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Swisher VS, Őri D, Rihmer Z, Wernigg R. Understanding mental health help-seeking and stigma among Hungarian adults: A network perspective. Eur Psychiatry 2024; 67:e52. [PMID: 39297225 PMCID: PMC11457119 DOI: 10.1192/j.eurpsy.2024.1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Hungarians exhibit more negative attitudes toward help-seeking for mental health problems compared to other European countries. However, research on help-seeking in Hungary is limited, and it is unclear how stigma relates to help-seeking when considering demographic and clinical characteristics. We used a network analytic approach to simulate a stigma model using hypothesized constructs in a sizable sample of Hungarian adults. METHODS Participants were 345 adults recruited from nine primary care offices across Hungary. Participants completed self-report measures assessing public stigma, self-stigma, experiential avoidance (EA), attitudes toward seeking professional psychological help, anxiety, depression, demographics, prior use of mental health services, and whether they have a family member or friend with a mental health condition. RESULTS EA and anxiety were the most central nodes in the network. The network also revealed associations between greater EA with greater public stigma, anxiety, depression, and having a family member or friend with a mental health condition. More positive attitudes toward seeking help were associated with lower self-stigma, public stigma, and having received psychological treatment in their lifetime. Being female was associated with lower income, higher education, and having received psychological treatment in their lifetime. Finally, having a family member or friend with a mental health condition was associated with having received psychological treatment in their lifetime and greater public stigma. CONCLUSIONS The strength centrality and associations of EA with clinical covariates and public stigma implicate its importance in stigma models. Findings also suggest that while some aspects of existing stigma models are retained in countries like Hungary, other aspects may diverge.
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Affiliation(s)
- Valerie S. Swisher
- The Pennsylvania State University, State College, University Park, PA, USA
| | - Dorottya Őri
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- Nyírő Gyula National Institute for Psychiatry and Addictions, Budapest, Hungary
| | - Róbert Wernigg
- National Directorate-General for Hospitals, Budapest, Hungary
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Flach R, Fodor R, Kettel-Fulop F, Osvath P, Lang A. Myths about suicide - validating the Hungarian version of the Literacy of Suicide Scale (H-LOSS) on a community sample. BMC Public Health 2024; 24:2351. [PMID: 39210328 PMCID: PMC11360470 DOI: 10.1186/s12889-024-19841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Suicide was exceptionally high in Hungary in the last century. According to Eurostat, Hungary ranks second in the EU in death by suicide and was among the few countries where the suicidal tendencies increased in 2020. Primary tasks of suicide prevention programs are to develop suicide literacy and dispel myths and misconceptions about suicide. Therefore, the goal of our research was the Hungarian validation of the 26-item Literacy of Suicide Scale (LOSS). METHODS 749 people (382 female (51.0%), 364 male (48.6%), 3 identify as non-binary or other (0.4%); 4 identifying as transgender (0.5%)) participated in our online cross-sectional survey with a mean age of 32.4 years (SD = 14.5 years). The H-LOSS questionnaire was adapted using the 2PL (two-parameter logistic) model with WLSE (weighted least squares) estimation in item response theory method, similarly to the original English version. RESULTS Scale unidimensionality was confirmed. Model fit indices and internal reliability indicators were acceptable. Item infit and outfit values were adequate, item discrimination values were within range, but one item had extremely high and three items had extremely low item difficulty parameters. Few items had differential item functioning by age, gender and own suidice attempt. CONCLUSIONS The H-LOSS scale deemed to be appropriate for assessing suicide literacy in Hungarian speaking samples.
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Affiliation(s)
- Richard Flach
- Institute of Psychology, University of Pécs, 6 Ifjusag Street, Pécs, Baranya, 7624, Hungary.
| | - Robert Fodor
- Ulster University, Belfast, Northern Ireland, UK
| | - Flora Kettel-Fulop
- Institute of Psychology, University of Pécs, 6 Ifjusag Street, Pécs, Baranya, 7624, Hungary
| | - Peter Osvath
- Department of Psychiatry and Psychotherapy, Medical School, University of Pecs, Pecs, Hungary
| | - Andras Lang
- Institute of Psychology, University of Pécs, 6 Ifjusag Street, Pécs, Baranya, 7624, Hungary
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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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Troya MI, Joyce M, Khashan A, Buckley C, Chakraborti K, Hoevel P, Humphries R, Kearney PM, Kiely E, Murphy M, Perry I, Arensman E. Mental health following an initial period of COVID-19 restrictions: findings from a cross-sectional survey in the Republic of Ireland. HRB Open Res 2022; 4:130. [PMID: 35633845 PMCID: PMC9120930 DOI: 10.12688/hrbopenres.13400.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background: We assessed the mental health of individuals in the general population, during an initial period of easing of COVID-19 restrictions in the Republic of Ireland (RoI). Methods: Data were collected through a nationally representative cross-sectional telephone survey, during the first period of easing of restrictions during the COVID-19 pandemic between May and July 2020. Mental health was examined using the Patient Health Questionnaire Anxiety Depression Scale. Poisson regression analyses were conducted to estimate risk ratios with robust variance estimation of the association between selected demographic factors and the risk of having depression and anxiety symptoms. Results: Of the 1,983 participants, 27.7% (n = 549; 95% CI: 0.26 - 0.30) reported depression and anxiety symptoms, while 74 (3.8%; 95% CI: 0.03 - 0.05) disclosed self-harm and/or suicidal thoughts. Females (RR: 1.60, 95% CI: 1.37 - 1.87, p < 0.0005), employed individuals who experienced a change in work status (RR: 1.50, 95% CI: 1.24 - 1.82, p < 0.0005), participants cocooning due to a health condition (RR: 1.34, 95% CI: 1.08 - 1.66, p< 0.01), participants who were self-isolating (RR: 1.25, 95% CI: 1.03 - 1.51, p=0.025) and moderate-heavy drinkers (RR: 1.27, 95% CI: 1.09 - 1.47, p<0.01) were at increased risk of depression and anxiety. Young people aged 18-29 years and those in the two lowest income categories were most likely to report self-harm and/or suicidal thoughts. Conclusion: As the COVID-19 pandemic continues, with further waves and associated restrictions, the impact on mental health in the population as a whole and in specific subgroups must be considered. Study protocol registration: doi.org/10.12688/hrbopenres.13103.2.
