Saška Roškar

Best practice elements of multilevel suicide prevention strategies: a review of systematic reviews.

Background: Evidence-based best practices for incorporation into an optimal multilevel intervention for suicide prevention should be identifiable in the literature. Aims: To identify effective interventions for the prevention of suicidal behavior. Methods: Review of systematic reviews found in the Pubmed, Cochrane, and DARE databases. Steps include risk-of-bias assessment, data extraction, summarization of best practices, and identification of synergistic potentials of such practices in multilevel approaches. Results: Six relevant systematic reviews were found. Best practices identified as effective were as follows: training general practitioners (GPs) to recognize and treat depression and suicidality, improving accessibility of care for at-risk people, and restricting access to means of suicide. Although no outcomes were reported for multilevel interventions or for synergistic effects of multiple interventions applied together, indirect support was found for possible synergies in particular combinations of interventions within multilevel strategies. Conclusions: A number of evidence-based best practices for the prevention of suicide and suicide attempts were identified. Research is needed on the nature and extent of potential synergistic effects of various preventive activities within multilevel interventions.

Optimizing Suicide Prevention Programs and Their Implementation in Europe (OSPI Europe): An evidence-based multi-level approach

BackgroundSuicide 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.MethodThe 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.DiscussionThis 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.

Suicide risk and its relationship to change in marital status.

BACKGROUND Different types of marital status are associated with different levels of suicidal risk. AIMS To study marital status change and the effect of its recency in relation to suicidal behavior. METHODS Suicide victims (1614) in Slovenia and matched controls (4617) were compared for incidence and recency of marital status change during the last 5 years of their lives. RESULTS A higher percentage of suicide victims (10.7%) had a marital status change in the last 5 years compared with the controls (5.6%). All types of marital status changes (becoming widowed, getting divorced, getting married) proved to be risk factors for suicidal behavior. Almost half of all marital status changes in suicide victims occurred in the year prior to suicide, whereas marital status changes in the control group were equally distributed over the last 5 years. For recently married and divorced people, the increase in suicide risk depended on age: The risk was higher in older people. CONCLUSIONS Marital status change represents a risk factor for suicidal behavior. The first year after the change is critical for elevated suicidal risk, in particular for older people.

Familial Study of Suicidal Behavior Among Adolescents in Slovenia

The number of adolescents who attempt or complete suicide is increasing. Risk factors range from mental disorders, to problems at school, family problems, or difficulties in establishing relationships. A further important, and too often underestimated, risk factor for adolescent suicide is the presence of suicidal behavior in the adolescents family. We investigated 184 high school adolescents in a region in Slovenia with a high suicide rate (30/100,000/year). They were questioned by means of an anonymous questionnaire about the presence of suicidal behavior in their relatives and about the presence of suicidal thoughts, plans, and acts in themselves. The results revealed that 13% of the adolescents studied had a relative who had attempted suicide and a further 9% of the adolescents had lost a relative due to suicide. About half of all females and almost a third of males had had suicidal thoughts (differences between sexes were statistically significant: chi2 = 6.13; p < .01). Attempted suicide among relatives was positively correlated with the presence of suicidal plans among adolescents (phi = 0.15; p < .05). This correlation proved to be even stronger and statistically more significant in men when we split the sample by gender. All variables (suicidal thoughts, suicidal plans, and suicide attempts) in the adolescent males positively correlated with attempted suicide among their relatives ((phi = 0.28, p < .01; phi) = 0.26, p < .05; phi = 0.34, p < .01; respectively). Our results speak in favor of a higher risk of suicidal behavior among adolescents with suicidal behavior in their families.

