Objectives

The aim of OSPI is to provide EU member states with an evidence based prevention concept, concrete materials and instruments for running and evaluating these interventions and recommendations for the proper implementation of the intervention. These aims will be achieved by the following five objectives:

(1) Analysis of differences in suicide rates among European countries and harmonisation of procedures for definition, assessment and evaluation of suicidality

A cross-country common definition of non-fatal self-inflicted injuries will be found by the flowing means: searching the literature and reporting results to project partners, interviewing experts in the EU countries on the definitions used there, and holding an expert consensus conference with all project partners and EU-stakeholders.

Guidelines for suicide registration with detailed descriptions of national practices relating suicide statistics from all EU-countries and recommendations to maximise the quality of registration and reporting suicides in EU-countries will be developed. Further, a database on suicide methods for all EU countries will be compiled to develop recommendations on fighting lethal means in the countries.

(2) Development of a state of the art intervention concept for the prevention of suicidality

The intervention to be developed within the OSPI-project seeks to consider current evidence-based best practices and international experiences with multilevel interventions, such as that of the European Alliance Against Depression. Therefore, current strategies for suicide prevention will be reviewed and evaluated. All strategies for which at least some evidence is available will be combined including strategies targeting the general population, as well as strategies targeting high risk groups. Because of the multi-factored causes of suicidality, interventions that address the problem on multiple levels by a multifaceted programme are considered to be most effective. Further, every global strategy to prevent suicide should also include the prevention of non-fatal suicidal acts, not only because they are the strongest predictor for suicide but also because of their great medical and health economic impact.

Best practice interventions will be defined and published in guidelines. Also, country specific recommendations for restrictions of lethal means will be developed. With all this efforts, a multilevel approach to suicide prevention (the OSPI-Intervention) will be created.

(3) Implementation of comparable multilevel community-based prevention interventions in four European model regions

Intervention countries represent different EU-health systems and different socio-cultural characteristics: Ireland, Germany, Hungary, and Portugal (for details of the implementation regions see table).

The intervention will be based on the 4 level approach of the Nuremberg Alliance Against Depression as well as the European Alliance Against Depression. The creation of local networks that engage regional stakeholders is crucial for this work of implementation of the multi-level community based intervention. An important point is also the distribution of local recommendations to create sustainability after the end of the intervention.

(4) Evaluation of the interventions in a pre-post, controlled and cross-nationally comparable design concerning effectiveness, efficiency, involved processes and the interplay between the single intervention measures

Evaluation will encompass four aspects:

(a) Primary and secondary outcome evaluation (suicide preventive efficacy): Suicidal acts (suicides + non-fatal suicidal acts) will be researched as primary outcome. The secondary outcome will be the aggregated rates of completed suicides of all four intervention regions after one year intervention derived from official statistics for suicide rates.

(b)  Evaluation concerning intermediate outcome, e.g changes in attitude or knowledge of the general population, changes in prescription rates of antidepressants, and media coverage of suicidality. Further intermediate outcomes will be defined in separate workpackage.

(c)  Process of the implementation of interventions: data about the actual process of implementation (characteristics of the local environment, prevailing local attitudes toward mental health treatment and suicidality, local health care structures and resources, other ongoing local actions targeting suicidality or related health aspects and historical, cultural and political aspects)

(d)  Health economic evaluation of suicidality and cost-effectiveness of the interventions: health economic evaluation of suicidality and cost-effectiveness of the intervention (cost-offset and cost-benefit). Further, a model project in economic impact over the coming years will be calculated.

(5) Distribution of an optimised suicide preventive intervention concept, corresponding materials and instruments, and recommendations for implementation to policy makers and stakeholders

Praxis transfer is a crucial aim of OSPI-Europe. Special emphasis is put on dissemination strategies on the local as well as the EU wide level. Successful implementation of the OSPI-Intervention in the intervention regions requires strong public relations work in order to win cooperation partners, to inform the public, to strengthen public discussion on suicide and to lobby for the restriction of lethal means.

The projects final results will be disseminated on three different levels. Level 1 is the dissemination in the scientific community. Results will be published in international scientific journals and presented at national and international scientific congresses dealing with public mental health issues. Level 2 is the dissemination to key players who are responsible for mental health policy in the EU countries such as the national ministries of health, NGO's active in mental health prevention and promotion in the EU member states, the EU-Directorate General for Health and Consumer Protection as well as other concerned directorates, and the Mental health Unit at WHO Copenhagen. This will be done through the manual guidelines and through the final project report. Level 3 is the nation wide dissemination of the OSPI-Intervention in 17 European countries. Therefore the EAAD network will be used, which represents 17 European countries with strong regional networks and several regional centres.