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Affiliation(s)
| | - Mary Joyce
- National Suicide Research Foundation, Cork, Ireland
| | - Ali Khashan
- School of Public Health, University College Cork, Cork, Ireland
| | - Claire Buckley
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Philipp Hoevel
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - Rory Humphries
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | | | - Elizabeth Kiely
- School of Applied Social Studies, University College Cork, Cork, Ireland
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Ivan Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
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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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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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Turmaine K, Dumas A, Chevreul K. Conditions for the Successful Integration of an eHealth Tool "StopBlues" Into Community-Based Interventions in France: Results From a Multiple Correspondence Analysis. J Med Internet Res 2022; 24:e30218. [PMID: 35451977 PMCID: PMC9077507 DOI: 10.2196/30218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/23/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background For over a decade, digital health has held promise for enabling broader access to health information, education, and services for the general population at a lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of eHealth technologies. In this context, community-based health promotion represents an interesting and efficient conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation. Objective To understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was related to the use of the tool. Methods The study was nested within a cluster-randomized controlled trial that was conducted to evaluate the effectiveness of the promotion, with before and after observation (NCT03565562). Data from questionnaires, observations, and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relations between context, type of implementation and promotion, and use of the tool. Results Three distinct promotion patterns emerged according to the profiles of the localities that were associated with specific SB utilization rates. From highest to lowest utilization rates, they are listed as follows: the privileged urban localities, investing in health that implemented a high-intensity and digital promotion, demonstrating a greater capacity to take ownership of the project; the urban, but less privileged localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion; and the rural localities, with little experience in addressing health issues, that implemented low-intensity promotion but could not overcome the challenges associated with their local context. Conclusions These findings indicate the substantial influence of local context on the reception of digital tools. The urban and socioeconomic status profiles of the localities, along with their investment and pre-existing experience in health, appear to be critical for shaping the promotion and implementation of eHealth tools in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention. International Registered Report Identifier (IRRID) RR2-10.1186/s13063-020-04464-2
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Affiliation(s)
| | - Agnès Dumas
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France
| | - Karine Chevreul
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France.,Assistance Publique-Hôpitaux de Paris, URC Eco Ile-de-France, Paris, France, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
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- See Authors' Contributions,
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8
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Troya MI, Joyce M, Khashan A, Buckley C, Chakraborti K, Hoevel P, Humphries R, Kearney PM, Kiely E, Murphy M, Perry I, Arensman E. Mental health following an initial period of COVID-19 restrictions: findings from a cross-sectional survey in the Republic of Ireland. HRB Open Res 2021; 4:130. [PMID: 35633845 PMCID: PMC9120930 DOI: 10.12688/hrbopenres.13400.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 03/04/2024] Open
Abstract
Background: We assessed the mental health of individuals in the general population, during an initial period of easing of COVID-19 restrictions in the Republic of Ireland (RoI). Methods: Data were collected through a nationally representative cross-sectional telephone survey, during the first period of easing of restrictions during the COVID-19 pandemic between May and July 2020. Mental health was examined using the Patient Health Questionnaire Anxiety Depression Scale. Poisson regression analyses were conducted to estimate risk ratios with robust variance estimation of the association between selected demographic factors and the risk of having depression and anxiety symptoms. Results: Of the 1,983 participants, 27.7% (n = 549; 95% CI: 0.26 - 0.30) reported depression and anxiety symptoms, while 74 (3.8%; 95% CI: 0.03 - 0.05) disclosed self-harm and/or suicidal thoughts. Females (RR: 1.60, 95% CI: 1.37 - 1.87, p < 0.0005), employed individuals who experienced a change in work status (RR: 1.50, 95% CI: 1.24 - 1.82, p < 0.0005), participants cocooning due to a health condition (RR: 1.34, 95% CI: 1.08 - 1.66, p< 0.01), participants who were self-isolating (RR: 1.25, 95% CI: 1.03 - 1.51, p=0.025) and moderate-heavy drinkers (RR: 1.27, 95% CI: 1.09 - 1.47, p<0.01) were at increased risk of depression and anxiety. Young people aged 18-29 years and those in the two lowest income categories were most likely to report self-harm and/or suicidal thoughts. Conclusion: As the COVID-19 pandemic continues, with further waves and associated restrictions, the impact on mental health in the population as a whole and in specific subgroups must be considered. Study protocol registration: doi.org/10.12688/hrbopenres.13103.2.
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Affiliation(s)
| | - Mary Joyce
- National Suicide Research Foundation, Cork, Ireland
| | - Ali Khashan
- School of Public Health, University College Cork, Cork, Ireland
| | - Claire Buckley
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Philipp Hoevel
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - Rory Humphries
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | | | - Elizabeth Kiely
- School of Applied Social Studies, University College Cork, Cork, Ireland
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Ivan Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
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Changes in the association between the traditional Japanese diet score and suicide rates over 26 years: A global comparative study. J Affect Disord 2021; 294:382-390. [PMID: 34315100 DOI: 10.1016/j.jad.2021.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/10/2021] [Accepted: 07/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study examined the global association between the Traditional Japanese Diet Score and suicide rate. METHODS Average food supply and energy supply by country were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database (FAOSTAT). Traditional Japanese Diet Score (TJDS) was calculated from food group classifications. Age-standardized suicide rates per 100,000 people by country were obtained from the Global Burden of Disease 2017 database. The 26-year associations between TJDS and suicide rates were examined controlling for covariates using a mixed-effects model in 138 countries with populations of 1 million or greater. RESULTS A significant negative association was found in the analysis of the relationship between TJDS and the prevalence of suicide [β (se) = -0.126 (0.031), p < 0.001]. The interaction term between TJDS and year was also significant [β (se) = -0.011 (0.003), p < 0.001]. The change in the effect of TJDS on suicide rates by year was examined. The effect of TJDS was not significant from 1991 to 1999 but became significant after 2000; the slope of the TJDS to suicide rate in 2017 was -0.270 (95% confidence interval -0.382, -0.169, p < 0.001). LIMITATIONS This was a national ecological study and did not consider individual differences in sex, age, and lifestyle. CONCLUSIONS TJDS may be is a protective factor for depression, which may prevent suicide. The association between TJDS and suicide rates became stronger over time and was inversely associated with suicide rates after 2000.
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Murakami O, Kanda K, Ngatu NR, Hirao T. Relationship between Willingness and Psychological Characteristics of Suicide Prevention Telephone Counselors: A Retrospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9800. [PMID: 34574721 PMCID: PMC8466911 DOI: 10.3390/ijerph18189800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022]
Abstract
Suicide is a major public health issue worldwide, and telephone counseling is an important preventive measure. As the number of telephone counselors is insufficient in Japan, public needs cannot be fully met. Willingness is important for securing telephone counselors, but few studies have examined the willingness to engage in telephone counseling activities. Therefore, we investigated the relationship between telephone counselors' willingness to perform their activities and their psychological characteristics, health status, and received social support. In this study, a questionnaire survey was conducted by mail among telephone counselors belonging to the Federation of Inochi No Denwa in Japan. The total number of valid responses was 709 (recovery rate: 50.4%). Following an exploratory factor analysis, three factors were extracted: (1) willingness to engage in telephone counseling activities, (2) sense of being burdened by telephone counseling activities, and (3) sense of difficulty in coping. Structural equation modeling, using all the factors, showed that social support and grit were directly related to the willingness to engage in telephone counseling activities, while physical health, mental health, and general self-efficacy were indirectly related to it. The findings obtained may be useful in devising concrete measures for telephone counselors to continue their activities.
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Affiliation(s)
- Osamu Murakami
- Department of Public Health, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe Miki-cho Kita-gun, Kagawa 761-0793, Japan; (K.K.); (N.R.N.); (T.H.)
