1) Development and implementation of an intervention concept for the prevention of suicidal behaviour
As a first step, best practice interventions were identified. This formed the basis for the implementation of the interventions in the four OSPI intervention regions (Limerick in Ireland, Leipzig in Germany, Amadora in Portugal, and Miskolc in Hungary).
(centralised national health insurance fund, limited private sector)
(Beverage like National Health Service)
(mix of National Health Service, special social health insurance schemes for certain professions and private health insurance)
Germany (Bismarckian/social health insurance system with strong public-private partnership)
The intervention concept consisted of five levels:
· trainings for general practitioners (GPs) (level 1)
· public awareness campaigns (level 2)
· trainings for community facilitators (level 3)
· offers of support for high-risk groups, patients and relatives (level 4)
· restriction of access to lethal means (level 5)
2) Evaluation of the multi-level intervention
Evaluation was conducted in a pre-post, controlled and cross-country comparable design.
The OSPI intervention was evaluated on different levels. Rates of fatal and non-fatal suicidal acts are the primary outcome. Additionally, several intermediate outcome measures were collected. The trainings for GPs and community facilitators were evaluated by measuring and identifying possible changes in attitudes and knowledge on depression and suicidality. A telephone survey was conducted in order to see changes in attitudes in the general population. Media reports from the intervention regions were collected to monitor reporting on suicidal acts. Furthermore, a health economic evaluation and comprehensive process evaluation were conducted.
The following results of the evaluation analyses of the multi-level intervention have been published so far (see also publication section):
- Primary outcome: none, to be submitted soon
- Intermediate outcome:
- Coppens et al. (2013): Public attitudes towards depression and help-seeking in four European countries: Baseline survey prior to the OSPI-Europe intervention. Journal of Affective Disorders.
- Coppens et al. (2014): Effectiveness of community facilitator training inimproving knowledge, attitudes, and confidence in relation to depression and suicidal behavior: Results of the OSPI-Europe intervention in four European countries. Journal of Affective Disorders.
- Kohls et al. (2017): Public attitudes toward depression and help-seeking: Impact of the OSPI-Europe depression awareness campaign in four European regions. Journal of Affective Disorders.
- Maloney et al. (2014): Media recommendations on reporting suicidal behaviour and suggestions for optimisation. Acta Psychiatrica Scandinavia.
- Health Economic analyses: none, to be submitted soon
- Process Analysis:
- Harris et al. (2013): Developing social capital in implementing a complex intervention: a process evaluation of the early implementation of a suicide prevention intervention in four European countries. BMC Public Health
- Harris et al. (2016): Exploring synergistic interactions and catalysts in complex interventions: longitudinal, mixed methods case studies of an optimised multi-level suicide prevention intervention in four European countries (OSPI-Europe). BMC Public Health
At project end, the intervention concepts and materials, as well as the implementation process were discussed in focus groups and revised.
The concept was shown to be applicable at a local level in different regional contexts and health systems. However, it has been recommended that some degree of flexibility should be granted to groups applying this concept in order to adapt the intervention measures at a local level. The most challenging aspect of the intervention emerged as being the restriction of access to lethal means, which often requires action beyond local level, e.g. involvement of national stakeholders. The efforts to restrict the access to local hotspots (e.g. jumping sites) has since been integrated into level 3, which was renamed as ‘cooperation with community facilitators and stakeholders’. Furthermore, it was noted that the group of mental health professionals should be included in the model. Focus of level 1 was widened respectively. Illustrated below is this slightly revised intervention concept, which is the present intervention concept of the EAAD.
Furthermore, a suicide prevention manual was prepared. It contains guidelines about how to plan and implement the evidence-based and revised 4-level intervention programme. After final results are available, this manual will be updated and distributed via the European Alliance against Depression to health politicians, stakeholders and researchers interested in establishing a multi-level-suicide prevention programme.
In parallel, there were efforts in all regions to implement all or at least part of the intervention measures in a sustainable manner. For instance, in Portugal, a national suicide prevention programme based on the EAAD/OSPI-Europe intervention concept was started and in the study region in Germany, a non-profit organization was established (Leipzig Alliance against Depression) to continue the activities established via OSPI-Europe.
An overview of all OSPI publications can be downloaded here.