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Ajluni V, Amarasinghe D. Youth suicide crisis: identifying at-risk individuals and prevention strategies. Child Adolesc Psychiatry Ment Health 2024; 18:58. [PMID: 38783338 PMCID: PMC11119010 DOI: 10.1186/s13034-024-00753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Victor Ajluni
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Daniel Amarasinghe
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
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2
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Mergl R, Heinz I, Allgaier AK, Hegerl U. Munich Alliance Against Depression. CRISIS 2023; 44:300-308. [PMID: 35757934 PMCID: PMC10448895 DOI: 10.1027/0227-5910/a000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022]
Abstract
Background: A four-level community-based intervention aiming simultaneously to improve the care for depression and to prevent suicidal behavior has been implemented in the German city Munich. Aims: Changes in suicide rates in Munich during 2009-2014 were analyzed with respect to a 10-year baseline. The same was true for a control region (Cologne) and Germany minus Munich. Method: The interventions included training of primary care providers, a public awareness campaign, training of community facilitators, and support for patients and relatives. Analyses included repeated-measures, generalized linear models. Results: In Munich, the suicide rate significantly decreased during the intervention period compared to baseline (percentage change = -15.0%; p < .001, 198 compared to 222 suicides per year). Differences in the change for Munich and the change for the control locations (Cologne; -1.7%; p = .71) and Germany minus Munich (-6.2%; p = .09) were not significant. Limitations: Data on suicide attempts were unavailable. Conclusion: In Munich, a clinically and statistically significant decrease in suicide rate was found. This change was numerically but not significantly larger than in the control regions. The results are promising, however. Because of low suicide base rates and limited power, no strong conclusions can be drawn concerning suicide preventive effects of the intervention.
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Affiliation(s)
- Roland Mergl
- Institute of Psychology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Ines Heinz
- German Depression Foundation, Leipzig, Germany
| | | | - Ulrich Hegerl
- German Depression Foundation, Leipzig, Germany
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe-Universität, Frankfurt am Main, Germany
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3
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Braam MWG, Rasing SPA, Heijs DAM, Lokkerbol J, van Bergen DD, Creemers DHM, Spijker J. Closing the gap between screening and depression prevention: a qualitative study on barriers and facilitators from the perspective of public health professionals in a school-based prevention approach. BMC Public Health 2023; 23:884. [PMID: 37173740 PMCID: PMC10176867 DOI: 10.1186/s12889-023-15705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The prevalence of depression has increased among adolescents in western countries. Prevention is needed to reduce the number of adolescents who experience depression and to avoid negative consequences, including suicide. Several preventive interventions are found to be promising, especially multi-modal approaches, for example combining screening and preventive intervention. However, an important bottleneck arises during the implementation of preventive intervention. Only a small percentage of adolescents who are eligible for participation actually participate in the intervention. To ensure that more adolescents can benefit from prevention, we need to close the gap between detection and preventive intervention. We investigated the barriers and facilitators from the perspective of public health professionals in screening for depressive and suicidal symptoms and depression prevention referral in a school-based setting. METHODS We conducted 13 semi-structured interviews with public health professionals, who execute screening and depression prevention referral within the Strong Teens and Resilient Minds (STORM) approach. The interviews were recorded, transcribed verbatim, and coded in several cycles using ATLAS.ti Web. RESULTS Three main themes of barriers and facilitators emerged from the interviews, namely "professional capabilities," "organization and collaboration," and "beliefs about depressive and suicidal symptoms and participation in prevention". The interviews revealed that professionals do not always feel sufficiently equipped in terms of knowledge, skills and supporting networks. Consequently, they do not always feel well able to execute the process of screening and prevention referral. In addition, a lack of knowledge and support in schools and other cooperating organizationorganizations was seen to hinder the process. Last, the beliefs of public health professionals, school staff, adolescents, and parents -especially stigma and taboo-were found to make the screening and prevention referral process more challenging. CONCLUSIONS To further improve the process of screening and prevention referral in a school-based setting, enhancing professional competence and a holding work environment for professionals, a strong collaboration and a joint approach with schools and other cooperating organizations and society wide education about depressive and suicidal symptoms and preventive intervention are suggested. Future research should determine whether these recommendations actually lead to closing the gap between detection and prevention.
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Affiliation(s)
- Marloes W G Braam
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.
- GGZ Oost Brabant, Oss, the Netherlands.
| | - Sanne P A Rasing
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- GGZ Oost Brabant, Oss, the Netherlands
| | | | | | | | - Daan H M Creemers
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- GGZ Oost Brabant, Oss, the Netherlands
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- Pro Persona, Nijmegen, the Netherlands
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4
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Mann JJ, Michel CA, Auerbach RP. Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:182-196. [PMID: 37201140 PMCID: PMC10172556 DOI: 10.1176/appi.focus.23021004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Objective The authors sought to identify scalable evidence-based suicide prevention strategies. Methods A search of PubMed and Google Scholar identi- fied 20,234 articles published between September 2005 and December 2019, of which 97 were randomized controlled trials with suicidal behavior or ideation as primary outcomes or epidemiological studies of limiting access to lethal means, using educational approaches, and the impact of antidepressant treatment. Results Training primary care physicians in depression rec- ognition and treatment prevents suicide. Educating youths on depression and suicidal behavior, as well as active out- reach to psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior. Meta-analyses find that antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered. Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention. Cognitive-behavioral therapy and dialectical behavior therapy prevent suicidal behavior. Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression. Education of gatekeepers about youth suicidal behavior lacks effectiveness. No randomized trials have been reported for gatekeeper training for prevention of adult suicidal behavior. Algorithm-driven electronic health record screening, Internet-based screening, and smartphone passive monitoring to identify high-risk patients are under-studied. Means restriction, including of firearms, prevents suicide but is sporadically employed in the United States, even though firearms are used in half of all U.S. suicides. Conclusions Training general practitioners warrants wider implementation and testing in other nonpsychiatrist physi- cian settings. Active follow-up of patients after discharge or a suicide-related crisis should be routine, and restricting firearm access by at-risk individuals warrants wider use. Combination approaches in health care systems show promise in reducing suicide in several countries, but evaluating the benefit attributable to each component is essential. Further suicide rate reduction requires evaluating newer approaches, such as electronic health record-derived algorithms, Internet-based screening methods, ketamine's potential benefit for preventing attempts, and passive monitoring of acute suicide risk change.Reprinted from Am J Psychiatry 2021; 178:611-624, with permission from American Psychiatric Association Publishing. Copyright © 2021.
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Affiliation(s)
- J John Mann
- Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuro- science, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach)
| | - Christina A Michel
- Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuro- science, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach)
| | - Randy P Auerbach
- Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuro- science, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach)
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5
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Linskens EJ, Venables NC, Gustavson AM, Sayer NA, Murdoch M, MacDonald R, Ullman KE, McKenzie LG, Wilt TJ, Sultan S. Population- and Community-Based Interventions to Prevent Suicide. CRISIS 2022. [PMID: 36052582 DOI: 10.1027/0227-5910/a000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Suicide is estimated to account for 1.4% of deaths worldwide, making it among the leading causes of premature death. Public health approaches to reduce suicide have the potential to reach individuals across the spectrum of suicide risk. Aims: To review the effectiveness of newer community-based or population-level suicide prevention strategies. Methods: We conducted a systematic review of literature published from January 2010 to November 2020 to evaluate the effectiveness of community- and population-level interventions. The US Center for Disease Control framework was used for grouping studies by strategy. Results: We included 56 publications that described 47 unique studies. Interventions that reduce access to lethal means, implement organizational policies and culture in police workplace settings, and involve community screening for depression may reduce suicide deaths. It is unclear if other interventions such as public awareness and education campaigns, crisis lines, and gatekeeper training prevent suicide. Evidence was inconsistent for community-based, multistrategy interventions. The most promising multistrategy intervention was the European Alliance Against Depression. Limitations: Most eligible studies were observational and many lacked concurrent control groups or adjustment for confounding variables. Conclusions: Community-based interventions that may reduce suicide deaths include reducing access to lethal means, implementing organizational policies in workplace settings, screening for depression, and the multistrategy European Alliance Against Depression Program. Evidence was unclear, inconsistent, or lacking regarding the impact of many other single- or multistrategy interventions on suicide deaths.
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Affiliation(s)
- Eric J Linskens
- Minneapolis VA Evidence Synthesis Program Center and the VA Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
| | - Noah C Venables
- Minneapolis VA Evidence Synthesis Program Center and the VA Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Allison M Gustavson
- Minneapolis VA Evidence Synthesis Program Center and the VA Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
| | - Nina A Sayer
- Minneapolis VA Evidence Synthesis Program Center and the VA Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Maureen Murdoch
- Minneapolis VA Evidence Synthesis Program Center and the VA Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Roderick MacDonald
- Minneapolis VA Evidence Synthesis Program Center and the VA Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
| | - Kristen E Ullman
- Minneapolis VA Evidence Synthesis Program Center and the VA Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
| | - Lauren G McKenzie
- Minneapolis VA Evidence Synthesis Program Center and the VA Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
| | - Timothy J Wilt
- Minneapolis VA Evidence Synthesis Program Center and the VA Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Shahnaz Sultan
- Minneapolis VA Evidence Synthesis Program Center and the VA Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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6
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Spottswood M, Lim CT, Davydow D, Huang H. Improving Suicide Prevention in Primary Care for Differing Levels of Behavioral Health Integration: A Review. Front Med (Lausanne) 2022; 9:892205. [PMID: 35712115 PMCID: PMC9196265 DOI: 10.3389/fmed.2022.892205] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
Importance Suicide prevention implementation in primary care is needed due to the increasing rate of suicide in the past few decades, particularly for young and marginalized people. Primary care is the most likely point of contact for suicidal patients in the healthcare system. Attention to the level of medical integration with behavioral health is vital to suicide prevention and is applied throughout this review. Methods A narrative review was performed. Observations Many interventions help improve suicide prevention care. PCP education, screening, safety planning/lethal means reduction, care transitions, psychotherapy, and medication management are all evidence-based strategies. Additionally, the pragmatic topics of financing suicide prevention, supporting providers, enacting suicide postvention, and preparing for future directions in the field at each level of primary care/behavioral health integration are discussed. Conclusions and Relevance The findings are clinically relevant for practices interested in implementing evidence-based suicide prevention strategies by attending to the behavioral health/medical interface. Leveraging the patient/provider relationship to allow for optimal suicide prevention care requires clinics to structure provider time to allow for emotionally present care. Defining clear roles for staff and giving attention to provider well being are also critical factors to supporting primary care-based suicide prevention efforts.
