1
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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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2
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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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3
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Toczyski P. The Local Awareness-Raising of Public Mental Health in the Capital City of Poland through Launch of Local Alliance against Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3892. [PMID: 36900901 PMCID: PMC10002039 DOI: 10.3390/ijerph20053892] [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: 10/30/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
The goal of this brief report is to show the specificity of building local alliances against depression in an Eastern European country within and after the series of 2021 lockdowns. It will be described in the form of a short communication piece. The semi-peripheral specificity of Poland adds some insights which will be useful for other leaders of similar alliances globally. This short report can be read as a higher resolution of the European Alliance Against Depression (EAAD) method activities known from other recent works. We want to answer the question of how to begin the activity and launch such an alliance in the semi-peripheral context of non-Western Europe.
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Affiliation(s)
- Piotr Toczyski
- Social Sciences, Maria Grzegorzewska University, 02-353 Warszawa, Poland
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4
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Saß H, Cording C. [Free responsibility of the decision for an assisted suicide]. DER NERVENARZT 2022; 93:1150-1155. [PMID: 36094583 PMCID: PMC9630393 DOI: 10.1007/s00115-022-01386-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 05/31/2023]
Abstract
The verdict of the German Federal Constitutional Court on assisted suicide has led to lively debates in the medical world, in the German Federal Parliament and the civil society. In the conception of the German Federal Constitutional Court the determination of free responsibility is of central importance for a protection concept that aims to minimize an uncontrolled assistance to suicide; however, the forensic aspects of this task need to be substantiated. This article comments on this from a psychiatric aspect in order to include the perspective of our discipline in the progression of the discussion.
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Affiliation(s)
- Henning Saß
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Clemens Cording
- Klinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg, Deutschland
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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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Sakashita T, Oyama H. Suicide Prevention Interventions and Their Linkages in Multilayered Approaches for Older Adults: A Review and Comparison. Front Public Health 2022; 10:842193. [PMID: 35619820 PMCID: PMC9127334 DOI: 10.3389/fpubh.2022.842193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Multilayered approaches to suicide prevention combine universal, selective, and indicated prevention interventions. These approaches may be more successful in reducing suicide rates among older adults if they link these layers more systematically: that is, if the programs are designed so that interventions at a lower level facilitate involvement at a higher level when appropriate. This study aimed to examine the effect on suicide rates of the structure of multilayered approaches, and in particular the types of interventions and the connections or linkages between them. We also wished to consider any different effects by sex. A literature search used PubMed and PsycINFO to identify systematic reviews of interventions in this age group. From the reference lists of these articles, we identified controlled studies assessing the impact of a multilayered program on suicide incidence among older adults. We were particularly interested in initiatives linking different kinds of prevention interventions. We found three relevant systematic reviews, and from these, we identified nine eligible studies. These included seven non-randomized controlled studies from rural areas in Japan (average eligible population: 3,087, 59% women, average duration: 8 years). We also found two cohort studies. The first was from a semi-urban area in Padua, Italy (18,600 service users, 84% women, duration: 11 years). The second was from urban Hong Kong, with 351 participants (57% women) over a 2-year follow-up period. We used a narrative synthesis of these studies to identify five different multilayered programs with different forms of connections or linkages between layers. Two studies/programs (Italy and Hong Kong) involved selective and indicated prevention interventions. One study/program (Yuri, Japan) included universal and selective prevention interventions, and the final six studies (two programs in northern Japan) involved linkages between all three layers. We also found that these linkages could be either formal or informal. Formal linkages were professional referrals between levels. Informal linkages included advice from professionals and self-referrals. Several of the studies noted that during the program, the service users developed relationships with services or providers, which may have facilitated movements between levels. All five programs were associated with reduced suicide incidence among women in the target groups or communities. Two programs were also associated with a reduction among men. The study authors speculated that women were more likely to accept services than men, and that the care provided in some studies did less to address issues that are more likely to affect men, such as suicidal impulsivity. We therefore suggest that it is important to build relationships between levels, especially between selective and indicated prevention interventions, but that these can be both formal and informal. Additionally, to reach older men, it may be important to create systematic methods to involve mental health professionals in the indicated prevention intervention. Universal interventions, especially in conjunction with systematically linked indicated and selective interventions, can help to disseminate the benefits across the community.
