Psychometric properties of the Depression Stigma Scale in the Portuguese population and its association with gender and depressive symptomatology.

BACKGROUND: Stigma is one of the most significant constraints on people living with depression. There is a lack of validated scales in Portugal to measure depression stigma; therefore, the Depression Stigma Scale (DSS) is essential to the depression stigma research in Portugal. METHODS: We developed the adaptation process with the ITC Guidelines for Translation and Adapting Tests taken into consideration. We collected the sample as part of the OSPI program-Optimizing suicide prevention programs and their implementation in Europe, specifically within the application in Portugal, and included 1693 participants. Floor-ceiling effects and response ranges were analyzed, and we calculated Cronbach alphas, and Confirmatory Analysis. Validity evidence was tested with two well-documented hypotheses, using data on gender and depression symptoms. RESULTS: The sample was well comparable with the general Portuguese population, indicating its representativeness. We identified a three-factor structure in each subscale (personal and perceived stigma): weak-not-sick, discrimination, and dangerous/unpredictable, with good model fit results. The Cronbach's alphas were satisfactory, and validity was confirmed. CONCLUSIONS: This study established the validity and demonstrated good psychometric properties of the DSS in the Portuguese population. The validation of the DSS can be beneficial in exploring stigma predictors and evaluating the effectiveness of stigma reduction interventions.

A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide.

OBJECTIVES: Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. METHOD: The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. RESULTS: This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. CONCLUSION: Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.

A cross-national study on gender differences in suicide intent.

BACKGROUND: Suicide accounts for over 58,000 deaths in Europe per annum, where suicide attempts are estimated to be 20 times higher. Males have been found to have a disproportionately lower rate of suicide attempts and an excessively higher rate of suicides compared to females. The gender difference in suicide intent is postulated to contribute towards this gender imbalance. The aim of this study is to explore gender differences in suicide intent in a cross-national study of suicide attempts. The secondary aims are to investigate the gender differences in suicide attempt across age and country. METHODS: Data on suicide attempts (acquired from the EU-funded OSPI-Europe project) was obtained from eight regions in Germany, Hungary, Ireland and Portugal. Suicide intent data was categorized into 'Non-habitual Deliberate Self-Harm' (DSH), 'Parasuicidal Pause' (SP), 'Parasuicidal Gesture' (SG), and 'Serious Suicide Attempt' (SSA), applying the Feuerlein scale. Gender differences in intent were explored for significance by using χ2-tests, odds ratios, and regression analyses. RESULTS: Suicide intent data from 5212 participants was included in the analysis. A significant association between suicide intent and gender was found, where 'Serious Suicide Attempts' (SSA) were rated significantly more frequently in males than females (p < .001). There was a statistically significant gender difference in intent and age groups (p < .001) and between countries (p < .001). Furthermore, within the most utilised method, intentional drug overdose, 'Serious Suicide Attempt' (SSA) was rated significantly more often for males than females (p < .005). CONCLUSIONS: Considering the differences in suicidal intent between males and females highlighted by the current study, gender targeted prevention and intervention strategies would be recommended.

EUDOR-A multi-centre research program: A naturalistic, European Multi-centre Clinical study of EDOR Test in adult patients with primary depression.

