1
|
Shand F, Torok M, Mackinnon A, Burnett A, Sharwood LN, Batterham PJ, Calear AL, Qian J, Zeritis S, Sara G, Page A, Cutler H, Maple M, Draper B, McGillivray L, Phillips M, Rheinberger D, Zbukvic I, Christensen H. Effect of the LifeSpan suicide prevention model on self-harm and suicide in four communities in New South Wales, Australia: a stepped-wedge, cluster randomised controlled trial. BMJ MENTAL HEALTH 2025; 28:e301429. [PMID: 40164469 PMCID: PMC11962778 DOI: 10.1136/bmjment-2024-301429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 03/14/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND There have been few rigorous evaluations of population, multi-strategy, suicide prevention programmes, despite increasing global recognition that such approaches are needed to reduce suicide. OBJECTIVE To examine the effects of a multi-strategy suicide prevention model on age-standardised rates of hospital presenting self-harm and suicide after 24 months of implementation. METHODS A stepped-wedge cluster randomised trial was conducted in four sites across New South Wales (NSW), Australia, from 2016 to 2020. Sites were randomised to a starting order and implemented the same set of interventions over a 24-month period. Changes in rates of hospital presenting self-harm and suicide deaths were measured using linked administrative health data sets of persons aged 10 or older. RESULTS Negative binomial regression models adjusted for linear trends and seasonality showed that LifeSpan was associated with a 13∙8% (incident response rate 0.86; 95% CI 0.79 to 0.94) reduction in hospital-presenting self-harm rates over the intervention period, compared with preintervention. These effects were not observed in the rest of NSW. There were statistically non-significant changes in suicide death rates during the intervention across all sites. CONCLUSIONS Locally implementing a multi-strategy suicide prevention model can reduce rates of hospital presentations for self-harm, but longer implementation and evaluation periods may be required to realise the full impacts of interventions for suicide, as a more intractable outcome. CLINICAL IMPLICATIONS Our findings can inform policy at all levels of government to invest in actions that may build cross-sectoral capacity in local communities to detect and respond to suicide risk.
Collapse
Affiliation(s)
- Fiona Shand
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Michelle Torok
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Andrew Mackinnon
- Black Dog Institute, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Lisa N Sharwood
- University of New South Wales, Sydney, New South Wales, Australia
| | - Philip J Batterham
- Black Dog Institute, Randwick, New South Wales, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alison L Calear
- Black Dog Institute, Randwick, New South Wales, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jiahui Qian
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Grant Sara
- University of New South Wales, Sydney, New South Wales, Australia
- New South Wales Ministry of Health, St Leonards, New South Wales, Australia
| | - Andrew Page
- Western Sydney University, Penrith, New South Wales, Australia
| | - Henry Cutler
- Macquarie University, Sydney, New South Wales, Australia
| | - Myfanwy Maple
- University of New England, Armidale, New South Wales, Australia
| | - Brian Draper
- University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren McGillivray
- Black Dog Institute, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Isabel Zbukvic
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- University of Melbourne, Parkville, VIC, Australia
| | | |
Collapse
|
2
|
Putri AK, McGrath M, Batchelor R, Ross V, Krysinska K, Hawgood J, Kõlves K, Reifels L, Pirkis J, Andriessen K. Strategies and evaluation underpinning the implementation of suicide prevention training: a systematic review. BMC Public Health 2025; 25:889. [PMID: 40050823 PMCID: PMC11883942 DOI: 10.1186/s12889-025-21999-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/18/2025] [Indexed: 03/10/2025] Open
Abstract
BACKGROUND Suicide prevention training programs can enhance the capacity for suicide prevention by improving the attitudes and comprehension of individuals regarding suicide and increasing their skills in supporting a suicidal person. However, little is known about how training programs are implemented and how implementation is assessed. Thus, our review aims to identify the strategies and evaluation methods underpinning the implementation of suicide prevention training programs. METHODS The systematic review adhered to the PRISMA guidelines and involved searches in MEDLINE, Embase, Emcare, PsycINFO, EBM Reviews, Scopus, and a forward and backward citation search following the full-text screening. Eligible studies (n = 28) reported the implementation strategy or implementation evaluation of a suicide prevention training program (PROSPERO #CRD42021288621). RESULTS The implementation strategies varied among three categories of training programs. Gatekeeper training predominantly utilized a train-the-trainer format and collaborations with stakeholders. Professional development training focused more on establishing supportive organizational infrastructure and extended post-training supervision. School-based curriculum training programs emphasized the distribution of educational materials and role-play activities. Surveys were the primary evaluation method, often complemented by interviews, observations, progress tracking, or focus groups. Evaluations primarily assessed acceptability, fidelity, and feasibility. CONCLUSION While certain training categories tend to employ specific strategies and evaluation measures more frequently than others, stakeholder collaboration, assessing content relevance, and follow-up supervision could be valuable across training programs. Tailored strategies may cater for groups with varying levels of knowledge and training in suicide prevention to enhance acceptability and feasibility. Future research should evaluate approaches that facilitate adoption and sustainability of suicide prevention training programs.