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Affiliation(s)
- Tomoe Sakashita
- Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
| | - Hirofumi Oyama
- Department of Social Welfare, Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
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7
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Köhler J, Heinz I, Mergl R, Elsner A, Hegerl U. The German Alliance Against Depression and suicide rates: A retrospective analysis. PLoS One 2021; 16:e0254133. [PMID: 34197545 PMCID: PMC8248967 DOI: 10.1371/journal.pone.0254133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/20/2021] [Indexed: 11/19/2022] Open
Abstract
Supported by the German Alliance Against Depression, 82 regions in Germany launched their own community-based multi-level intervention programs targeting both depression and suicidal behavior prior to January 2016. Sixteen of these regions have implemented the full 4-level intervention program comprising 1) training of General Practitioners, 2) a public awareness campaign, 3) training of community facilitators and 4) support for depressed patients and their relatives for at least three years. The aim of the study was to examine possible suicide prevention effects in these sixteen 4-level intervention regions (comprising a population of 6,976,309) by 1) comparing the annual suicide rates during the 3-year intervention period to a 10-year baseline and 2) comparing these differences to corresponding trends in Germany after excluding all intervention regions (Germany-IR). Primary outcome was the annual rate of suicides. Analyses included negative binomial regression models. When examining differences between suicide rates during the intervention period compared to the baseline period, only a trend towards a significant reduction was found. This reduction of suicides in the sixteen 4-level intervention regions did not differ from that in Germany-IR as control. The interpretation of these findings has to take into account that the training of General Practitioners, police and other community facilitators might have improved the recognition of suicides, thus increasing detection rates. Furthermore, destigmatizing effects of the public awareness campaigns might have increased the number of suicides by lowering suicide threshold ("normalization") for those at risk and by decreasing the rate of suicides deliberately hidden by suicide victims or their relatives.
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Affiliation(s)
- Judith Köhler
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Leipzig, Leipzig, Germany
| | - Ines Heinz
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Leipzig, Leipzig, Germany
- German Alliance Against Depression, Leipzig, Germany
| | - Roland Mergl
- Universität der Bundeswehr München, Institute of Psychology, Neubiberg, Germany
| | - Anne Elsner
- German Depression Foundation, Leipzig, Germany
| | - Ulrich Hegerl
- German Depression Foundation, Leipzig, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University Frankfurt (Distinguished Professorship funded by Dr. Senckenbergische Stiftung), Frankfurt am Main, Germany
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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: 201] [Impact Index Per Article: 67.0] [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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Onyeka IN, O'Reilly D, Maguire A. The association between self-reported mental health, medication record and suicide risk: A population wide study. SSM Popul Health 2021; 13:100749. [PMID: 33665331 PMCID: PMC7901032 DOI: 10.1016/j.ssmph.2021.100749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 01/13/2023] Open
Abstract
Suicide mortality and mental ill health are increasing globally. Mental ill health can be measured in multiple ways. It is unclear which measure is most associated with suicide risk. This study explored the association between self-rated mental health and medication record and death by suicide. The 2011 Northern Ireland Census records of adults aged 18-74 years (n=1,098,967) were linked to a centralised database of dispensed prescription medication and death registrations until the end of 2015. Mental health status was ascertained through both a single-item self-reported question in the Census and receipt of psychotropic medication. Logistic regression models examined the association between indicators of mental ill health and likelihood of suicide mortality. Of the 1,098,967 cohort members, 857 died by suicide during the study period. Just over half of these deaths (n=429, 50.1%) occurred in individuals with neither indicator of mental ill health. Cohort members with both self-reported mental ill health and receipt of psychotropic medication had the highest risk of suicide (OR=6.13, 95%CI: 4.94–7.61), followed by those with psychotropic medication record only (OR=4.00, 95%CI: 3.28–4.88) and self-report only (OR=2.88, 95%CI: 2.16–3.84). Individuals who report mental ill health and have a history of psychotropic medication use are at a high risk of suicide mortality. However, neither measure is particularly sensitive, as both failed to signal over half of subsequent suicides. Some individuals who report poor mental health but are not in receipt of psychotropic medication are at increased risk of suicide, indicating possible unmet treatment need. The combination of the two indicators offers more precision for identifying those most at risk for targeted interventions. Mental ill health is associated with an increased risk of suicide, but measuring population mental health is difficult. The suicide risk associated with both subjective and objective indicators of mental ill health have not been examined. Most individuals who die by suicide have no indicator of mental ill health. Having both self-reported poor mental health and psychotropic medication record carried the highest risk of suicide death. Increased risk of suicide in individuals who report poor mental health but are not on medication may indicate unmet need.
