Abstract
BackgroundIn the Netherlands, suicide rates showed a sharp incline and this pertains particularly to the province of Noord-Brabant, one of the southern provinces in the Netherlands. This calls for a regional suicide prevention effort.Methods/designStudy protocol. A regional suicide prevention systems intervention is implemented and evaluated by a stepped wedge trial design in five specialist mental health institutions and their adherent chain partners. Our system intervention is called SUPREMOCOL, which stands for Suicide Prevention by Monitoring and Collaborative Care, and focuses on four pillars: 1) recognition of people at risk for suicide by the development and implementation of a monitoring system with decision aid, 2) swift access to specialist care of people at risk, 3) positioning nurse care managers for collaborative care case management, and 4) 12 months telephone follow up. Eligible patients are persons attempting suicide or expressing suicidal ideation. Primary outcome is number of completed suicides, as reported by Statistics Netherlands and regional Public Health Institutes. Secondary outcome is number of attempted suicides, as reported by the regional ambulance transport and police. Suicidal ideation of persons registered in the monitoring system will, be assessed by the PHQ-9 and SIDAS questionnaires at baseline and 3, 6, 9 and 12 months after registration, and used as exploratory process measure. The impact of the intervention will be evaluated by means of the RE-AIM dimensions reach, efficacy, adoption, implementation, and maintenance. Intervention integrity will be assessed and taken into account in the analysis.DiscussionThe present manuscript presents the design and development of the SUPREMOCOL study. The ultimate goal is to lower the completed suicides rate by 20%, compared to the control period and compared to other provinces in the Netherlands. Moreover, our goal is to provide specialist mental health institutions and chain partners with a sustainable and adoptable intervention for suicide prevention.Trial registrationNetherlands Trial Register under registration number NL6935 (5 April 2018). This is the first version of the study protocol (September 2019).
Highlights
In the Netherlands, suicide rates showed a sharp incline and this pertains to the province of Noord-Brabant, one of the southern provinces in the Netherlands
Suicide rates in the Netherlands were equal to the European Union (EU)-average [3], they did show a sharp incline of 37% between 2007 and 2013 [4]
Statistical methods To examine whether SUPREMOCOL leads to a reduction of completed suicides of 20% in the province of Noord-Brabant, the total number of completed suicides in the post-measurement will be compared to the total number of completed suicides in the pre-measurement
Summary
In the Netherlands, suicide rates showed a sharp incline and this pertains to the province of Noord-Brabant, one of the southern provinces in the Netherlands This calls for a regional suicide prevention effort. At the start of the grant application for this study in 2015, Noord-Brabant even ranked second nationally over the five previous years (2010–2014) and there were 293 suicides in 2014, which is 11,5 suicides per 100,000 residents [4]. This poses a problem in the Netherlands and a regional problem in Noord-Brabant
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