Sustainable effects on suicidality were found for the Nuremberg alliance against depression

  • Ulrich Hegerl
  • Roland Mergl
  • Inga Havers
  • Armin Schmidtke
  • Hartmut Lehfeld
  • Günter Niklewski
  • David Althaus
Original Paper

Abstract

During an intense four-level community-based intervention program conducted in Nuremberg (490,000 inhabitants) in 2001 and 2002 [Nuremberg Alliance Against Depression (NAD)], the number of suicidal acts (main outcome completed + attempted suicides) had dropped significantly (−21.7%), a significant effect compared with the baseline year and the control region (Wuerzburg, about 290,000 inhabitants). To assess the sustainability of the intervention effects the number of suicidal acts was assessed in the follow-up year (2003), after the termination of the 2-year intervention. Also, in the follow-up year (2003), the reduction in suicidal acts compared with the baseline year in Nuremberg (2000 vs. 2003: −32.4%) was significantly larger than that in the control region (P = 0.0065). The reduction was even numerically larger than that of the intervention years (2001, 2002). Thus, 1 year after the end of the main intervention, preventive effects on suicidality of the NAD remain at least stable. The four-level intervention concept appears to be cost-effective and is presently implemented in many European regions.

Keywords

Depression Suicidality Intervention Sustainability 

References

  1. 1.
    Althaus D, Hegerl U (2003) The evaluation of suicide prevention activities: state of the art. World J Biol Psychiatry 4:156–165CrossRefPubMedGoogle Scholar
  2. 2.
    Althaus D, Niklewski G, Schmidtke A, Hegerl U (2007) Veränderung der Häufigkeit suizidaler Handlungen nach zwei Jahren. “Bündnis gegen Depression”. [Changes in the frequency of suicidal behaviour after a 2-year intervention campaign.] Nervenarzt 78:272–276, 278–280, 282Google Scholar
  3. 3.
    Angermeyer MC, Beck M, Dietrich S, Holzinger A (2004) The stigma of mental illness: patients’ anticipations and experiences. Int J Soc Psychiatry 50:153–162CrossRefPubMedGoogle Scholar
  4. 4.
    Bille-Brahe U, Kerkhof A, De Leo D, Schmidtke A, Crepet P, Lönnqvist J, Michel K, Salander-Renberg E, Stiles TC, Wasserman D, Aagaard B, Egebo H, Jensen B (1997) A repetition-prediction study of European parasuicide populations: a summary of the first report from part II of the WHO/EURO Multicentre Study on Parasuicide in co-operation with the EC concerted action on attempted suicide. Acta Psychiatr Scand 95:81–86CrossRefPubMedGoogle Scholar
  5. 5.
    Bostwick JM, Pankratz VS (2000) Affective disorders and suicide risk: a re-examination. Am J Psychiatr 157:1925–1932CrossRefPubMedGoogle Scholar
  6. 6.
    Dietrich S, Mergl R, Freudenberg P, Althaus D, Hegerl U (2009) Impact of a campaign on the public’s attitudes toward depression. Health Educ Res. doi:10.1093/her/cyp050
  7. 7.
    Docherty JP (1997) Barriers to the diagnosis of depression in primary care. J Clin Psychiatry 58:5–10PubMedGoogle Scholar
  8. 8.
    Goldman LS, Nielsen NH, Champion HC (1999) Awareness, diagnosis, and treatment of depression. J Gen Intern Med 14:569–580CrossRefPubMedGoogle Scholar
  9. 9.
    Hegerl U, Althaus D, Schmidtke A, Niklewski G (2006) The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality. Psychol Med 36:1225–1233CrossRefPubMedGoogle Scholar
  10. 10.
    Hegerl U, Althaus D, Stefanek J (2003) Public attitudes towards treatment of depression: effects of an information campaign. Pharmacopsychiatry 36:288–291CrossRefPubMedGoogle Scholar
  11. 11.
    Hegerl U, Wittenburg L, the European Alliance Against Depression Consortium (2009) Focus on mental health care reforms in Europe: the European Alliance Against Depression: a multilevel approach to the prevention of suicidal behavior. Psychiatr Serv 60:596–599CrossRefPubMedGoogle Scholar
  12. 12.
    Hegerl U, Wittmann M, Arensman E, Van Audenhove C, Bouleau JH, Van Der Feltz-Cornelis C, Gusmao R, Kopp M, Löhr C, Maxwell M, Meise U, Mirjanic M, Oskarsson H, Sola VP, Pull C, Pycha R, Ricka R, Tuulari J, Värnik A, Pfeiffer-Gerschel T (2008) The ‘European Alliance Against Depression (EAAD)’: a multifaceted, community-based action programme against depression and suicidality. World J Biol Psychiatry 9:51–58CrossRefPubMedGoogle Scholar
  13. 13.