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Affiliation(s)
- Ifeoma N Onyeka
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK.,Administrative Data Research Centre Northern Ireland, Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK.,Administrative Data Research Centre Northern Ireland, Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Aideen Maguire
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
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10
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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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11
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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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Audouard-Marzin Y, Kopp-Bigault C, Scouarnec P, Walter M. General practitioners training about suicide prevention and risk: A systematic review of literature. Presse Med 2019; 48:767-779. [DOI: 10.1016/j.lpm.2019.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/25/2018] [Accepted: 05/28/2019] [Indexed: 11/15/2022] Open
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Pirkis J, Rossetto A, Nicholas A, Ftanou M, Robinson J, Reavley N. Suicide Prevention Media Campaigns: A Systematic Literature Review. HEALTH COMMUNICATION 2019; 34:402-414. [PMID: 29190128 DOI: 10.1080/10410236.2017.1405484] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Suicide prevention media campaigns are gaining traction as a means of combatting suicide. The current review set out to synthesize information about the effectiveness of these campaigns. We searched four electronic databases for studies that provided evidence on the effectiveness of media campaigns. We focused on studies that described an evaluation of the effectiveness of an entire campaign or a public service announcement explicitly aimed at suicide prevention. We identified 20 studies of varying quality. Studies that looked at whether campaign exposure leads to improved knowledge and awareness of suicide found support for this. Most studies that considered whether campaign materials can achieve improvements in attitudes toward suicide also found this to be the case, although there were some exceptions. Some studies found that media campaigns could boost help-seeking, whereas others suggested that they made no difference or only had an impact when particular sources of help or particular types of help-seeking were considered. Relatively few studies had sufficient statistical power to examine whether media campaigns had an impact on the ultimate behavioral outcome of suicides, but those that did demonstrated significant reductions. Our review indicates that media campaigns should be considered in the suite of interventions that might be used to prevent suicide. Evidence for their effectiveness is still amassing, but there are strong suggestions that they can achieve positive results in terms of certain suicide-related outcomes. Care should be taken to ensure that campaign developers get the messaging of campaigns right, and further work is needed to determine which messages work and which ones do not, and how effective messages should be disseminated. There is an onus on those developing and delivering campaigns to evaluate them carefully and to share the findings with others. There is a need for evaluations that employ rigorous designs assessing the most pertinent outcomes. These evaluations should explore the nature of given campaigns in detail - in particular the messaging contained within them - in order to tease out which messages work well and which do not. They should also take into account the reach of the campaign, in order to determine whether it would be reasonable to expect that they might have their desired effect.
