Background

Suicide is a significant public health issue. This is especially true for Europe where the highest rates for completed suicide in the world are found. Every year more than 58,000 persons commit suicide within the European Union. According to WHO data, suicide is among the 10 leading causes of death for all ages (World Health Organization, 2003).

Closely related to completed suicides are non-fatal suicidal acts which encompass parasuicides, suicide attempts, and deliberate self harm or self-inflicted injuries. The rate of non-fatal suicidal acts is estimated to be about 10 times higher than that of suicides. In Europe, the highest rates for non-fatal suicidal acts are found in younger women, whereas the highest rates for suicide are found in older men.

Rates of non-fatal suicidal acts and suicides depend on many factors. The most important appears to be psychiatric morbidity. It is estimated that 90% of suicides occur within a psychiatric disorder (Mann et al., 2005). The most important disorder in this context is major depression. Other contributing aspects are choice of more or less lethal suicide attempt methods, access to lethal means, gender, cultural and social factors including attitudes towards suicidality, imitation effects, and personality associated factors such as impulsivity and (auto-) aggression.

The numerous suicide prevention activities which have been implemented worldwide on regional or national levels can be divided into strategies targeting the population and those targeting high-risk groups (Althaus & Hegerl, 2003). Strong empirical evidence, however, is lacking for all of the single measures mentioned (education and awareness programs, improved treatment of psychiatric disorders, media guidelines for suicide reporting, screening high risk populations, and restriction of access to lethal means) (Mann et al., 2005).

The groundwork for OSPI-Europe has been laid through implementation of a multifaceted intervention programme for suicide prevention in Nuremberg, Germany (Nuremberg Alliance Against Depression) and the later expansion of the Nuremberg-concept to other EU countries, which formed the European Alliance Against Depression (EAAD). The Nuremberg intervention was a four level approach including education of GPs using training sessions and videos (level 1), public relations activities (level 2), training sessions for multipliers such as priests, social workers, geriatric care givers, teachers and the media (level 3), offers for high risk groups (persons after suicide attempt) and support of self-help activities and relatives (level 4). The NAAD was rigorously evaluated in a controlled and pre-post design, revealing a highly relevant reduction of the number of suicidal acts compared to the baseline year (-24%), a reduction which was clearly significant compared to corresponding changes in the control region. The reduction was even more pronounced (-53%) when looking only at the five most drastic suicide attempt methods (Hegerl, Althaus, Schmidtke, & Niklewski, 2006).

The strong evidence basis, materials, concepts and evaluation tools of the NAAD, combined with the network and experience of the EAAD formed the background as well as the starting point from which the OSPI-concept is developed.