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Affiliation(s)
- Margaret Spottswood
- Department of Psychiatry, University of Vermont Medical Center, University of Vermont, Burlington, VT, United States
- Department of Psychiatry, Community Health Centers of Burlington, Burlington, VT, United States
| | - Christopher T. Lim
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Dimitry Davydow
- Executive Leadership, Comprehensive Life Resources, Tacoma, WA, United States
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
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Reccord C, Power N, Hatfield K, Karaivanov Y, Mulay S, Wilson M, Pollock N. Rural-Urban Differences in Suicide Mortality: An Observational Study in Newfoundland and Labrador, Canada: Différences de la Mortalité Par Suicide en Milieu Rural-Urbain: Une Étude Observationnelle à Terre-Neuve et Labrador, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:918-928. [PMID: 33576277 PMCID: PMC8573702 DOI: 10.1177/0706743721990315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Suicide rates are higher in rural compared to urban areas. Although this pattern appears to be driven by higher rates among men, there is limited evidence about the characteristics of rural people who die by suicide in Canada. The objective of this study was to examine the demographics, manner of death, and social and clinical antecedents of people who died by suicide in rural areas compared to urban areas. METHODS We conducted an observational study of all suicide deaths that occurred among Newfoundland and Labrador residents between 1997 and 2016 using a linked data set derived from a comprehensive review of provincial medical examiner records. We used t tests and χ2 to assess associations between rural/urban status and variables related to demographics, circumstances, and manner of death, as well as social and medical history. Logistic regression was utilized to assess the independent contribution of any variable found to be significant in univariate analysis. RESULTS Rural people who died by suicide accounted for 54.8% of all deaths over a 20-year period. Overall, 81.6% of people who died were male. Compared to urban, rural people who died by suicide were younger, more likely to use firearms or hanging, and had a higher mean blood alcohol content at the time of death (27.69 vs. 22.95 mmol/L). Rural people were also less likely to have had a known history of a prior suicide attempt, psychiatric disorder, alcohol or substance abuse, or chronic pain. DISCUSSION The demographic and clinical differences between rural and urban people who died by suicide underscore the need for suicide prevention approaches that account for place-based differences. A key challenge for suicide prevention in rural communities is to ensure that interventions are developed and implemented in a manner that fits local contexts.
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Affiliation(s)
- Charlene Reccord
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nicole Power
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Keeley Hatfield
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada.,McMaster University, Hamilton, Ontario, Canada
| | - Yordan Karaivanov
- Medical Services, Labrador Health Centre, Labrador-Grenfell Health, Labrador, Newfoundland and Labrador, Canada.,Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Margo Wilson
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nathaniel Pollock
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,School of Public Health, University of Alberta, Edmonton, Canada.,School of Arctic and Subarctic Studies, Labrador Institute, Memorial University, Happy Valley-Goose Bay, NL
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8
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Mann JJ, Michel CA, Auerbach RP. Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review. Am J Psychiatry 2021; 178:611-624. [PMID: 33596680 PMCID: PMC9092896 DOI: 10.1176/appi.ajp.2020.20060864] [Citation(s) in RCA: 218] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to identify scalable evidence-based suicide prevention strategies. METHODS A search of PubMed and Google Scholar identified 20,234 articles published between September 2005 and December 2019, of which 97 were randomized controlled trials with suicidal behavior or ideation as primary outcomes or epidemiological studies of limiting access to lethal means, using educational approaches, and the impact of antidepressant treatment. RESULTS Training primary care physicians in depression recognition and treatment prevents suicide. Educating youths on depression and suicidal behavior, as well as active outreach to psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior. Meta-analyses find that antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered. Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention. Cognitive-behavioral therapy and dialectical behavior therapy prevent suicidal behavior. Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression. Education of gatekeepers about youth suicidal behavior lacks effectiveness. No randomized trials have been reported for gatekeeper training for prevention of adult suicidal behavior. Algorithm-driven electronic health record screening, Internet-based screening, and smartphone passive monitoring to identify high-risk patients are understudied. Means restriction, including of firearms, prevents suicide but is sporadically employed in the United States, even though firearms are used in half of all U.S. suicides. CONCLUSIONS Training general practitioners warrants wider implementation and testing in other nonpsychiatrist physician settings. Active follow-up of patients after discharge or a suicide-related crisis should be routine, and restricting firearm access by at-risk individuals warrants wider use. Combination approaches in health care systems show promise in reducing suicide in several countries, but evaluating the benefit attributable to each component is essential. Further suicide rate reduction requires evaluating newer approaches, such as electronic health record-derived algorithms, Internet-based screening methods, ketamine's potential benefit for preventing attempts, and passive monitoring of acute suicide risk change.
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Affiliation(s)
- J. John Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, and Department of Psychiatry and Radiology, Columbia University, New York, NY
| | - Christina A. Michel
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY
| | - Randy P. Auerbach
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, and Department of Psychiatry, Columbia University, New York, NY,Division of Clinical Developmental Neuroscience, Sackler Institute
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9
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Abstract
This chapter presents a narrative synthesis of the evidence relating to the effectiveness of 13 different approaches (interventions) that have been incorporated into national suicide prevention programs. These approaches are presented in an analytic framework that distinguishes between national and community-based multilevel programs, prevention, and treatment/maintenance. The primary source of evidence are six reviews of reviews published since 2005, supplemented by a small number of systematic reviews and primary studies. We report strongly supportive evidence concerning the effectiveness of structural interventions (restrictions on access to bridges, tall buildings, and railways) and restriction on access to pharmacological agents. Weakly supportive evidence of effectiveness is available for community-based multilevel programs; restrictions on access to firearms and ligature points in institutional settings; settings-based programs (in schools, communities, workplaces, prisons, and the armed forces); education and training targeted at primary care physicians; lithium; cognitive behavioral therapy and dialectical behavioral therapy; and brief contact. There is insufficient or conflicting evidence concerning the effectiveness of the remaining approaches. We conclude that the evidence base for effective suicide prevention is far from convincing. Major improvement in the extent and quality of collaboration between researchers, policymakers, and practitioners and a considerable increase in funding for evaluation studies in suicide prevention are required if the current knowledge gap about effective interventions is to be bridged.
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10
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Hawgood J, Ownsworth T, Kõlves K, Spence SH, Arensman E, De Leo D. Impact of Systematic Tailored Assessment for Responding to Suicidality (STARS) Protocol Training on Mental Health Professionals' Attitudes, Perceived Capabilities, Knowledge, and Reluctance to Intervene. Front Psychiatry 2021; 12:827060. [PMID: 35211039 PMCID: PMC8861433 DOI: 10.3389/fpsyt.2021.827060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND AIMS Systematic Tailored Assessment for Responding to Suicidality (STARS) protocol and associated training were developed with the key objectives of supporting clinicians to conduct a suicide enquiry, obtaining a comprehensive account of psycho-social factors contributing to suicidality, and collaboratively developing a safety plan with clients. STARS training aims to address knowledge, attitudes and capabilities that influence intervention behavior/skills. This study aimed to examine associations between clinician characteristics and pre-training competencies in suicide risk assessment (SRA), as well as the impact of STARS training workshop on clinician competencies; and to determine the predictors of SRA training outcomes. METHOD Australian mental health professionals working with suicidal persons who undertook the STARS 2-day face-to-face workshop between 2018 and 2020 completed an online survey at pre- and post-training. Of the 222 participants who completed the pre-training questionnaire, 144 (64.9%) also completed the post-training questionnaire. Participants were mostly female (75.7%), had completed a university degree (86.4%), had <10 years of experience in suicide prevention (71.7%), and were allied and mental health professionals (78.1%). We used linear mixed-effects regression for statistical analyses. RESULTS STARS participants who reported higher perceived capability at baseline had significantly greater formal and informal training, more years of experience in suicide prevention, and were more likely to have experienced client suicide and/or suicide attempt and to report fewer SRA related fears. We found overall significant positive impacts of STARS training on clinician competencies (attitudes, perceived capability, declarative knowledge) from pre- to post-training. The most distinct changes following STARS training were for perceived capability and declarative knowledge. Participants who had more positive attitudes after training were significantly more likely to have had less prior supervision/mentoring. Reluctance to intervene was not found to significantly change after training. CONCLUSIONS We found evidence that attitudes, perceived capability and declarative knowledge changed positively from pre- to post-STARS training among mental health professionals. Underpinned by the minimum standardized SRA competencies, STARS training may be critical for informing evidence-based knowledge and skills in SRA and safety planning.
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Affiliation(s)
- Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Menzies Health Institute of Queensland, The Hopkins Centre, Griffith University, Queensland, QLD, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Susan H Spence
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland.,Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
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11
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Hegerl U, Heinz I, O'Connor A, Reich H. The 4-Level Approach: Prevention of Suicidal Behaviour Through Community-Based Intervention. Front Psychiatry 2021; 12:760491. [PMID: 34925092 PMCID: PMC8679083 DOI: 10.3389/fpsyt.2021.760491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
Due to the many different factors contributing to diagnostic and therapeutic deficits concerning depression and the risk of suicidal behaviour, community-based interventions combining different measures are considered the most efficient way to address these important areas of public health. The network of the European Alliance Against Depression has implemented in more than 120 regions within and outside of Europe community-based 4-level-interventions that combine activities at four levels: (i) primary care, (ii) general public, (iii) community facilitators and gatekeepers (e.g., police, journalists, caregivers, pharmacists, and teachers), and (iv) patients, individuals at high risk and their relatives. This review will discuss lessons learned from these broad implementation activities. These include targeting depression and suicidal behaviour within one approach; being simultaneously active on the four different levels; promoting bottom-up initiatives; and avoiding any cooperation with the pharmaceutical industry for reasons of credibility.
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Affiliation(s)
- Ulrich Hegerl
- Johann Christian Senckenberg Distinguished Professorship, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany.,German Depression Foundation, Leipzig, Germany.,German Alliance Against Depression, Leipzig, Germany.,European Alliance Against Depression e.V., Frankfurt, Germany
| | - Ines Heinz
- German Depression Foundation, Leipzig, Germany.,German Alliance Against Depression, Leipzig, Germany
| | | | - Hanna Reich
- German Depression Foundation, Leipzig, Germany.,Depression Research Centre of the German Depression Foundation, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
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12
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van der Burgt MCA, Beekman ATF, Hoogendoorn AW, Berkelmans G, Franx G, Gilissen R. The effect of local Suicide Prevention Action Networks (SUPRANET) on stigma, taboo and attitudes towards professional help-seeking: an exposure-response analysis. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2199-2208. [PMID: 33934184 PMCID: PMC8558270 DOI: 10.1007/s00127-021-02078-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE In 2017, the European Alliance against Depression (EAAD) programme was introduced in the Netherlands through the creation of six local Suicide Prevention Action Networks (SUPRANET Community). This programme consists of interventions on four levels: (1) a public awareness campaign, (2) training local gatekeepers, (3) targeting high-risk persons in the community and (4) training of primary care professionals. This study aims to gain insight into the effectiveness of the SUPRANET programme on attitudinal changes in the general public by studying the exposure-response relationship. METHODS A repeated cross-sectional design, using general population surveys to measure key variables over time. The surveys were conducted in the six intervention regions (N = 2586) and in the Netherlands as a whole as a control region (N = 4187) and include questions on socio-demographic variables, brand awareness of the Dutch helpline, perceived taboo on suicide, attitudes towards depression and help-seeking. To examine the exposure-response relationship, regions were differentiated into 3 groups: low, medium and high exposure of the SUPRANET programme. RESULTS The results revealed that respondents in the intervention regions considered professional help to be more valuable and were more likely to be familiar with the Dutch helpline than respondents in the control region. In the exposure-response analyses, the grading of effects was too small to reach statistical significance. CONCLUSION Our study provides the first evidence for the effectiveness of the SUPRANET Community programme on creating attitudinal change in the general public.
