TY - JOUR A1 - Hegerl, Ulrich A1 - Wittenburg, Lisa A1 - Arensman, Ella A1 - Van Audenhove, Chantal A1 - Coyne, James C. A1 - McDaid, David A1 - van der Feltz-Cornelis, Christina M. A1 - Gusmão, Ricardo A1 - Kopp, Mária A1 - Maxwell, Margaret A1 - Meise, Ullrich A1 - Roskar, Saska A1 - Sarchiapone, Marco A1 - Schmidtke, Armin A1 - Värnik, Airi A1 - Bramesfeld, Anke T1 - Optimizing Suicide Prevention Programs and Their Implementation in Europe (OSPI Europe): an evidence-based multi-level approach JF - BMC Public Health N2 - Background Suicide 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. Method The 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. Discussion This 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. KW - suicide prevention KW - preventive strategies KW - Europe Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-154695 VL - 9 IS - 428 ER - TY - JOUR A1 - Blanco, Ignacio A1 - Kuchenbaecker, Karoline A1 - Cuadras, Daniel A1 - Wang, Xianshu A1 - Barrowdale, Daniel A1 - Ruiz de Garibay, Gorka A1 - Librado, Pablo A1 - Sanchez-Gracia, Alejandro A1 - Rozas, Julio A1 - Bonifaci, Núria A1 - McGuffog, Lesley A1 - Pankratz, Vernon S. A1 - Islam, Abul A1 - Mateo, Francesca A1 - Berenguer, Antoni A1 - Petit, Anna A1 - Català, Isabel A1 - Brunet, Joan A1 - Feliubadaló, Lidia A1 - Tornero, Eva A1 - Benítez, Javier A1 - Osorio, Ana A1 - Ramón y Cajal, Teresa A1 - Nevanlinna, Heli A1 - Aittomäki, Kristina A1 - Arun, Banu K. A1 - Toland, Amanda E. A1 - Karlan, Beth Y. A1 - Walsh, Christine A1 - Lester, Jenny A1 - Greene, Mark H. A1 - Mai, Phuong L. A1 - Nussbaum, Robert L. A1 - Andrulis, Irene L. A1 - Domchek, Susan M. A1 - Nathanson, Katherine L. A1 - Rebbeck, Timothy R. A1 - Barkardottir, Rosa B. A1 - Jakubowska, Anna A1 - Lubinski, Jan A1 - Durda, Katarzyna A1 - Jaworska-Bieniek, Katarzyna A1 - Claes, Kathleen A1 - Van Maerken, Tom A1 - Díez, Orland A1 - Hansen, Thomas V. A1 - Jønson, Lars A1 - Gerdes, Anne-Marie A1 - Ejlertsen, Bent A1 - De la Hoya, Miguel A1 - Caldés, Trinidad A1 - Dunning, Alison M. A1 - Oliver, Clare A1 - Fineberg, Elena A1 - Cook, Margaret A1 - Peock, Susan A1 - McCann, Emma A1 - Murray, Alex A1 - Jacobs, Chris A1 - Pichert, Gabriella A1 - Lalloo, Fiona A1 - Chu, Carol A1 - Dorkins, Huw A1 - Paterson, Joan A1 - Ong, Kai-Ren A1 - Teixeira, Manuel R. A1 - Hogervorst, Frans B. L. A1 - Van der Hout, Annemarie H. A1 - Seynaeve, Caroline A1 - Van der Luijt, Rob B. A1 - Ligtenberg, Marjolijn J. L. A1 - Devilee, Peter A1 - Wijnen, Juul T. A1 - Rookus, Matti A. A1 - Meijers-Heijboer, Hanne E. J. A1 - Blok, Marinus J. A1 - Van den Ouweland, Ans M. W. A1 - Aalfs, Cora M. A1 - Rodriguez, Gustavo C. A1 - Phillips, Kelly-Anne A. A1 - Piedmonte, Marion A1 - Nerenstone, Stacy R. A1 - Bae-Jump, Victoria L. A1 - O'Malley, David M. A1 - Schmutzler, Rita K. A1 - Wappenschmidt, Barbara A1 - Rhiem, Kerstin A1 - Engel, Christoph A1 - Meindl, Alfons A1 - Ditsch, Nina A1 - Arnold, Norbert A1 - Plendl, Hansjoerg J. A1 - Niederacher, Dieter A1 - Sutter, Christian A1 - Wang-Gohrke, Shan A1 - Steinemann, Doris A1 - Preisler-Adams, Sabine A1 - Kast, Karin A1 - Varon-Mateeva, Raymonda A1 - Gehrig, Andrea A1 - Bojesen, Anders A1 - Pedersen, Inge Sokilde A1 - Sunde, Lone A1 - Birk Jensen, Uffe A1 - Thomassen, Mads A1 - Kruse, Torben A. A1 - Foretova, Lenka A1 - Peterlongo, Paolo A1 - Bernard, Loris A1 - Peissel, Bernard A1 - Scuvera, Giulietta A1 - Manoukian, Siranoush A1 - Radice, Paolo A1 - Ottini, Laura A1 - Montagna, Marco A1 - Agata, Simona A1 - Maugard, Christine A1 - Simard, Jacques A1 - Soucy, Penny A1 - Berger, Andreas A1 - Fink-Retter, Anneliese A1 - Singer, Christian F. A1 - Rappaport, Christine A1 - Geschwantler-Kaulich, Daphne A1 - Tea, Muy-Kheng A1 - Pfeiler, Georg A1 - John, Esther M. A1 - Miron, Alex A1 - Neuhausen, Susan L. A1 - Terry, Mary Beth A1 - Chung, Wendy K. A1 - Daly, Mary B. A1 - Goldgar, David E. A1 - Janavicius, Ramunas A1 - Dorfling, Cecilia M. A1 - Van Rensburg, Elisabeth J. A1 - Fostira, Florentia