title: Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidence-based multi-level approach.
abstract: BACKGROUND
  Suicide and non-fatal suicidal behaviour are significant public health issues in Europe requiring effective preventive interventions. However, the evidence for effective preventive strategies is scarce. The protocol of a European research project to develop an optimized evidence based program for suicide prevention is presented.
  
  
  METHODS
  The groundwork for this research has been established by a regional community based intervention for suicide prevention that focuses on improving awareness and care for depression performed within the European Alliance Against Depression (EAAD). The EAAD intervention consists of (1) training sessions and practice support for primary care physicians,(2) public relations activities and mass media campaigns, (3) training sessions for community facilitators who serve as gatekeepers for depressed and suicidal persons in the community and treatment and (4) outreach and support for high risk and self-help groups (e.g. helplines). The intervention has been shown to be effective in reducing suicidal behaviour in an earlier study, the Nuremberg Alliance Against Depression. In the context of the current research project described in this paper (OSPI-Europe) the EAAD model is enhanced by other evidence based interventions and implemented simultaneously and in standardised way in four regions in Ireland, Portugal, Hungary and Germany. The enhanced intervention will be evaluated using a prospective controlled design with the primary outcomes being composite suicidal acts (fatal and non-fatal), and with intermediate outcomes being the effect of training programs, changes in public attitudes, guideline-consistent media reporting. In addition an analysis of the economic costs and consequences will be undertaken, while a process evaluation will monitor implementation of the interventions within the different regions with varying organisational and healthcare contexts.
  
  
  CONCLUSIONS
  This multi-centre research seeks to overcome major challenges of field research in suicide prevention. It pools data from four European regions, considerably increasing the study sample, which will be close to one million. In addition, the study will gather important information concerning the potential to transfer this multilevel program to other health care systems. The results of this research will provide a basis for developing an evidence-based, efficient concept for suicide prevention for EU-member states.
authors.affiliation: University of Leipzig, Department of Psychiatry, Germany. ulrich.hegerl@medizin.uni-leipzig.de
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hegerl
authors.forename: Lisa
authors.initials: L
authors.lastname: Wittenburg
authors.forename: Ella
authors.initials: E
authors.lastname: Arensman
authors.forename: Chantal
authors.initials: C
authors.lastname: Van Audenhove
authors.forename: James C
authors.initials: JC
authors.lastname: Coyne
authors.forename: David
authors.initials: D
authors.lastname: McDaid
authors.forename: Christina M
authors.initials: CM
authors.lastname: van der Feltz-Cornelis
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gusmão
authors.forename: Mária
authors.initials: M
authors.lastname: Kopp
authors.forename: Margaret
authors.initials: M
authors.lastname: Maxwell
authors.forename: Ullrich
authors.initials: U
authors.lastname: Meise
authors.forename: Saska
authors.initials: S
authors.lastname: Roskar
authors.forename: Marco
authors.initials: M
authors.lastname: Sarchiapone
authors.forename: Armin
authors.initials: A
authors.lastname: Schmidtke
authors.forename: Airi
authors.initials: A
authors.lastname: Värnik
authors.forename: Anke
authors.initials: A
authors.lastname: Bramesfeld
mesh_terms: D004502:Education, Medical, Continuing; D005060:Europe; D019317:Evidence-Based Medicine; D006266:Health Education; D006284:Health Plan Implementation; D006801:Humans; D011314:Preventive Health Services / Q000379:methods*; D016730:Program Development; D011446:Prospective Studies; D013405:Suicide / Q000523:psychology; D035862:Vulnerable Populations; D000092864:Suicide Prevention