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11
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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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12
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Dabkowski E, Porter JE. An exploration into suicide prevention initiatives for mental health nurses: A systematic literature review. Int J Ment Health Nurs 2021; 30:610-623. [PMID: 33856744 DOI: 10.1111/inm.12872] [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] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
Mental health and suicide prevention are national health priorities in Australia, with research currently focussed towards the ZERO Suicide (ZS) initiative. The aim of this review was to evaluate the impact of suicide prevention programmes, in particular the ZS prevention initiative. A systematic review using the PRISMA guidelines was conducted using six EBSCO Host databases; Academic Search Complete, Australian/New Zealand Reference Centre, CINAHL Complete, MEDLINE, APA PsycINFO, and APA Psyc Articles. The data extracted from the eligible papers were analysed using a thematic approach. The final data set consisted of fourteen (n = 14) peer-reviewed articles meeting the eligibility criteria, which included quantitative (n = 10), mixed methods (n = 2), and qualitative studies (n = 2). Results indicated variances between suicide prevention programmes with some papers examining single workshops and others assessing multimodal, organizational interventions. Five major themes were produced from this review including measuring the success of suicide prevention programmes, improvements to the delivery of suicide prevention programmes, barriers to implementing changes, cultural considerations, and further research required for suicide prevention programmes. This review concludes that further long-term research is required to evaluate the implementation and efficacy of suicide prevention programmes in health care. Cultural awareness in suicide prevention training is another area that may benefit from further research. A growing body of evidence establishes the need for multimodal and organizational approaches for suicide prevention initiatives.
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Affiliation(s)
- Elissa Dabkowski
- Collaborative Evaluation Unit, School of Health, Federation University Australia, Churchill, Victoria, Australia
| | - Joanne E Porter
- Collaborative Evaluation Unit, School of Health, Federation University Australia, Churchill, Victoria, Australia
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Abstract
This chapter presents a narrative synthesis of the evidence relating to the effectiveness of 13 different approaches (interventions) that have been incorporated into national suicide prevention programs. These approaches are presented in an analytic framework that distinguishes between national and community-based multilevel programs, prevention, and treatment/maintenance. The primary source of evidence are six reviews of reviews published since 2005, supplemented by a small number of systematic reviews and primary studies. We report strongly supportive evidence concerning the effectiveness of structural interventions (restrictions on access to bridges, tall buildings, and railways) and restriction on access to pharmacological agents. Weakly supportive evidence of effectiveness is available for community-based multilevel programs; restrictions on access to firearms and ligature points in institutional settings; settings-based programs (in schools, communities, workplaces, prisons, and the armed forces); education and training targeted at primary care physicians; lithium; cognitive behavioral therapy and dialectical behavioral therapy; and brief contact. There is insufficient or conflicting evidence concerning the effectiveness of the remaining approaches. We conclude that the evidence base for effective suicide prevention is far from convincing. Major improvement in the extent and quality of collaboration between researchers, policymakers, and practitioners and a considerable increase in funding for evaluation studies in suicide prevention are required if the current knowledge gap about effective interventions is to be bridged.
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14
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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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15
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Gandré C, Le Jeannic A, Vinet MA, Turmaine K, Courtet P, Roelandt JL, Vaiva G, Giraudeau B, Alberti C, Chevreul K. The PRINTEMPS study: protocol of a cluster-randomized controlled trial of the local promotion of a smartphone application and associated website for the prevention of suicidal behaviors in the adult general population in France. Trials 2020; 21:553. [PMID: 32571432 PMCID: PMC7309990 DOI: 10.1186/s13063-020-04464-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide constitutes a cause of death which could be prevented by e-health programs accessible to the general population. Effective promotion has the potential to maximize the uptake of such programs. However, few e-health programs have been combined with promotion campaigns. The primary objective of this trial is to assess the effectiveness of a tailored promotion, at a local level, of a mobile application and website offering evidence-based content for suicide prevention (the StopBlues program), and to compare the effectiveness of two types of local promotion in terms of their impact on suicidal acts. Secondary objectives focus on the effectiveness of the promotion in terms of the intensity of utilization of the StopBlues program, help-seeking behaviors and the level of psychological impairment of program users. METHODS/DESIGN This is a three-arm, parallel-group, cluster-randomized controlled trial, with before-and-after observation. Thirty-four clusters, corresponding to geographical areas sharing a common local authority in France, will be included. They will be randomly assigned to one of the following arms with a ratio of 1:1:1: a control group; a basic promotion group in which promotion of the StopBlues program will be done by local authorities; and an intensified promotion group in which basic promotion will be supplemented by an additional one in a general practitioner's waiting room. The primary outcome measure will be the number of suicidal acts within each cluster over a 12-month period following the launch of the intervention. Baseline data will be collected for each cluster over the 12-month period prior to the trial. Secondary outcomes will include length of use of the StopBlues program, measures of help-seeking behaviors and level of psychological distress among users of the program, as well as the cost-effectiveness and budgetary impact of its promotion. A more sustained promotion by local authorities will also be implemented after 12 months in the control group and assessed using the same outcome measures. DISCUSSION This research should contribute to the sparse evidence base regarding the promotion of e-health programs and will support the wider delivery of the intervention evaluated if proven effective. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03565562. Registered on 11 June 2018.
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Affiliation(s)
- Coralie Gandré
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
| | - Anaïs Le Jeannic
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- Health Economics Clinical Research Platform (URC Eco), AP-HP, 1 Place du Parvis Notre-Dame, 75004, Paris, France
| | - Marie-Amélie Vinet
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- Health Economics Clinical Research Platform (URC Eco), AP-HP, 1 Place du Parvis Notre-Dame, 75004, Paris, France
| | | | - Philippe Courtet
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France
| | - Jean-Luc Roelandt
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Établissement Public de Santé Mentale Lille Metropole, Lille, Hellemmes, France
| | - Guillaume Vaiva
- Department of Adult Psychiatry, CHU Lille, Lille, France
- Centre National de Ressources et Résilience pour le Psychotraumatisme (Cn2r Lille Paris), Lille, France
| | - Bruno Giraudeau
- INSERM CIC 1415, CHRU de Tours, Tours, France
- Tours University, Nantes University, INSERM SPHERE, U1246, Tours, France
| | - Corinne Alberti
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France
- Hôpital Robert Debré, CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karine Chevreul
- Université de Paris, Unité UMR 1123 ECEVE, INSERM, Paris, France.
- Health Economics Clinical Research Platform (URC Eco), AP-HP, 1 Place du Parvis Notre-Dame, 75004, Paris, France.
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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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de Beurs D, ten Have M, Cuijpers P, de Graaf R. The longitudinal association between lifetime mental disorders and first onset or recurrent suicide ideation. BMC Psychiatry 2019; 19:345. [PMID: 31694603 PMCID: PMC6836643 DOI: 10.1186/s12888-019-2328-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/17/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although the cross-sectional association between mental disorders and suicide ideation is well studied, less is known about the prospective association. In this paper, we estimated among those without 12-month suicide ideation at baseline, the association between a wide variety of common mental disorders at baseline and suicide ideation within the 6-year follow-up period, after controlling for history of other mental disorders and demographic variables. METHODS Data were used from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a prospective representative adult cohort study with baseline (n = 6646) with a 6-year follow-up period. Lifetime mental disorders were assessed at baseline with the Composite International Diagnostic Interview 3.0. Within the longitudinal design, participants with first time or recurrent suicide ideation were defined follows: having no suicide ideation in the 12 months before the baseline assessment, and reporting to have had seriously thought about suicide between baseline and the 6-year follow-up period. Multiple logistical regression was used to estimate the longitudinal association between suicide ideation and a specific mental disorder while controlling for comorbidity and baseline variables. To account for the prevalence of a disorder in the population, for each disorder, the population attributable risk proportion (PARP) was calculated. RESULTS 2.9% (n = 132) of the participants that did not report suicide ideation in the past 12 months at baseline reported suicide ideation at follow-up. Of these 132 cases, 81 (61%) experienced suicide ideation for the first time in their lives and could be viewed as first onset cases. 51 (39%) reported recurrent suicide ideation. After controlling for comorbidity, the only two disorders that were significantly related to suicide ideation at follow-up were lifetime major depressive disorder (MDD) and generalized anxiety disorder (GAD). PARP for MDD was 47.8 and 16.6% for GAD. CONCLUSIONS After controlling for all other mental disorders, a lifetime history of MDD and GAD were related to suicide ideation at follow-up. For clinical practice, this indicates that patients with a history of MDD or GAD stay vulnerable for suicide ideation, even though they did not report suicide ideation in the past year.