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Affiliation(s)
- Margot C. A. van der Burgt
- 113 Suicide Prevention, Amsterdam, The Netherlands ,Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands ,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Adriaan W. Hoogendoorn
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands ,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Guus Berkelmans
- 113 Suicide Prevention, Amsterdam, The Netherlands ,Centrum Wiskunde & Informatica (CWI), Amsterdam, The Netherlands
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Kollmann B, Darwiesh T, Tüscher O, Lieb K. The Importance of Assessing Mental Health Issues and Preventing Suicidality in Studies on Healthy Participants. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:75-77. [PMID: 32945743 DOI: 10.1080/15265161.2020.1806387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Bianca Kollmann
- University Medical Center Mainz
- Leibniz Institute for Resilience Research (LIR) gGmbH
| | | | - Oliver Tüscher
- University Medical Center Mainz
- Leibniz Institute for Resilience Research (LIR) gGmbH
| | - Klaus Lieb
- University Medical Center Mainz
- Leibniz Institute for Resilience Research (LIR) gGmbH
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Hill K, Somerset S, Schwarzer R, Chan C. Promoting the Community's Ability to Detect and Respond to Suicide Risk Through an Online Bystander Intervention Model-Informed Tool. CRISIS 2020; 42:225-231. [PMID: 32781898 DOI: 10.1027/0227-5910/a000708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: The public health sector has advocated for more innovative, technology-based, suicide prevention education for the community, to improve their ability to detect and respond to suicide risk. Emerging evidence suggests addressing the bystander effect through the Bystander Intervention Model (BIM) in education material may have potential for suicide prevention. Aims: The current study aimed to assess whether BIM-informed tools can lead to improved readiness, confidence and intent in the community to detect and respond to suicide risk in others. Method: A sample of 281 adults recruited from the community participated in a randomized controlled trial comprising a factsheet designed according to the BIM (intervention group) and a standard factsheet about suicide and mental health (control group). Participants' self-reported detecting and responding to suicide risk readiness, confidence, and intent when presented with a suicidal peer was tested pre- and postintervention and compared across time and between groups. Results: The intervention group had significantly higher levels of detecting and responding to suicide risk readiness, confidence, and intent than the control group at postintervention (all p < .001) with moderate-to-large effect sizes. Limitations: The study was limited by a homogenous sample, too low numbers at follow-up to report, and self-report data only. Conclusion: This study demonstrates BIM-informed suicide prevention training may enhance the community's intervention readiness, confidence, and intent better than current standard material. Further testing in this area is recommended. While results were statistically significant, clinical significance requires further exploration.
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Affiliation(s)
- Karien Hill
- Department of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Shawn Somerset
- Department of Public Health, University of Canberra, Australia
| | - Ralf Schwarzer
- Department of Health Psychology, Free University of Berlin, Germany
| | - Carina Chan
- Department of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Möller HJ, Bitter I, Bobes J, Fountoulakis K, Höschl C, Kasper S. Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression. Eur Psychiatry 2020; 27:114-28. [DOI: 10.1016/j.eurpsy.2011.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 12/28/2022] Open
Abstract
AbstractThis position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5–7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk–benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of ‘the right drug/treatment for the right patient’ is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact.
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Hegerl U, Maxwell M, Harris F, Koburger N, Mergl R, Székely A, Arensman E, Van Audenhove C, Larkin C, Toth MD, Quintão S, Värnik A, Genz A, Sarchiapone M, McDaid D, Schmidtke A, Purebl G, Coyne JC, Gusmão R. Prevention of suicidal behaviour: Results of a controlled community-based intervention study in four European countries. PLoS One 2019; 14:e0224602. [PMID: 31710620 PMCID: PMC6844461 DOI: 10.1371/journal.pone.0224602] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 10/17/2019] [Indexed: 11/18/2022] Open
Abstract
The 'European Alliance Against Depression' community-based intervention approach simultaneously targets depression and suicidal behaviour by a multifaceted community based intervention and has been implemented in more than 115 regions worldwide. The two main aims of the European Union funded project "Optimizing Suicide Prevention Programmes and Their Implementation in Europe" were to optimise this approach and to evaluate its implementation and impact. This paper reports on the primary outcome of the intervention (the number of completed and attempted suicides combined as 'suicidal acts') and on results concerning process evaluation analysis. Interventions were implemented in four European cities in Germany, Hungary, Portugal and Ireland, with matched control sites. The intervention comprised activities with predefined minimal intensity at four levels: training of primary care providers, a public awareness campaign, training of community facilitators, support for patients and their relatives. Changes in frequency of suicidal acts with respect to a one-year baseline in the four intervention regions were compared to those in the four control regions (chi-square tests). The decrease in suicidal acts compared to baseline in the intervention regions (-58 cases, -3.26%) did not differ significantly (χ2 = 0.13; p = 0.72) from the decrease in the control regions (-18 cases, -1.40%). However, intervention effects differed between countries (χ2 = 8.59; p = 0.04), with significant effects on suicidal acts in Portugal (χ2 = 4.82; p = 0.03). The interviews and observations explored local circumstances in each site throughout the study. Hypothesised mechanisms of action for successful implementation were observed and drivers for 'added-value' were identified: local partnership working and 'in-kind' contributions; an approach which valued existing partnership strengths; and synergies operating across intervention levels. It can be assumed that significant events during the implementation phase had a certain impact on the observed outcomes. However, this impact was, of course, not proven.
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland, United Kingdom
| | - Fiona Harris
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland, United Kingdom
| | - Nicole Koburger
- Department of Research Services, University of Leipzig, Leipzig, Saxonia, Germany
| | - Roland Mergl
- Department of Psychology, Bundeswehr University Munich
| | - András Székely
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - Ella Arensman
- National Suicide Research Foundation and School of Public Health, University College Cork, Cork, Ireland
| | - Chantal Van Audenhove
- Center for care research and consultancy at KU Leuven (LUCAS), University of Leuven, Leuven, Belgium
| | - Celine Larkin
- National Suicide Research Foundation and School of Public Health, University College Cork, Cork, Ireland
| | - Mónika Ditta Toth
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - Sónia Quintão
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Airi Värnik
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn, Estonia & Tallinn University, Tallinn, Estonia
| | - Axel Genz
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Otto-von-Guericke University, Magdeburg, Saxonia-Anhalt, Germany
| | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - David McDaid
- London School of Economics and Political Science, London, United Kingdom
| | - Armin Schmidtke
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Bavaria, Germany
| | - György Purebl
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - James C. Coyne
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ricardo Gusmão
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- ISPUP, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
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Pollock NJ. Place, the Built Environment, and Means Restriction in Suicide Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224389. [PMID: 31717635 PMCID: PMC6888187 DOI: 10.3390/ijerph16224389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 01/19/2023]
Abstract
Restricting access to lethal means is a key public health intervention for preventing suicide. Means restriction research has often focused on suicide methods that are modifiable through legislation or policy interventions. However, some of the most common methods such as hanging may not be sensitive to regulation. The aims of this paper are to examine built environment and place-based approaches to means restriction in suicide prevention, and further consider the connections between place, the environment, and suicide methods. To increase knowledge about specific methods and mechanisms of injury in suicide deaths, higher resolution data for surveillance and epidemiology is required. Data that can be used to better discern patterns about specific locations and materials used in suicide and self-harm will support efforts to uncover new directions for prevention.
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Affiliation(s)
- Nathaniel J. Pollock
- School of Public Health, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John’s, NL A1C 5S7, Canada
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de Beurs D, ten Have M, Cuijpers P, de Graaf R. The longitudinal association between lifetime mental disorders and first onset or recurrent suicide ideation. BMC Psychiatry 2019; 19:345. [PMID: 31694603 PMCID: PMC6836643 DOI: 10.1186/s12888-019-2328-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/17/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although the cross-sectional association between mental disorders and suicide ideation is well studied, less is known about the prospective association. In this paper, we estimated among those without 12-month suicide ideation at baseline, the association between a wide variety of common mental disorders at baseline and suicide ideation within the 6-year follow-up period, after controlling for history of other mental disorders and demographic variables. METHODS Data were used from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a prospective representative adult cohort study with baseline (n = 6646) with a 6-year follow-up period. Lifetime mental disorders were assessed at baseline with the Composite International Diagnostic Interview 3.0. Within the longitudinal design, participants with first time or recurrent suicide ideation were defined follows: having no suicide ideation in the 12 months before the baseline assessment, and reporting to have had seriously thought about suicide between baseline and the 6-year follow-up period. Multiple logistical regression was used to estimate the longitudinal association between suicide ideation and a specific mental disorder while controlling for comorbidity and baseline variables. To account for the prevalence of a disorder in the population, for each disorder, the population attributable risk proportion (PARP) was calculated. RESULTS 2.9% (n = 132) of the participants that did not report suicide ideation in the past 12 months at baseline reported suicide ideation at follow-up. Of these 132 cases, 81 (61%) experienced suicide ideation for the first time in their lives and could be viewed as first onset cases. 51 (39%) reported recurrent suicide ideation. After controlling for comorbidity, the only two disorders that were significantly related to suicide ideation at follow-up were lifetime major depressive disorder (MDD) and generalized anxiety disorder (GAD). PARP for MDD was 47.8 and 16.6% for GAD. CONCLUSIONS After controlling for all other mental disorders, a lifetime history of MDD and GAD were related to suicide ideation at follow-up. For clinical practice, this indicates that patients with a history of MDD or GAD stay vulnerable for suicide ideation, even though they did not report suicide ideation in the past year.
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Affiliation(s)
- Derek de Beurs
- Netherlands Institute of Health Services Research, Utrecht, Netherlands. .,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Margreet ten Have
- 0000 0001 0835 8259grid.416017.5Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Pim Cuijpers
- 0000 0004 1754 9227grid.12380.38Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ron de Graaf
- 0000 0001 0835 8259grid.416017.5Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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19
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Grendas LN, Rojas SM, Puppo S, Vidjen P, Portela A, Chiapella L, Rodante DE, Daray FM. Interaction between prospective risk factors in the prediction of suicide risk. J Affect Disord 2019; 258:144-150. [PMID: 31401542 DOI: 10.1016/j.jad.2019.07.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/03/2019] [Accepted: 07/29/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND To meet the goal of preventing suicide the most important thing is to know the risk factors of suicidal behavior and understand their interaction. AIMS The current study aims to evaluate prospective predictors and the interaction between factors for suicide and suicide re-attempts in high-risk, suicidal patients during a 24 month prospective follow-up period. METHODS A multicenter prospective cohort study was designed to compare data obtained from 324 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Participants were clinically evaluated at baseline and follow-up every 6 months to assess any unfavorable events (suicide or a suicide attempt). To estimate the rate of unfavorable events, the Kaplan-Meier method was used and Cox Proportional Hazards Regression Model was employed to examine predictors of suicide and suicide reattempt. RESULTS The incidence of a new suicide attempt was 26,000 events/100,000 persons-years. The incidence of death by suicide was 1110 events/100,000 person-year. The most reliable predictors of unfavorable events were being women, previous suicide attempts, younger age, and childhood sexual abuse. Findings revealed an interaction between childhood sexual abuse and low psychosocial functioning that increased the risk of an unfavorable event. CONCLUSION The risk of suicide re-attempts and suicide in the current 2-year follow-up was high. There was an interaction between low psychosocial functioning and childhood sexual abuse. This evidence should be taken into account for the evaluation and planning of preventive strategies.
