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BMC Medicine
Published in: BMC Medicine 1/2021

Open Access 01-12-2021 | Suicide | Research article

Reducing youth suicide: systems modelling and simulation to guide targeted investments across the determinants

Authors: Jo-An Occhipinti, Adam Skinner, Frank Iorfino, Kenny Lawson, Julie Sturgess, Warren Burgess, Tracey Davenport, Danica Hudson, Ian Hickie

Published in: BMC Medicine | Issue 1/2021

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Abstract

Background

Reducing suicidal behaviour (SB) is a critical public health issue globally. The complex interplay of social determinants, service system factors, population demographics, and behavioural dynamics makes it extraordinarily difficult for decision makers to determine the nature and balance of investments required to have the greatest impacts on SB. Real-world experimentation to establish the optimal targeting, timing, scale, frequency, and intensity of investments required across the determinants is unfeasible. Therefore, this study harnesses systems modelling and simulation to guide population-level decision making that represent best strategic allocation of limited resources.

Methods

Using a participatory approach, and informed by a range of national, state, and local datasets, a system dynamics model was developed, tested, and validated for a regional population catchment. The model incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and SB. Intervention scenarios were investigated to forecast their impact on SB over a 20-year period.

Results

A combination of social connectedness programs, technology-enabled coordinated care, post-attempt assertive aftercare, reductions in childhood adversity, and increasing youth employment projected the greatest impacts on SB, particularly in a youth population, reducing self-harm hospitalisations (suicide attempts) by 28.5% (95% interval 26.3–30.8%) and suicide deaths by 29.3% (95% interval 27.1–31.5%). Introducing additional interventions beyond the best performing suite of interventions produced only marginal improvement in population level impacts, highlighting that ‘more is not necessarily better.’

Conclusion

Results indicate that targeted investments in addressing the social determinants and in mental health services provides the best opportunity to reduce SB and suicide. Systems modelling and simulation offers a robust approach to leveraging best available research, data, and expert knowledge in a way that helps decision makers respond to the unique characteristics and drivers of SB in their catchments and more effectively focus limited health resources.
Appendix
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Metadata
Title
Reducing youth suicide: systems modelling and simulation to guide targeted investments across the determinants
Authors
Jo-An Occhipinti
Adam Skinner
Frank Iorfino
Kenny Lawson
Julie Sturgess
Warren Burgess
Tracey Davenport
Danica Hudson
Ian Hickie
Publication date
01-12-2021
Publisher
BioMed Central
Keywords
Suicide
Suicide
Published in
BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-021-01935-4

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