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Affiliation(s)
- Derek de Beurs
- Netherlands Institute of Health Services Research, Utrecht, Netherlands. .,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Margreet ten Have
- 0000 0001 0835 8259grid.416017.5Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Pim Cuijpers
- 0000 0004 1754 9227grid.12380.38Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ron de Graaf
- 0000 0001 0835 8259grid.416017.5Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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ASSAN A, AIKINS M, TAKIAN A. Suicide in Ghana: How Could the Community-Based Health Planning and Service (CHPS) Effectively Contribute to Its Prevention? IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:2097-2099. [PMID: 31970115 PMCID: PMC6961178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Abraham ASSAN
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Global Policy and Advocacy Network (GLOOPLAN), Accra, Ghana
| | - Moses AIKINS
- School of Public Health, College of Health Science, University of Ghana, Legon, Ghana
| | - Amirhossein TAKIAN
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
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19
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Ayuso-Mateos JL. Suicide prevention: towards an evidence-based policy. Epidemiol Psychiatr Sci 2019; 28:467-468. [PMID: 30873929 PMCID: PMC6998921 DOI: 10.1017/s204579601900012x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/18/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jose L. Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Centre for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
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20
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Genuchi MC. The Role of Masculinity and Depressive Symptoms in Predicting Suicidal Ideation in Homeless Men. Arch Suicide Res 2019; 23:289-311. [PMID: 29461153 DOI: 10.1080/13811118.2018.1428705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Men's suicide rates may be influenced by difficulties recognizing externalizing depressive symptoms in men that adhere to hegemonic masculine gender role norms. The purpose of this study was to investigate the ability of externalizing depressive symptoms, internalizing depressive symptoms, and hegemonic masculinity in predicting the existence and severity of suicidal ideation. Homeless men (n = 94) completed questionnaires at a resource center in the Rocky Mountain Western United States. Internalizing symptoms predicted the existence of suicidal ideation, and both externalizing and internalizing symptoms predicted increased severity of suicidal ideation. The masculine norms violence and playboy were correlated with men's suicidal ideation. An externalizing-internalizing model of predicting suicide in men and men's adherence to certain masculine gender role norms may be valuable to further efforts in suicide assessment and prevention.
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21
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Murphy AL, O'Reilly CL, Ataya R, Doucette SP, Martin-Misener R, Rosen A, Gardner DM. A survey of Canadian and Australian pharmacists' stigma of suicide. SAGE Open Med 2019; 7:2050312118820344. [PMID: 30728964 PMCID: PMC6350138 DOI: 10.1177/2050312118820344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/26/2018] [Indexed: 11/16/2022] Open
Abstract
Background There is limited information available regarding community pharmacists' stigma of suicide. Pharmacists regularly interact with people at risk of suicide and stigmatizing attitudes may impact care. Objective To measure community pharmacists' stigma of suicide. Method Pharmacists in Canada and Australia completed an online survey with the Stigma of Suicide Scale-Short Form. Data were analysed descriptively and with univariate and multivariate analyses. Results Three hundred and ninety-six pharmacists returned completed surveys (Canada n = 235; Australia n = 161; female 70%; mean age = 38.6 ± 12.7 years). The rate of endorsement of stigmatizing terms was low overall. Canadian and Australian pharmacists differed (p < 0.05) for several variables (e.g. age, friend or relative with a mental illness, training in mental health crisis). Pharmacists without someone close to them living with a mental illness were more likely to strongly agree/agree with words describing those who die by suicide as pathetic, stupid, irresponsible, and cowardly. Those without a personal diagnosis of mental illness strongly agreed/agreed with the terms immoral, irresponsible, vengeful, and cowardly. More Australian pharmacists strongly agreed/agreed that people who die by suicide are irresponsible, cowardly, and disconnected. Independent variables associated with a higher stigma were male sex, Australian, and negative perceptions about suicide preventability. Conclusion Community pharmacists frequently interact with people at risk of suicide and generally have low agreement of stigmatizing terms for people who die by suicide. Research should focus on whether approaches such as contact-based education can minimize existing stigma.
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Affiliation(s)
- Andrea L Murphy
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Claire L O'Reilly
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Randa Ataya
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Steve P Doucette
- Research Methods Unit, Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Alan Rosen
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.,Illawarra Institute for Mental Health, University of Wollongong, Wollongong, NSW, Australia
| | - David M Gardner
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Sakashita T, Oyama H. Developing a Hypothetical Model for Suicide Progression in Older Adults With Universal, Selective, and Indicated Prevention Strategies. Front Psychiatry 2019; 10:161. [PMID: 30971963 PMCID: PMC6445050 DOI: 10.3389/fpsyt.2019.00161] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 03/05/2019] [Indexed: 12/11/2022] Open
Abstract
Suicide prevention is an increasingly important issue, especially among older people. Recent work on improving its effectiveness has focused on developing a framework aligning interventions with key risk factors and stages of the suicide process. We have developed this further, by integrating psycho-behavioral components associated with suicide, existing guidelines for identifying critical points of intervention, and the previous preventive strategies framework. Our schematic diagram shows the relationship between the suicide process and prevention strategies, combined with initiatives for linking different types of strategies, from universal strategies at population level, through selective strategies focusing on groups at risk, to indicated strategies, aimed at specific high-risk individuals. We tested our framework using previous studies assessing the impact of suicide prevention interventions on suicide rates in older adults. It was possible to place all identified interventions within the framework. Examining effectiveness within the framework suggests that some interventions may be more successful in reducing suicide rates because they developed systematic linkages between universal, selective, and indicated prevention interventions. Other studies, however, show that interventions can be successful without these linkages, so other factors may also be important. The main weakness of our framework is a lack of evidence about critical intervention points within the suicide process, which may limit its practical application. However, the framework may help to improve the linkages between types of interventions, and support practitioners in developing a wide range of strategies across different areas and stages of the suicide process.