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Affiliation(s)
- Leandro N Grendas
- University of Buenos Aires, School of Medicine, Institute of Pharmacology, Argentina; Teodoro Alvarez Hospital, City of Buenos Aires, Argentina
| | - Sasha M Rojas
- University of Arkansas, Department of Psychological Science, Fayetteville, United States
| | - Soledad Puppo
- Hospital de Clínicas José de San Martín, City of Buenos Aires, Argentina
| | - Patricia Vidjen
- José Tiburcio Borda Hospital, City of Buenos Aires, Argentina
| | - Alicia Portela
- José Tiburcio Borda Hospital, City of Buenos Aires, Argentina
| | - Luciana Chiapella
- National University of Rosario, School of Biochemical and Pharmaceutical Sciences, Argentina; National Scientific and Technical Research Council (CONICET), Argentina
| | - Demián E Rodante
- University of Buenos Aires, School of Medicine, Institute of Pharmacology, Argentina; Braulio A. Moyano Neuropsychiatric Hospital, City of Buenos Aires, Argentina
| | - Federico M Daray
- University of Buenos Aires, School of Medicine, Institute of Pharmacology, Argentina; National Scientific and Technical Research Council (CONICET), Argentina.
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Gratzer D, Goldbloom D. ThriveNYC Is Ambitious—Lessons From the International Experience With Mental Health Reform Can Make It Successful. Am J Public Health 2019; 109:S166-S167. [DOI: 10.2105/ajph.2019.305083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- David Gratzer
- David Gratzer and David S. Goldbloom are with the Centre for Addiction and Mental Health, Toronto, and the Department of Psychiatry, University of Toronto, Toronto, ON
| | - David Goldbloom
- David Gratzer and David S. Goldbloom are with the Centre for Addiction and Mental Health, Toronto, and the Department of Psychiatry, University of Toronto, Toronto, ON
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21
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Goldstone D, Bantjes J, Dannatt L. Mental health care providers' suggestions for suicide prevention among people with substance use disorders in South Africa: a qualitative study. Subst Abuse Treat Prev Policy 2018; 13:47. [PMID: 30526637 PMCID: PMC6286590 DOI: 10.1186/s13011-018-0185-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND People with substance use disorders (PWSUDs) are a clearly delineated group at high risk for suicidal behaviour. Expert consensus is that suicide prevention strategies should be culturally sensitive and specific to particular populations and socio-cultural and economic contexts. The aim of this study was to explore mental health care providers' context- and population-specific suggestions for suicide prevention when providing services for PWSUDs in the Western Cape, South Africa. METHODS Qualitative data were collected via in-depth, semi-structured interviews with 18 mental health care providers providing services to PWSUDs in the public and private health care sectors of the Western Cape, South Africa. Data were analysed inductively using thematic analysis. RESULTS Participants highlighted the importance of providing effective mental health care, transforming the mental health care system, community interventions, and early intervention, in order to prevent suicide amongst PWSUDs. Many of their suggestions reflected basic principles of effective mental health care provision. However, participants also suggested further training in suicide prevention for mental health care providers, optimising the use of existing health care resources, expanding service provision for suicidal PWSUDs, improving policies and regulations for the treatment of substance use disorders, provision of integrated health care, and focusing on early intervention to prevent suicide. CONCLUSIONS Training mental health care providers in suicide prevention must be augmented by addressing systemic problems in the provision of mental health care and contextual problems that make suicide prevention challenging. Many of the suggestions offered by these participants depart from individualist, biomedical approaches to suicide prevention to include a more contextual view of suicide prevention. A re-thinking of traditional bio-medical approaches to suicide prevention may be warranted in order to reduce suicide among PWSUDs.
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Affiliation(s)
- Daniel Goldstone
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602 South Africa
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602 South Africa
| | - Lisa Dannatt
- Department of Psychiatry and Mental Health, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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22
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Bachmann S. Epidemiology of Suicide and the Psychiatric Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1425. [PMID: 29986446 PMCID: PMC6068947 DOI: 10.3390/ijerph15071425] [Citation(s) in RCA: 658] [Impact Index Per Article: 109.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 06/28/2018] [Accepted: 07/01/2018] [Indexed: 12/12/2022]
Abstract
Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.
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Affiliation(s)
- Silke Bachmann
- Clienia Littenheid AG, Hauptstrasse 130, 9573 Littenheid, Switzerland.
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University Halle (Saale), Julius-Kühn-Strasse 7, 6112 Halle (Saale), Germany.
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Lenz B, Röther M, Bouna-Pyrrou P, Mühle C, Tektas OY, Kornhuber J. The androgen model of suicide completion. Prog Neurobiol 2018; 172:84-103. [PMID: 29886148 DOI: 10.1016/j.pneurobio.2018.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 09/02/2017] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
Suicide is a devastating public health issue that imposes severe psychological, social, and economic burdens not only for the individuals but also for their relatives, friends, clinicians, and the general public. Among the different suicidal behaviors, suicide completion is the worst and the most relevant outcome. The knowledge of biological etiopathological mechanisms involved in suicide completion is limited. Hitherto, no objective markers, either alone or in combination, can reliably predict who will complete a suicide. However, such parameters are strongly needed to establish and optimize prediction and prevention. We introduce here a novel ideation-to-completion framework in suicide research and discuss the problems of studies aiming at identifying and validating clinically useful markers. The male gender is a specific risk factor for suicide, which suggests that androgen effects are implicated in the transition from suicidal ideation to suicide completion. We present multiple lines of direct and indirect evidence showing that both an increased prenatal androgen load (with subsequent permanent neuroadaptations) and increased adult androgen activity are involved in suicide completion. We also review data arguing that modifiable maternal behavioral traits during pregnancy contribute to the offspring's prenatal androgen load and increase the risk for suicide completion later in life. We conclude that in utero androgen exposure and adult androgen levels facilitate suicide completion in an synergistic manner. The androgen model of suicide completion provides the basis for the development of novel predictive and preventive strategies in the future.
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Affiliation(s)
- Bernd Lenz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
| | - Mareike Röther
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Polyxeni Bouna-Pyrrou
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Christiane Mühle
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Ozan Y Tektas
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
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Baker STE, Nicholas J, Shand F, Green R, Christensen H. A comparison of multi-component systems approaches to suicide prevention. Australas Psychiatry 2018; 26:128-131. [PMID: 29160089 PMCID: PMC5888769 DOI: 10.1177/1039856217743888] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the new Australian approach to suicide prevention, LifeSpan, and compare it to other multi-component intervention models. METHOD The components, implementation strategies and effectiveness of three multi-component intervention models are described and compared in a narrative review. RESULTS The LifeSpan, European Alliance Against Depression (EAAD), and Zero Suicide models emphasise the provision of evidence-based interventions and continuity of care. Only LifeSpan and EAAD include community-based interventions at the population level, and LifeSpan is the only model to include school-based interventions. Zero Suicide focuses on healthcare settings. Implementation of LifeSpan and EAAD involves the convening of multi-stakeholder teams at the local level. To date, there is some, albeit mixed, evidence in support of EAAD, while LifeSpan and Zero Suicide await further evaluation. CONCLUSIONS Although multi-component approaches to suicide prevention share similar components, there are some important differences. Multiple interventions implemented at the same time and tailored to the local community context are likely to be the most effective way of reducing the rate of suicide. There is growing evidence for the effectiveness of multi-component systems approaches to suicide prevention; however, further evaluation is required.
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Affiliation(s)
- Simon TE Baker
- Research Officer, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
| | - Jennifer Nicholas
- PhD Candidate, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
| | - Fiona Shand
- Research Director, LifeSpan, and Senior Research Fellow, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
| | - Rachel Green
- Director, LifeSpan, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
| | - Helen Christensen
- Director and Chief Scientist, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
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Collings S, Jenkin G, Stanley J, McKenzie S, Hatcher S. Preventing suicidal behaviours with a multilevel intervention: a cluster randomised controlled trial. BMC Public Health 2018; 18:140. [PMID: 29338723 PMCID: PMC5771156 DOI: 10.1186/s12889-018-5032-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 01/04/2018] [Indexed: 11/16/2022] Open
Abstract
Background In the context of the recent surge in community based multilevel interventions for suicide prevention, all of which show promising results, we discuss the implications of the findings of such an intervention designed for and implemented in New Zealand. The multi-level intervention for suicide prevention in New Zealand (MISP-NZ) was a cluster randomised controlled community intervention trial involving eight hospital regions matched into four pairs and randomised to either the intervention or practice as usual (the control). Intervention regions received 25 months of interventions (01 June 2010 to 30 June 2012) including: 1) training in recognition of suicide risk factors; 2) workshops on mental health issues; 3) community based interventions (linking in with community events); and 4) distribution of print material and information on web-based resources. Results There was no significant difference between the change in rate of suicidal behaviours (ISH or self-inflicted deaths) in the intervention group compared with the control group (rate ratio = 1.07, 95% CI 0.82, 1.38). Conclusions This study did not provide substantive evidence that the MISP-NZ intervention had an effect on suicidal behaviours raising important questions about the potential effectiveness of the multilevel intervention model for suicide prevention for all countries. Although a range of factors may account for this unanticipated finding, including inadequate study power, differences in design and intervention focus, and country-specific contextual factors, it is possible that the effectiveness of the multilevel intervention model for reducing suicidal behaviours may have been overstated. Trial registration This trial was retrospectively registered on 11 April 2013. ACTRN12613000399796.
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Affiliation(s)
- Sunny Collings
- Suicide and Mental Health Research Group, University of Otago, PO Box 7343, Mein St, Newtown, Wellington, New Zealand.
| | - Gabrielle Jenkin
- Suicide and Mental Health Research Group, University of Otago, PO Box 7343, Mein St, Newtown, Wellington, New Zealand
| | - James Stanley
- University of Otago, PO Box 7343, Mein St, Newtown, Wellington, New Zealand
| | - Sarah McKenzie
- Suicide and Mental Health Research Group, University of Otago, PO Box 7343, Mein St, Newtown, Wellington, New Zealand
| | - Simon Hatcher
- Department of Psychiatry and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
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Abstract
More than 800 000 people die every year from suicide, and about 20 times more attempt suicide. In most countries, suicide risk is highest in older males, and risk of attempted suicide is highest in younger females. The higher lethal level of suicidal acts in males is explained by the preference for more lethal methods, as well as other factors. In the vast majority of cases, suicidal behavior occurs in the context of psychiatric disorders, depression being the most important one. Improving the treatment of depression, restricting access to lethal means, and avoiding the Werther effect (imitation suicide) are central aspects of suicide prevention programs. In several European regions, the four-level intervention concept of the European Alliance Against Depression (www.EAAD.net), simultaneously targeting depression and suicidal behavior, has been found to have preventive effects on suicidal behavior. It has already been implemented in more than 100 regions in Europe.