A1 - Konstantopoulou, Irene A1 - Garber, Judy A1 - Godwin, Andrew K. A1 - Olah, Edith A1 - Narod, Steven A. A1 - Rennert, Gad A1 - Paluch, Shani Shimon A1 - Laitman, Yael A1 - Friedman, Eitan A1 - Liljegren, Annelie A1 - Rantala, Johanna A1 - Stenmark-Askmalm, Marie A1 - Loman, Niklas A1 - Imyanitov, Evgeny N. A1 - Hamann, Ute A1 - Spurdle, Amanda B. A1 - Healey, Sue A1 - Weitzel, Jeffrey N. A1 - Herzog, Josef A1 - Margileth, David A1 - Gorrini, Chiara A1 - Esteller, Manel A1 - Gómez, Antonio A1 - Sayols, Sergi A1 - Vidal, Enrique A1 - Heyn, Holger A1 - Stoppa-Lyonnet, Dominique A1 - Léoné, Melanie A1 - Barjhoux, Laure A1 - Fassy-Colcombet, Marion A1 - Pauw, Antoine de A1 - Lasset, Christine A1 - Fert Ferrer, Sandra A1 - Castera, Laurent A1 - Berthet, Pascaline A1 - Cornelis, François A1 - Bignon, Yves-Jean A1 - Damiola, Francesca A1 - Mazoyer, Sylvie A1 - Sinilnikova, Olga M. A1 - Maxwell, Christopher A. A1 - Vijai, Joseph A1 - Robson, Mark A1 - Kauff, Noah A1 - Corines, Marina J. A1 - Villano, Danylko A1 - Cunningham, Julie A1 - Lee, Adam A1 - Lindor, Noralane A1 - Lázaro, Conxi A1 - Easton, Douglas F. A1 - Offit, Kenneth A1 - Chenevix-Trench, Georgia A1 - Couch, Fergus J. A1 - Antoniou, Antonis C. A1 - Pujana, Miguel Angel T1 - Assessing associations between the AURKA-HMMR-TPX2-TUBG1 functional module and breast cancer risk in BRCA1/2 mutation carriers JF - PLoS ONE N2 - While interplay between BRCA1 and AURKA-RHAMM-TPX2-TUBG1 regulates mammary epithelial polarization, common genetic variation in HMMR (gene product RHAMM) may be associated with risk of breast cancer in BRCA1 mutation carriers. Following on these observations, we further assessed the link between the AURKA-HMMR-TPX2-TUBG1 functional module and risk of breast cancer in BRCA1 or BRCA2 mutation carriers. Forty-one single nucleotide polymorphisms (SNPs) were genotyped in 15,252 BRCA1 and 8,211 BRCA2 mutation carriers and subsequently analyzed using a retrospective likelihood approach. The association of HMMR rs299290 with breast cancer risk in BRCA1 mutation carriers was confirmed: per-allele hazard ratio (HR) = 1.10, 95% confidence interval (CI) 1.04 - 1.15, p = 1.9 x 10\(^{-4}\) (false discovery rate (FDR)-adjusted p = 0.043). Variation in CSTF1, located next to AURKA, was also found to be associated with breast cancer risk in BRCA2 mutation carriers: rs2426618 per-allele HR = 1.10, 95% CI 1.03 - 1.16, p = 0.005 (FDR-adjusted p = 0.045). Assessment of pairwise interactions provided suggestions (FDR-adjusted p\(_{interaction}\) values > 0.05) for deviations from the multiplicative model for rs299290 and CSTF1 rs6064391, and rs299290 and TUBG1 rs11649877 in both BRCA1 and BRCA2 mutation carriers. Following these suggestions, the expression of HMMR and AURKA or TUBG1 in sporadic breast tumors was found to potentially interact, influencing patients' survival. Together, the results of this study support the hypothesis of a causative link between altered function of AURKA-HMMR-TPX2-TUBG1 and breast carcinogenesis in BRCA1/2 mutation carriers. KW - genetic interaction networks KW - genome-wide association KW - expression signature KW - susceptibility loci KW - survival KW - modifiers KW - polymorphism KW - cell KW - chip-seq KW - elements Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-143469 VL - 10 IS - 4 ER - TY - JOUR A1 - Harris, Fiona M. A1 - Maxwell, Margaret A1 - O'Connor, Rory C. A1 - Coyne, James A1 - Arensman, Ella A1 - András, Székely A1 - Gusmão, Ricardo A1 - Coffey, Claire A1 - Costa, Susana A1 - Zoltan, Cserháti A1 - Koburger, Nicole A1 - van Audenhove, Chantal A1 - McDaid, David A1 - Maloney, Julia A1 - Värnik, Peeter A1 - Hegerl, Ulrich T1 - Developing social capital in implementing a complex intervention: a process evaluation of the early implementation of a suicide prevention intervention in four European countries JF - BMC Public Health N2 - Background: Variation in the implementation of complex multilevel interventions can impact