Werdin, Sophia. Implementation and outcomes of suicide prevention measures in Switzerland. 2024, Doctoral Thesis, University of Basel, Associated Institution, Faculty of Science.
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Abstract
Background
Suicide is a significant public health challenge with wide-ranging impacts, even in politically stable, high-income countries with advanced healthcare systems such as Switzerland. As a multicausal phenomenon, suicidality is linked to various interacting risk factors at both individual and structural levels. Suicide rates vary based on factors such as gender, age, geographical region, occupation, and mental health status. Effective suicide prevention requires a holistic approach that integrates and coordinates measures across universal, selective, and indicated prevention levels, fostering collaboration among various sectors, stakeholders, and professions. In 2016, Switzerland launched a national suicide prevention strategy to strengthen related efforts nationwide and sustainably reduce the suicide rate. Since suicidality is closely linked to mental disorders, effective mental healthcare is a critical component of suicide prevention. The exceptionally high suicide risk during the first weeks and months after discharge from a psychiatric inpatient unit highlights the importance of targeted post-discharge support measures for vulnerable patients. Since 2021, the foundation Health Promotion Switzerland has been co-funding four regional suicide prevention projects focused on supporting patients at suicide risk following hospital discharge.
Objectives
The overarching aim of this PhD thesis was to advance suicide prevention in Switzerland by providing evidence-based insights into contextual conditions and regional prevention measures. Specific objectives included raising awareness of suicide among the elderly, addressing challenges, gaps, and success factors in suicide prevention across Germany, Austria, and Switzerland, assessing the effects of interventions from two regional suicide prevention projects for patients at increased suicide risk, and promoting the sustainability of project-based suicide prevention initiatives.
Methods
To achieve the specific objectives and the overall aim, several research projects using different methods were conducted. First, a qualitative study based on semi-structured interviews examined the experiences and opinions of 36 experts in suicide prevention from Germany, Austria, and Switzerland. Incorporating perspectives from policy, science, and practice allowed for a comprehensive understanding of the current challenges, gaps, and success factors in suicide prevention across the three countries. A cross-sectional survey collected data via a standardized questionnaire to evaluate the utilization and perceived usefulness of measures from a regional suicide prevention project among individuals at increased suicide risk. Additionally, an interrupted time series analysis of administrative patient data from a psychiatric hospital was conducted to assess the effects of this intervention package on psychiatric readmissions. Within a longitudinal observational study, we examined changes in the therapeutic alliance and perceived self-efficacy over the course of a project-based, suicide-specific treatment among patients with suicidal behavior. In addition to this original research, an editorial and a policy brief were developed to support the translation of research findings into policy and practice.
Results
The research identified key aspects to advance suicide prevention in Germany, Austria, and Switzerland. Challenges that need to be addressed include persistent stigmatization of suicidal thoughts and behavior, as well as structural deficiencies in mental healthcare. Significant gaps remain in multilevel collaboration, and there is a lack of targeted programs for older adults and men. Key success factors include the implementation of a national suicide prevention strategy and involving individuals with lived experience in the design, implementation, and evaluation of preventive measures. Notable examples of good practice include regional networks that foster intersectoral and interprofessional collaboration and initiatives promoting responsible media coverage of suicide. Regarding the multicomponent suicide prevention project in Central Switzerland, we found that the different measures were used to varying degrees by the target groups, with around half of the users considering the self-management interventions helpful. In line with this, the secondary data analysis revealed that the intervention package was associated with significant reductions in psychiatric readmissions among individuals at increased suicide risk, with larger reductions observed among women compared to men. The evaluation of the project-based, suicide-specific treatment demonstrated that the therapeutic alliance and perceived self-efficacy improved over the course of therapy for individuals with suicidal behavior. Notably, higher perceived self-efficacy at the beginning of the intervention was associated with less suicidal ideation throughout the treatment.
Conclusion
Switzerland has made considerable progress in suicide prevention, with various stakeholders engaged, a national action plan implemented, and targeted financial investments. Nevertheless, there remain significant areas for improvement, which have been outlined in this PhD thesis. Sustainable progress toward reducing suicide rates can be achieved through consistent multisectoral engagement and efficient allocation of resources, supported by a shift in perspective that frames suicide prevention as a broader societal responsibility. While primary and secondary prevention are essential to reducing the onset of suicidal thoughts and behaviors, it is equally imperative to address the persistent gaps and deficiencies in mental healthcare. The findings from the evaluation of two regional suicide prevention projects underscore the importance and positive effects of structured post-discharge support for vulnerable patients. To strengthen both individual and systemic support mechanisms, multicomponent approaches to suicide prevention that target different groups with integrated interventions have proven particularly valuable.