Collapse
Affiliation(s)
- Adelia Khrisna Putri
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Martina McGrath
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Batchelor
- The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
| | - Victoria Ross
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Karolina Krysinska
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Lennart Reifels
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Karl Andriessen
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| |
Collapse
|
3
|
Schnitzspahn K, Abdulla K, Arensman E, Van Audenhove C, Mere R, Pérez Sola V, Sisask M, Székely A, Toczyski P, Hegerl U. Community-Based 4-Level Intervention Targeting Depression and Suicidal Behavior in Europe: Protocol for an Implementation Project. JMIR Res Protoc 2025; 14:e64218. [PMID: 39793023 PMCID: PMC11759909 DOI: 10.2196/64218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/20/2024] [Accepted: 09/28/2024] [Indexed: 01/12/2025] Open
Abstract
BACKGROUND The community-based, 4-level intervention of the European Alliance Against Depression (EAAD) is simultaneously addressing depression and suicidal behavior. Intervention activities target primary care health professionals (level 1), the general public (level 2), community facilitators (level 3), and patients and their relatives (level 4). Activities comprise the digital iFightDepression tool, a guided self-management tool based on cognitive behavioral therapy. OBJECTIVE This study aimed to present the European Union-cofunded EAAD-Best study protocol, aiming at the implementation, dissemination, and evaluation of the 4-level intervention and the iFightDepression tool in several countries across Europe. METHODS The 4-level intervention has been implemented for the first time in Bulgaria, Estonia, Greece, and Poland. In 3 countries that have already implemented the 4-level intervention (Hungary, Ireland, and Spain), activities have been extended to new regions. In addition, the nationwide uptake of the iFightDepression tool by patients with depression has been promoted in all mentioned countries and Italy. RESULTS To evaluate the implementation of the 4-level intervention and the iFightDepression tool, data related to the process, output, and outcome were collected between 2022 and 2024. Data processing and analyses started in 2023. Analyses are expected to be completed in 2024. Results are expected to be published in 2025. CONCLUSIONS This paper informs researchers, practitioners, and stakeholders on how to implement best practices in mental health promotion and evaluate their effectiveness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/64218.
Collapse
Affiliation(s)
| | - Kahar Abdulla
- European Alliance Against Depression e.V., Leipzig, Germany
- Ruhr University Bochum, Bochum, Germany
| | - Ella Arensman
- University College Cork, National Suicide Research Foundation, Cork, Ireland
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | | | - Rainer Mere
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia
- School of Governance, Law and Society (SOGOLAS), Tallinn University, Tallinn, Estonia
| | - Victor Pérez Sola
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia
- School of Governance, Law and Society (SOGOLAS), Tallinn University, Tallinn, Estonia
| | | | | | - Ulrich Hegerl
- European Alliance Against Depression e.V., Leipzig, Germany
- Goethe University, Frankfurt, Germany
| |
Collapse
|
4
|
Vargiu N, Belfanti A, Roberti M, Trentin S, Ferrara C, Tosti M, Lazzeri M, Giupponi G, Conca A. Empowerment of Italian general practitioners in depression and suicide prevention: the iFightDepression tool, a game changer of the EAAD-Best project. Ann Gen Psychiatry 2024; 23:24. [PMID: 38926725 PMCID: PMC11210018 DOI: 10.1186/s12991-024-00506-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 06/28/2024] Open
Abstract
General Practitioners (GPs) play a key role in the early detection and management of depression and in preventing suicide risk. They are often the first healthcare professionals that people in crisis contact. However, their effectiveness can be limited by several barriers, including the lack of specific training and appropriate tools.The EAAD-Best project aims to fill these gaps through its iFightDepression tool, an online tool designed to support patients, psychologists, psychiatrists, and GPs in managing depression and preventing suicide. This article examines the implementation of the iFightDepression platform in Italy, assessing its impact on the empowerment of GPs in the fight against depression. Through a qualitative and quantitative analysis of the data collected by the project, the 'unmet need' of GPs' in Italy regarding their specific training in mental health is highlighted.The response of 2,068 Italian GPs in just 7 months after the start of the iFD project is an expression of GPs' engagement to work against depression and for suicide risk prevention.
Collapse
Affiliation(s)
- Nuhara Vargiu
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy.
| | - Aurora Belfanti
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Michela Roberti
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Serena Trentin
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Camilla Ferrara
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Manuela Tosti
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Marco Lazzeri
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Giancarlo Giupponi
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy
| | - Andreas Conca
- Azienda Sanitaria Alto Adige - South Tyrol Health Authority, Bolzano, Italy.