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Affiliation(s)
- Jane Pirkis
- a Centre for Mental Health, Melbourne School of Population and Global Health , The University of Melbourne
| | - Alyssia Rossetto
- a Centre for Mental Health, Melbourne School of Population and Global Health , The University of Melbourne
| | - Angela Nicholas
- a Centre for Mental Health, Melbourne School of Population and Global Health , The University of Melbourne
| | - Maria Ftanou
- a Centre for Mental Health, Melbourne School of Population and Global Health , The University of Melbourne
| | - Jo Robinson
- b Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne
| | - Nicola Reavley
- a Centre for Mental Health, Melbourne School of Population and Global Health , The University of Melbourne
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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: 26] [Impact Index Per Article: 4.3] [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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Abstract
BACKGROUND Male suicide rates are higher than their female counterparts in almost every country around the world. Several developed countries have attempted to implement suicide prevention programmes, but few have specifically targeted men. AIMS To identify what is currently known about suicide prevention strategies, programmes, and interventions of relevance to men. METHOD A scoping review guided by Arksey and O'Malley's five-stage framework. RESULTS Twenty-two studies were included. Thematic analysis identified three categories: (i) male suicide prevention interventions; (ii) factors or coping strategies that interrupt the suicidal process in men; (iii) men's perspectives on service provision. Interventions included awareness campaigns; training of community "gatekeepers"; psychological support; and educational initiatives targeted to either GPs or depressed or suicidal men. Men emphasised the need to receive support from a trusted and respected individual, preferably in an informal setting. Connecting with others, reframing help-seeking as masculine, and the use of emotional regulation techniques were all identified as factors with potential to interrupt the suicidal process. CONCLUSIONS This review demonstrates the need for further research examining the perspectives of suicidal middle-aged men and their close family and friends.
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Affiliation(s)
- Sophia Struszczyk
- a Department of Health Sciences , Seebohm Rowntree Building, University of York , York , UK
| | - Paul Michael Galdas
- a Department of Health Sciences , Seebohm Rowntree Building, University of York , York , UK
| | - Paul Alexander Tiffin
- a Department of Health Sciences , Seebohm Rowntree Building, University of York , York , UK
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The psychenet public health intervention for anorexia nervosa: a pre-post-evaluation study in a female patient sample. Prim Health Care Res Dev 2017; 19:42-52. [PMID: 28829284 DOI: 10.1017/s1463423617000524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim This non-randomized pre-post-intervention study investigated the effect of a systemic public health intervention on the length of time between anorexia nervosa symptom onset and contact with the health care system as well as the initiation of treatment. BACKGROUND Although systemic public health interventions have successfully been implemented in physical and mental health fields, their effect on the early treatment of patients with anorexia nervosa remains unclear. METHODS In total, 59 anorexia nervosa patients (mean age=21.5 years, SD=7.2) were recruited before a systemic public health intervention, and 18 patients (mean age=22.2 years, SD=8.9) were recruited afterwards. Using validated self-report measures and a semi-structured interview, the duration of untreated anorexia nervosa and the duration until first contact with the health care system were investigated. Findings At the beginning of the individual treatment initiation process, participants in both samples most frequently consulted their general practitioner or paediatrician about their eating disorder-related symptoms. Neither the mean duration of untreated anorexia nervosa, that is, the time between illness onset and the initiation of a recommended treatment, nor the duration until first contact with the health care system significantly decreased after the implementation of the systemic public health intervention. The mean duration of untreated anorexia nervosa was 36.5 months (SD=68.2) before the systemic public health intervention and 40.1 months (SD=89.4) after the implementation of the systemic public health intervention. The mean duration until first contact with the health care system was 25.0 months (SD=53.0) before the intervention and 32.8 months (SD=86.5) after the intervention. CONCLUSION Primary care providers are crucial to the treatment initiation process and should be involved in future interventions to improve early detection and treatment commencement amongst patients with anorexia nervosa.