    Hirschfeld RM, Keller MB, Panico S, Arons BS, Barlow D, Davidoff F, Endicott J, Froom J, Goldstein M, Gorman JM, Marek RG, Maurer TA, Meyer R, Phillips K, Ross J, Schwenk TL, Sharfstein SS, Thase ME, Wyatt RJ (1997) The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. JAMA 277:333–340CrossRefPubMedGoogle Scholar
  14. 14.
    Jorm AF, Medway J, Christensen H, Korten AE, Jacomb PA, Rodgers B (2000) Attitudes towards people with depression: effects on the public’s help-seeking and outcome when experiencing common psychiatric symptoms. Aust N Z J Psychiatry 34:612–618PubMedGoogle Scholar
  15. 15.
    Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA (1999) Public conceptions of mental illness: labels, causes, dangerousness, and social distance. Am J Public Health 89:1328–1333CrossRefPubMedGoogle Scholar
  16. 16.
    Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ (2006) Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 367:1747–1757CrossRefPubMedGoogle Scholar
  17. 17.
    Morgan HG, Jones EM, Owen JH (1993) Secondary prevention of non-fatal deliberate self-harm. The green card study. Br J Psychiatry 163:111–112CrossRefPubMedGoogle Scholar
  18. 18.
    Murray CJL, Lopez AD (1996) Global and regional descriptive epidemiology of disability: incidence, prevalence, health expectancies and years lived with disability. In: Murray CJL, Lopez AD (eds) The global burden of disease, vol 1. Harvard University Press, Cambridge, pp 201–246Google Scholar
  19. 19.
    Murray CJL, Lopez AD (1996) The global burden of disease in 1990: final results and their sensitivity to alternative epidemiological perspectives, discount rates, age-weights and disability weights. In: Murray CJL, Lopez AD (eds) The global burden of disease, vol 1. Harvard University Press, Cambridge, pp 247–293Google Scholar
  20. 20.
    Patten SB (2008) Major depression prevalence is very high, but the syndrome is a poor proxy for community populations’ clinical treatment needs. Can J Psychiatry 53:411–419PubMedGoogle Scholar
  21. 21.
    Philipps DP (1974) The influence of suggestion on suicide: substantive and theoretical implications of the Werther effect. Am Sociol Rev 39:340–354CrossRefGoogle Scholar
  22. 22.
    Preti A, Tondo L, Sisti D, Rocchi MB, de Girolamo G and for the PROGRES-Acute group (2009) Correlates and antecedents of hospital admission for attempted suicide: a nationwide survey in Italy. Eur Arch Psychiatry Clin Neurosci. doi:10.1007/s00406-009-0037-x
  23. 23.
    Rihmer Z (2004) Decreasing national suicide rates—fact or fiction? World J Biol Psychiatry 5:55–56CrossRefPubMedGoogle Scholar
  24. 24.
    Rutz W, Von Knorring L, Wålinder J (1989) Frequency of suicide on Gotland after systematic postgraduate education of general practitioners. Acta Psychiatr Scand 80:151–154CrossRefPubMedGoogle Scholar
  25. 25.
    Rutz W, Von Knorring L, Wålinder J, Wistedt B (1990) Effect of an educational program for general practitioners on Gotland on the pattern of prescription of psychotropic drugs. Acta Psychiatr Scand 82:399–403CrossRefPubMedGoogle Scholar
  26. 26.
    Sartorius N (2001) The economic and social burden of depression. J Clin Psychiatry 62(Suppl.15):8–11PubMedGoogle Scholar
  27. 27.
    Schmidtke A, Bille-Brahe U, De Leo D, Kerkhof A, Bjerke T, Crepet P, Haring C, Hawton K, Lönnqvist J, Michel K, Pommereau X, Querejeta I, Phillips I, Salander-Renberg E, Temesváry B, Wasserman D, Fricke S, Weinacker B, Sampaio-Faria JG (1996) Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989–1992. Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatr Scand 93:327–338CrossRefPubMedGoogle Scholar
  28. 28.
    Simon GE, Fleck M, Lucas R, Bushnell DM, LIDO Group (2004) Prevalence and predictors of depression treatment in an international primary care study. Am J Psychiatry 161:1626–1634Google Scholar
  29. 29.
    Sunnqvist C, Westrin Å, Träskman-Bendz L (2008) Suicide attempters: biological stressmarkers and adverse life events. Eur Arch Psychiatry Clin Neurosci 258:456–462CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ulrich Hegerl
    • 1
  • Roland Mergl
    • 1
  • Inga Havers
    • 1
  • Armin Schmidtke
    • 2
  • Hartmut Lehfeld
    • 3
  • Günter Niklewski
    • 3
  • David Althaus
    • 4
  1. 1.Department of PsychiatryUniversity of LeipzigLeipzigGermany
  2. 2.Department of Psychiatry, Psychosomatic Medicine and PsychotherapyJulius-Maximilian-University WuerzburgWuerzburgGermany
  3. 3.Hospital for Psychiatry and PsychotherapyNurembergGermany
  4. 4.Praxis for PsychotherapyDachauGermany

Personalised recommendations