| |
Collapse
|
5
|
Pilbrow S, Staniland L, Uren HV, Shand F, McGoldrick J, Thorp E, MacKrill M, Moullin JC. Evaluation of an online advanced suicide prevention training for pharmacists. Int J Clin Pharm 2023; 45:1203-1211. [PMID: 37702959 PMCID: PMC10600280 DOI: 10.1007/s11096-023-01636-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND With the pharmacist role extending internationally to include health promotion and harm reduction, pharmacists are well-suited to adopt a frontline role within suicide prevention efforts. To maximise their abilities to implement suicide prevention strategies, suicide prevention training is essential to improve pharmacists' knowledge of, attitudes towards, and confidence in pharmacy-based suicide prevention. AIM This study aimed to evaluate the impact of an online Advanced Suicide Prevention Training for Pharmacists and explore how participant feedback may direct training improvements. METHOD One hundred and fifty pharmacists in Tasmania, Australia, completed the training. Of these, 109 participants completed surveys pre-, post- and 6-months post-training to evaluate changes in suicide prevention knowledge, confidence, and attitudes, and explore participants' perceptions of the training. RESULTS Significant improvements were observed in suicide prevention attitudes (F(2, 20) = 4.12, p = 0.032, partial η2 = 0.292), and self-efficacy (F(2, 20) = 7.84, p = 0.003, partial η2 = 0.439), across the three timepoints, with improvements to knowledge and confidence evident between pre- and post-training (p < 0.05). Qualitative data reflected that the training was beneficial in aiding the identification and support of at-risk individuals, however barriers such as the pharmacy setting, personal discomfort, and perceptions of the pharmacist role were identified as impeding the implementation of suicide prevention within pharmacy practice. CONCLUSION Training is an effective means of improving pharmacists' suicide prevention knowledge, confidence, and attitudes. While personal barriers to suicide prevention improved, contextual and social barriers continue to impede pharmacists' implementation of suicide prevention in practice.
Collapse
Affiliation(s)
- Samantha Pilbrow
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Lexy Staniland
- Curtin enAble Institute, Curtin University, Perth, WA, Australia
| | - Hannah V Uren
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Fiona Shand
- Black Dog Institute, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | | | - Emily Thorp
- Pharmaceutical Society of Australia Tasmanian Branch, Hobart, TAS, Australia
| | - Monique MacKrill
- The Pharmacy Guild of Australia Tasmanian Branch, Battery Point, TAS, Australia
| | - Joanna C Moullin
- School of Population Health, Curtin University, Perth, WA, Australia.
- Curtin enAble Institute, Curtin University, Perth, WA, Australia.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Carpenter DM, Stover AN, Harris SC, Anksorus H, Lavigne JE. Impact of a Brief Suicide Prevention Training with an Interactive Video Case Assessment on Student Pharmacist Outcomes. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100093. [PMID: 37380269 DOI: 10.1016/j.ajpe.2023.100093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/20/2022] [Accepted: 03/07/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To determine whether a brief suicide prevention training with an interactive video case (Pharm-SAVES) improves student pharmacists' suicide prevention knowledge and self-efficacy. METHODS Student pharmacists (N = 146) from 2 United States universities completed the 75-minute Pharm-SAVES training in September 2021. Suicide prevention knowledge and self-efficacy were measured via an online pre-test and post-test, and a post-test interactive video case assessed self-efficacy to engage in SAVES steps (recognize Signs, Ask about suicide, Validate feelings, Expedite a National Suicide Prevention Lifeline [NSPL] referral, and Set a follow-up reminder). Paired samples t tests compared pre-test and post-test scores (alpha = 0.05). Three months later, students indicated if they had used Pharm-SAVES in practice. RESULTS Mean knowledge and self-efficacy significantly improved from pre-test to post-test. The interactive video case assessment revealed that students were least confident asking about suicide, moderately confident referring to or calling the NSPL on behalf of patients, and most confident following up with patients. Three months later, 17 (11.6%) students reported that they had recognized someone with suicide warning signs (S in SAVES). Among them, 9 (52.9%) reported asking the person with warning signs if they were considering suicide (A in SAVES), 13 (76.5%) validated feelings (V in SAVES), 3 (9.4%) called the NSPL for the patient, and 6 (35.3%) referred to the NSPL (E in SAVES). CONCLUSION Pharm-SAVES increased student pharmacists' suicide prevention knowledge and self-efficacy. Within 3 months, more than 10% had used Pharm-SAVES skills with at-risk individuals. All Pharm-SAVES content is now online and available for asynchronous or synchronous instruction.
Collapse
Affiliation(s)
- Delesha M Carpenter
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA; Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY, USA.
| | - Amanda N Stover
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Suzanne C Harris
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Heidi Anksorus
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Jill E Lavigne
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY, USA; Wegmans School of Pharmacy, St John Fisher College, Rochester, NY, USA
| |
Collapse
|
8
|
Le Jeannic A, Turmaine K, Gandré C, Vinet MA, Michel M, Chevreul K. Defining the Characteristics of an e-Health Tool for Suicide Primary Prevention in the General Population: The StopBlues Case in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6096. [PMID: 37372683 DOI: 10.3390/ijerph20126096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
With over one million deaths per year in the world, suicide is a major public health problem that could be significantly reduced by effective prevention programs. E-health tools are of particular interest for primary prevention as they can address a broad population including people unaware of their own risk and provide information and help without the fear of stigma. Our main objective was to define the overall characteristics of an e-health tool for suicide primary prevention in the French general population by defining the characteristics of the IT features; the content of the information delivered; the best way to structure it; and how it should be relayed and by whom. The research was carried out through a literature review and a co-construction phase with stakeholders. Four types of strategies may guide the construction of e-health tools for suicide primary prevention: education and awareness, (self-)screening, accessing support, and mental health coping. They should be accessible on different devices to reach the most users, and language and content should be adapted to the target population and to the issue being addressed. Finally, the tool should be consistent with ethical and quality best practices. The e-health tool StopBlues was developed following those recommendations.