Suicide is a significant public health challenge with wide-ranging impacts, even in politically stable, high-income countries with advanced healthcare systems such as Switzerland. As a multicausal phenomenon, suicidality is linked to various interacting risk factors at both individual and structural levels. Suicide rates vary based on factors such as gender, age, geographical region, occupation, and mental health status. Effective suicide prevention requires a holistic approach that integrates and coordinates measures across universal, selective, and indicated prevention levels, fostering collaboration among various sectors, stakeholders, and professions. In 2016, Switzerland launched a national suicide prevention strategy to strengthen related efforts nationwide and sustainably reduce the suicide rate. Since suicidality is closely linked to mental disorders, effective mental healthcare is a critical component of suicide prevention. The exceptionally high suicide risk during the first weeks and months after discharge from a psychiatric inpatient unit highlights the importance of targeted post-discharge support measures for vulnerable patients. Since 2021, the foundation Health Promotion Switzerland has been co-funding four regional suicide prevention projects focused on supporting patients at suicide risk following hospital discharge.
Objectives
The overarching aim of this PhD thesis was to advance suicide prevention in Switzerland by providing evidence-based insights into contextual conditions and regional prevention measures. Specific objectives included raising awareness of suicide among the elderly, addressing challenges, gaps, and success factors in suicide prevention across Germany, Austria, and Switzerland, assessing the effects of interventions from two regional suicide prevention projects for patients at increased suicide risk, and promoting the sustainability of project-based suicide prevention initiatives.
Methods
To achieve the specific objectives and the overall aim, several research projects using different methods were conducted. First, a qualitative study based on semi-structured interviews examined the experiences and opinions of 36 experts in suicide prevention from Germany, Austria, and Switzerland. Incorporating perspectives from policy, science, and practice allowed for a comprehensive understanding of the current challenges, gaps, and success factors in suicide prevention across the three countries. A cross-sectional survey collected data via a standardized questionnaire to evaluate the utilization and perceived usefulness of measures from a regional suicide prevention project among individuals at increased suicide risk. Additionally, an interrupted time series analysis of administrative patient data from a psychiatric hospital was conducted to assess the effects of this intervention package on psychiatric readmissions. Within a longitudinal observational study, we examined changes in the therapeutic alliance and perceived self-efficacy over the course of a project-based, suicide-specific treatment among patients with suicidal behavior. In addition to this original research, an editorial and a policy brief were developed to support the translation of research findings into policy and practice.
Results
The research identified key aspects to advance suicide prevention in Germany, Austria, and Switzerland. Challenges that need to be addressed include persistent stigmatization of suicidal thoughts and behavior, as well as structural deficiencies in mental healthcare. Significant gaps remain in multilevel collaboration, and there is a lack of targeted programs for older adults and men. Key success factors include the implementation of a national suicide prevention strategy and involving individuals with lived experience in the design, implementation, and evaluation of preventive measures. Notable examples of good practice include regional networks that foster intersectoral and interprofessional collaboration and initiatives promoting responsible media coverage of suicide. Regarding the multicomponent suicide prevention project in Central Switzerland, we found that the different measures were used to varying degrees by the target groups, with around half of the users considering the self-management interventions helpful. In line with this, the secondary data analysis revealed that the intervention package was associated with significant reductions in psychiatric readmissions among individuals at increased suicide risk, with larger reductions observed among women compared to men. The evaluation of the project-based, suicide-specific treatment demonstrated that the therapeutic alliance and perceived self-efficacy improved over the course of therapy for individuals with suicidal behavior. Notably, higher perceived self-efficacy at the beginning of the intervention was associated with less suicidal ideation throughout the treatment.
Conclusion
Switzerland has made considerable progress in suicide prevention, with various stakeholders engaged, a national action plan implemented, and targeted financial investments. Nevertheless, there remain significant areas for improvement, which have been outlined in this PhD thesis. Sustainable progress toward reducing suicide rates can be achieved through consistent multisectoral engagement and efficient allocation of resources, supported by a shift in perspective that frames suicide prevention as a broader societal responsibility. While primary and secondary prevention are essential to reducing the onset of suicidal thoughts and behaviors, it is equally imperative to address the persistent gaps and deficiencies in mental healthcare. The findings from the evaluation of two regional suicide prevention projects underscore the importance and positive effects of structured post-discharge support for vulnerable patients. To strengthen both individual and systemic support mechanisms, multicomponent approaches to suicide prevention that target different groups with integrated interventions have proven particularly valuable.
Advisors: | Wyss, Kaspar |
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Committee Members: | Fink, Günther and Glaesmer, Heide |
Faculties and Departments: | 05 Faculty of Science 09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Household Economics and Health Systems Research > Epidemiology and Household Economics (Fink) 06 Faculty of Business and Economics > Departement Wirtschaftswissenschaften > Professuren Wirtschaftswissenschaften > Epidemiology and Household Economics (Fink) |
UniBasel Contributors: | Wyss, Kaspar and Fink, Günther |
Item Type: | Thesis |
Thesis Subtype: | Doctoral Thesis |
Thesis no: | 15590 |
Thesis status: | Complete |
Number of Pages: | xi, 158 Seiten, XXVI |
Language: | English |
Identification Number: |
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edoc DOI: | |
Last Modified: | 23 Jan 2025 05:30 |
Deposited On: | 22 Jan 2025 15:46 |
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