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University Hospital of Leipzig, Leipzig, Germany
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Parra-Uribe I, Blasco-Fontecilla H, Garcia-Parés G, Martínez-Naval L, Valero-Coppin O, Cebrià-Meca A, Oquendo MA, Palao-Vidal D. Risk of re-attempts and suicide death after a suicide attempt: A survival analysis. BMC Psychiatry 2017; 17:163. [PMID: 28472923 PMCID: PMC5415954 DOI: 10.1186/s12888-017-1317-z] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/20/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Suicide is the primary cause of unnatural death in Spain, and suicide re-attempts a major economic burden worldwide. The risk factors for re-attempt and suicide after an index suicide attempt are different. This study aims to investigate risk factors for re-attempt and suicide after an index suicide attempt. METHODS This observational study is part of a one-year telephone management program. We included all first-time suicide attempters evaluated in the emergency department at Parc Taulí-University Hospital (n = 1241) recruited over a five-year period (January 2008 to December 2012). Suicide attempters were evaluated at baseline using standardized instruments. Bivariate logistic regression models were used to identify risk factors. Kaplan-Meier curves were used to compare the time to re-attempt between categorical variables. Comparisons were performed using Log-Rank and Wilcoxon tests. Variables with a p-value lower than 0.2 were included in a multivariate Cox regression model. Bivariate logistic regression models were considered to identify risk factors for suicide. The significance level was set to 0.05. RESULTS Suicide re-attempters were more likely diagnosed with cluster B personality disorders (36.8% vs. 16.6%; p < 0.001), and alcohol use disorders (19.8 vs. 13.9; p = 0.02). Several [1.2% (15/1241)] of them died by suicide. Attempters who suicide were more likely alcohol users (33.3% vs. 17.2%; p = 0.047), and older (50.9 ± 11.9 vs. 40.7 ± 16.0; p = 0.004). CONCLUSIONS Alcohol use, personality disorders and younger age are risk factors for re-attempting. Older age is a risk factor for suicide among suicide attempters. Current prevention programs of suicidal behaviour should be tailored to the specific profile of each group.
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Affiliation(s)
- Isabel Parra-Uribe
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208 Sabadell, Barcelone Spain ,grid.7080.fDepartment of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelone, Spain ,0000 0004 1762 4012grid.418264.dCIBERSAM, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, Autonoma University of Madrid, Avenida Manuel de Falla s/n, Madrid, Spain. .,CIBERSAM, Madrid, Spain.
| | - Gemma Garcia-Parés
- Department of Mental Health, Meritxell Hospital, Andorra la Vella, Andorra
| | | | - Oliver Valero-Coppin
- grid.7080.fStatistical Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annabel Cebrià-Meca
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208 Sabadell, Barcelone Spain ,0000 0004 1762 4012grid.418264.dCIBERSAM, Madrid, Spain
| | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
| | - Diego Palao-Vidal
- Department of Mental Health, Parc Tauli-University Hospital, Parc Taulí 1, 08208, Sabadell, Barcelone, Spain. .,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelone, Spain. .,CIBERSAM, Madrid, Spain.
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Gilissen R, De Beurs D, Mokkenstorm J, Mérelle S, Donker G, Terpstra S, Derijck C, Franx G. Improving Suicide Prevention in Dutch Regions by Creating Local Suicide Prevention Action Networks (SUPRANET): A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040349. [PMID: 28350367 PMCID: PMC5409550 DOI: 10.3390/ijerph14040349] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/16/2017] [Accepted: 03/22/2017] [Indexed: 11/16/2022]
Abstract
The European Alliance against Depression (EAAD) program is to be introduced in The Netherlands from 2017 onwards. This program to combat suicide consists of interventions on four levels: (1) increasing the awareness of suicide by local media campaigns; (2) training local gatekeepers, such as teachers or police officers; (3) targeting high-risk persons in the community; and (4) training and support of professionals in primary care settings. The implementation starts in seven Dutch pilot regions. Each region is designated as a Suicide Prevention Action NETwork (SUPRANET). This paper describes the SUPRANET program components and the evaluation of its feasibility and impact. The findings will be used to facilitate the national implementation of EAAD in The Netherlands and to add new findings to the existing literature on EAAD.
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Affiliation(s)
- Renske Gilissen
- Department of Research, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (J.M.); (S.T.)
- Correspondence:
| | - Derek De Beurs
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands; (D.d.B.); (G.D.)
| | - Jan Mokkenstorm
- Department of Research, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (J.M.); (S.T.)
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT Amsterdam, The Netherlands
- Department of Research & Innovation, GGZ inGeest, 1070 BB Amsterdam, The Netherlands
| | - Saskia Mérelle
- Public Health Service (GGD) Kennemerland, 2015 CK Haarlem, The Netherlands;
| | - Gé Donker
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands; (D.d.B.); (G.D.)
| | - Sanne Terpstra
- Department of Research, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (J.M.); (S.T.)
| | - Carla Derijck
- Department of Implementation, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (C.D.); ; (G.F.)
| | | | - Gerdien Franx
- Department of Implementation, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (C.D.); ; (G.F.)
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Keller SN, Wilkinson T. Preventing Suicide in Montana: A Community-Based Theatre Intervention. JOURNAL OF SOCIAL MARKETING 2017; 7:423-440. [PMID: 29255588 PMCID: PMC5731785 DOI: 10.1108/jsocm-12-2016-0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE This study examined whether a community-based suicide prevention project could increase willingness to seek professional help for suicidal ideation among eastern Montana youth. DESIGN Online surveys were administered at baseline (N = 224) and six months post-test (N = 217) consisting of the Risk Behavior Diagnosis Scale (RBD), self-report questions on suicidality, willingness to engage with suicide prevention resources, and willingness to communicate with peers, family members, teachers or counselors about suicide. FINDINGS A comparison of means within groups from pre- to post-test showed increases in self-efficacy for communicating about suicidal concerns with a teacher, school counselor or social worker; increases in self-efficacy for helping others; and increases in response-efficacy of interpersonal communication about suicide with a teacher, school counselor or social worker. PRACTICAL IMPLICATIONS Young adults need to be willing and able to intervene in life-threatening situations affecting their peers. In step with narrative empowerment education, personal experiences can be used to communicatively reduce peer resistance to behavior change. ORIGINALITY Health communicators tend to rely on overly didactic education and awareness-raising when addressing suicide prevention. This research shows the importance of direct and personal forms of influence advocated by social marketing professionals.
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Affiliation(s)
- Sarah N Keller
- Department of Communication & Theater, Montana State University Billings, 1500 University Drive, Billings, MT 59101, (406) 896-5824,
| | - Tim Wilkinson
- Professor and Charles L. Boppell Dean, School of Business, Whitworth University, 300 W. Hawthorne Road, Spokane, WA 99251, (509) 777-4567,
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Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, Carli V, Höschl C, Barzilay R, Balazs J, Purebl G, Kahn JP, Sáiz PA, Lipsicas CB, Bobes J, Cozman D, Hegerl U, Zohar J. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry 2016; 3:646-59. [PMID: 27289303 DOI: 10.1016/s2215-0366(16)30030-x] [Citation(s) in RCA: 967] [Impact Index Per Article: 120.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/27/2016] [Accepted: 03/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide prevention interventions since 2005. METHODS We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis. FINDINGS We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0·45, 95% CI 0·24-0·85; p=0·014) and suicidal ideation (0·5, 0·27-0·92; p=0·025). The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions. INTERPRETATION In the quest for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs. FUNDING The Expert Platform on Mental Health, Focus on Depression, and the European College of Neuropsychopharmacology.
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Affiliation(s)
- Gil Zalsman
- Geha Mental Health Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA.
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | | | - Ella Arensman
- National Suicide Research Foundation, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Via De Santis Campobasso and National Institute for Health, Migration and Poverty, Roma, Italy
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Cyril Höschl
- National Institute of Mental Health, Klecany, Czech Republic
| | - Ran Barzilay
- Geha Mental Health Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - György Purebl
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - Jean Pierre Kahn
- Université de Lorraine, Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy-Laxou, Nancy-Laxou, France
| | - Pilar Alejandra Sáiz
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, Spain
| | - Cendrine Bursztein Lipsicas
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, Spain
| | - Doina Cozman
- Department of Clinical Psychology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Joseph Zohar
- Psychiatry Department, Sheba Health Center and Sackler School of Medicine, Tel Aviv University, Tel Avis, Israel
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de Beurs DP, Hooiveld M, Kerkhof AJFM, Korevaar JC, Donker GA. Trends in suicidal behaviour in Dutch general practice 1983-2013: a retrospective observational study. BMJ Open 2016; 6:e010868. [PMID: 27165647 PMCID: PMC4874133 DOI: 10.1136/bmjopen-2015-010868] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To analyse trends in suicidal behaviour as reported by the Dutch sentinel general practices from 1983 to 2013. Second, to examine the relationship between suicidal behaviour and several patient characteristics. Finally, to compare the relationship between suicidal behaviour and patient characteristics before (1983-2007) and after (2008-2013) the start of the crisis. SETTING 40 general practices in the Netherlands during the period 1983-2013. PARTICIPANTS Patients with an ICPC code of P77 (suicide attempt). PRIMARY AND SECONDARY OUTCOMES Primary outcomes were age-adjusted and gender-specific trends in reported suicides (342) and suicide attempts (1614). Secondary outcomes were the relationship between suicidal behaviour and age, household composition, history of depression, recognition of suicide ideation, treatment before the suicidal behaviour and contact within the past month before suicidal behaviour for the period 1983-2013. Additionally, separate frequencies for the periods 1983-2007 and 2008-2013 were presented. RESULTS Join-point analyses revealed a significant rise in male suicides from 2008 (b=0.32, SE=0.1, p=0.008), and an increase in male suicide attempts since 2009 (b=0.19, SE=0.04, p<0.001). Female suicidal behaviour showed a steady decrease from 1989 to 2013(b=-0.03, SE=0.007, p<0.0001 for female suicide, b=-0.02, SE=0.002, p<0.001 for female attempts). Before 2007, a history of depression was reported in 65% (168/257) of the suicides. After the start of the recession, a depression was recognised in 44% (22/50) of the patients who died by suicide. CONCLUSIONS Since 2008, there was a rise in the male suicide rate while female suicide behaviour has continued to decline. General practitioners less often reported a history of depression within patients who died due to suicide after 2007 than before. Training in the early recognition of suicide ideation in depressive patients might improve suicide prevention in primary care.
