Implementation of an integrated community-based suicide prevention programme, Gujarat, India: cluster randomised controlled trial.
Lakshmi Vijayakumar, Soumitra Pathare, Nikhil Jain et al.
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In 30 seconds
This pragmatic cluster randomised controlled trial tested an integrated suicide prevention programme in villages in Mehsana, India. The intervention combined school-based awareness, household pesticide storage, and community health worker training to identify and support people at risk. Across the intervention and control arms, there was no statistically significant difference in the primary outcome of suicide attempts plus deaths by suicide. However, at 12 months, the intervention arm had a lower suicide death rate: 30.7 versus 43.6 per 100 000 person-years (incidence rate ratio 0.57, 95% CI: 0.32-1.02).
Key findings
- The primary outcome, suicide attempts plus deaths by suicide, did not differ significantly between intervention and control arms.
- At 12 months, suicide rates were 30.7 versus 43.6 per 100 000 person-years; incidence rate ratio 0.57, 95% CI: 0.32-1.02.
- At least 90% of students in 47 schools received the intervention and had lower depression and suicidal ideation than controls at month 3.
- Community health workers identified 108 at-risk individuals; intervention-arm workers also had higher knowledge, confidence and skills than controls.
Why it matters
The trial evaluates a multicomponent prevention approach delivered at village scale in a low- and middle-income setting, where evidence on large-scale suicide prevention is limited. Its findings distinguish implementation gains and a lower observed suicide death rate from the absence of a significant effect on the combined primary outcome, helping frame both the potential and uncertainty of integrated community programmes.
What to keep in mind
The primary outcome did not differ significantly between arms. The reported reduction in suicide deaths had a 95% CI of 0.32-1.02, which includes 1.