Suicide Victims’ Last Contact With the Primary Care Physician: Report From Slovenia

Background: Previous studies have reported that many suicide victims have had contact with their physicians a week or month prior to their suicide. Aims: To assess the date of the last appointment (and complaint) of suicide victims in the Škofja Loka region within Slovenia. Method: We included all suicide victims in the region in the period 1993—2003. Each of the cases was assigned the closest control in terms of age and gender. Medical death certificates served as a source of demographic data information and information about suicide method. From personal medical records we obtained the date of the last appointment (and the complaint) with the primary care physician. The same was done for the control group. The groups were compared for their last appointment with their physician (date and complaint). Results: Thirty out of 77 suicide victims visited their physician in the last month before suicide (14/77 in the last week); only 16/77 controls did so before the index day (3/77 in the last week). In 30% of suicide victims, the reason for the last visit was mental health problems (only 3% in the control group). Conclusion: The results emphasize the important role of primary care physicians in suicide prevention.

Celebrity suicide on the railway network: Can one case trigger international effects?

BACKGROUND After the railway suicide of the German national goalkeeper Robert Enke in 2009, a significant increase of railway suicides was observed nationally. This study analyses whether this incident also triggered copycat effects in other European countries. Additionally, media coverage proxied by Google Trends and long-term changes taking into account general changes in suicide rates and kilometres driven by trains were examined. METHODS The numbers of railway suicides before and after Enke´s suicide were analysed for short and long-term periods (2 weeks and 2 years post-event) across five European countries. Incidence ratios and resulting percentage changes were computed. RESULTS Similar to Germany, there were significant short and long-term effects for the combined data of the four other countries (increase of 93.9%; p=0.004 and 16.7%; p=0.003). There was no indication that long-term effects are a mere reflection of an overall increase in suicide frequencies or due to increased numbers of kilometres driven by trains. Analyses on country level revealed heterogeneous results. LIMITATIONS Due to incomplete data, analyses regarding age and gender were not performed. Media coverage was only proxied by a Google Trends analysis. The study includes a small sample of European countries. CONCLUSIONS Enkes suicide in 2009 was followed by increasing train suicide numbers in Europe. Although this incident may have reinforced an existing European trend of growing railway suicides, an international copycat effect and/or an increased overall awareness about this particular suicide method appears to be one likely explanation for the changes.

Some factors affecting the decision on non-mandatory vaccination in an influenza pandemic: comparison of pandemic (H1N1) and seasonal influenza vaccination

Some factors affecting the decision on non-mandatory vaccination in an influenza pandemic: comparison of pandemic (H1N1) and seasonal influenza vaccination Background: The 2009 influenza pandemic caused by the influenza A (H1N1) 2009 virus was accompanied by a debate about whether or not to be vaccinated. The percentage of people who decided to be vaccinated was lower than in the case of seasonal influenza vaccination. We therefore compared factors influencing the decision on pandemic and seasonal influenza vaccination. Method: Slovene inhabitants aged 18 and over (N=1383) completed an internet based survey on socio-demographic and health behaviour-related characteristics, personality traits, and characteristics of decision-making. Two stepwise logistic regression analyses were performed, one with an uptake of the pandemic influenza vaccine and the other with an uptake of the seasonal influenza vaccine as a dependent variable. Results: In addition to common predictors of a decision in favour of the two vaccinations (age, gender, chronic illnesses, working in healthcare, trust in media news and vaccination side-effects in someone close), deciding in favour of vaccination against the pandemic virus was related to living with children and thoroughness in decision-making. It was also related to being vaccinated against seasonal influenza, trust in pandemic vaccine safety and professional information in favour of vaccination, and the decision of someone close. Conclusions: In the face of the pandemic threat and lack of information, people behaved as they had in previous similar situations and according to the behaviour of people close to them and information from trusted sources. Concern for children and decision-making characteristics also became important. These factors should be considered in future crisis interventions. Nekateri Dejavniki Odločanja za Prostovoljno Cepljenje V Primeru Pandemije Gripe: Primerjava Cepljenja Proti Pandemski GRIPI (H1N1) in Sezonski Gripi Izhodišče: Pandemijo gripe, ki jo je v letu 2009 povzročil virus influence A (H1N1), so spremljale polemike o tem, ali se je smiselno cepiti ali ne. Delež oseb, ki so se odločile za cepljenje, je bil nižji kot v primeru cepljenja proti sezonski gripi. Zato smo želeli dejavnike, ki so vplivali na odločitev za cepljenje proti pandemski gripi, primerjati z dejavniki, ki vplivajo na odločitev za cepljenje proti sezonski gripi. Metoda: Polnoletni Slovenci (N=1383) so na spletnem vprašalniku poročali o svojih socialno-demografskih lastnostih in z zdravjem povezanih vedenjih, osebnostnih potezah in značilnostih odločanja. Izvedli smo dve logistični regresiji, pri čemer je v prvi odvisno spremenljivko predstavljala odločitev o cepljenju proti pandemski gripi, v drugi pa odločitev glede cepljenja proti sezonski gripi. Rezultati: Poleg skupnih napovednikov, ki vplivajo na odločitev za obe cepljenji (starost, spol, kronične bolezni, zaposlitev v zdravstvu, zaupanje medijem in pojav morebitnih stranskih učinkov po nekem cepljenju pri bližnji osebi) je bilo cepljenje proti pandemski gripi povezano tudi s tem, ali posameznik živi z otroki ali ne, z njegovo temeljitostjo pri odločanju, z odločitvijo za cepljenje proti sezonski gripi, zaupanjem v varnost cepiva proti pandemski gripi in v strokovne informacije v prid cepljenju ter s podobno odločitvijo bližnje osebe. Zaključki: V primeru grozeče pandemije in pomanjkljivih informacij se ljudje obnašajo v skladu s svojim vedenjem v preteklosti in z vedenjem bližnjih oseb ter v skladu z informacijami iz virov, ki jim zaupajo. Pomembna dejavnika, ki vplivata na odločitev o cepljenju, postaneta tudi skrb za otroke in temeljitost odločanja. Vse naštete dejavnike bi morali upoštevati pri načrtovanju kriznih ukepov v prihodnosti.

