Optimizing Suicide Prevention Programs and Their Implementation in Europe (OSPI Europe): an evidence-based multi-level approach

Abstract

BackgroundSuicide and non-fatal suicidal behaviour are significant public health issues in Europe requiring effective preventive interventions. However, the evidence for effective preventive strategies is scarce. The protocol of a European research project to develop an optimized evidence based program for suicide prevention is presented.MethodThe groundwork for this research has been established by a regional community based intervention for suicide prevention that focuses on improving awareness and care for depression performed within the European Alliance Against Depression (EAAD). The EAAD intervention consists of (1) training sessions and practice support for primary care physicians,(2) public relations activities and mass media campaigns, (3) training sessions for community facilitators who serve as gatekeepers for depressed and suicidal persons in the community and treatment and (4) outreach and support for high risk and self-help groups (e.g. helplines). The intervention has been shown to be effective in reducing suicidal behaviour in an earlier study, the Nuremberg Alliance Against Depression. In the context of the current research project described in this paper (OSPI-Europe) the EAAD model is enhanced by other evidence based interventions and implemented simultaneously and in standardised way in four regions in Ireland, Portugal, Hungary and Germany.The enhanced intervention will be evaluated using a prospective controlled design with the primary outcomes being composite suicidal acts (fatal and non-fatal), and with intermediate outcomes being the effect of training programs, changes in public attitudes, guideline-consistent media reporting. In addition an analysis of the economic costs and consequences will be undertaken, while a process evaluation will monitor implementation of the interventions within the different regions with varying organisational and healthcare contexts.DiscussionThis multi-centre research seeks to overcome major challenges of field research in suicide prevention. It pools data from four European regions, considerably increasing the study sample, which will be close to one million. In addition, the study will gather important information concerning the potential to transfer this multilevel program to other health care systems. The results of this research will provide a basis for developing an evidence-based, efficient concept for suicide prevention for EU-member states.

Suicides in the Centre of Portugal: Seven years analysis

“…These and many other studies have offered an approach on the typical profile of an increased suicide risk, in order to ensure the proper and targeted prevention strategies that have been outlined by the European Commission (suicide is one of five primal areas of the European Pact for Mental Health and Welfare, 2008) [14]. Family problems; economic, religious and cultural issues; social loss of cohesion; medical troubles, with a great influence of psychiatric history (alcohol, drugs, mood disorders…), difficulties at work, school or court; isolation; and even the newly titled Werther-Cobain effect, represent slices of the complex role of extreme motivations [3,8,9,11,15].…”

Perspectives de la santé publique pour la prévention du suicide

“…Ces programmes comportent des stratégies multimodales, et la clef de leur succès est leur application constante associée à une surveillance de son application. C'est l'orientation de l'étude d'implantation du programme de Nuremberg dans plusieurs sous-régions européennes (Hegerl et al, 2009). On pourrait argumenter de même alors que confrontées à des taux alarmants de suicide, les forces armées américaines n'arrivent pas à implanter suffisamment de ressources en santé mentale, pourtant un élément-clef de l'efficace programme de l'US Air Force (Thompson et Gibbs, 2012).…”

Innovative Prospects for Suicide Prevention and Action Opportunities for the Public Health Agency of Canada and the Government of Canada

“…The goal is to ensure that (a) the population is able to identify signs and symptoms when a person or a family member is depressed and to seek consultation and (b) that effective treatments are offered in the context of social services and health primary care. The best-known and most extensively studied program of bestpractices population strategies for treating depression was developed in Nuremberg and spread to several European countries (Hegerl, Althaus, Schmidtke, & Niklewski, 2006;Hegerl et al, 2009). It is based on four strategies: (a) raising public awareness of how to identify depression and of the fact that it can be treated; (b) training family physicians in the detection and therapeutic management of depression and suicide risks; (c) training of front-line psychosocial workers in the detection and therapeutic management of depression and suicide risks; and (d) improving the therapeutic management of people at known risk, such as those presenting in emergencies following a suicide attempt.…”

“…Il s'agit d'assurer (a) que la population soit en mesure d'identifier les signes et les symptômes lorsqu'une personne ou son proche souffre de dépression et consulter, et (b) que des traitements efficaces soient offerts dans un contexte de soins sociaux et de santé primaires. Le programme de straté-gies populationnelles du meilleur traitement de la dépression le plus connu et étudié est celui développé à Nuremberg et étendu dans plusieurs pays européens (Hegerl, Althaus, Schmidtke et Niklewski, 2006;Hegerl et al, 2009). Il repose sur quatre stratégies : (a) campagnes publiques de sensibilisation à l'identification de la dépression et au fait qu'elle peut être traitée; (b) formation des médecins de famille à la détection et la gestion thérapeutique de la dépression et des risques suicidaires; (c) formation des intervenantes et intervenants psychosociaux de première ligne à la détection et la gestion thérapeutique de la dépression et des risques suicidaires; et (d) amélioration de la gestion thérapeutique des personnes à risque connu, par exemple celles se présentant dans les urgences suite à une tentative suicidaire.…”