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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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23
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Affiliation(s)
- Ella Arensman
- 1 President, International Association for Suicide Prevention (IASP).,2 Director of Research, National Suicide Research Foundation, Department of Epidemiology and Public Health, University College Cork, Ireland.,3 WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
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Terpstra S, Beekman A, Abbing J, Jaken S, Steendam M, Gilissen R. Suicide prevention gatekeeper training in the Netherlands improves gatekeepers' knowledge of suicide prevention and their confidence to discuss suicidality, an observational study. BMC Public Health 2018; 18:637. [PMID: 29776415 PMCID: PMC5960185 DOI: 10.1186/s12889-018-5512-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background The gatekeeper training is designed to help identify suicidal individuals, respond to suicidal ideation and refer to help. The internationally widely used training shows promising results. This is the first study presenting its effectiveness in the Netherlands and the first study investigating the effect in different employment sectors. Methods In an observational study, 113 Suicide Prevention – the Dutch suicide prevention expertise centre and lifeline - trained 526 professionals as gatekeepers. Changes in gatekeepers’ identifying and referral behaviour, knowledge of suicide prevention and skills-confidence were studied, using a pre-post (6 weeks after training) self-report questionnaire. Outcomes were analyzed with General Linear Model (GLM) repeated measures with four employment sectors (healthcare-, educational-, socioeconomic and other sectors) as a between-subjects factor. Results Pre-post self-reports of 174 respondents showed no change in the identification of suicidal people, referrals to the general practitioner (GP) or lifeline 113, but significant improvement in professionals’ knowledge and confidence (p < .001). Results did not differ between employment sectors. Conclusions The gatekeeper training significantly increases suicide prevention knowledge and skills confidence in abilities to address suicidality. Healthcare, education, socioeconomic and other professionals (e.g. security, justice, transport, church workers) benefit similarly from the training. Increasing the number of gatekeeper training programs in all sectors is recommended. Electronic supplementary material The online version of this article (10.1186/s12889-018-5512-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sanne Terpstra
- Department of Research & Innovation, GGz InGeest, Amsterdam, The Netherlands.
| | - Aartjan Beekman
- Department of Research & Innovation, GGz InGeest, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jens Abbing
- Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands
| | - Sabine Jaken
- 113 Suicide Prevention, Amsterdam, The Netherlands
| | - Martin Steendam
- Department of Psychology, GGz Friesland, Leeuwarden, The Netherlands
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Baker STE, Nicholas J, Shand F, Green R, Christensen H. A comparison of multi-component systems approaches to suicide prevention. Australas Psychiatry 2018; 26:128-131. [PMID: 29160089 PMCID: PMC5888769 DOI: 10.1177/1039856217743888] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the new Australian approach to suicide prevention, LifeSpan, and compare it to other multi-component intervention models. METHOD The components, implementation strategies and effectiveness of three multi-component intervention models are described and compared in a narrative review. RESULTS The LifeSpan, European Alliance Against Depression (EAAD), and Zero Suicide models emphasise the provision of evidence-based interventions and continuity of care. Only LifeSpan and EAAD include community-based interventions at the population level, and LifeSpan is the only model to include school-based interventions. Zero Suicide focuses on healthcare settings. Implementation of LifeSpan and EAAD involves the convening of multi-stakeholder teams at the local level. To date, there is some, albeit mixed, evidence in support of EAAD, while LifeSpan and Zero Suicide await further evaluation. CONCLUSIONS Although multi-component approaches to suicide prevention share similar components, there are some important differences. Multiple interventions implemented at the same time and tailored to the local community context are likely to be the most effective way of reducing the rate of suicide. There is growing evidence for the effectiveness of multi-component systems approaches to suicide prevention; however, further evaluation is required.
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Affiliation(s)
- Simon TE Baker
- Research Officer, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
| | - Jennifer Nicholas
- PhD Candidate, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
| | - Fiona Shand
- Research Director, LifeSpan, and Senior Research Fellow, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
| | - Rachel Green
- Director, LifeSpan, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
| | - Helen Christensen
- Director and Chief Scientist, Black Dog Institute, UNSW Sydney, Randwick, NSW, Australia
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Collings S, Jenkin G, Stanley J, McKenzie S, Hatcher S. Preventing suicidal behaviours with a multilevel intervention: a cluster randomised controlled trial. BMC Public Health 2018; 18:140. [PMID: 29338723 PMCID: PMC5771156 DOI: 10.1186/s12889-018-5032-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 01/04/2018] [Indexed: 11/16/2022] Open
Abstract
Background In the context of the recent surge in community based multilevel interventions for suicide prevention, all of which show promising results, we discuss the implications of the findings of such an intervention designed for and implemented in New Zealand. The multi-level intervention for suicide prevention in New Zealand (MISP-NZ) was a cluster randomised controlled community intervention trial involving eight hospital regions matched into four pairs and randomised to either the intervention or practice as usual (the control). Intervention regions received 25 months of interventions (01 June 2010 to 30 June 2012) including: 1) training in recognition of suicide risk factors; 2) workshops on mental health issues; 3) community based interventions (linking in with community events); and 4) distribution of print material and information on web-based resources. Results There was no significant difference between the change in rate of suicidal behaviours (ISH or self-inflicted deaths) in the intervention group compared with the control group (rate ratio = 1.07, 95% CI 0.82, 1.38). Conclusions This study did not provide substantive evidence that the MISP-NZ intervention had an effect on suicidal behaviours raising important questions about the potential effectiveness of the multilevel intervention model for suicide prevention for all countries. Although a range of factors may account for this unanticipated finding, including inadequate study power, differences in design and intervention focus, and country-specific contextual factors, it is possible that the effectiveness of the multilevel intervention model for reducing suicidal behaviours may have been overstated. Trial registration This trial was retrospectively registered on 11 April 2013. ACTRN12613000399796.
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Affiliation(s)
- Sunny Collings
- Suicide and Mental Health Research Group, University of Otago, PO Box 7343, Mein St, Newtown, Wellington, New Zealand.
| | - Gabrielle Jenkin
- Suicide and Mental Health Research Group, University of Otago, PO Box 7343, Mein St, Newtown, Wellington, New Zealand
| | - James Stanley
- University of Otago, PO Box 7343, Mein St, Newtown, Wellington, New Zealand
| | - Sarah McKenzie
- Suicide and Mental Health Research Group, University of Otago, PO Box 7343, Mein St, Newtown, Wellington, New Zealand
| | - Simon Hatcher
- Department of Psychiatry and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
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Torok M, Calear A, Shand F, Christensen H. A Systematic Review of Mass Media Campaigns for Suicide Prevention: Understanding Their Efficacy and the Mechanisms Needed for Successful Behavioral and Literacy Change. Suicide Life Threat Behav 2017; 47:672-687. [PMID: 28044354 DOI: 10.1111/sltb.12324] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 10/03/2016] [Indexed: 11/29/2022]
Abstract
Mass media campaigns are increasingly seen as an important part of suicide prevention; however, despite their popularity, their efficacy is not well understood. The current review aimed to address key knowledge gaps regarding how mass media campaigns can be optimized to prevent suicide, by looking at their global efficacy, and mechanisms related to successful outcomes. A systematic review of the international literature examined studies which evaluated mass media campaigns targeted at suicide prevention, where suicide behaviors (mortality, attempts) or suicide literacy (knowledge, attitudes, help-seeking) was identified as a primary outcome. Thirteen articles describing 12 unique campaigns met eligibility criteria. For behavioral outcomes, mass media campaigns appear to be most effective when delivered as part of a multicomponent suicide prevention strategy, while "standalone campaigns" were modestly useful for increasing suicide literacy. Level of exposure, repeat exposure, and community engagement appeared to be fundamental to the success of these campaigns; however, these constructs were poorly adhered to in the development and implementation of campaigns. Overall, the mixed quality of the included studies highlights a need for increased quantity, consistency, and quality of evaluations to advance the evidence base.
