How to decrease suicide rates in both genders? An effectiveness study of a community-based intervention (EAAD)

András Székely, Barna Konkolÿ Thege, Roland Mergl, Emma Birkás, Sándor Rózsa, György Purebl, Ulrich Hegerl, András Székely, Barna Konkolÿ Thege, Roland Mergl, Emma Birkás, Sándor Rózsa, György Purebl, Ulrich Hegerl

Abstract

Background: The suicide rate in Hungary is high in international comparison. The two-year community-based four-level intervention programme of the European Alliance Against Depression (EAAD) is designed to improve the care of depression and to prevent suicidal behaviour. Our aim was to evaluate the effectiveness of a regional community-based four-level suicide prevention programme on suicide rates.

Method: The EAAD programme was implemented in Szolnok (population 76,311), a town in a region of Hungary with an exceptionally high suicide rate. Effectiveness was assessed by comparing changes in suicide rates in the intervention region after the intervention started with changes in national suicide rates and those in a control region (Szeged) in the corresponding period.

Results: For the duration of the programme and the follow-up year, suicide rates in Szolnok were significantly lower than the average of the previous three years (p = .0076). The suicide rate thus went down from 30.1 per 100,000 in 2004 to 13.2 in 2005 (-56.1 %), 14.6 in 2006 (-51.4 %) and 12.0 in 2007 (-60.1 %). This decrease of annual suicide rates in Szolnok after the onset of the intervention was significantly stronger than that observed in the whole country (p = .017) and in the control region (p = .0015). Men had the same decrease in suicide rates as women. As secondary outcome, an increase of emergency calls to the hotline service (200%) and outpatient visits at the local psychiatry clinic (76%) was found.

Conclusions: These results seem to provide further support for the effectiveness of the EAAD concept. Whilst the majority of suicide prevention programs mainly affect female suicidal behaviour, this programme seems to be beneficial for both sexes. The sustainability and the role of the mediating factors (social service and health care utilization, community attitudes about suicide) should be key points in future research.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. The four-level approach of the…
Figure 1. The four-level approach of the European Alliance Against Depression.
Figure 2. Suicide rates in Szolnok, Szeged,…
Figure 2. Suicide rates in Szolnok, Szeged, and Hungary (1998–2009).
Figure 3. Number of telephone calls with…
Figure 3. Number of telephone calls with suicide problems to the hotline service in Szolnok between 2003 and 2007.

