4 These findings make it possible to develop and test suicide prevention strategies. A first step is to investigate whether there are subgroups of the population who are at very high risk, for whom focused intervention strategies are most needed and might have their greatest impact. In the case of suicide risk prevention, the extraordinarily high rates of suicide in the elderly justify designing an intervention for this group. The next step is to identify an appropriate target for the prevention intervention. A useful strategy is to identify a risk factor that is common, strongly related to suicide risk, and is, in and of itself, malleable. Inhibitors,research,lifescience,medical The epidemiologic notion of “population-attributable risk” (PAR) may be useful to
this argument. The PAR is an estimate of the proportion of all cases (eg, suicide) in a population than can be ascribed to a particular
risk factor.5 The PAR is a compound measure reflecting the relative risk and the frequency (prevalence) Inhibitors,research,lifescience,medical of the factor in the population. A factor may incur a very large risk for suicide, but be so rare in the target population that even a highly effective intervention-targeting condition may do little to reduce the overall rate of suicide in the population. Conversely, a significant risk factor for suicide may be very prevalent in the population (eg, living alone), but be so weakly associated with Inhibitors,research,lifescience,medical suicide risk that a successful intervention will also do little to reduce the Inhibitors,research,lifescience,medical overall rate of suicide in the population. Successfully intervening on a factor that both strongly affects the risk of suicide and Thiazovivin ic50 occurs in a large number of individuals would potentially reduce the overall suicide rates in the target population. An effective public health suicide prevention strategy needs to identify a risk factor that is not only highly prevalent and strongly associated with suicide, but also changeable. Inhibitors,research,lifescience,medical Old age, male gender, living alone, widowhood, and other sociodemographic factors associated with suicide are difficult, if not impossible, to modify,
making them inappropriate intervention targets (although, as noted above, potentially useful ways to narrow target populations). Depression, other psychiatric disorders, and access to firearms or other lethal methods are risk factors for suicide that are potentially amenable to change and thus potentially appropriate over targets for an suicide prevention intervention. The purpose of intervention studies is to investigate both the extent to which the intervention does modify the risk factor and then whether changing the risk factor changes the outcome of interest. While the methodology for choosing a risk factor to target for an intervention draws heavily from epidemiologic and other observational sciences, the design of the intervention is informed by a wide range of sources, including naturalistic and controlled treatment studies as well as a wide range of other human, social, or organizational experiments.
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