Collapse
Affiliation(s)
- Anaïs Le Jeannic
- ECEVE, UMR 1123, Université Paris Cité, Inserm, 75010 Paris, France
- Unité de Recherche Clinique en Économie de la Santé (URC Eco), Assistance Publique-Hôpitaux de Paris, 1 Place du Parvis Notre-Dame, 75004 Paris, France
| | | | - Coralie Gandré
- ECEVE, UMR 1123, Université Paris Cité, Inserm, 75010 Paris, France
| | - Marie-Amélie Vinet
- ECEVE, UMR 1123, Université Paris Cité, Inserm, 75010 Paris, France
- Unité de Recherche Clinique en Économie de la Santé (URC Eco), Assistance Publique-Hôpitaux de Paris, 1 Place du Parvis Notre-Dame, 75004 Paris, France
| | - Morgane Michel
- ECEVE, UMR 1123, Université Paris Cité, Inserm, 75010 Paris, France
- Unité D'épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019 Paris, France
| | - Karine Chevreul
- ECEVE, UMR 1123, Université Paris Cité, Inserm, 75010 Paris, France
- Unité de Recherche Clinique en Économie de la Santé (URC Eco), Assistance Publique-Hôpitaux de Paris, 1 Place du Parvis Notre-Dame, 75004 Paris, France
- Unité D'épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 75019 Paris, France
| |
Collapse
|
9
|
Mann JJ, Michel CA, Auerbach RP. Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:182-196. [PMID: 37201140 PMCID: PMC10172556 DOI: 10.1176/appi.focus.23021004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Objective The authors sought to identify scalable evidence-based suicide prevention strategies. Methods A search of PubMed and Google Scholar identi- fied 20,234 articles published between September 2005 and December 2019, of which 97 were randomized controlled trials with suicidal behavior or ideation as primary outcomes or epidemiological studies of limiting access to lethal means, using educational approaches, and the impact of antidepressant treatment. Results Training primary care physicians in depression rec- ognition and treatment prevents suicide. Educating youths on depression and suicidal behavior, as well as active out- reach to psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior. Meta-analyses find that antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered. Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention. Cognitive-behavioral therapy and dialectical behavior therapy prevent suicidal behavior. Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression. Education of gatekeepers about youth suicidal behavior lacks effectiveness. No randomized trials have been reported for gatekeeper training for prevention of adult suicidal behavior. Algorithm-driven electronic health record screening, Internet-based screening, and smartphone passive monitoring to identify high-risk patients are under-studied. Means restriction, including of firearms, prevents suicide but is sporadically employed in the United States, even though firearms are used in half of all U.S. suicides. Conclusions Training general practitioners warrants wider implementation and testing in other nonpsychiatrist physi- cian settings. Active follow-up of patients after discharge or a suicide-related crisis should be routine, and restricting firearm access by at-risk individuals warrants wider use. Combination approaches in health care systems show promise in reducing suicide in several countries, but evaluating the benefit attributable to each component is essential. Further suicide rate reduction requires evaluating newer approaches, such as electronic health record-derived algorithms, Internet-based screening methods, ketamine's potential benefit for preventing attempts, and passive monitoring of acute suicide risk change.Reprinted from Am J Psychiatry 2021; 178:611-624, with permission from American Psychiatric Association Publishing. Copyright © 2021.
Collapse
Affiliation(s)
- J John Mann
- Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuro- science, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach)
| | - Christina A Michel
- Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuro- science, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach)
| | - Randy P Auerbach
- Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuro- science, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach)
| |
Collapse
|
10
|
Stover AN, Lavigne JE, Carpenter DM. A Scoping Review of Suicide Prevention Training Programs for Pharmacists and Student Pharmacists. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe8917. [PMID: 35012944 PMCID: PMC10159549 DOI: 10.5688/ajpe8917] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/05/2022] [Indexed: 05/06/2023]
Abstract
Objective. This scoping review updates a 2018 review of suicide prevention training programs for community and student pharmacists. Five scholarly databases were searched for articles published between January 2018 and December 2020. Articles were excluded if they did not describe an educational or training program for pharmacists or student pharmacists, did not explicitly include suicide, focused solely on attitudes, or did not provide sufficient detail to evaluate program content. The quality of each study was examined using a quality assessment tool.Findings. Seven studies met inclusion criteria. Most trainings (86%) were delivered live with interactive or role play scenarios to promote verbal and behavioral skill practice. About half (57%) assessed changes in knowledge, and fewer programs (29%) assessed changes in communication. All assessed participants' ability to identify suicide warning signs and included referral resources. Six studies were assessed for quality, of which 67% had a rating of good and 33% were rated as fair.Summary. Given the increase in suicide rates nationally, it is likely that pharmacists will encounter a patient in need of suicide prevention services. Since 2018, seven new suicide prevention training programs for community and student pharmacists have been reported, which demonstrates growing interest in suicide prevention training in the pharmacy profession. When integrated in Doctor of Pharmacy (PharmD) curricula, trainings may help prepare the pharmacy workforce for encounters with patients in crisis. The impact of training on self-efficacy and communication skills warrants additional attention. Variation between programs should be evaluated to understand which instructional methods best prepare pharmacy professionals to engage in suicide prevention.