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Affiliation(s)
- Michelle Torok
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Alison Calear
- National Institute for Mental Health Research, The Australian National University, Acton, ACT, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
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Fitzpatrick SJ. Reshaping the Ethics of Suicide Prevention: Responsibility, Inequality and Action on the Social Determinants of Suicide. Public Health Ethics 2017. [DOI: 10.1093/phe/phx022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
More than 800 000 people die every year from suicide, and about 20 times more attempt suicide. In most countries, suicide risk is highest in older males, and risk of attempted suicide is highest in younger females. The higher lethal level of suicidal acts in males is explained by the preference for more lethal methods, as well as other factors. In the vast majority of cases, suicidal behavior occurs in the context of psychiatric disorders, depression being the most important one. Improving the treatment of depression, restricting access to lethal means, and avoiding the Werther effect (imitation suicide) are central aspects of suicide prevention programs. In several European regions, the four-level intervention concept of the European Alliance Against Depression (www.EAAD.net), simultaneously targeting depression and suicidal behavior, has been found to have preventive effects on suicidal behavior. It has already been implemented in more than 100 regions in Europe.
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University Hospital of Leipzig, Leipzig, Germany
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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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Bantjes J. 'Don't push me aside, Doctor': Suicide attempters talk about their support needs, service delivery and suicide prevention in South Africa. Health Psychol Open 2017; 4:2055102917726202. [PMID: 29379617 PMCID: PMC5779928 DOI: 10.1177/2055102917726202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Few studies have explored the expressed support needs of suicide attempters in developing countries. Data, collected via in-depth interviews with suicide attempters admitted to a South African hospital, were analysed using thematic content analysis. Participants explicitly asked for integrated psycho-social services at a primary health care level and say they require assistance with alleviating psychiatric symptoms, establishing connectedness, interpersonal conflict and solving socio-economic problems. Findings highlight the importance for suicide prevention of (1) considering interpersonal and contextual socio-economic factors in addition to the psychiatric causes of suicidal behaviour; and (2) multilevel strategies, intersectoral collaboration and integrated person-centred primary health care.
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Oyama H, Sakashita T. Community-based screening intervention for depression affects suicide rates among middle-aged Japanese adults. Psychol Med 2017; 47:1500-1509. [PMID: 28193313 DOI: 10.1017/s0033291717000204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND It has been suggested that screening interventions may be effective for suicide prevention. Few studies, however, have reported their effects on outcome measures, including death by suicide among middle-aged adults. METHOD We used a quasi-experimental parallel cluster design with matched community-based intervention and control municipalities (total eligible population: 90 000) in Japan. At-risk residents within the intervention area were invited for universal depression screening and subsequent care/support. We compared changes in suicide incidence of adults aged 40-64 years for the 4-year pre- and post-implementation periods in the intervention group with the control group and the whole country. Incidence rate ratios (IRRs) of the outcomes were adjusted for age group, gender and interaction terms, using mixed-effects negative binomial regression models. Suicide rates among intervention and control subgroups were compared. RESULTS The screening procedure was offered to 52% of the intervention group, and 61% of those contacted responded over the implementation period. Suicide rates decreased more in the intervention group [IRR 0.57, 95% (CI) 0.41-0.78; F 1,36 = 12.52, p = 0.001] than the control group (IRR proportion 1.63, 95% CI 1.06-2.48; F 1,82 = 5.20, p = 0.025) or the whole country (IRR proportion 1.64, 95% CI 1.16-2.34; F 1,42 = 8.21, p = 0.006). Sensitivity analyses confirmed the results from the primary analysis. There were lower suicide rates among both respondents and non-respondents to the screening than in the control group during the implementation period. CONCLUSIONS Prevention efforts involved in the depression screening intervention were probably successful in reducing suicide rates.
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Affiliation(s)
- H Oyama
- Department of Social Welfare,Faculty of Heath Sciences,Aomori University of Health and Welfare,Aomori,Japan
| | - T Sakashita
- Department of Social Welfare,Faculty of Heath Sciences,Aomori University of Health and Welfare,Aomori,Japan
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Gilissen R, De Beurs D, Mokkenstorm J, Mérelle S, Donker G, Terpstra S, Derijck C, Franx G. Improving Suicide Prevention in Dutch Regions by Creating Local Suicide Prevention Action Networks (SUPRANET): A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040349. [PMID: 28350367 PMCID: PMC5409550 DOI: 10.3390/ijerph14040349] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/16/2017] [Accepted: 03/22/2017] [Indexed: 11/16/2022]
Abstract
The European Alliance against Depression (EAAD) program is to be introduced in The Netherlands from 2017 onwards. This program to combat suicide consists of interventions on four levels: (1) increasing the awareness of suicide by local media campaigns; (2) training local gatekeepers, such as teachers or police officers; (3) targeting high-risk persons in the community; and (4) training and support of professionals in primary care settings. The implementation starts in seven Dutch pilot regions. Each region is designated as a Suicide Prevention Action NETwork (SUPRANET). This paper describes the SUPRANET program components and the evaluation of its feasibility and impact. The findings will be used to facilitate the national implementation of EAAD in The Netherlands and to add new findings to the existing literature on EAAD.
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Affiliation(s)
- Renske Gilissen
- Department of Research, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (J.M.); (S.T.)
- Correspondence:
| | - Derek De Beurs
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands; (D.d.B.); (G.D.)
| | - Jan Mokkenstorm
- Department of Research, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (J.M.); (S.T.)
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT Amsterdam, The Netherlands
- Department of Research & Innovation, GGZ inGeest, 1070 BB Amsterdam, The Netherlands
| | - Saskia Mérelle
- Public Health Service (GGD) Kennemerland, 2015 CK Haarlem, The Netherlands;
| | - Gé Donker
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands; (D.d.B.); (G.D.)
| | - Sanne Terpstra
- Department of Research, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (J.M.); (S.T.)
| | - Carla Derijck
- Department of Implementation, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (C.D.); ; (G.F.)
| | | | - Gerdien Franx
- Department of Implementation, 113 Suicide Prevention, 1100 CE Amsterdam, The Netherlands; (C.D.); ; (G.F.)
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DeSilva M, Samele C, Saxena S, Patel V, Darzi A. Policy actions to achieve integrated community-based mental health services. Health Aff (Millwood) 2016; 33:1595-602. [PMID: 25201664 DOI: 10.1377/hlthaff.2014.0365] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Globally, the majority of people with mental health problems do not receive evidence-based interventions that can transform their lives. We describe six mental health policy actions adopted at the World Innovation Summit for Health in 2013. For each policy action, we offer real-world examples of mental health innovations that governments and health care providers can implement to move toward universal health coverage for mental health. The six policy actions are empowering people with mental health problems and their families, building a diverse mental health workforce, developing collaborative and multidisciplinary mental health teams, using technology to increase access to mental health care, identifying and treating mental health problems early, and reducing premature mortality in people with mental health problems. Challenges to implementing these policy actions include the lack of recognition of mental health as a global health priority and the resulting lack of investment in mental health, the difficulties of integrating mental health into primary care health services because of a scarcity of human and financial resources, and the lack of evidence on the effectiveness and costs of taking innovations to a national scale.