BACKGROUND: Electrodermal reactivity has been successfully used as indicator of interest, curiosity as well as depressive states. The measured reactivity depends on the quantity of sweat secreted by those eccrine sweat glands that are located in the hypodermis of palmar and plantar regions. Electrodermal hyporeactive individuals are those who show an unusual rapid habituation to identical non-significant stimuli. Previous findings suggested that electrodermal hyporeactivity has a high sensitivity and a high specificity for suicide. The aims of the present study are to test the effectiveness and the usefulness of the EDOR (ElectroDermal Orienting Reactivity) Test as a support in the suicide risk assessment of depressed patients and to assess the predictive value of electrodermal hyporeactivity, measured through the EDOR Test, for suicide and suicide attempt in adult patients with a primary diagnosis of depression. METHODS AND DESIGN: 1573 patients with a primary diagnosis of depression, whether currently depressed or in remission, have been recruited at 15 centres in 9 different European countries. Depressive symptomatology was evaluated through the Montgomery-Asberg Depression Scale. Previous suicide attempts were registered and the suicide intent of the worst attempt was rated according to the first eight items of the Beck Suicide Intent Scale. The suicide risk was also assessed according to rules and traditions at the centre. The EDOR Test was finally performed. During the EDOR Test, two fingers are put on gold electrodes and direct current of 0.5 V is passed through the epidermis of the fingers according to standards. A moderately strong tone is presented through headphones now and then during the test. The electrodermal responses to the stimuli represent an increase in the conductance due to the increased number of filled sweat ducts that act as conductors through the electrically highly resistant epidermis. Each patient is followed up for one year in order to assess the occurrence of intentional self-harm. DISCUSSION: Based on previous studies, expected results would be that patients realizing a suicide attempt with a strong intent or committing suicide should be electrodermally hyporeactive in most cases and non-hyporeactive patients should show only few indications of death intent or suicides. TRIAL REGISTRATION: The German Clinical Trials Register, DRKS00010082 . Registered May 31st, 2016. Retrospectively registered.

Exploring synergistic interactions and catalysts in complex interventions: longitudinal, mixed methods case studies of an optimised multi-level suicide prevention intervention in four european countries (Ospi-Europe).

BACKGROUND: The Medical Research Council (MRC) Framework for complex interventions highlights the need to explore interactions between components of complex interventions, but this has not yet been fully explored within complex, non-pharmacological interventions. This paper draws on the process evaluation data of a suicide prevention programme implemented in four European countries to illustrate the synergistic interactions between intervention levels in a complex programme, and to present our method for exploring these. METHODS: A realist evaluation approach informed the process evaluation, which drew on mixed methods, longitudinal case studies. Data collection consisted of 47 semi-structured interviews, 12 focus groups, one workshop, fieldnoted observations of six programme meetings and 20 questionnaires (delivered at six month intervals to each of the four intervention sites). Analysis drew on the framework approach, facilitated by the use of QSR NVivo (v10). Our qualitative approach to exploring synergistic interactions (QuaSIC) also developed a matrix of hypothesised synergies that were explored within one workshop and two waves of data collection. RESULTS: All four implementation countries provided examples of synergistic interactions that added value beyond the sum of individual intervention levels or components in isolation. For instance, the launch ceremony of the public health campaign (a level 3 intervention) in Ireland had an impact on the community-based professional training, increasing uptake and visibility of training for journalists in particular. In turn, this led to increased media reporting of OSPI activities (monitored as part of the public health campaign) and also led to wider dissemination of editorial guidelines for responsible reporting of suicidal acts. Analysis of the total process evaluation dataset also revealed the new phenomenon of the OSPI programme acting as a catalyst for externally generated (and funded) activity that shared the goals of suicide prevention. CONCLUSIONS: The QuaSIC approach enabled us to develop and refine our definition of synergistic interactions and add the innovative concept of catalytic effects. This represents a novel approach to the evaluation of complex interventions. By exploring synergies and catalytic interactions related to a complex intervention or programme, we reveal the added value to planned activities and how they might be maximised.

Effects of a stigma reduction intervention on help-seeking behaviors in university students: A 2019-2021 randomized controlled trial.