Collapse
Affiliation(s)
- Amanda N Stover
- University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Jill E Lavigne
- St John Fisher College, Wegmans School of Pharmacy, Rochester, New York
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, New York
| | - Delesha M Carpenter
- University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, North Carolina
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, New York
| |
Collapse
|
11
|
Krishnamoorthy S, Mathieu S, Armstrong G, Ross V, Francis J, Reifels L, Kõlves K. Utilisation and application of implementation science in complex suicide prevention interventions: A systematic review. J Affect Disord 2023; 330:57-73. [PMID: 36870455 DOI: 10.1016/j.jad.2023.02.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES Little is known about how complex, multilevel, and multicomponent suicide prevention interventions work in real life settings. Understanding the methods used to systematically adopt, deliver, and sustain these interventions could ensure that they have the best chance of unfolding their full effect. This systematic review aimed to examine the application and extent of utilisation of implementation science in understanding and evaluating complex suicide prevention interventions. METHODS The review adhered to updated PRISMA guidelines and was prospectively registered with PROSPERO (CRD42021247950). PubMed, CINAHL, PsycINFO, ProQuest, SCOPUS and CENTRAL were searched. All English-language records (1990-2022) with suicide and/or self-harm as the primary aims or targets of intervention were eligible. A forward citation search and a reference search further bolstered the search strategy. Interventions were considered complex if they consisted of three or more components and were implemented across two or more levels of socio-ecology or levels of prevention. RESULTS One hundred thirty-nine records describing 19 complex interventions were identified. In 13 interventions, use of implementation science approaches, primarily process evaluations, was explicitly stated. However, extent of utilisation of implementation science approaches was found to be inconsistent and incomprehensive. LIMITATIONS The inclusion criteria, along with a narrow definition of complex interventions may have limited our findings. CONCLUSION Understanding the implementation of complex interventions is crucial for unlocking key questions about theory-practice knowledge translation. Inconsistent reporting and inadequate understanding of implementation processes can lead to loss of critical, experiential knowledge related to what works to prevent suicide in real world settings.
Collapse
Affiliation(s)
- Sadhvi Krishnamoorthy
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Queensland, Australia.
| | - Sharna Mathieu
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Queensland, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Victoria Ross
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Queensland, Australia
| | - Jillian Francis
- School of Health Sciences, The University of Melbourne, Victoria, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Victoria, Australia; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Queensland, Australia
| |
Collapse
|
12
|
Toczyski P. The Local Awareness-Raising of Public Mental Health in the Capital City of Poland through Launch of Local Alliance against Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3892. [PMID: 36900901 PMCID: PMC10002039 DOI: 10.3390/ijerph20053892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
The goal of this brief report is to show the specificity of building local alliances against depression in an Eastern European country within and after the series of 2021 lockdowns. It will be described in the form of a short communication piece. The semi-peripheral specificity of Poland adds some insights which will be useful for other leaders of similar alliances globally. This short report can be read as a higher resolution of the European Alliance Against Depression (EAAD) method activities known from other recent works. We want to answer the question of how to begin the activity and launch such an alliance in the semi-peripheral context of non-Western Europe.
Collapse
Affiliation(s)
- Piotr Toczyski
- Social Sciences, Maria Grzegorzewska University, 02-353 Warszawa, Poland
| |
Collapse
|
13
|
Stulz N, Hepp U, Kupferschmid S, Raible-Destan N, Zwahlen M. Trends in suicide methods in Switzerland from 1969 to 2018: an observational study. Swiss Med Wkly 2022; 152:40007. [PMID: 36592392 DOI: 10.57187/smw.2022.40007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Suicide is a serious societal and health problem. We examined changes in rates of completed suicides in Switzerland between 1969-2018 with particular regard to different methods of suicide used in different subgroups of the resident population. METHODS We used data of the Swiss cause of death statistics and Poisson regression models to analyse annual incidence rates and calendar time trends of specific suicide methods used in population subgroups by sex (men vs women), age (10-29, 30-64, >64 years), and nationality (Swiss vs other citizenship). RESULTS There were 64,996 registered suicides between 1969 and 2018. Across these 5 decades, the overall suicide rate was higher in men than in women (incidence rate ratio [IRR] 2.62, 95% confidence interval [CI] 2.58-2.67), in Swiss citizens than in foreigners (IRR 2.02; 95% CI 1.97-2.07), and in older residents (>64 years) than in the age groups 30-64 years (IRR 1.35, 95% CI 1.32-1.37) and 10-29 years (IRR 2.37, 95% CI 2.32-2.43). After peaking in the 1980s, the overall suicide rate had declined in all of these population subgroups, with flattening trends over most recent years. The most common specific methods of suicide were hanging (accounting for 26.7% of all suicides) and firearms (23.6%). The rates of the specific suicide methods were usually higher in men, in Swiss citizens and in older residents, and they had typically declined over most recent decades in the population subgroups examined. However, some methods diverged from this general pattern, at least in some population subgroups. For instance, railway suicides most recently increased in younger and in male residents whereas suicides by gas and by drowning were only at a low level after rapid declines in the last millennium. CONCLUSIONS Restricting access to lethal means (e.g., detoxification of domestic gas), improvements in health care and media guidelines for responsible reporting of suicides are possible explanations for the generally declining suicide rates in Switzerland. Whereas some methods (e.g., poisoning by gases or drowning) had become rare, others continue to account for many suicides every year, at least in some population subgroups (e.g., firearms in older Swiss men or railway suicides in younger and in male residents). As different methods of suicide are chosen by different people or subgroups of the population, preventive efforts should include differentiated strategies and targeted measures to further reduce suicides in Switzerland and elsewhere.