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Affiliation(s)
- Mary DeSilva
- Mary DeSilva is a senior lecturer at the London School of Hygiene and Tropical Medicine, in the United Kingdom
| | - Chiara Samele
- Chiara Samele is director of Informed Thinking, in London, and a senior fellow at the Institute of Mental Health, in Nottingham
| | - Shekhar Saxena
- Shekhar Saxena is cochair of the Mental Health Forum, World Innovation Summit for Health (WISH), Qatar Foundation; and director of the Department of Mental Health and Substance Abuse, World Health Organization, in Geneva, Switzerland
| | - Vikram Patel
- Vikram Patel is cochair of the Mental Health Forum, WISH, and a professor at both the Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, and the Centre for Mental Health, the Public Health Foundation of India, in Sangath, Goa
| | - Ara Darzi
- Ara Darzi is executive chair of WISH, Qatar Foundation, and director of the Centre for Health Policy, Institute of Global Health Innovation, Imperial College London
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Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, Carli V, Höschl C, Barzilay R, Balazs J, Purebl G, Kahn JP, Sáiz PA, Lipsicas CB, Bobes J, Cozman D, Hegerl U, Zohar J. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry 2016; 3:646-59. [PMID: 27289303 DOI: 10.1016/s2215-0366(16)30030-x] [Citation(s) in RCA: 967] [Impact Index Per Article: 120.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/27/2016] [Accepted: 03/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide prevention interventions since 2005. METHODS We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis. FINDINGS We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0·45, 95% CI 0·24-0·85; p=0·014) and suicidal ideation (0·5, 0·27-0·92; p=0·025). The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions. INTERPRETATION In the quest for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs. FUNDING The Expert Platform on Mental Health, Focus on Depression, and the European College of Neuropsychopharmacology.
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Affiliation(s)
- Gil Zalsman
- Geha Mental Health Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA.
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | | | - Ella Arensman
- National Suicide Research Foundation, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Via De Santis Campobasso and National Institute for Health, Migration and Poverty, Roma, Italy
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Cyril Höschl
- National Institute of Mental Health, Klecany, Czech Republic
| | - Ran Barzilay
- Geha Mental Health Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - György Purebl
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - Jean Pierre Kahn
- Université de Lorraine, Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy-Laxou, Nancy-Laxou, France
| | - Pilar Alejandra Sáiz
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, Spain
| | - Cendrine Bursztein Lipsicas
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, Spain
| | - Doina Cozman
- Department of Clinical Psychology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Joseph Zohar
- Psychiatry Department, Sheba Health Center and Sackler School of Medicine, Tel Aviv University, Tel Avis, Israel
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A systematic review of psychosocial suicide prevention interventions for youth. Eur Child Adolesc Psychiatry 2016; 25:467-82. [PMID: 26472117 DOI: 10.1007/s00787-015-0783-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/05/2015] [Indexed: 01/12/2023]
Abstract
Youth suicide is a significant public health problem. A systematic review was conducted to examine the effectiveness of school, community and healthcare-based interventions in reducing and preventing suicidal ideation, suicide attempts and deliberate self-harm in young people aged 12-25 years. PsycInfo, PubMed and Cochrane databases were searched to the end of December 2014 to identify randomised controlled trials evaluating the effectiveness of psychosocial interventions for youth suicide. In total, 13,747 abstracts were identified and screened for inclusion in a larger database. Of these, 29 papers describing 28 trials fulfilled the inclusion criteria for the current review. The results of the review indicated that just over half of the programs identified had a significant effect on suicidal ideation (Cohen's d = 0.16-3.01), suicide attempts (phi = 0.04-0.38) or deliberate self-harm (phi = 0.29-0.33; d = 0.42). The current review provides preliminary support for the implementation of universal and targeted interventions in all settings, using a diverse range of psychosocial approaches. Further quality research is needed to strengthen the evidence-base for suicide prevention programs in this population. In particular, the development of universal school-based interventions is promising given the potential reach of such an approach.
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Abstract
Suicide is a complex public health problem of global importance. Suicidal behaviour differs between sexes, age groups, geographic regions, and sociopolitical settings, and variably associates with different risk factors, suggesting aetiological heterogeneity. Although there is no effective algorithm to predict suicide in clinical practice, improved recognition and understanding of clinical, psychological, sociological, and biological factors might help the detection of high-risk individuals and assist in treatment selection. Psychotherapeutic, pharmacological, or neuromodulatory treatments of mental disorders can often prevent suicidal behaviour; additionally, regular follow-up of people who attempt suicide by mental health services is key to prevent future suicidal behaviour.
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Affiliation(s)
- Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada.
| | - David A Brent
- Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
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[From the Competence Network on Depression and Suicidality to the German Depression Foundation. National and international prevention of suicidal behaviour and optimizing health care through using of E‑Mental-Health]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:406-11. [PMID: 26961867 DOI: 10.1007/s00103-016-2310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Depression is a very common, severe, socio-economically highly relevant disorder and the main cause for approximately 10,000 suicides in Germany annually. There is capital room for improvement and optimization of the care for depressed patients, as effective and evidence-based treatment options are available. However, they are only used optimally by a minority of the people affected due to huge diagnostic and therapeutic deficits. The "Compentence Network on Depression and Suicidality" provided several evidence-based concepts to improve care for patients affected by depression and to prevent suicidal behaviour. Especially the four-level intervention approach of the Alliances Against Depression has been successfully adapted and implemented by more than 100 regions within Europe and globally as well. The infrastructure of the Competence Network could be efficiently sustained throughout the establishment of the German Depression Foundation and the European Alliance against Depression. Since 2014, all research activities have been extended nationally and internationally by the establishment of a Depression Research Centre with a special focus on various E‑Mental-Health-projects.
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Werner-Seidler A, Perry Y, Christensen H. An Australian Example of Translating Psychological Research into Practice and Policy: Where We are and Where We Need to Go. Front Psychol 2016; 7:200. [PMID: 26925018 PMCID: PMC4759571 DOI: 10.3389/fpsyg.2016.00200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/02/2016] [Indexed: 11/13/2022] Open
Abstract
Research findings from psychological science have identified interventions that will benefit human health. However, these findings are not often incorporated into practice-based settings or used to inform policy, in part, due to methodological and contextual limitations. A strategic approach is required if we are to find a way to facilitate the translation of these findings into areas that will offer genuine impact on health. There is an overwhelming focus on conducting more clinical trials, without consideration of how to ensure that findings from such trials make it to the patients or populations for whom they were intended. The aim of this paper is to outline how the Black Dog Institute, an Australian medical research institute, has created a framework designed to facilitate the translation of research findings into practice-based community settings, and how these findings can be used to inform policy. We propose that the core strategies adopted at the Black Dog Institute to prioritize and implement a translational program will be useful to institutes and organizations worldwide to augment the impact of their work. We provide several examples of how our research has been implemented in practice-based settings at a community-level, and how we have used research in psychology as a platform to inform policy change.
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Fleischmann A, Arensman E, Berman A, Carli V, De Leo D, Hadlaczky G, Howlader S, Vijayakumar L, Wasserman D, Saxena S. Overview evidence on interventions for population suicide with an eye to identifying best-supported strategies for LMICs. Glob Ment Health (Camb) 2016; 3:e5. [PMID: 28596874 PMCID: PMC5314741 DOI: 10.1017/gmh.2015.27] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 11/23/2015] [Accepted: 12/03/2015] [Indexed: 01/07/2023] Open
Abstract
Globally, over 800 000 people died by suicide in 2012 and there are indications that for each adult who died of suicide there were likely to be many more attempting suicide. There are many millions of people every year who are affected by suicide and suicide attempts, taking into consideration the family members, friends, work colleagues and communities, who are bereaved by suicide. In the WHO Mental Health Action Plan 2013-2020, Member States committed themselves to work towards the global target of reducing the suicide rate in countries by 10% by 2020. Hence, the first-ever WHO report on suicide prevention, Preventing suicide: a global imperative, published in September 2014, is a timely call to take action using effective evidence-based interventions. Their relevance for low- and middle-income countries is discussed in this paper, highlighting restricting access to means, responsible media reporting, introducing mental health and alcohol policies, early identification and treatment, training of health workers, and follow-up care and community support following a suicide attempt.
