Interventions to Prevent Suicide: A Literature Review to Guide Evaluation of California's Mental Health Prevention and Early Intervention Initiative.

To help inform the evaluation design for CalMHSA's suicide prevention (SP) and early intervention initiatives, a review of program evaluation literature was done to assess program effectiveness and identify previously used evaluation methodologies. Using evidence from the literature review, the authors provide an overview of the epidemiology of suicides and of non-fatal self-inflicted injuries in California and present a framework for evaluating SP programs, including candidate evaluation measures. The review identified three methodological considerations that can inform the evaluation of SP programs: (1) identifying whether a SP program was effective at reducing suicide deaths is challenging because suicide is such a rare event; (2) SP programs may have differential effects on population subgroups, because suicide rates differ by age, race, and sex; and (3) SP programs may show immediate reductions in suicide attempts but their long-term effects are uncertain. The review also identified two critical gaps in the literature. First, SP evaluation research explores the effects of programs on such outcomes as reduced access to lethal means, provision of care, and crisis response; however, we need to learn more about how these programs influence suicide rates. Second, more research must address the differential effectiveness of SP programs for population subgroups vulnerable to suicide.