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Affiliation(s)
- Derek P de Beurs
- Netherlands Institute for Health Services Research (NIVEL, Utrecht, The Netherlands
| | - Mariette Hooiveld
- Netherlands Institute for Health Services Research (NIVEL, Utrecht, The Netherlands
| | - Ad J F M Kerkhof
- Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL, Utrecht, The Netherlands
| | - Gé A Donker
- Netherlands Institute for Health Services Research (NIVEL, Utrecht, The Netherlands
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Marzano L, Smith M, Long M, Kisby C, Hawton K. Police and Suicide Prevention. CRISIS 2016; 37:194-204. [DOI: 10.1027/0227-5910/a000381] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Abstract. Background: Police officers are frequently the first responders to individuals in crisis, but generally receive little training for this role. We developed and evaluated training in suicide awareness and prevention for frontline rail police in the UK. Aims: To investigate the impact of training on officers’ suicide prevention attitudes, confidence, and knowledge. Method: Fifty-three participants completed a brief questionnaire before and after undertaking training. In addition, two focus groups were conducted with 10 officers to explore in greater depth their views and experiences of the training program and the perceived impact on practice. Results: Baseline levels of suicide prevention attitudes, confidence, and knowledge were mixed but mostly positive and improved significantly after training. Such improvements were seemingly maintained over time, but there was insufficient power to test this statistically. Feedback on the course was generally excellent, notwithstanding some criticisms and suggestions for improvement. Conclusion: Training in suicide prevention appears to have been well received and to have had a beneficial impact on officers’ attitudes, confidence, and knowledge. Further research is needed to assess its longer-term effects on police attitudes, skills, and interactions with suicidal individuals, and to establish its relative effectiveness in the context of multilevel interventions.
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Affiliation(s)
- Lisa Marzano
- Psychology Department, Middlesex University, London, UK
| | | | | | | | - Keith Hawton
- Centre for Suicide Research, University of Oxford, UK
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de Beurs DP, de Groot MH, de Keijser J, van Duijn E, de Winter RFP, Kerkhof AJFM. Evaluation of benefit to patients of training mental health professionals in suicide guidelines: cluster randomised trial. Br J Psychiatry 2016; 208:477-83. [PMID: 26678866 DOI: 10.1192/bjp.bp.114.156208] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 05/09/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Randomised studies examining the effect on patients of training professionals in adherence to suicide guidelines are scarce. AIMS To assess whether patients benefited from the training of professionals in adherence to suicide guidelines. METHOD In total 45 psychiatric departments were randomised (Dutch trial register: NTR3092). In the intervention condition, all staff in the departments were trained with an e-learning supported train-the-trainer programme. After the intervention, patients were assessed at admission and at 3-month follow-up. Primary outcome was change in suicide ideation, assessed with the Beck Scale for Suicide Ideation. RESULTS For the total group of 566 patients with a positive score on the Beck Scale for Suicide Ideation at baseline, intention-to-treat analysis showed no effects of the intervention on patient outcomes at 3-month follow-up. Patients who were suicidal with a DSM-IV diagnosis of depression (n = 154) showed a significant decrease in suicide ideation when treated in the intervention group. Patients in the intervention group more often reported that suicidality was discussed during treatment. CONCLUSIONS Overall, no effect of our intervention on patients was found. However, we did find a beneficial effect of the training of professionals on patients with depression.
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Affiliation(s)
- Derek P de Beurs
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Marieke H de Groot
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Jos de Keijser
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Erik van Duijn
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Remco F P de Winter
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Ad J F M Kerkhof
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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[From the Competence Network on Depression and Suicidality to the German Depression Foundation. National and international prevention of suicidal behaviour and optimizing health care through using of E‑Mental-Health]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:406-11. [PMID: 26961867 DOI: 10.1007/s00103-016-2310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Depression is a very common, severe, socio-economically highly relevant disorder and the main cause for approximately 10,000 suicides in Germany annually. There is capital room for improvement and optimization of the care for depressed patients, as effective and evidence-based treatment options are available. However, they are only used optimally by a minority of the people affected due to huge diagnostic and therapeutic deficits. The "Compentence Network on Depression and Suicidality" provided several evidence-based concepts to improve care for patients affected by depression and to prevent suicidal behaviour. Especially the four-level intervention approach of the Alliances Against Depression has been successfully adapted and implemented by more than 100 regions within Europe and globally as well. The infrastructure of the Competence Network could be efficiently sustained throughout the establishment of the German Depression Foundation and the European Alliance against Depression. Since 2014, all research activities have been extended nationally and internationally by the establishment of a Depression Research Centre with a special focus on various E‑Mental-Health-projects.
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Hegerl U, Arensman E, van Audenhove C, Baader T, Gusmão R, Ibelshäuser A, Merali Z, Rummel-Kluge C, Peréz Sola V, Pycha R, Värnik A, Székely A. Community-based 4-level approach: Background, implementation and evidence for efficacy. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The community-based 4-level-intervention concept developed within the “European Alliance against Depression” (http://www.eaad.net/) combines two important aims: to improve the care and treatment of patients with depression and to prevent suicidal behavior. It has been shown to be effective concerning the prevention of suicidal behavior [1–4] and is worldwide the most broadly implemented community-based intervention targeting depression and suicidal behavior. The 4-level intervention concept comprises training and support of primary care providers (level 1), a professional public relation campaign (level 2), training of community facilitators (teacher, priests, geriatric caregivers, pharmacists, journalists) (level 3), and support for self-help of patients with depression and for their relatives (level 4). In order to deepen the understanding of factors influencing the effectiveness of the intervention, a systematic implementation research and process analysis was performed within the EU-funded study “Optimizing Suicide Prevention Programs and Their Implementation in Europe” (http://www.ospi-europe.com/; 7th Framework Programme) [5]. These analyses were based on data from four intervention and four control regions from four European countries. In addition to intervention effects on suicidal behaviour, a variety of intermediate outcomes (e.g. changes in attitude or knowledge in different populations) were considered. Strong synergistic as well as catalytic effects were identified as a result of being active simultaneously at four different levels. Predictable and unpredictable obstacles to a successful implementation of such community-based programs will be discussed. Via the EAAD, the intervention concept and materials (available in eight different languages) are offered to interested region in and outside of Europe.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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de Beurs DP, Bosmans JE, de Groot MH, de Keijser J, van Duijn E, de Winter RFP, Kerkhof AJFM. Training mental health professionals in suicide practice guideline adherence: Cost-effectiveness analysis alongside a randomized controlled trial. J Affect Disord 2015; 186:203-10. [PMID: 26247913 DOI: 10.1016/j.jad.2015.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/13/2015] [Accepted: 07/23/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is a lack of information on the cost-effectiveness of suicide prevention interventions. The current study examines the cost-effectiveness of a multifaceted structured intervention aiming to improve adherence to the national suicide practice guideline in comparison with usual implementation. METHODS In the intervention condition, professionals of psychiatric departments were trained using an e-learning supported Train-the-Trainer program. Newly admitted suicidal patients were assessed as soon as their department was trained and at 3 months follow-up. The primary outcome was improvement in suicide ideation. Missing cost and effect data were imputed using multiple imputation. Cost-effectiveness planes were plotted, and cost-effectiveness acceptability curves were estimated. RESULTS For the total group of suicidal patients (n=566), no effect of the intervention on suicide ideation or costs was found. For a subgroup of depressed suicidal patients (n=154, intervention=75, control=79), mean level of suicide ideation decreased with 2.7 extra points in the intervention condition, but this was not statistically significant. For this subgroup, the intervention may be considered cost-effective in comparison with usual implementation if society is willing to pay≥€ 6100 per unit of effect on the suicide ideation scale extra. LIMITATIONS Considering the cost outcomes, we had almost no cases that were complete, and heavily relied on statistical techniques to impute the missing data. Also, diagnoses were not derived from structured clinical interviews. CONCLUSIONS We presented the first randomized trial (trial registration: The Netherlands Trial Register (NTR3092 www.trialregister.nl)) on cost-effectiveness of a suicide practice guideline implementation in mental health care. The intervention might be considered cost-effective for depressed suicidal patients if society is willing to make substantial investments.
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Affiliation(s)
- Derek P de Beurs
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands; The Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Nethterlands.
| | - Judith E Bosmans
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marieke H de Groot
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - Jos de Keijser
- GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands
| | - Erik van Duijn
- GGZ Foundation for Mental Health Care Delfland, The Netherlands
| | - Remco F P de Winter
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands; GGZ Foundation for Mental Health Care, Parnassia Group, The Netherlands
| | - Ad J F M Kerkhof
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
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An e-learning supported Train-the-Trainer program to implement a suicide practice guideline. Rationale, content and dissemination in Dutch mental health care. Internet Interv 2015. [DOI: 10.1016/j.invent.2015.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Arensman E, Koburger N, Larkin C, Karwig G, Coffey C, Maxwell M, Harris F, Rummel-Kluge C, van Audenhove C, Sisask M, Alexandrova-Karamanova A, Perez V, Purebl G, Cebria A, Palao D, Costa S, Mark L, Tóth MD, Gecheva M, Ibelshäuser A, Gusmão R, Hegerl U. Depression Awareness and Self-Management Through the Internet: Protocol for an Internationally Standardized Approach. JMIR Res Protoc 2015; 4:e99. [PMID: 26251104 PMCID: PMC4705028 DOI: 10.2196/resprot.4358] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 11/13/2022] Open
Abstract
Background Depression incurs significant morbidity and confers increased risk of suicide. Many individuals experiencing depression remain untreated due to systemic and personal barriers to care. Guided Internet-based psychotherapeutic programs represent a promising means of overcoming such barriers and increasing the capacity for self-management of depression. However, existing programs tend to be available only in English and can be expensive to access. Furthermore, despite evidence of the effectiveness of a number of Internet-based programs, there is limited evidence regarding both the acceptability of such programs and feasibility of their use, for users and health care professionals. Objective This paper will present the protocol for the development, implementation, and evaluation of the iFightDepression tool, an Internet-based self-management tool. This is a cost-free, multilingual, guided, self-management program for mild to moderate depression cases. Methods The Preventing Depression and Improving Awareness through Networking in the European Union consortium undertook a comprehensive systematic review of the available evidence regarding computerized cognitive behavior therapy in addition to a consensus process involving mental health experts and service users to inform the development of the iFightDepression tool. The tool was implemented and evaluated for acceptability and feasibility of its use in a pilot phase in 5 European regions, with recruitment of users occurring through general practitioners and health care professionals who participated in a standardized training program. Results Targeting mild to moderate depression, the iFightDepression tool is based on cognitive behavioral therapy and addresses behavioral activation (monitoring and planning daily activities), cognitive restructuring (identifying and challenging unhelpful thoughts), sleep regulation, mood monitoring, and healthy lifestyle habits. There is also a tailored version of the tool for young people, incorporating less formal language and additional age-appropriate modules on relationships and social anxiety. The tool is accompanied by a 3-hour training intervention for health care professionals. Conclusions It is intended that the iFightDepression tool and associated training for health care professionals will represent a valuable resource for the management of depression that will complement existing resources for health care professionals. It is also intended that the iFightDepression tool and training will represent an additional resource within a multifaceted approach to improving the care of depression and preventing suicidal behavior in Europe.
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Affiliation(s)
- Ella Arensman
- National Suicide Research Foundation, Cork, Ireland.