References

    1. Zonda T, Bozsonyi K, Veres E (2005) Seasonal fluctuation of suicide in Hungary between 1970–2000. Archives of Suicide Research 9: 77–85.
    1. Hungarian Central Statistical Office (2010) Hungarian Statistical Yearbook. Budapest: Hungarian Central Statistical Office. pp. 61.
    1. Kopp MS, Skrabski Á, Szedmák S (2001) The influence of societal structure on depressive symptomatology and morbidity in the Hungarian population. In: Wosinska W, Cialdini RB, Reykowski J, Barrett DW, editors. The practice of social influence in multiple cultures. Mahwah: Lawrence Erlbaum. pp. 207–221.
    1. Kopp MS, Réthelyi J (2004) Where psychology meets physiology: chronic stress and premature mortality – the Central-Eastern European health paradox. Brain Res Bull 62: 351–367.
    1. Kopp MS (2007) The Central-Eastern European health paradox: why are men more vulnerable in a changing society? In: Ennals R, editor. From slavery to citizenship. London: John Wiley and Sons. pp. 242–248.
    1. Réthelyi J, Purebl Gy, Kopp MS (2002) Gender and sociodemographic correlates of depressive symptomatology in the population of Hungary. In: Weidner G, Kopp MS, Kristenson M, editors. Heart disease: environment, stress and gender. Amsterdam: IOS Press. pp. 114–120.
    1. Kopp MS, Skrabski Á, László KD, Janszky I (2011) Gender patterns of socioeconomic differences in premature mortality: Follow-up of the Hungarian epidemiological panel. Int? J? Behav Med 18: 22–34.
    1. Rihmer Z, Rutz W, Pihlgren H (1995) Depression and suicide on Gotland: an intensive study of all suicides before and after a depression-training programme for general practitioners. J? Affect Disord 35(4): 147–152.
    1. Kessler RC, Brown RL, Broman CL (1981) Sex differences in psychiatric help-seeking: evidence from four large-scale surveys. J? Health Soc Behav 22(1): 49–64.
    1. Möller-Leimkühler AM (2002) Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. J? Affect Disord 71(1-3): 1–9.
    1. Althaus D, Hegerl U (2003) The evaluation of suicide prevention activities: State of the art. World? J? Biol Psych 4(4): 156–165.
    1. Bennewith O, Stocks N, Gunnell D, Peters TJ, Evans MO, et al. (2002) General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial. British Med Journal 324: 1254–1257.
    1. Gilbody S, Whitty P, Grimshaw J, Thomas R (2003) Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA 289(23): 3145–3151.
    1. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, et al. (2005) Suicide prevention strategies: a systematic review. JAMA 294(16): 2064–2074.
    1. Rihmer Z (2011) Prevention of suicide in mood-disorder patients: Individual and public health perspective. In: Pompili M, editor. Suicide in the words of suicidologists. New York: Nova Science Publishers Inc. pp. 179–182.
    1. Rutz W, von Knorring L, Walinder J, Wistedt B (1990) Effect of an educational programme for general practitioners on Gotland on the pattern of prescription of psychotropic drugs. Acta Psychiatr Scand 82(6): 399–403.
    1. Rutz W, von Knorring L, Walinder J (1992) Long-term effects of an educational programme for general practitioners given by the Swedish Committee for the Prevention and Treatment of Depression. Acta Psychiatr Scand 85(1): 83–88.
    1. Rutz W, Walinder J, Pihigren H, von Knorring L, Rihmer Z (1996) Lessons from the Gotland Study on depression suicide and education: effects shortcomings and challenges. Int? J? Methods Psychiatr Res 6: S9–S14.
    1. Rutz W, Walinder J, von Knorring L, Rihmer Z, Pihlgren H (1997) Prevention of depression and suicide by education and medication: impact on male suicidality. An update from the Gotland Study. Int? J? Psych Clin Pract 1: 39–46.
    1. Rutz W, Walinder J, Eberhard G, Holmberg G, von Knorring AL, et al. (1989) An educational programme on depressive disorders for general practitioners on Gotland: background and evaluation. Acta Psychiatr Scand 79(1): 19–26.
    1. Szanto K, Kalmar S, Hendin H, Rihmer Z, Mann JJ (2007) A suicide prevention programme in a region with a very high suicide rate. Arch Gen Psychiatry 64(8): 914–920.
    1. Hegerl U, Althaus D, Schmidtke A, Niklewski G (2006) The Alliance Against Depression: Two year evaluation of a community-based intervention to reduce suicidality. Psychol Med 36(9): 1225–1234.
    1. Hegerl U, Mergl R, Havers I, Schmidtke A, Lehfeld H, et al. (2010) Sustainable effects on suicidality were found for the Nuremberg Alliance Against Depression. Eur Arch Psychiatry Clin Neurosci 260: 401–406.
    1. Hegerl U, Althaus D, Stefanek J (2003) Public attitudes towards treatment of depression: effects of an information campaign. Pharmacopsychiatry 36(6): 288–291.
    1. European Commission (2005) Green Paper: Improving the mental health of the population: Towards a strategy on mental health for the European. p. 10. Available: . Accessed 2013 Aug 22.
    1. Kopp MS, Skrabski Á, Magyar I (1987) Neurotics at risk and suicidal behaviour in the Hungarian population. Acta Psychiatr Scand 76(4): 406–413.
    1. Hegerl U, Wittenburg L, Arensman E, Van Audenhove C, Coyne J, et al. (2009) Optimizing Suicide Prevention Programmes and Their Implementation in Europe (OSPI Europe): an evidence-based multi-level approach. BMC Public Health 9(1): 428.
    1. Hegerl U, Arensman E, Aromaa E, Coyne J, Gusmao R, et al. (2011) Improving the care of depressed patients and preventing suicides – The European Alliance Against Depression. German Med? J 11: 74–78.
    1. Kopp MS, Konkolÿ Thege B, Balog P, Stauder A, Salavecz Gy, et al. (2010) Measures of stress in epidemiological research. J? Psychosom Res 69: 211–225.
    1. Csépe A (2007) Összefogás a depresszió ellen [Together against Depression]. Budapest: Semmelweis Kiadó. 235 p.
    1. Pászthy B (2005) Depresszió gyermek- és serdülőkorban. [Depression among children and adolescents]. Fejlesztő Pedagógia 5–6: 12–15.
    1. Hegerl U, Wittmann M, Arensman E, van Audenhove C, Bouleau J-H, et al. (2008) The “European Alliance Against Depression (EAAD)”: A multifaceted community based action programme against depression and suicidality. World? J? Biol Psych 9(1): 51–59.
    1. Kopp M, Székely A, Bagi M, Purebl Gy (2008) Depresszió stop – “Európai Szövetség a Depresszió Ellen” A magyarországi program bemutatása és eredményei II [Depresszio-stop – “European alliance against Depression” The presentation and the results of the program in Hungary II. ]. Magyar Epidemiológia 5: 109–120.

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