on their delivery and outcomes. Few suicide prevention interventions, especially multilevel interventions, have included evaluation of both the process of implementation as well as outcomes. Such evaluation is essential for the replication of interventions, for interpreting and understanding outcomes, and for improving implementation science. This paper reports on a process evaluation of the early implementation stage of an optimised suicide prevention programme (OSPI-Europe) implemented in four European countries. Methods: The process analysis was conducted within the framework of a realist evaluation methodology, and involved case studies of the process of implementation in four European countries. Datasets include: repeated questionnaires to track progress of implementation including delivery of individual activities and their intensity; serial interviews and focus groups with stakeholder groups; and detailed observations at OSPI implementation team meetings. Results: Analysis of local contexts in each of the four countries revealed that the advisory group was a key mechanism that had a substantial impact on the ease of implementation of OSPI interventions, particularly on their ability to recruit to training interventions. However, simply recruiting representatives of key organisations into an advisory group is not sufficient to achieve impact on the delivery of interventions. In order to maximise the potential of high level 'gatekeepers', it is necessary to first transform them into OSPI stakeholders. Motivations for OSPI participation as a stakeholder included: personal affinity with the shared goals and target groups within OSPI; the complementary and participatory nature of OSPI that adds value to pre-existing suicide prevention initiatives; and reciprocal reward for participants through access to the extended network capacity that organisations could accrue for themselves and their organisations from participation in OSPI. Conclusions: Exploring the role of advisory groups and the meaning of participation for these participants revealed some key areas for best practice in implementation: careful planning of the composition of the advisory group to access target groups; the importance of establishing common goals; the importance of acknowledging and complementing existing experience and activity; and facilitating an equivalence of benefit from network participation. KW - suicide prevention KW - realist evaluation KW - social capital KW - advisory groups KW - depression KW - strategies KW - alliance KW - complex interventions KW - process evaluation Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-122117 VL - 13 IS - 158 ER - TY - JOUR A1 - Mergl, Roland A1 - Koburger, Nicole A1 - Heinrichs, Katherina A1 - Székely, András A1 - Tóth, Mónika Ditta A1 - Coyne, James A1 - Quintão, Sónia A1 - Arensman, Ella A1 - Coffey, Claire A1 - Maxwell, Margaret A1 - Värnik, Airi A1 - van Audenhove, Chantal A1 - McDaid, David A1 - Sarchiapone, Marco A1 - Schmidtke, Armin A1 - Genz, Axel A1 - Gusmão, Ricardo A1 - Hegerl, Ulrich T1 - What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries JF - PLoS ONE N2 - Background In Europe, men have lower rates of attempted suicide compared to women and at the same time a higher rate of completed suicides, indicating major gender differences in lethality of suicidal behaviour. The aim of this study was to analyse the extent to which these gender differences in lethality can be explained by factors such as choice of more lethal methods or lethality differences within the same suicide method or age. In addition, we explored gender differences in the intentionality of suicide attempts. Methods and Findings Methods. Design: Epidemiological study using a combination of self-report and official data. Setting: Mental health care services in four European countries: Germany, Hungary, Ireland, and Portugal. Data basis: Completed suicides derived from official statistics for each country (767 acts, 