The Burden of Suicide and . . . Have We Forgotten the Open Verdicts

As Retterstol (1993) once wrote, suicide is probably the most personal act anyone can perform as few acts have such deep roots in social and human conditions, or have such far-reaching consequences, including economically. It is estimated that, worldwide, around one million people die by suicide each year, making suicide and attempted suicide major public health problems. Evidence-based programs of action directed at preventing suicide and attempted suicide are greatly needed. However, a comprehensive review of knowledge on the burden of suicidal behavior is needed before such programs can be developed and subsequently evaluated.

Development and Implementation of Suicide Prevention Activities - Report from Slovenia

On-going development and sustainable implementation of suicide prevention activities seem to be important factors that contribute to lower suicide rates over several years. In Slovenia, new programmes, initiatives and suicide prevention and research centres have emerged in the last decades. In our chapter we are presenting very well accepted project Let’s Talk about Suicide and its impact on the society. The project is aimed to decrease suicidal behaviour among different high-risk groups. It integrates research, prevention and intervention through different activities targeting healthcare professionals, school counsellors and media.

Attitudes within the general population towards seeking professional help in cases of mental distress

Background: Although effective treatment is available for a variety of mental disorders, the treatment and help-seeking gap remains high. One of the main obstacles to help-seeking behaviour is prevailing stigmatizing attitudes. Aim: To examine attitudes within the general population towards seeking professional help in times of mental distress. Methods: A representative general population survey (N = 594) was conducted in Slovenia by means of an Internet-based questionnaire, covering data on demographic variables and attitudes towards help-seeking behaviour. Results: More stigmatizing attitudes towards help-seeking behaviour were found in men, single persons, those of a younger age and lower educational achievement and in respondents coming from regions with a high suicide rate. Furthermore, 52.50% of the total sample have had an experience with psychological problems, yet only 41.50% of those have sought professional help. Experience with help-seeking behaviour in the past was associated with less stigmatizing attitudes. Conclusion: Knowledge and understanding of mental health problems are necessary prerequisites to seeking help, but not the only ones. To improve help-seeking behaviour, it is also important to combat stigmatizing attitudes. Additionally, destigmatizing campaigns should also focus on social norms.