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Milner A, Witt K, Pirkis J, Hetrick S, Robinson J, Currier D, Spittal MJ, Page A, Carter GL. The effectiveness of suicide prevention delivered by GPs: A systematic review and meta-analysis. J Affect Disord 2017; 210:294-302. [PMID: 28068618 DOI: 10.1016/j.jad.2016.12.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/01/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this review was to assess whether suicide prevention provided in the primary health care setting and delivered by GPs results in fewer suicide deaths, episodes of self-harm, attempts and lower frequency of thoughts about suicide. METHODS We conducted a systematic review and meta-analysis using PRIMSA guidelines. Eligible studies: 1) evaluated an intervention provided by GPs; 2) assessed suicide, self-harm, attempted suicide or suicide ideation as outcomes, and; 3) used a quasi-experimental observational or trial design. Study specific effect sizes were combined using the random effects meta-analysis, with effects transformed into relative risk (RR). RESULTS We extracted data from 14 studies for quantitative meta-analysis. The RR for suicide death in quasi-experimental observational studies comparing an intervention region against another region acting as a "control" was 1.26 (95% CI 0.58, 2.74). When suicide in the intervention region was compared before and after the GP program, the RR was 0.78 (95% CI 0.62, 0.97). There was no evidence of a treatment effect for GP training on rates of suicide death in one cRCT (RR 1.07, 95% CI 0.79, 1.45). There was no evidence of effect for the most other outcomes studied. LIMITATIONS All of the studies included in this review are likely to have a high level of bias. It is also possible that we excluded or missed relevant studies in our review process CONCLUSIONS: Interventions have produced equivocal results, which varied by study design and outcome. Given these results, we cannot recommend the roll out of GP suicide prevention initiatives.
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Affiliation(s)
- Allison Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Work, Health and Wellbeing Unit, Population Health Research Centre, School of Health & Social Development, Deakin University, Melbourne, Australia.
| | - Katrina Witt
- Turning Point, Monash University, Melbourne, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sarah Hetrick
- Orygen National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Jo Robinson
- Orygen National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Dianne Currier
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Andrew Page
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia
| | - Gregory L Carter
- Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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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: 946] [Impact Index Per Article: 118.3] [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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Vancayseele N, Portzky G, van Heeringen K. Increase in Self-Injury as a Method of Self-Harm in Ghent, Belgium: 1987-2013. PLoS One 2016; 11:e0156711. [PMID: 27249421 PMCID: PMC4889035 DOI: 10.1371/journal.pone.0156711] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/18/2016] [Indexed: 11/24/2022] Open
Abstract
Background Self-harm is a major health care problem and changes in its prevalence and characteristics can have important implications for suicide prevention. The objective was to describe trends in the epidemiology of self-harm based on emergency department (A&E departments) visits over a 26-year period in Ghent, Belgium. Methods We analyzed data on all self-harm presentations from the three large general hospitals in Ghent between 1987 and 2013. We investigated trends in prevalence (events by year per 100.000), methods and alcohol use. Results Rates of self-harm steadily decreased during the 26-year study period. In general female rates of self-harm were higher than male rates. The mean patient age was 35 years. The most commonly used method of self-harm was self-poisoning by means of an overdose of medication (80.8%), followed by cutting (10.2%) and hanging (4.2%). Psychotropics (including antidepressants, benzodiazepines, barbiturates and other tranquilizers) were the most frequently used drugs (74.5%). A proportional increase in the use of self-injurious methods in self-harm was highly significant, more specifically in the use of hanging, jumping from heights and the use of other violent methods such as the use of firearms, jumping before a moving object or other traffic related injury. Conclusion This epidemiological study showed an increase in the use of high-lethality methods in self-harm which has important implications for suicide prevention. As restrictions in the availability of these methods are difficult or impossible to achieve, prevention programmes will have to emphasize the role of thorough psychosocial assessment and adequate follow-up care of self-harm patients.