74.4% male) and assessed suicide attempts excluding habitual intentional self-harm (8,175 acts, 43.2% male). Main Outcome Measures and Data Analysis. We collected data on suicidal acts in eight regions of four European countries participating in the EU-funded "OSPI-Europe"-project (www.ospi-europe.com). We calculated method-specific lethality using the number of completed suicides per method * 100 /(number of completed suicides per method + number of attempted suicides per method). We tested gender differences in the distribution of suicidal acts for significance by using the \(\chi\)\(^{2}\)-test for two-by-two tables. We assessed the effect sizes with phi coefficients (φ). We identified predictors of lethality with a binary logistic regression analysis. Poisson regression analysis examined the contribution of choice of methods and method-specific lethality to gender differences in the lethality of suicidal acts. Findings Main Results Suicidal acts (fatal and non-fatal) were 3.4 times more lethal in men than in women (lethality 13.91% (regarding 4106 suicidal acts) versus 4.05% (regarding 4836 suicidal acts)), the difference being significant for the methods hanging, jumping, moving objects, sharp objects and poisoning by substances other than drugs. Median age at time of suicidal behaviour (35-44 years) did not differ between males and females. The overall gender difference in lethality of suicidal behaviour was explained by males choosing more lethal suicide methods (odds ratio (OR) = 2.03; 95% CI = 1.65 to 2.50; p < 0.000001) and additionally, but to a lesser degree, by a higher lethality of suicidal acts for males even within the same method (OR = 1.64; 95% CI = 1.32 to 2.02; p = 0.000005). Results of a regression analysis revealed neither age nor country differences were significant predictors for gender differences in the lethality of suicidal acts. The proportion of serious suicide attempts among all non-fatal suicidal acts with known intentionality (NFSAi) was significantly higher in men (57.1%; 1,207 of 2,115 NFSAi) than in women (48.6%; 1,508 of 3,100 NFSAi) (\(\chi\)\(^{2}\) = 35.74; p < 0.000001). Main limitations of the study Due to restrictive data security regulations to ensure anonymity in Ireland, specific ages could not be provided because of the relatively low absolute numbers of suicide in the Irish intervention and control region. Therefore, analyses of the interaction between gender and age could only be conducted for three of the four countries. Attempted suicides were assessed for patients presenting to emergency departments or treated in hospitals. An unknown rate of attempted suicides remained undetected. This may have caused an overestimation of the lethality of certain methods. Moreover, the detection of attempted suicides and the registration of completed suicides might have differed across the four countries. Some suicides might be hidden and misclassified as undetermined deaths. Conclusions Men more often used highly lethal methods in suicidal behaviour, but there was also a higher method-specific lethality which together explained the large gender differences in the lethality of suicidal acts. Gender differences in the lethality of suicidal acts were fairly consistent across all four European countries examined. Males and females did not differ in age at time of suicidal behaviour. Suicide attempts by males were rated as being more serious independent of the method used, with the exceptions of attempted hanging, suggesting gender differences in intentionality associated with suicidal behaviour. These findings contribute to understanding of the spectrum of reasons for gender differences in the lethality of suicidal behaviour and should inform the development of gender specific strategies for suicide prevention. KW - case fatality rates KW - behavior KW - multicenter KW - depression KW - deaths KW - alliance KW - states Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-151547 VL - 10 IS - 7 ER -