INTRODUCTION: Stigma is one of the most frequently identified help-seeking barriers, but there is a lack of research on the effects of stigma reduction interventions on actual mental health help-seeking behaviors during crucial academic years. This research explores the effects of stigma on university students' mental health care help-seeking behaviors before and during the pandemic. METHODS: A randomized control trial spanned from 2019 to 2021 at the University of Porto, along five evaluation moments, with students into one control group and two intervention groups-the interventions aimed to reduce depression stigma. RESULTS: Among the 702 participants (mean age 18.87, 59.4 % female), the intervention groups significantly increased help-seeking behaviors. In 2020, the intervention groups, having reduced stigma, continued to demonstrate to be more prompt to seek mental health help. In 2021, 22 months, the effects of the intervention on help-seeking were no longer significant; however, participants in the intervention groups showed less severe symptomatology. CONCLUSION: Stigma reduction interventions have a pronounced effect on enhancing help-seeking behaviors among university students, even during times of crisis. This study advocates for prioritizing stigma reduction in academic settings, highlighting its value in promoting mental health access during crucial academic and life challenges.

Long-term Exposure to Ambient Air Pollution and its Association with Mental Well-Being, Depression and Anxiety: A Nationally Representative Study.

INTRODUCTION: Exposure to ambient air pollution may play a role in the onset of common mental disorders like depressive and anxiety disorders. The association of long-term exposure to particles smaller than 10 µm (PM10) with these diseases remains unclear. This study aimed to estimate the association of long-term exposure to PM10 with mental well-being and the frequency of probable diagnosis of common mental disorders. METHODS: A nationally representative cross-sectional study was done in mainland Portugal. Long-term exposure was estimated through one-year average concentrations of PM10, calculated with data from the Portuguese Environment Agency, attributed individually considering individuals' postal codes of residence. The mental well-being and the probable diagnosis of common mental disorders were ascertained through the five-item Mental Health Inventory scale. Linear and Robust Poisson regression models were computed to estimate change percentages, prevalence ratios (PR), and their 95% confidence intervals (95% CI). RESULTS: The median (interquartile range) concentration of PM10 was 18.6 (15.3 - 19.3) µg/m3. The mental well-being score was 72 (56 - 84) points, on a scale from 0 to 100. A probable diagnosis of common mental disorders was found in 22.7% (95% CI: 20.0 to 25.6). Long-term exposure to PM10 was associated with a non-statistically significant decrease in the mental well-being score [for each 10 µg/m³ increment in one-year average PM10 concentrations, there was a 2% (95% CI: -8 to 4) decrease], and with a non-statistically significant increase in the common mental health frequency (PR = 1.012, 95% CI: 0.979 to 1.045). CONCLUSION: We did not find statistically significant associations between long-term exposure to PM10 and mental well-being or the frequency of probable diagnosis of common mental disorders. These results may be explained by the reduced variability in the exposure values, given the geographical distribution and functioning of the network of air quality monitoring stations. This study contributes with evidence for low levels of air pollutants, being one of the first to adjust for individual and aggregate-level variables. Moreover, to the best of our knowledge, this was the first nationally representative, population-based study conducted on the Portuguese population using real-life data. Maintaining a robust and nationwide air quality monitoring network is essential for obtaining quality exposure data.

Methylphenidate in mania project (MEMAP): study protocol of an international randomised double-blind placebo-controlled study on the initial treatment of acute mania with methylphenidate.

BACKGROUND: Treatment of patients with acute mania remains a considerable medical challenge since onset of action of antimanic medication is delayed for several days. Psychostimulants could have an earlier onset of action. This assumption is based on the 'vigilance regulation model of mania' which postulates that vigilance is unstable in manic patients. Accordingly, vigilance-stabilising psychostimulants could be more useful than conventional treatment in acute mania. We present here the study protocol of a trial intended to study the efficacy and safety of methylphenidate in the initial treatment of acute mania. METHODS/DESIGN: A multi-centre, randomised, double-blind, placebo-controlled clinical trial will be conducted in 88 bipolar inpatients with acute mania. Male and female patients older than 18 years will be randomised to treatment with either methylphenidate (20 to 40 mg/day) or placebo for 2.5 days, given once or twice daily. The main outcome measure is the reduction in the Young Mania Rating Scale (YMRS) after 2.5 days of treatment. Other outcome measures include the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) the Clinical Global Impression-Bipolar Scale (CGI-BP), the Screen for Cognitive Impairment in Psychiatry (SCIP), actigraphy and the EEG-'Vigilance Algorithm Leipzig' (VIGALL). DISCUSSION: A positive study outcome of the proposed study could substantially impact our understanding of the etiopathogenesis of mania and open new treatment perspectives.