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Affiliation(s)
- Nikita Vancayseele
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
- * E-mail:
| | - Gwendolyn Portzky
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
| | - Kees van Heeringen
- Department of psychiatry and medical psychology, Ghent University, Ghent, Belgium
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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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Hegerl U, Kohls E. Synergistic effects of multi-level suicide preventive interventions: Important, but difficult to disentangle. Aust N Z J Psychiatry 2016; 50:178-9. [PMID: 26744518 DOI: 10.1177/0004867415621398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ulrich Hegerl
- Faculty of Medicine, Department of Psychiatry, Leipzig University, Leipzig, Germany Depression Research Centre, German Depression Foundation, Leipzig, Germany
| | - Elisabeth Kohls
- Faculty of Medicine, Department of Psychiatry, Leipzig University, Leipzig, Germany
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Raeisei A, Mojahed A, Bakhshani NM. The relationship between personality styles of sociotropy and autonomy and suicidal tendency in medical students. Glob J Health Sci 2015; 7:345-50. [PMID: 25948467 PMCID: PMC4802088 DOI: 10.5539/gjhs.v7n3p345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022] Open
Abstract
The research aim was investigating the relationship between personality styles of autonomy and sociotropy, and suicidal behavior at Zahedan University of medical sciences’ medical students. This was a descriptive correlational study. The population consisted of all medical students at Zahedan University of Medical Sciences internship period 2002-2003. The number of samples was 102 patients, including 47 males and 55 females. To collect information, the personal style inventory (PSI) with 48 items. Twenty four items to assess sociotropy, 24 items to assess autonomy, and to measure suicide the suicidal subscale (MMPI) with 21 items were used. The two scales had the content validity and for the reliability used Cronbach α. So the reliability of the personality styles is 0.84 and the reliability of the suicidal subscales is 0.83. Data were analyzed using Pearson’s correlation methods. The results showed that there is an inverse and significant relation between autonomic style and trends of suicide in men (P = 0.02, r = -0.43), but no association between sociotropy and suicidal tendencies were observed in men. There was no significant relationship between autonomy and sociotropy personality styles and tendency towards suicide in women.
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Affiliation(s)
- Ahmadali Raeisei
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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Gómez Restrepo C, Bohórquez Peñaranda AP, Gil Lemus LM, Jaramillo LE, García Valencia J, Bravo Narváez E, de la Hoz Bradford AM, Palacio C. [Suicide Risk Assessment in the Clinical Practice Guidelines for the Diagnosis and Management of Depression in Colombia]. REVISTA COLOMBIANA DE PSIQUIATRIA 2014; 43 Suppl 1:3-11. [PMID: 26574108 DOI: 10.1016/j.rcp.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 11/28/2013] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Suicide is the most serious complications of depression. It has high associated health costs and causes millions of deaths worldwide per year. Given its implications, it is important to know the factors that increase the risk of its occurrence and the most useful tools for addressing it. OBJECTIVES To identify the signs and symptoms that indicate an increased risk of suicide, and factors that increase the risk in patients diagnosed with depression. To establish the tools best fitted to identify suicide risk in people with depression. METHOD Clinical practice guidelines were developed, following those of the methodmethodological guidelines of the Ministry of Social Protection, to collect evidence and to adjust recommendations. Recommendations from the NICE90 and CANMAT guidelines were adopted and updated for questions found in these guidelines, while new recommendations were developed for questions not found in them. RESULTS Basic points and recommendations are presented from a chapter of the clinical practice guidelines on depressive episodes and recurrent depressive disorder related to suicide risk assessment. Their corresponding recommendation levels are included.