Collapse
Affiliation(s)
- Niklaus Stulz
- Integrated Psychiatric Services Winterthur - Zurcher Unterland, Switzerland
| | - Urs Hepp
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Switzerland.,Meilener Institute Zurich, Switzerland
| | | | | | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| |
Collapse
|
14
|
The effectiveness of an Australian community suicide prevention networks program in preventing suicide: a controlled longitudinal study. BMC Public Health 2022; 22:1945. [PMID: 36261796 PMCID: PMC9583518 DOI: 10.1186/s12889-022-14331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Suicide is a major issue affecting communities around the world. Community-based suicide prevention approaches can tailor activities at a local level and are recognised as a key component of national suicide prevention strategies. Despite this, research exploring their effects on completed suicides is rare. This study examined the effect of a national program of community suicide prevention networks on suicide rates in catchment areas across Australia. Methods Australian suicide data from the National Coronial Information System for 2001–2017 were mapped to geographic catchment areas of community suicide prevention networks and matched control areas with similar characteristics. The effect of network establishment on suicide rates was evaluated using longitudinal models including fixed effects for site type (network or control), time, season, and intervention (network establishment), with site included as a random intercept. Results Sixty suicide prevention networks were included, servicing areas with a population of 3.5 million. Networks varied in when they were established, ranging from 2007 to 2016. Across the time-period, suicide rates per 100,000 per quarter averaged 3.73 (SD = 5.35). A significant reduction in the suicide rate of 7.0% was found after establishment of networks (IRR = 0.93, 95% CI 0.87 to 0.99, p = .025). Conclusion This study found evidence of an average reduction in suicide rates following the establishment of suicide prevention networks in Australian communities. These findings support the effectiveness of empowering local communities to take action to prevent suicide.
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
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: 0.7] [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.
Collapse
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
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Mann JJ, Michel CA, Auerbach RP. Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review. Am J Psychiatry 2021; 178:611-624. [PMID: 33596680 PMCID: PMC9092896 DOI: 10.1176/appi.ajp.2020.20060864] [Citation(s) in RCA: 286] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to identify scalable evidence-based suicide prevention strategies. METHODS A search of PubMed and Google Scholar identified 20,234 articles published between September 2005 and December 2019, of which 97 were randomized controlled trials with suicidal behavior or ideation as primary outcomes or epidemiological studies of limiting access to lethal means, using educational approaches, and the impact of antidepressant treatment. RESULTS Training primary care physicians in depression recognition and treatment prevents suicide. Educating youths on depression and suicidal behavior, as well as active outreach to psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior. Meta-analyses find that antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered. Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention. Cognitive-behavioral therapy and dialectical behavior therapy prevent suicidal behavior. Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression. Education of gatekeepers about youth suicidal behavior lacks effectiveness. No randomized trials have been reported for gatekeeper training for prevention of adult suicidal behavior. Algorithm-driven electronic health record screening, Internet-based screening, and smartphone passive monitoring to identify high-risk patients are understudied. Means restriction, including of firearms, prevents suicide but is sporadically employed in the United States, even though firearms are used in half of all U.S. suicides. CONCLUSIONS Training general practitioners warrants wider implementation and testing in other nonpsychiatrist physician settings. Active follow-up of patients after discharge or a suicide-related crisis should be routine, and restricting firearm access by at-risk individuals warrants wider use. Combination approaches in health care systems show promise in reducing suicide in several countries, but evaluating the benefit attributable to each component is essential. Further suicide rate reduction requires evaluating newer approaches, such as electronic health record-derived algorithms, Internet-based screening methods, ketamine's potential benefit for preventing attempts, and passive monitoring of acute suicide risk change.