Developing social capital in implementing a complex intervention: a process evaluation of the early implementation of a suicide prevention intervention in four European countries.

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.

The effects of a video-based randomized controlled trial intervention on depression stigma and help-seeking attitudes in university students.

University students are a risk group for developing mental illness, but they do not receive the care they need because of hampered help-seeking induced by stigma. This study evaluates the effects of a video-based stigma reduction intervention and help-seeking attitudes promotion in university students. We randomly distributed a sample of university students among one control group (CG, n = 188) and two intervention groups (IG-1, n = 222 and IG-2, n = 216): IG-1 watched a contact-based video and IG-2 the same video plus a psychoeducational video. The study followed an experimental single-blind randomized control trial design with a pre-test before the intervention (M0), a post-test, and a follow-up test. We evaluated participants using a sociodemographic questionnaire, the Attitudes Toward Seeking Professional Psychological Help Questionnaire, the Depression Stigma Scale, the 9-item Patient Health Questionnaire, and the 7-item Generalized Anxiety Disorder. A total of 626 participants with a mean age of 19.85 (SD=1.48) responded to all evaluation moments. At M0, there were no differences between groups on stigma or help-seeking attitudes. Immediately after the intervention, stigma levels significantly decreased, and help-seeking attitudes significantly improved. These effects persisted for the next five months. Video-based depression stigma reduction intervention can be an essential tool to reduce depression stigma and improve help-seeking attitudes.

The association between stigmatizing attitudes towards depression and help seeking attitudes in college students.

Depression stigma has been considered a significant barrier to treatment and rehabilitation. This study aimed to understand the effects of gender, previous mental health care, and symptomatology on depression stigma and analyze the impact of depression stigma on help-seeking attitudes. A total of 969 students with a mean age of 18.87 (SD = 1.49) were included in this study and completed the Depression Stigma Scale, the Attitude Toward Seeking Professional Psychological Help, the Patient Health Questionnaire-4 questionnaire, and a socio-demographic questionnaire. We analyzed data using SPSS 24.0, with a 95% confidence interval. Participants came from all University schools, and 64.6% were women. Personal stigma and help-seeking attitudes were affected by gender (ß(male) = 5.65, CI = 4.07, 7.25) and previous access to mental healthcare services (ß(previous help) = -4.35, CI = -5.89, -2.82). Perceived depression stigma was affected gender (ß(male) = -2.67, CI = -5.00, -0.34) and symptomatology (ß(no symptomatology) = -3.29, CI = -6.09, -0.49). Personal (r = -0.42, p<0.01) and perceived (r = 0.10, p<0.01) depression stigma correlated with help-seeking attitudes, but we detected no direct symptomatology effect on help-seeking attitudes. Personal depression stigma significantly affected help-seeking attitudes (ß = -0.15, CI = -0.17, -0.12). Promoting literacy may decrease personal depression stigma and increase professional help-seeking attitudes and behaviors.

Drug suicide: a sex-equal cause of death in 16 European countries.