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Affiliation(s)
- Carlos Gómez Restrepo
- Médico psiquiatra, MSc en Epidemiología Clínica, psiquiatra de enlace, psicoanalista, profesor titular del Departamento de Psiquiatría y Salud Mental, director del Departamento de Epidemiología Clínica y Bioestadística de la Pontificia Universidad Javeriana. Psiquiatra de enlace del Hospital Universitario San Ignacio. Director de GAI Depresión. Codirector del CINETS. Bogotá, Colombia.
| | - Adriana Patricia Bohórquez Peñaranda
- Médica psiquiatra, Maestría en Epidemiología Clínica, profesora del Departamento de Psiquiatría y Salud Mental de la Pontificia Universidad Javeriana. Coordinadora de GAI Depresión. Bogotá, Colombia
| | - Laura Marcela Gil Lemus
- Médica psiquiatra, especialista en terapia cognitivo conductual y terapia dialéctico comportamental, experta temática del Departamento de Epidemiología Clínica y Bioestadística de la Pontificia Universidad Javeriana. Bogotá, Colombia
| | - Luis Eduardo Jaramillo
- Médico psiquiatra, MSc en Farmacología, profesor titular del Departamento de Psiquiatría de la Universidad Nacional de Colombia. Delegado de la Asociación Colombiana de Psiquiatría. Bogotá, Colombia
| | - Jenny García Valencia
- Médica psiquiatra, MSc PhD en Epidemiología, profesora del Departamento de Psiquiatría de la Universidad de Antioquia. Medellín, Colombia
| | - Eliana Bravo Narváez
- Médica, residente de tercer año, asistente de investigación del Departamento de Psiquiatría y Salud Mental de la Pontificia Universidad Javeriana. Bogotá, Colombia
| | - Ana María de la Hoz Bradford
- Médica, MSc en Epidemiología Clínica del Departamento de Epidemiología Clínica y Bioestadística de la Pontificia Universidad Javeriana. Bogotá, Colombia
| | - Carlos Palacio
- Médico psiquiatra, MSc en Epidemiología Clínica, profesor titular del Departamento de Psiquiatría, Universidad de Antioquia. Medellín, Colombia
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Abstract
Purpose
– The purpose of this paper is to report findings from a formative evaluation of a suicide prevention public awareness campaign – Choose Life, North Lanarkshire. The focus is on preventing male suicide. The paper explores how the public campaign supports a co-ordinated and community-based direction for suicide prevention work, and examines how good practice can be identified, spread, and sustained.
Design/methodology/approach
– The paper draws on data collected from March to November 2011, using mixed primary research methods, including a quota survey, discussion groups with the general public, and stakeholder interviews.
Findings
– The campaign effectively raised the suicide awareness of a substantial proportion of those targeted, but with regional variations. It also affected the attitudes and behaviour of those who were highly aware. However, men and women engaged somewhat differently with the campaign. The sports and leisure settings approach was effective in reaching younger men.
Practical implications
– The paper discusses emerging considerations for suicide prevention, focusing on gender and approaches and materials for engaging with the public as “influencers”. There are challenges to target audiences more specifically, provide a clear call to action, and engage the public in a sustained way.
Originality/value
– This paper reflects on insights from a complex programme, exceptional in its focus on targeted sections of the public, especially young males. The paper indicates the importance for research and practice of intersecting dimensions of male identity, stigma and mental health, and other risk and protective factors which can inform campaigns highlighting talk about suicide among men.
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Riihimäki K, Vuorilehto M, Melartin T, Haukka J, Isometsä E. Incidence and predictors of suicide attempts among primary-care patients with depressive disorders: a 5-year prospective study. Psychol Med 2014; 44:291-302. [PMID: 23570583 DOI: 10.1017/s0033291713000706] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND No previous study has prospectively investigated incidence and risk factors for suicide attempts among primary care patients with depression. METHOD In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients was screened for depression, and Structured Clinical Interviews for DSM-IV used to diagnose Axis I and II disorders. A total of 137 patients were diagnosed with a DSM-IV depressive disorder. Altogether, 82% of patients completed the 5-year follow-up. Information on timing of suicide attempts, plus major depressive episodes (MDEs) and partial or full remission, or periods of substance abuse were examined with life charts. Incidence of suicide attempts and their stable and time-varying risk factors (phases of depression/substance abuse) were investigated using Cox proportional hazard and Poisson regression models. RESULTS During the follow-up there were 22 discrete suicide attempts by 14/134 (10.4%) patients. The incidence rates were 0, 5.8 and 107 during full or partial remission or MDEs, or 22.2 and 142 per 1000 patient-years during no or active substance abuse, respectively. In Cox models, current MDE (hazard ratio 33.5, 95% confidence interval 3.6-309.7) was the only significant independent risk factor. Primary care doctors were rarely aware of the suicide attempts. CONCLUSIONS Of the primary care patients with depressive disorders, one-tenth attempted suicide in 5 years. However, risk of suicidal acts was almost exclusively confined to MDEs, with or without concurrent active substance abuse. Suicide prevention among primary care patients with depression should focus on active treatment of major depressive disorder and co-morbid substance use, and awareness of suicide risk.