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de Beurs DP, de Groot MH, de Keijser J, Mokkenstorm J, van Duijn E, de Winter RFP, Kerkhof AJFM. The effect of an e-learning supported Train-the-Trainer programme on implementation of suicide guidelines in mental health care. J Affect Disord 2015; 175:446-53. [PMID: 25679199 DOI: 10.1016/j.jad.2015.01.046] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Randomized studies examining the effect of training of mental health professionals in suicide prevention guidelines are scarce. We assessed whether professionals benefited from an e-learning supported Train-the-Trainer programme aimed at the application of the Dutch multidisciplinary suicide prevention guideline. METHODS 45 psychiatric departments from all over the Netherlands were clustered in pairs and randomized. In the experimental condition, all of the staff of psychiatric departments was trained by peers with an e-learning supported Train-the-Trainer programme. Guideline adherence of individual professionals was measured by means of the response to on-line video fragments. Multilevel analyses were used to establish whether variation between conditions was due to differences between individual professionals or departments. RESULTS Multilevel analysis showed that the intervention resulted in an improvement of individual professionals. At the 3 month follow-up, professionals who received the intervention showed greater guideline adherence, improved self-perceived knowledge and improved confidence as providers of care than professionals who were only exposed to traditional guideline dissemination. Subgroup analyses showed that improved guideline adherence was found among nurses but not among psychiatrists and psychologists. No significant effect of the intervention on team performance was found. LIMITATIONS The ICT environment in departments was often technically inadequate when displaying the video clips clip of the survey. This may have caused considerable drop-out and possibly introduced selection bias, as professionals who were strongly affiliated to the theme of the study might have been more likely to finish the study. CONCLUSIONS Our results support the idea that an e-learning supported Train-the-Trainer programme is an effective strategy for implementing clinical guidelines and improving care for suicidal patients. TRIAL REGISTRATION Netherlands Trial Register (NTR3092 www.trialregister.nl).
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Affiliation(s)
- Derek P de Beurs
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | - Marieke H de Groot
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | | | - Jan Mokkenstorm
- GGZ Foundation for Mental Health Care GGZ inGeest, The Netherlands.
| | - Erik van Duijn
- GGZ Foundation for Mental Health Care Delfland, The Netherlands.
| | - Remco F P de Winter
- GGZ Foundation for Mental Health Care, Parnassia, The Hague, The Netherlands.
| | - Ad J F M Kerkhof
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
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Hickie IB, McGorry PD, Christensen H. Getting mental health reform back on track: a leadership challenge for the new Australian Government. Med J Aust 2014; 201:323. [DOI: 10.5694/mja14.00841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/24/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Ian B Hickie
- Brain & Mind Research Institute, University of Sydney, Sydney, NSW
| | - Patrick D McGorry
- Orygen Youth Health Research Centre, University of Melbourne, Melbourne, VIC
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Coppens E, Van Audenhove C, Iddi S, Arensman E, Gottlebe K, Koburger N, Coffey C, Gusmão R, Quintão S, Costa S, Székely A, Hegerl U. Effectiveness of community facilitator training in improving knowledge, attitudes, and confidence in relation to depression and suicidal behavior: results of the OSPI-Europe intervention in four European countries. J Affect Disord 2014; 165:142-50. [PMID: 24882192 DOI: 10.1016/j.jad.2014.04.052] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Community facilitators (CFs), such as teachers, nurses and social workers, are well placed as gatekeepers for depression and suicidal behavior, but not properly prepared to provide preventive and supportive services. The current study aimed: (1) to improve CFs' attitudes toward depression, knowledge on suicide, and confidence to detect suicidal behavior in four European countries and (2) to identify specific training needs across regions and CF groups. METHODS A standardized training program was provided to 1276 CFs in Germany, Hungary, Ireland, and Portugal. Attitudes toward depression, knowledge about suicide, and confidence in identifying suicidal persons were assessed before training, after training, and at three to six months follow-up. Additionally, several participants' characteristics were registered. RESULTS At baseline, CFs showed relatively favorable attitudes toward depression, but limited knowledge on suicide, and little confidence to identify suicidal behavior. Basic skills strongly differed across CF groups and countries. For example, in Germany, carers for the elderly, nurses, teachers, and managers were most in need of training, while in Portugal pharmacists and the clergy appeared to be important target groups. Most importantly, the training program improved the competencies of CF groups across countries and these improvements were sustained after three to six months. CFs with low basic skills benefited most of the training. LIMITATIONS The observed training effects could be influenced by other external factors as our results are based upon a pre-post comparison with no control group. CONCLUSIONS Gatekeeper trainings in community settings are successful in improving knowledge, reshaping attitudes, and boosting the confidence of gatekeepers. The most effective strategy to achieve the preferred objectives is to target those CF groups that are most in need of training and to tailor the content of the training program to the individual needs of the target group.
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Affiliation(s)
- Evelien Coppens
- LUCAS, Centre for Care Research and Consultancy, University of Leuven, Leuven, Belgium
| | - Chantal Van Audenhove
- LUCAS, Centre for Care Research and Consultancy, University of Leuven, Leuven, Belgium.
| | - Samuel Iddi
- Biostatistics and Statistical Bioinformatics Centre, University of Leuven, Leuven, Belgium; Department of Statistics, University of Ghana, Ghana
| | - Ella Arensman
- National Suicide Research Foundation & Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Katrin Gottlebe
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Nicole Koburger
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Claire Coffey
- National Suicide Research Foundation & Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Ricardo Gusmão
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal; Serviço de Psiquiatria, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Sónia Quintão
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Susana Costa
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal
| | - András Székely
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
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Triñanes Y, Senra-Rivera C, Seoane-Pesqueira G, González-García A, Álvarez-Ariza M, de-Las-Heras-Liñero E, Atienza G. [Perceived satisfaction and usefulness of suicide prevention information for patients and relatives]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2014; 29:36-42. [PMID: 24210519 DOI: 10.1016/j.cali.2013.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 09/17/2013] [Accepted: 09/18/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the satisfaction of persons with suicidal behaviour and their relatives using patient information material included in the Clinical Practice Guidelines on Prevention and Treatment of Suicidal Behaviour. METHOD The sample was made up of 57 patients with suicidal ideation or behaviour, and 52 relatives. The participants were recruited through a suicide prevention programme (Programa de intervención intensiva en conducta suicida [PII] - Suicidal Behaviour Intensive Intervention Programme) and a family association (Federación de Asociaciones de Familiares y Personas con enfermedad mental de Galicia [FEAFES] - Galician Federation of Associations of Relatives and Persons with mental diseases). An ad-hoc questionnaire was designed to ascertain the degree of perceived satisfaction and usefulness of using the information included in the guidelines. RESULTS The descriptive data of the sample is presented, along with an exploratory factorial analysis of the questionnaire that yielded two dimensions, i.e., format and usefulness. Patients scored significantly lower than the relatives in two dimensions; nevertheless, no significant differences were found between the two groups in the level of general satisfaction. The socio-demographic variables did not influence the results. Similarly, no differences were observed between patients with and without history of suicidal behaviour. Participants stressed that Primary Care was the setting best suited for dissemination of this type of information. CONCLUSIONS In general, both patients and relatives displayed a high level of satisfaction with the patient information material assessed. Furnishing information of this type to patients with suicidal ideation and/or behaviour could act as a preventive-educational tool.
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Affiliation(s)
- Y Triñanes
- Axencia de Avaliación de Tecnoloxías Sanitarias de Galicia, Consellería de Sanidade, Santiago de Compostela, España.
| | - C Senra-Rivera
- Departamento de Psicología Clínica y Psicobiología, Universidad de Santiago de Compostela, Santiago de Compostela, España
| | - G Seoane-Pesqueira
- Departamento de Psicología Social, Básica y Metodología, Universidad de Santiago de Compostela, Santiago de Compostela, España
| | - A González-García
- Programa de Intervención Intensiva en conducta suicida, Complexo Hospitalario de Ourense, Ourense, España
| | - M Álvarez-Ariza
- Servicio de Psiquiatría, Complexo Hospitalario Universitario de Vigo, Vigo, España
| | | | - G Atienza
- Axencia de Avaliación de Tecnoloxías Sanitarias de Galicia, Consellería de Sanidade, Santiago de Compostela, España
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Hegerl U, Rummel-Kluge C, Värnik A, Arensman E, Koburger N. Alliances against depression – A community based approach to target depression and to prevent suicidal behaviour. Neurosci Biobehav Rev 2013; 37:2404-9. [DOI: 10.1016/j.neubiorev.2013.02.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 02/01/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
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de Beurs DP, de Groot MH, Bosmans JE, de Keijser J, Mokkenstorm J, Verwey B, van Duijn E, de Winter RFP, Kerkhof AJFM. Reducing patients' suicide ideation through training mental health teams in the application of the Dutch multidisciplinary practice guideline on assessment and treatment of suicidal behavior: study protocol of a randomized controlled trial. Trials 2013; 14:372. [PMID: 24195781 PMCID: PMC3826515 DOI: 10.1186/1745-6215-14-372] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 10/23/2013] [Indexed: 11/22/2022] Open
Abstract
Background To strengthen suicide prevention skills in mental health care in The Netherlands, multidisciplinary teams throughout the country are trained in the application of the new Dutch guideline on the assessment and treatment of suicidal behavior. Previous studies have shown beneficial effects of additional efforts for guideline implementation on professionals’ attitude, knowledge, and skills. However, the effects on patients are equally important, but are rarely measured. The main objective of this study is to examine whether patients of multidisciplinary teams who are trained in guideline application show greater recovery from suicide ideation than patients of untrained teams. Methods/Design This is a multicentre cluster randomized controlled trial (RCT), in which multidisciplinary teams from mental health care institutions are matched in pairs, and randomly allocated to either the experimental or control condition. In the experimental condition, next to the usual dissemination of the guideline (internet, newsletter, books, publications, and congresses), teams will be trained in the application of the guideline via a 1-day small interactive group training program supported by e-learning modules. In the control condition, no additional actions next to usual dissemination of the guideline will be undertaken. Assessments at patient level will start when the experimental teams are trained. Assessments will take place upon admission and after 3 months, or earlier if the patient is discharged. The primary outcome is suicide ideation. Secondary outcomes are non-fatal suicide attempts, level of treatment satisfaction, and societal costs. Both a cost-effectiveness and cost-utility analysis will be performed. The effects of the intervention will be examined in multilevel models. Discussion The strengths of this study are the size of the study, RCT design, training of complete multidisciplinary teams, and the willingness of both management and staff to participate. Trial registration Netherlands trial register: NTR3092
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Affiliation(s)
- Derek P de Beurs
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
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Székely A, Konkolÿ Thege B, Mergl R, Birkás E, Rózsa S, Purebl G, Hegerl U. How to decrease suicide rates in both genders? An effectiveness study of a community-based intervention (EAAD). PLoS One 2013; 8:e75081. [PMID: 24086443 PMCID: PMC3781024 DOI: 10.1371/journal.pone.0075081] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/09/2013] [Indexed: 11/18/2022] Open
Abstract
Background The suicide rate in Hungary is high in international comparison. The two-year community-based four-level intervention programme of the European Alliance Against Depression (EAAD) is designed to improve the care of depression and to prevent suicidal behaviour. Our aim was to evaluate the effectiveness of a regional community-based four-level suicide prevention programme on suicide rates. Method The EAAD programme was implemented in Szolnok (population 76,311), a town in a region of Hungary with an exceptionally high suicide rate. Effectiveness was assessed by comparing changes in suicide rates in the intervention region after the intervention started with changes in national suicide rates and those in a control region (Szeged) in the corresponding period. Results For the duration of the programme and the follow-up year, suicide rates in Szolnok were significantly lower than the average of the previous three years (p = .0076). The suicide rate thus went down from 30.1 per 100,000 in 2004 to 13.2 in 2005 (−56.1 %), 14.6 in 2006 (−51.4 %) and 12.0 in 2007 (−60.1 %). This decrease of annual suicide rates in Szolnok after the onset of the intervention was significantly stronger than that observed in the whole country (p = .017) and in the control region (p = .0015). Men had the same decrease in suicide rates as women. As secondary outcome, an increase of emergency calls to the hotline service (200%) and outpatient visits at the local psychiatry clinic (76%) was found. Conclusions These results seem to provide further support for the effectiveness of the EAAD concept. Whilst the majority of suicide prevention programs mainly affect female suicidal behaviour, this programme seems to be beneficial for both sexes. The sustainability and the role of the mediating factors (social service and health care utilization, community attitudes about suicide) should be key points in future research.