Collapse
Affiliation(s)
- J. John Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, and Department of Psychiatry and Radiology, Columbia University, New York, NY
| | - Christina A. Michel
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY
| | - Randy P. Auerbach
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, and Department of Psychiatry, Columbia University, New York, NY,Division of Clinical Developmental Neuroscience, Sackler Institute
| |
Collapse
|
19
|
van der Burgt MCA, Beekman ATF, Hoogendoorn AW, Berkelmans G, Franx G, Gilissen R. The effect of local Suicide Prevention Action Networks (SUPRANET) on stigma, taboo and attitudes towards professional help-seeking: an exposure-response analysis. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2199-2208. [PMID: 33934184 PMCID: PMC8558270 DOI: 10.1007/s00127-021-02078-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE In 2017, the European Alliance against Depression (EAAD) programme was introduced in the Netherlands through the creation of six local Suicide Prevention Action Networks (SUPRANET Community). This programme consists of interventions on four levels: (1) a public awareness campaign, (2) training local gatekeepers, (3) targeting high-risk persons in the community and (4) training of primary care professionals. This study aims to gain insight into the effectiveness of the SUPRANET programme on attitudinal changes in the general public by studying the exposure-response relationship. METHODS A repeated cross-sectional design, using general population surveys to measure key variables over time. The surveys were conducted in the six intervention regions (N = 2586) and in the Netherlands as a whole as a control region (N = 4187) and include questions on socio-demographic variables, brand awareness of the Dutch helpline, perceived taboo on suicide, attitudes towards depression and help-seeking. To examine the exposure-response relationship, regions were differentiated into 3 groups: low, medium and high exposure of the SUPRANET programme. RESULTS The results revealed that respondents in the intervention regions considered professional help to be more valuable and were more likely to be familiar with the Dutch helpline than respondents in the control region. In the exposure-response analyses, the grading of effects was too small to reach statistical significance. CONCLUSION Our study provides the first evidence for the effectiveness of the SUPRANET Community programme on creating attitudinal change in the general public.
Collapse
Affiliation(s)
- Margot C. A. van der Burgt
- 113 Suicide Prevention, Amsterdam, The Netherlands ,Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands ,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Adriaan W. Hoogendoorn
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands ,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Guus Berkelmans
- 113 Suicide Prevention, Amsterdam, The Netherlands ,Centrum Wiskunde & Informatica (CWI), Amsterdam, The Netherlands
| | | | | |
Collapse
|
20
|
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: 5] [Impact Index Per Article: 1.3] [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.
Collapse
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
| |
Collapse
|
21
|
Engaging primary care professionals in suicide prevention: A qualitative study. PLoS One 2020; 15:e0242540. [PMID: 33253178 PMCID: PMC7704003 DOI: 10.1371/journal.pone.0242540] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 11/04/2020] [Indexed: 01/06/2023] Open
Abstract
In health systems with strongly developed primary care, such as in the Netherlands, effectively engaging primary care professionals (PCPs) in suicide prevention is a key strategy. As part of the national Suicide Prevention Action Network (SUPRANET), a program was offered to PCPs in six regions in the Netherlands in 2017–2018 to more effectively engage them in suicide prevention. This implementation study aimed to evaluate to what extent SUPRANET was helpful in supporting PCPs to apply suicide prevention practices. From March to May 2018, 21 semi-structured interviews have been carried out with PCPs and other non-clinical professionals from SUPRANET regions in the Netherlands. Verbatim transcripts were analysed using the grounded theory approach. Data was structured using the Consolidated Framework for Implementation Research, which enabled identifying facilitating and challenging factors for PCPs to carry out suicide prevention practices. An important challenge included difficulties in assessing suicide risk (intervention characteristics) due to PCPs’ self-perceived incompetence, burdensomeness of suicide and limited time and heavy workload of PCPs. Another important limitation was collaboration with mental health care (outer setting), whereas mental health nurses (inner setting) and SUPRANET (implementation process) were facilitating factors for applying suicide prevention practices. With regard to SUPRANET, especially the training was positively evaluated by PCPs. PCPs expressed a strong need for improving collaboration with specialized mental health care, which was not provided by SUPRANET. Educating PCPs on suicide prevention seems beneficial, but is not sufficient to improve care for suicidal patients. Effective suicide prevention also requires improved liaison between mental health services and primary care, and should therefore be the focus of future suicide prevention strategies aimed at primary care.
Collapse
|
22
|
Owens M, Watkins E, Bot M, Brouwer IA, Roca M, Kohls E, Penninx BWJH, Grootheest G, Hegerl U, Gili M, Visser M. Nutrition and depression: Summary of findings from the EU‐funded MooDFOOD depression prevention randomised controlled trial and a critical review of the literature. NUTR BULL 2020. [DOI: 10.1111/nbu.12447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M. Owens
- Department of Psychology University of Exeter Exeter UK
| | - E. Watkins
- Department of Psychology University of Exeter Exeter UK
| | - M. Bot
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - I. A. Brouwer
- Department of Health Sciences Faculty of Science Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - M. Roca
- Institut Universitari d’ Investigació en Ciències de la Salut (IUNICS/IDISBA) Rediapp University of Balearic Islands Palma de Mallorca Spain
| | - E. Kohls
- Department of Psychiatry and Psychotherapy Medical Faculty University Leipzig Leipzig Germany
| | - B. W. J. H. Penninx
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - G. Grootheest
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - U. Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy Goethe‐University Frankfurt Germany
| | - M. Gili
- Institut Universitari d’ Investigació en Ciències de la Salut (IUNICS/IDISBA) Rediapp University of Balearic Islands Palma de Mallorca Spain
| | - M. Visser
- Department of Health Sciences Faculty of Science Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | | |
Collapse
|
23
|
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: 4] [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.