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Affiliation(s)
- K Riihimäki
- National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland
| | - M Vuorilehto
- National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland
| | - T Melartin
- National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland
| | - J Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Isometsä
- National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland
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Gómez-Restrepo C, Peñaranda APB, Valencia JG, Guarín MR, Narváez EB, Jaramillo LE, Acosta CAP, Pedraza RS, Díaz SMC. [Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder: Part I: Risk Factors, Screening, Suicide Risk Diagnosis and Assessment in Patients with a Depression Diagnosis]. ACTA ACUST UNITED AC 2012; 41:719-39. [PMID: 26572263 DOI: 10.1016/s0034-7450(14)60044-5] [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: 10/25/2012] [Accepted: 11/06/2012] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Depression is an important cause of morbidity and disability in the world; however, it is under-diagnosed at all care levels. OBJECTIVE The purpose here is to present recommendations based on the evidence gathered to answer a series of clinical questions concerning risk factors, screening, suicide risk diagnosis and evaluation in patients undergoing a depressive episode and recurrent depressive disorder. Emphasis has been made upon the approach used at the primary care level so as to grant adult diagnosed patients the health care guidelines based on the best and more updated evidence available thus achieving minimum quality standards. METHODOLOGY A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from guides NICE90 and CANMAT were adopted and updated so as to answer the questions posed while de novo questions were developed. RESULTS Recommendations 1-22 corresponding to screening, suicide risk and depression diagnosis were presented. The corresponding degree of recommendation is included.
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Affiliation(s)
- Carlos Gómez-Restrepo
- Médico psiquiatra, MSc Epidemiología Clínica, Psiquiatra de Enlace, Psicoanalista, profesor titular Departamento de Psiquiatría y Salud Mental, director Departamento de Psiquiatría y Salud Mental, director Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Director GAI Depresión, codirector CINETS, Bogotá, Colombia.
| | - Adriana Patricia Bohórquez Peñaranda
- Médica psiquiatra, Maestría Epidemiología Clínica, profesora Departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana, Coordinadora GAI Depresión, Bogotá, Colombia
| | - Jenny García Valencia
- Médica psiquiatra, MSc, PhD Epidemiología, profesora Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Colombia
| | - Maritza Rodríguez Guarín
- Médica psiquiatra, MSc Epidemiología Clínica, profesora Departamento de Psiquiatría y Salud Mental Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Eliana Bravo Narváez
- Médica, residente de tercer año, asistente de investigación, Departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Luis Eduardo Jaramillo
- Médico psiquiatra, MSc Farmacología, profesor titular Departamento de Psiquiatría, Universidad Nacional de Colombia, delegado Asociación Colombiana de Psiquiatría, Bogotá, Colombia
| | - Carlos Alberto Palacio Acosta
- Médico psiquiatra, MSc Epidemiología Clínica, profesor titular Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Colombia
| | - Ricardo Sánchez Pedraza
- Médico psiquiatra, MSc Epidemiología Clínica, profesor titular Departamento de Psiquiatría, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Sergio Mario Castro Díaz
- Médico residente Psiquiatría, asistente de investigación, Departamento de Psiquiatría y Salud Mental, Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
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