BACKGROUND: There is a lack of international research on suicide by drug overdose as a preventable suicide method. Sex- and age-specific rates of suicide by drug self-poisoning (ICD-10, X60-64) and the distribution of drug types used in 16 European countries were studied, and compared with other self-poisoning methods (X65-69) and intentional self-injury (X70-84). METHODS: Data for 2000-04/05 were collected from national statistical offices. Age-adjusted suicide rates, and age and sex distributions, were calculated. RESULTS: No pronounced sex differences in drug self-poisoning rates were found, either in the aggregate data (males 1.6 and females 1.5 per 100,000) or within individual countries. Among the 16 countries, the range (from some 0.3 in Portugal to 5.0 in Finland) was wide. 'Other and unspecified drugs' (X64) were recorded most frequently, with a range of 0.2-1.9, and accounted for more than 70% of deaths by drug overdose in France, Luxembourg, Portugal and Spain. Psychotropic drugs (X61) ranked second. The X63 category ('other drugs acting on the autonomic nervous system') was least frequently used. Finland showed low X64 and high X61 figures, Scotland had high levels of X62 ('narcotics and hallucinogens, not elsewhere classified') for both sexes, while England exceeded other countries in category X60. Risk was highest among the middle-aged everywhere except in Switzerland, where the elderly were most at risk. CONCLUSIONS: Suicide by drug overdose is preventable. Intentional self-poisoning with drugs kills as many males as females. The considerable differences in patterns of self-poisoning found in the various European countries are relevant to national efforts to improve diagnostics of suicide and appropriate specific prevention. The fact that vast majority of drug-overdose suicides came under the category X64 refers to the need of more detailed ICD coding system for overdose suicides is needed to permit better design of suicide-prevention strategies at national level.

The Association Between Changes in the University Educational Setting and Peer Relationships: Effects in Students' Depressive Symptoms During the COVID-19 Pandemic.

Objective: Abrupt life changes imposed by the lockdown measures, with a direct impact on teaching methodology and social interactions, as well as sleeping patterns, harmed university students' mental health. This study aimed to analyze the relationship between satisfaction with online teaching, social interaction with depression, anxiety symptomatology, and to analyze the effects of the pandemic and the lockdown in mental care access. Methods: The online survey collected demographic data, satisfaction with online teaching, and social interaction. We evaluated the depression and anxiety symptomatology using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder, respectively. For the PHQ-9, we used the cut-off 15 for moderately severe depressive symptoms, whereas for GAD-7, we recurred to the cut-off 10 for moderately severe anxiety symptoms. This study used three data points: October 2019, June 2020, and March 2021. Findings: The study included n = 366 participants from all university study fields, with a mean age of 21.71 (SD = 1.42) in the last survey, and 71.3% were women. Depressive symptoms increased significantly from October 2019 to June 2020, and the mean scores grew until March 2021. Anxiety symptoms also significantly increased from October 2019 to June 2020; however, from June 2020 to March 2021, there was a non-significant decrease in the proportion. Mean scores for satisfaction with online teaching were 38.23% in June 2020 and 34.25% in March 2021, a non-significant difference. Satisfaction with social interaction significantly decreased from 37.35% in 2020 to 24.41% in 2021. Participants with scores above the cut-off of moderately severe and severe depressive and anxiety symptoms showed significantly lower satisfaction with online teaching than students with lower depression and anxiety scores. Despite the significant increase in clinical symptomatology, help-seeking behaviors did not change accordingly, and more than 50% of the students with mild or severe depressive and anxiety symptomatology did not get treatment during the pandemic. Conclusion: The findings of this study suggest that most students are dissatisfied with online teaching and the type of social interaction they were forced to adopt because of the pandemic. The severity of depressive and anxiety symptomatology significantly increased between October 2019 and March 2021, but help-seeking behaviors did not increase accordingly.

Suicide time-series structural change analysis in Portugal (1913-2018): Impact of register bias on suicide trends.

BACKGROUND: Suicide is a potentially preventable cause of death. Epidemiology might help to identify death determinants and to monitor prevention strategies. Few studies address secular trends in suicide deaths, and even fewer describe trend-changes in relation to data collection/registration bias. Moreover, suicide is admittedly underreported. It is crucial to validate results in the context of other external causes of death trends, such as unintentional and undetermined intent deaths. We aimed to explore trends in suicide and other external causes of death in Portugal from the inception of registries until 2018, considering breaks in series. METHODS: We collected data from all available official primary sources. We calculated cause-specific age-standardized death rates (SDR) by sex for ages equal or higher than 15 years with reference to the European Standard Population. We considered suicide (S), undetermined intent deaths (UnD), accidents (Accs), and all causes of death (ttMty). A time-series structural analysis was executed. RESULTS: Suicide and other external causes of death rates were consistently higher in males than females. A global decline of deaths by suicide, undetermined intention and unintentional is observable. Breakpoints in years 1930, 1954, 1982, 2000-2001 were associated with major changes in deaths registration procedures or methodology. CONCLUSIONS: The epidemiology of suicide in Portugal has changed over 106 years. However, adjusted data and consideration of bias reduce trends fluctuation. Trend changes are akin to specific changes in methodology of death registry. Suicide surveillance will improve with more reliable and stable procedures.