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Affiliation(s)
- A. Fleischmann
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - E. Arensman
- Department of Epidemiology and Public Health, National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - A. Berman
- American Association of Suicidology, USA
| | - V. Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - D. De Leo
- Australian Institute for Suicide Research and Prevention, Brisbane, Australia
| | - G. Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - S. Howlader
- University of Melbourne, Melbourne, Australia
| | | | - D. Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - S. Saxena
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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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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Arensman E, Koburger N, Larkin C, Karwig G, Coffey C, Maxwell M, Harris F, Rummel-Kluge C, van Audenhove C, Sisask M, Alexandrova-Karamanova A, Perez V, Purebl G, Cebria A, Palao D, Costa S, Mark L, Tóth MD, Gecheva M, Ibelshäuser A, Gusmão R, Hegerl U. Depression Awareness and Self-Management Through the Internet: Protocol for an Internationally Standardized Approach. JMIR Res Protoc 2015; 4:e99. [PMID: 26251104 PMCID: PMC4705028 DOI: 10.2196/resprot.4358] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 11/13/2022] Open
Abstract
Background Depression incurs significant morbidity and confers increased risk of suicide. Many individuals experiencing depression remain untreated due to systemic and personal barriers to care. Guided Internet-based psychotherapeutic programs represent a promising means of overcoming such barriers and increasing the capacity for self-management of depression. However, existing programs tend to be available only in English and can be expensive to access. Furthermore, despite evidence of the effectiveness of a number of Internet-based programs, there is limited evidence regarding both the acceptability of such programs and feasibility of their use, for users and health care professionals. Objective This paper will present the protocol for the development, implementation, and evaluation of the iFightDepression tool, an Internet-based self-management tool. This is a cost-free, multilingual, guided, self-management program for mild to moderate depression cases. Methods The Preventing Depression and Improving Awareness through Networking in the European Union consortium undertook a comprehensive systematic review of the available evidence regarding computerized cognitive behavior therapy in addition to a consensus process involving mental health experts and service users to inform the development of the iFightDepression tool. The tool was implemented and evaluated for acceptability and feasibility of its use in a pilot phase in 5 European regions, with recruitment of users occurring through general practitioners and health care professionals who participated in a standardized training program. Results Targeting mild to moderate depression, the iFightDepression tool is based on cognitive behavioral therapy and addresses behavioral activation (monitoring and planning daily activities), cognitive restructuring (identifying and challenging unhelpful thoughts), sleep regulation, mood monitoring, and healthy lifestyle habits. There is also a tailored version of the tool for young people, incorporating less formal language and additional age-appropriate modules on relationships and social anxiety. The tool is accompanied by a 3-hour training intervention for health care professionals. Conclusions It is intended that the iFightDepression tool and associated training for health care professionals will represent a valuable resource for the management of depression that will complement existing resources for health care professionals. It is also intended that the iFightDepression tool and training will represent an additional resource within a multifaceted approach to improving the care of depression and preventing suicidal behavior in Europe.
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Affiliation(s)
- Ella Arensman
- National Suicide Research Foundation, Cork, Ireland.
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Jensen KB, Morthorst BR, Vendsborg PB, Hjorthøj CR, Nordentoft M. The effect of the mental health first-aid training course offered employees in Denmark: study protocol for a randomized waitlist-controlled superiority trial mixed with a qualitative study. BMC Psychiatry 2015; 15:80. [PMID: 25884517 PMCID: PMC4411756 DOI: 10.1186/s12888-015-0466-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/30/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies show a high and growing prevalence of mental disorders in the population worldwide. 25% of the general population in Europe will during their lifetime experience symptoms related to a mental disorder. The Mental Health First Aid concept (MHFA) was founded in 2000 in Australia by Kitchener and Jorm, in order to provide the population with mental health first aid skills. The aim of the concept is, through an educational intervention (course), to increase confidence in how to help people suffering from mental health problems. Further, secondary aims are to increase the mental health literacy of the public by increasing knowledge, reduce stigma and initiate more supportive actions leading towards professional care. An investigation of the effect of MHFA offered a Danish population is needed. METHODS The design is a randomized waitlist-controlled superiority trial, in which 500 participants will be allocated to either the intervention group or the control group. The control group will attend the course six months later, hence waiting list design. From fall 2013 to spring 2014 participants will be educated to be "mental health first-aiders" following a manualized, two days MHFA course. All the participants will answer a questionnaire at base-line and at 6 months follow-up. The questionnaire is a back-translation of the questionnaire used in Australian trials. The trial will be complemented by a qualitative study, in which focus groups will be carried out. DISCUSSION Outcomes measured are sensitive to interpretation, hence a challenge to uniform. This trial will add to the use of a mixed-methods design and exemplify how it can strengthen the analysis and take up the challenge of a sensitive outcome. TRIAL REGISTRATION https://clinicaltrials.gov identifier NCT02334020.
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Affiliation(s)
- Kamilla B Jensen
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
| | - Britt R Morthorst
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
| | - Per B Vendsborg
- Danish Mental Health Foundation, Hejrevej 43, DK, 2400, Copenhagen, Denmark.
| | - Carsten R Hjorthøj
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
| | - Merete Nordentoft
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
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Laszlo AM, Hulman A, Csicsman J, Bari F, Nyari TA. The use of regression methods for the investigation of trends in suicide rates in Hungary between 1963 and 2011. Soc Psychiatry Psychiatr Epidemiol 2015; 50:249-56. [PMID: 24990277 DOI: 10.1007/s00127-014-0926-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/22/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Suicide rates in Hungary have been analyzed from different aspects in recent decades. However, only descriptive rates have been reported. The aim of our epidemiological study was to characterize the pattern of annual rates of suicide in Hungary during the period 1963-2011 by applying advanced statistical methods. METHODS Annual suicide rates per 100,000 population (>6 years) for gender, age group and suicide method were determined from published frequency tables and reference population data obtained from the Hungarian Central Statistical Office. Trends and relative risks of suicide were investigated using negative binomial regression models overall and in stratified analyses (by gender, age group and suicide method). Joinpoint regression analyses were additionally applied to characterize trends and to find turning points during the period 1963-2011. RESULTS Overall, 178,323 suicides (50,265 females and 128,058 males) were committed in Hungary during the investigated period. The risk of suicide was higher among males than females overall, in all age groups and for most suicide methods. The annual suicide rate exhibited a significant peak in 1982 and remained basically constant after 2006. Different segmented patterns were observed for the suicide rates in the various age groups. CONCLUSIONS Suicide rates revealed segmented linear pattern. This is the first detailed trend analysis with risk estimates obtained via joinpoint and negative binomial regression methods simultaneously for age-specific suicide frequencies in Hungary.
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Affiliation(s)
- Anna M Laszlo
- Department of Medical Physics and Informatics, Faculty of Medicine, University of Szeged, Korányi fasor 9, 6720, Szeged, Hungary,
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Hegerl U. EPA-0972 – Optimising suicide prevention programmes and their implementation in europe (OSPI-europe): results on suicidal behaviour. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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