients ; P = .73 ) . CONCLUSIONS Clozapine therapy demonstrated superiority to olanzapine therapy in preventing suicide attempts in patients with schizophrenia and schizoaffective disorder at high risk for suicide . Use of clozapine in this population should lead to a significant reduction in suicidal behavior OBJECTIVE To evaluate the efficacy of multisystemic therapy ( MST ) in reducing attempted suicide among predominantly African American youths referred for emergency psychiatric hospitalization . METHOD Youths presenting psychiatric emergencies were r and omly assigned to MST or hospitalization . Indices of attempted suicide , suicidal ideation , depressive affect , and parental control were assessed before treatment , at 4 months after 
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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 .
Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates .
Other interventions need more evidence of efficacy .