Specialized nursing terminology for the care of people with COVID-19.

OBJECTIVE: To create specialized nursing terminology for the care of people with COVID-19. METHODS: Methodological study, carried out based on the identification of concepts related to the care of the person with the infection, present in the official guidelines of the Brazilian Ministry of Health; the concepts were validated by three specialist nurses; and a cross-mapping of the extracted concepts was done with CIPE® 2019 primitive concepts. RESULTS: Out of 436 unique concepts, being 399 of these validated; of these, 70.9% were in the Classification and referred to the nursing care of people with COVID-19. In the Axis, the concepts related to Focus, Action, and Environment stood out. As for the non-validated concepts, 78.4% were not included in the 2019 version of CIPE®. CONCLUSION: We were able to structure a specialized CIPE® terminology, with the potential to generate nursing care indicators for people with COVID-19.

A Naturalistic, European Multi-Center Clinical Study of Electrodermal Reactivity and Suicide Risk Among Patients With Depression.

Background: Electrodermal hyporeactivity has been proposed as a marker of suicidal risk. The EUDOR-A study investigated the prevalence of electrodermal hyporeactivity among patients with depression and its association with attempted and completed suicide. Methods: Between August 2014 and March 2016, 1,573 in- and outpatients with a primary diagnosis of depression (active or remission phase) were recruited at 15 European psychiatric centers. Each patient was followed-up for 1 year. Electrodermal activity was assessed at baseline with the ElectroDermal Orienting Reactivity Test. Data on the sociodemographic characteristics, clinical diagnoses, and treatment of the subjects were also collected. The severity of the depressive symptoms was assessed through the Montgomery-Asberg Depression Rating Scale. Information regarding number, time, and method of suicide attempts was gathered at baseline and at the end of the 1-year follow-up. The same data were collected in case of completed suicide. Results: Hyporeactive patients were shown to be significantly more at risk of suicide attempt compared to reactive patients, both at baseline and follow-up. A sensitivity of 29.86% and a positive predictive value (PPV) of 46.77% were found for attempted suicide at baseline, while a sensitivity of 35.36% and a PPV of 8.92% were found for attempted suicide at follow-up. The sensitivity and PPV for completed suicide were 25.00 and 0.61%, respectively. However, when controlled for suicide attempt at baseline, the association between hyporeactivity and follow-up suicide attempt was no longer significant. The low number of completed suicides did not allow any analysis.

Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidence-based multi-level approach.

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.

Nursing diagnoses in a home-based program: cross-mapping and NANDA-I Taxonomy.

OBJECTIVE: to identify Nursing diagnoses in patients in home care by cross-mapping terms obtained in the anamnesis and clinical examination, with NANDA-I Taxonomy. METHOD: descriptive exploratory study, transversal type, performed with 131 patients from a home health care program in northern Minas Gerais State. With the aid of an instrument based on the theoretical model of Basic Human Needs, the terms indicators of conditions that required nursing interventions were extracted. The cross-mapping of these terms was also performed with NANDA-I Taxonomy diagnoses. RESULTS: 378 terms and expressions referring to 49 different diagnoses were identified in 11 of the 13 domains of NANDA-I Taxonomy. CONCLUSION: the profile of identified nursing diagnoses can contribute to care management and organizational processes of nurses who provide care to patients in home care.