Collapse
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.
| |
Collapse
|
24
|
Pérez V, Elices M, Prat B, Vieta E, Blanch J, Alonso J, Pifarré J, Mortier P, Cebrià AI, Campillo MT, Vila-Abad M, Colom F, Dolz M, Molina C, Palao DJ. The Catalonia Suicide Risk Code: A secondary prevention program for individuals at risk of suicide. J Affect Disord 2020; 268:201-205. [PMID: 32174478 DOI: 10.1016/j.jad.2020.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/25/2020] [Accepted: 03/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide prevention is an emerging priority for public health systems. Here, we present the Catalonia Suicide Risk Code (CSRC), a secondary suicide prevention program that provides a systematic approach to follow-up care for patients at risk. We describe the care pathway of the CSRC and characteristics of the patients enrolled in the program. METHODS Observational study based on data extracted from the Catalan health care system between the years 2014 and 2019. The following patient-related data were obtained: sociodemographic and clinical characteristics, characteristics of suicidal behaviour, and pathway of care. RESULTS A total of 12,596 individuals (64.1% women) were screened for suicide risk and 8,403 (66.7%) were subsequently enrolled in the CSRC. Adherence data show that most patients (81.9%) attended a face-to-face appointment and most (67.1%) were successfully contacted by telephone afterwards. Most face-to-face appointments were performed within 10 days of enrolment for adults and 72 h for minors. Psychiatric disorders were significant risk factors for both men and women. Females were significantly more likely to report stressful life events, while males were more likely to report social problems. Compared to men, women were more likely to use poisoning. LIMITATIONS Adherence to the CSRC care pathway might reflect obstacles to its implementation. Due to the observational study design, it is not possible to determine the effectiveness of the CSRC to reduce suicide re-attempts. CONCLUSIONS Although the CSRC successfully provided follow-up care for many individuals at high risk of suicide, greater adherence to the CSRC care pathway is needed.
Collapse
Affiliation(s)
- Víctor Pérez
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Matilde Elices
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
| | - Bibiana Prat
- Master Plan on Mental Health and Addictions, Ministry of Health, Catalan Government, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Jordi Blanch
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Master Plan on Mental Health and Addictions, Ministry of Health, Catalan Government, Spain; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Jordi Alonso
- Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Josep Pifarré
- Department of Mental Health, Hospital Universitari de Santa Maria. SJD Terres de Lleida. IRBLleida, Spain
| | - Philippe Mortier
- Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ana Isabel Cebrià
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Department of Mental Health, Corporació Sanitaria Parc Taulí de Sabadell, Barcelona
| | - Maria T Campillo
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain
| | - Montserrat Vila-Abad
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain
| | - Francesc Colom
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Hospital del Mar Medical Research Institute, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Montserrat Dolz
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Hospital Sant Joan de Déu, Espluges de Llobregat, Barcelona, Spain; Children and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Cristina Molina
- Master Plan on Mental Health and Addictions, Ministry of Health, Catalan Government, Spain
| | - Diego J Palao
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Department of Mental Health, Corporació Sanitaria Parc Taulí de Sabadell, Barcelona
| |
Collapse
|
25
|
Aldridge LR, Garman EC, Luitel NP, Jordans MJD. Impact of a district mental health care plan on suicidality among patients with depression and alcohol use disorder in Nepal. PLoS One 2020; 15:e0231158. [PMID: 32255802 PMCID: PMC7138320 DOI: 10.1371/journal.pone.0231158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/17/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Large scale efforts to expand access to mental healthcare in low- and middle-income countries have focused on integrating mental health services into primary care settings using a task sharing approach delivered by non-specialist health workers. Given the link between mental disorders and risk of suicide mortality, treating common mental disorders using this approach may be a key strategy to reducing suicidality. METHODS AND FINDINGS The Programme for Improving Mental Health Care (PRIME) evaluated mental health services for common mental disorders delivered by non-specialist health workers at ten primary care facilities in Chitwan, Nepal from 2014 to 2016. In this paper, we present the indirect impact of treatment on suicidality, as measured by suicidal ideation, among treatment and comparison cohorts for depression and AUD using multilevel logistic regression. Patients in the treatment cohort for depression had a greater reduction in ideation relative to those in the comparison cohort from baseline to three months (OR = 0.16, 95% CI: 0.05-0.59; p = 0.01) and twelve months (OR = 0.31, 95% CI: 0.08-1.12; p = 0.07), with a significant effect of treatment over time (p = 0.02). Among the AUD cohorts, there were no significant differences between treatment and comparison cohorts in the change in ideation from baseline to three months (OR = 0.64, 95% CI: 0.07-6.26; p = 0.70) or twelve months (OR = 0.46, 95% CI: 0.06-3.27; p = 0.44), and there was no effect of treatment over time (p = 0.72). CONCLUSION The results provide evidence integrated mental health services for depression benefit patients by accelerating the rate at which suicidal ideation naturally abates over time. Integrated services do not appear to impact ideation among people with AUD, though baseline levels of ideation were much lower than for those with depression and may have led to floor effects. The findings highlight the importance of addressing suicidality as a specific target-rather than an indirect effect-of treatment in community-based mental healthcare programs.
Collapse
Affiliation(s)
- Luke R. Aldridge
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Emily C. Garman
- Alan J F Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Mark J. D. Jordans
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| |
Collapse
|