VA researchers assessed the efficacy of a series of suicide prevention methods used around the world by reviewing randomized controlled trials. In their meta–analysis – a type of review study that combines data from past studies – they homed in on one WHO program, describing it as a "promising suicide prevention strategy." No other intervention showed a "statistically significant" effect in reducing death by suicide, they concluded.

Their review, published in April 2017 in The British Journal of Psychiatry, says three past trials found the WHO's brief intervention and contact (BIC) program to be linked to "significantly lower odds of suicide," specifically 80 percent less than the control group. The program targets people who go to an emergency room following a suicide attempt and involves a one–hour educational session and regular contact with a health care professional after they are discharged.

The researchers indicate that six trials apiece on two other suicide prevention strategies, cognitive behavioral therapy (CBT) and the drug lithium, showed fewer deaths by suicide among the intervention groups than the controls. But the differences were "not statistically significant."

Cognitive behavioral therapy is a short–term, low–risk psychotherapy that aims to change negative patterns of thinking or behavior that underlie people's difficulties, and to improve the way they feel by challenging unhelpful thinking patterns. Lithium is used to treat psychiatric illnesses such as bipolar disorder or manic depression. Based on positive evidence from past research, VA is doing a large trial to test lithium for suicide prevention that is scheduled to run through 2019.

The lead researcher on the review, Dr. Natalie Riblet, a psychiatrist at the White River Junction VA Medical Center in Vermont, cautions about the adaptability of the BIC program, which is not used in the VA system.

"Available results of the BIC trials may not be generalizable since the BIC program was only conducted in low– and middle–income countries," she says. "Our review suggests the program should be studied in high–income countries such as the United States and specifically in the Veteran population."

Death by suicide is an alarming problem in the Veteran community. Of the more than 40,000 suicides in the United States each year, about 20 percent are Veterans. Also, research suggests that 20 Veterans die by suicide each day, putting former service members at even greater risk than the general public.

VA/DoD clinical practice guidelines recommend a follow–up within seven days of discharge from hospitals and emergency rooms for patients who remain at high risk of suicide. The guidelines say the patients and family members should receive suicide prevention information, such as a crisis hotline telephone number, as well as treatment plans for psychiatric conditions and for suicide prevention therapies.

The BIC program was tested in low– to middle–income countries as part of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE–MISS), which was launched in 2002 to reduce morbidity and mortality tied to suicidal behaviors - both attempted suicide and death by suicide.

Riblet's study describes BIC as a "complex psychosocial intervention." Core elements of the program include a one–hour educational session about suicide risk before discharge from an inpatient setting or emergency room following a suicide attempt, as well as a structured follow–up by telephone or in person to help motivate patients to stay engaged in outpatient care.