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Affiliation(s)
- András Székely
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Barna Konkolÿ Thege
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Roland Mergl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig AoR, Leipzig, Germany
| | - Emma Birkás
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Sándor Rózsa
- Department of Personality and Health Psychology, Eötvös Loránd University, Budapest, Hungary
| | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Ulrich Hegerl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig AoR, Leipzig, Germany
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The impact of a depression awareness campaign on mental health literacy and mental morbidity among gay men. J Affect Disord 2013; 150:306-12. [PMID: 23683994 DOI: 10.1016/j.jad.2013.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/15/2013] [Accepted: 04/15/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND High prevalences of depression and suicidality have been found among gay men. This paper assesses the possible impact of Blues-out, a depression awareness campaign based on the European Alliance Against Depression targeting the gay/lesbian community in Geneva, Switzerland. METHODS In 2007 and 2011, pre- and post-intervention surveys were conducted among two distinct samples of gay men in Geneva, recruited by probability-based time-space sampling. Effect sizes and net percent changes are reported for mental health literacy and mental health outcomes in 2007 and 2011 as well as among men aware and unaware of Blues-out in 2011. RESULTS 43% of the respondents correctly recognized depression in 2011 with no change vis-à-vis 2007. Despite small effect sizes, significant net decreases (from -18% to -28%) were seen in lifetime suicide plans, 12-month suicidal ideation, lifetime depression, and 4-week psychological distress between 2007 and 2011. These decreases were not accompanied by changes in any of the numerous items on attitudes/knowledge, found only when comparing men aware and unaware of Blues-out in 2011. More men aware of Blues-out found specialists and psychological therapies helpful than their counterparts and correctly identified depression and gay men's greater risk for depression. LIMITATIONS Community-level assessment with no control. CONCLUSIONS Although improvement in depression recognition and decrease in suicide attempts could not be replicated unequivocally in this adapted intervention among gay men, there are indications that this evidence-based depression awareness campaign may have lessened suicidality and mental morbidity and improved mental health literacy and help-seeking.
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Harris FM, Maxwell M, O’Connor RC, Coyne J, Arensman E, Székely A, Gusmão R, Coffey C, Costa S, Cserháti Z, Koburger N, van Audenhove C, McDaid D, Maloney J, Värnik P, Hegerl U. Developing social capital in implementing a complex intervention: a process evaluation of the early implementation of a suicide prevention intervention in four European countries. BMC Public Health 2013; 13:158. [PMID: 23425005 PMCID: PMC3599799 DOI: 10.1186/1471-2458-13-158] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Variation in the implementation of complex multilevel interventions can impact on their delivery and outcomes. Few suicide prevention interventions, especially multilevel interventions, have included evaluation of both the process of implementation as well as outcomes. Such evaluation is essential for the replication of interventions, for interpreting and understanding outcomes, and for improving implementation science. This paper reports on a process evaluation of the early implementation stage of an optimised suicide prevention programme (OSPI-Europe) implemented in four European countries. METHODS The process analysis was conducted within the framework of a realist evaluation methodology, and involved case studies of the process of implementation in four European countries. Datasets include: repeated questionnaires to track progress of implementation including delivery of individual activities and their intensity; serial interviews and focus groups with stakeholder groups; and detailed observations at OSPI implementation team meetings. RESULTS Analysis of local contexts in each of the four countries revealed that the advisory group was a key mechanism that had a substantial impact on the ease of implementation of OSPI interventions, particularly on their ability to recruit to training interventions. However, simply recruiting representatives of key organisations into an advisory group is not sufficient to achieve impact on the delivery of interventions. In order to maximise the potential of high level 'gatekeepers', it is necessary to first transform them into OSPI stakeholders. Motivations for OSPI participation as a stakeholder included: personal affinity with the shared goals and target groups within OSPI; the complementary and participatory nature of OSPI that adds value to pre-existing suicide prevention initiatives; and reciprocal reward for participants through access to the extended network capacity that organisations could accrue for themselves and their organisations from participation in OSPI. CONCLUSIONS Exploring the role of advisory groups and the meaning of participation for these participants revealed some key areas for best practice in implementation: careful planning of the composition of the advisory group to access target groups; the importance of establishing common goals; the importance of acknowledging and complementing existing experience and activity; and facilitating an equivalence of benefit from network participation.
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Affiliation(s)
- Fiona M Harris
- Nursing, Midwifery and Allied Health Professions Research Unit, Iris Murdoch Building, University of Stirling, FK9 4LA, Stirling, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, Iris Murdoch Building, University of Stirling, FK9 4LA, Stirling, UK
| | - Rory C O’Connor
- Suicidal Behaviour Research Laboratory, School of Natural Sciences, University of Stirling, FK9 4LA, Stirling, UK
| | - James Coyne
- Department of Psychiatry, University of Pennsylvania School of Medicine, 3535 Market Street, 6th Floor, 19104, Philadelphia, PA, USA
| | - Ella Arensman
- National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork, Ireland
| | - András Székely
- Institute of Behavioural Sciences, Semmelweis University Budapest, Nagyvárad tér 4, 1089, Budapest, Hungary
| | - Ricardo Gusmão
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, 1169-056, Lisbon, Portugal
| | - Claire Coffey
- National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork, Ireland
| | - Susana Costa
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, 1169-056, Lisbon, Portugal
| | - Zoltan Cserháti
- Institute of Behavioural Sciences, Semmelweis University Budapest, Nagyvárad tér 4, 1089, Budapest, Hungary
| | - Nicole Koburger
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig AöR, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Chantal van Audenhove
- LUCAS, Katholieke Universiteit Leuven, Kapucijnenvoer 39 - bus 5310, 3000, Leuven, Belgium
| | - David McDaid
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, WC2A 2AE, London, UK
| | - Julia Maloney
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie der Universität Würzburg, Füchsleinstraße 15, 97080, Würzburg, Germany
| | - Peeter Värnik
- Estonian-Swedish Mental Health and Suicidology Institute, Õie 39, 11615, Tallinn, Estonia
| | - Ulrich Hegerl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig AöR, Semmelweisstraße 10, 04103, Leipzig, Germany
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Langford L, Litts D, Pearson JL. Using science to improve communications about suicide among military and veteran populations: looking for a few good messages. Am J Public Health 2013; 103:31-8. [PMID: 23153130 PMCID: PMC3518352 DOI: 10.2105/ajph.2012.300905] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2012] [Indexed: 11/04/2022]
Abstract
Concern about suicide in US military and veteran populations has prompted efforts to identify more effective prevention measures. Recent expert panel reports have recommended public communications as one component of a comprehensive effort. Messaging about military and veteran suicide originates from many sources and often does not support suicide prevention goals or adhere to principles for developing effective communications. There is an urgent need for strategic, science-based, consistent messaging guidance in this area. Although literature on the effectiveness of suicide prevention communications for these populations is lacking, this article summarizes key findings from several bodies of research that offer lessons for creating safe and effective messages that support and enhance military and veteran suicide prevention efforts.
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Affiliation(s)
- Linda Langford
- Suicide Prevention Resource Center, Education Development Center Inc., Waltham, MA 02453, USA.
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van der Feltz-Cornelis CM, Sarchiapone M, Postuvan V, Volker D, Roskar S, Grum AT, Carli V, McDaid D, O'Connor R, Maxwell M, Ibelshäuser A, Van Audenhove C, Scheerder G, Sisask M, Gusmão R, Hegerl U. Best practice elements of multilevel suicide prevention strategies: a review of systematic reviews. CRISIS 2012; 32:319-33. [PMID: 21945840 PMCID: PMC3306243 DOI: 10.1027/0227-5910/a000109] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Evidence-based best practices for incorporation
into an optimal multilevel intervention for suicide prevention should be
identifiable in the literature. Aims: To identify effective
interventions for the prevention of suicidal behavior. Methods:
Review of systematic reviews found in the Pubmed, Cochrane, and DARE databases.
Steps include risk-of-bias assessment, data extraction, summarization of best
practices, and identification of synergistic potentials of such practices in
multilevel approaches. Results: Six relevant systematic reviews
were found. Best practices identified as effective were as follows: training
general practitioners (GPs) to recognize and treat depression and suicidality,
improving accessibility of care for at-risk people, and restricting access to
means of suicide. Although no outcomes were reported for multilevel
interventions or for synergistic effects of multiple interventions applied
together, indirect support was found for possible synergies in particular
combinations of interventions within multilevel strategies.
Conclusions: A number of evidence-based best practices for
the prevention of suicide and suicide attempts were identified. Research is
needed on the nature and extent of potential synergistic effects of various
preventive activities within multilevel interventions.
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Cibis A, Mergl R, Bramesfeld A, Althaus D, Niklewski G, Schmidtke A, Hegerl U. Preference of lethal methods is not the only cause for higher suicide rates in males. J Affect Disord 2012; 136:9-16. [PMID: 21937122 DOI: 10.1016/j.jad.2011.08.032] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 08/25/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND In most countries worldwide suicide rates are higher for males whereas attempted suicide rates are higher for females. The aim is to investigate if the choice of more lethal methods by males explains gender differences in suicide rates. METHODS Data on completed and attempted suicides were collected (n=3235, Nuremberg and Wuerzburg, years 2000-2004). The research question was analyzed by comparing the method-specific case fatality (= completed suicides/completed+attempted suicides) for males and females. RESULTS Among the events captured, men chose high-risk methods like hanging significantly more often than women (φ=-0.27; p<0.001). However, except for drowning, case fatalities were higher for males than for females within each method. This was most apparent in "hanging" (men 83.5%, women 55.3%; φ=-0.28; p<0.001) and "poisoning by drugs" (men 7.2%, women 3.4%; φ=-0.09; p<0.001). LIMITATIONS The sample size (n=3235) was not enough for comparing method and gender specific case fatalities with a fine-meshed stratification regarding age. CONCLUSIONS Higher suicide rates in males not only result from the choice of more lethal methods. Other factors have to be considered.
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Affiliation(s)
- Anna Cibis
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Roland Mergl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
| | - Anke Bramesfeld
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | | | | | - Armin Schmidtke
- Department of Psychiatry and Psychotherapy, Julius-Maximilians-University Wuerzburg, Wuerzburg, Germany
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
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