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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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van der Burgt MCA, Beekman ATF, Hoogendoorn AW, Berkelmans G, Franx G, Gilissen R. The impact of a suicide prevention awareness campaign on stigma, taboo and attitudes towards professional help-seeking. J Affect Disord 2021; 279:730-736. [PMID: 33234278 DOI: 10.1016/j.jad.2020.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/29/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In 2017, the European Alliance against Depression (EAAD) was introduced in The Netherlands through the creation of six Suicide Prevention Action Networks (SUPRANET Community). The intervention was launched with a national suicide prevention awareness campaign. This campaign aims to encourage the general public to talk about suicide. This study aimed to gain insight into the effectiveness of the campaign in achieving attitudinal change in the general public, as stigmas related to mental health disorders and -services are an important reason for insufficient help-seeking. METHODS A repeated cross-section design, using general population surveys (N = 6,773) to measure key variables over time. The survey includes questions on socio-demographic variables, campaign visibility, brand awareness of the Dutch helpline, perceived taboo on suicide, attitudes towards depression and help-seeking. RESULTS The public awareness campaign was predominantly visible among the younger generation. Respondents who indicated having seen the public awareness campaign showed more openness towards seeking professional help and were considerably more likely to be familiar with the Dutch helpline than those who reported not having seen the campaign. Campaign awareness also seemed to relate to a higher perceived taboo on suicide and a lower estimation of the value of professional help. LIMITATIONS Due to the nature of the intervention, we used a quasi-experimental design. Self-report can lead to desirability bias, especially when measuring attitudes and stigmas. CONCLUSIONS Our results strengthen the idea that awareness campaigns can make a contribution to informing the general public about mental health services and improving help-seeking behaviour.
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Affiliation(s)
| | - 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, The Netherlands; Centrum Wiskunde & Informatica (CWI), Amsterdam, The Netherlands
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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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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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Martínez-Alés G, Jiménez-Sola E, Román-Mazuecos E, Sánchez-Castro MP, de Dios C, Rodríguez-Vega B, Bravo-Ortiz MF. An Emergency Department-Initiated Intervention to Lower Relapse Risk after Attempted Suicide. Suicide Life Threat Behav 2019; 49:1587-1599. [PMID: 30762253 DOI: 10.1111/sltb.12542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 01/08/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE According to randomized trials, contact after a suicide attempt lowers relapse risk. However, effectiveness studies based on real clinical data can provide additional external validity. METHOD We conducted an observational study to determine if an emergency department (ED)-initiated intervention for suicide attempt risk reduction, consisting on scheduling a single added appointment within 7 days after discharge following a suicide attempt, can reduce the risk of relapse. The study included 1,775 patients who had been treated at a general hospital ED due to a suicide attempt. The principal outcome measure was ED return after a new attempt. We obtained Kaplan-Meier survival functions and used Cox proportional hazard regression models to estimate unadjusted and adjusted risks of relapse by treatment phase. Covariates included: age, gender, history of suicide attempts, history of psychiatric disorders, concurrent alcohol/drug abuse, number of attempts during follow-up, admission as an inpatient and family support. RESULTS A total of 497 (22.5%) attempts were followed by a relapse. Subjects exposed to the studied intervention had a lower risk of relapse after a suicide attempt, with a 24% adjusted risk reduction estimate. CONCLUSION Our real-world results suggest that an additional early appointment, scheduled before discharging suicide attempters, reduces suicide reattempt risk.
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Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Psychiatry, La Paz University Hospital, Madrid, Spain.,Universidad Autónoma de Madrid School of Medicine, Madrid, Spain
| | | | | | | | - Consuelo de Dios
- Department of Psychiatry, La Paz University Hospital, Madrid, Spain.,Universidad Autónoma de Madrid School of Medicine, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Department of Psychiatry, La Paz University Hospital, Madrid, Spain.,Universidad Autónoma de Madrid School of Medicine, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
| | - María Fe Bravo-Ortiz
- Department of Psychiatry, La Paz University Hospital, Madrid, Spain.,Universidad Autónoma de Madrid School of Medicine, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
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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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Abstract
OBJECTIVE Economic recessions and severe weather events are often associated with increased suicide rates. The Global Dairy Crisis 2015/2016 led to an economic downturn in the New Zealand dairy farming industry and, coupled with droughts in some regions and floods in others, raised fears about increased suicide rates among farmers. However, little was known about suicides in the farming sector. This study reviews characteristics of recent farm-related suicides in New Zealand and assesses the extent to which financial stresses contributed to the deaths. METHODS Data were abstracted from coroners' records for a consecutive series of 185 people in farm- and agriculture-related occupations who died by suicide between 2007 and 2015 and for whom coronial inquiries had been completed. RESULTS Farm suicides were heterogeneous: six distinct risk profiles were identified. Financial stresses made negligible contributions to farm suicides. Overall, risk factors for farm suicides differed little from risk factors for suicide in the general population. However, suicide risk in farmers was exacerbated by ready access to firearms: almost 40% of farm suicides involved firearms, compared to 8% in the general population over the same time. Among farm suicides, young male farm labourers predominated, rather than farm owners or managers. For many young men, relationship losses, acute alcohol intoxication and ready access to a firearm formed a common constellation of risk factors. CONCLUSIONS While coroners' records are variable and do not record specific information about financial stresses and weather events, it was clear that these issues made a negligible contribution to farm suicides. A range of rural suicide prevention initiatives are needed to address various farm suicide risk profiles. In particular, young male labourers often had no contact with health services prior to death, suggesting that rural suicide prevention efforts need to be positioned within community, farming and sports organisations, as well as health and social service providers.
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Affiliation(s)
- Annette L Beautrais
- Department of Health Sciences, University of Canterbury, Christchurch, New Zealand
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Public attitudes toward depression and help-seeking: Impact of the OSPI-Europe depression awareness campaign in four European regions. J Affect Disord 2017; 217:252-259. [PMID: 28437762 DOI: 10.1016/j.jad.2017.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/28/2017] [Accepted: 04/02/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Public attitudes toward depression and help-seeking behaviour are important factors influencing depressed people to obtain professional help and adequate treatment. OSPI-Europe is a multi-level suicide prevention programme including a public awareness campaign. It was implemented in four regions of four European countries (Germany, Hungary, Ireland and Portugal). This paper reports the results of the evaluation of the campaign, including its visibility and effects of the campaign on stigma associated with depression and help-seeking behaviour. METHODS A representative general population survey (N=4004) including measures on personal stigma, perceived stigma, openness to help, perceived value of help, and socio-demographic variables was conducted in the four intervention and four control regions in a cross-sectional pre-post design. RESULTS The public awareness campaign was considerably more visible in Germany and Portugal compared to Ireland and Hungary. Visibility was further affected by age and years of schooling. Personal stigma, perceived stigma and openness toward professional help varied significantly across the four countries. Respondents in the intervention regions showed significantly less personal depression stigma than respondents in the control regions after the campaign. Respondents of the intervention region who were aware of the campaign reported more openness toward seeking professional help than respondents who were unaware of it. CONCLUSION The OSPI-Europe awareness campaign was visible and produced some positive results. At the same time, it proved to be difficult to show strong, measurable and unambiguous effects, which is in line with previous studies. Public awareness campaigns as conducted within OSPI-Europe can contribute to improved attitudes and knowledge about depression in the general public and produce synergistic effects, in particular when the dissemination of awareness campaign materials is simultaneously reinforced by other intervention levels of a multi-level intervention programme. LIMITATIONS The survey was cross-sectional and based on self-report, so no causal inferences could be drawn.
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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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