Population ethical intuitions.

Is humanity's existence worthwhile? If so, where should the human species be headed in the future? In part, the answers to these questions require us to morally evaluate the (potential) human population in terms of its size and aggregate welfare. This assessment lies at the heart of population ethics. Our investigation across nine experiments (N = 5776) aimed to answer three questions about how people aggregate welfare across individuals: (1) Do they weigh happiness and suffering symmetrically?; (2) Do they focus more on the average or total welfare of a given population?; and (3) Do they account only for currently existing lives, or also lives that could yet exist? We found that, first, participants believed that more happy than unhappy people were needed in order for the whole population to be net positive (Studies 1a-c). Second, participants had a preference both for populations with greater total welfare and populations with greater average welfare (Study 3a-d). Their focus on average welfare even led them (remarkably) to judge it preferable to add new suffering people to an already miserable world, as long as this increased average welfare. But, when prompted to reflect, participants' preference for the population with the better total welfare became stronger. Third, participants did not consider the creation of new people as morally neutral. Instead, they viewed it as good to create new happy people and as bad to create new unhappy people (Studies 2a-b). Our findings have implications for moral psychology, philosophy and global priority setting.

Sustainable effects on suicidality were found for the Nuremberg alliance against depression.

During an intense four-level community-based intervention program conducted in Nuremberg (490,000 inhabitants) in 2001 and 2002 [Nuremberg Alliance Against Depression (NAD)], the number of suicidal acts (main outcome completed + attempted suicides) had dropped significantly (-21.7%), a significant effect compared with the baseline year and the control region (Wuerzburg, about 290,000 inhabitants). To assess the sustainability of the intervention effects the number of suicidal acts was assessed in the follow-up year (2003), after the termination of the 2-year intervention. Also, in the follow-up year (2003), the reduction in suicidal acts compared with the baseline year in Nuremberg (2000 vs. 2003: -32.4%) was significantly larger than that in the control region (P = 0.0065). The reduction was even numerically larger than that of the intervention years (2001, 2002). Thus, 1 year after the end of the main intervention, preventive effects on suicidality of the NAD remain at least stable. The four-level intervention concept appears to be cost-effective and is presently implemented in many European regions.

Seasonality of suicide attempts: association with gender.

Some studies suggest seasonality of suicide attempts in females, but not in males. The reasons for this gender difference remain unclear. Only few studies addressed the question whether gender differences in seasonality of suicide attempts reflect gender differences in the choice of method for suicide attempts, with inconsistent results. So, this study aimed to analyze the association of gender with seasonality in suicide attempts by persons living in two Northern Bavarian regions [city of Nuremberg (480,000 inhabitants) and region of Wuerzburg (270,000 inhabitants)] between 2000 and 2004. We addressed this question by focussing on the frequency of suicide attempts in relation to the seasons. The sample consisted of 2,269 suicide attempters (882 males and 1,387 females). The overall seasonality was assessed using the chi(2) test for multinomials. Moreover, the ratio of observed to expected number of suicide attempts (OER) with 95% confidence intervals within each season was calculated. As a result, overall distribution of suicide attempts differed significantly between seasons for women (chi(2) = 9.19, df = 3, P = 0.03), but not for men. Female suicide attempts showed a trough in the spring (decline compared to the expected value by 10%; OER = 0.9, 95% CI = 0.8-1.0). This trough was restricted to female low-risk suicide attempts (decline by 13%; OER = 0.87, 95% CI = 0.77-0.98). No seasonality was found for men. Seasonality of high-risk methods was more pronounced than that of low-risk methods; however, no significant gender differences were found concerning this aspect. The overall distribution of the sub-types of suicidal acts (parasuicidal gestures, suicidal pauses, suicide attempts in the strict sense) showed seasonality neither for males nor for females. Whereas seasonality was absent in male suicide attempters, the frequency of low-risk suicide attempts in females was 13.1% lower than expected in the spring.

Impact of a campaign on the public's attitudes towards depression.

A public campaign was launched in 2000 as part of the four-level community-based intervention 'Nuremberg Alliance Against Depression' (NAD) in Nuremberg, Germany. Evaluation results will be presented. A baseline survey was done before the campaign in Nuremberg and Wuerzburg (control region), two surveys followed 10 and 22 months after the implementation. Multiple regression analyses were performed, with time, place and the interaction of time and location as independent and the corresponding items as dependent variables. For the general population, the campaign was successful in creating awareness for the NAD. For persons who reported experience with depression and persons aware of the NAD, analyses showed positive desirable effects: more awareness of depression and the NAD. In addition, among those aware, more positive attitudes towards medication treatment and antidepressants developed and also 'lack of self-discipline' declined as causal explanation as did the notion 'pull yourself together' as treatment option. The campaign induced relevant changes mainly in persons aware of the NAD and persons who reported to have had experience with depression. The fact that many of the changes in the general population declined in the second year of the campaign, when activities were done with lower intensity, illustrates the need for permanent depression awareness action.

The evaluation of suicide prevention activities: state of the art.

One million people commit suicide world-wide every year. The need for suicide prevention is obvious, and very different approaches have been investigated to reduce the number of suicides. Some interventions aim at identified high-risk groups (e.g. support for people after suicide attempt), some at the population as a whole (e.g. restricting the access to means for suicide). There is, however, but little evidence for the efficacy of suicide prevention activities. This can mostly be attributed to methodological problems such as the lack of randomised controlled studies and the fact that the sample size is too small to show an effect. Despite these problems, some interventions showed promising results (e.g. long-term lithium treatment). A main problem, however, is that many people at risk do not get in contact with health care institutions. Moreover, no single approach by itself seems to contribute to a substantial decline in the suicide rate. The authors therefore argue that a combination of different strategies in a multi-level approach might prove to be the most effective.

Preference of lethal methods is not the only cause for higher suicide rates in males.

BACKGROUND: In most countries worldwide suicide rates are higher for males whereas attempted suicide rates are higher for females. The aim is to investigate if the choice of more lethal methods by males explains gender differences in suicide rates. METHODS: Data on completed and attempted suicides were collected (n=3235, Nuremberg and Wuerzburg, years 2000-2004). The research question was analyzed by comparing the method-specific case fatality (= completed suicides/completed+attempted suicides) for males and females. RESULTS: Among the events captured, men chose high-risk methods like hanging significantly more often than women (φ=-0.27; p<0.001). However, except for drowning, case fatalities were higher for males than for females within each method. This was most apparent in "hanging" (men 83.5%, women 55.3%; φ=-0.28; p<0.001) and "poisoning by drugs" (men 7.2%, women 3.4%; φ=-0.09; p<0.001). LIMITATIONS: The sample size (n=3235) was not enough for comparing method and gender specific case fatalities with a fine-meshed stratification regarding age. CONCLUSIONS: Higher suicide rates in males not only result from the choice of more lethal methods. Other factors have to be considered.

The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality.

BACKGROUND: The global burden and large diagnostic and therapeutic deficits associated with depressive disorders call for intervention programs. The aim of the Nuremberg Alliance against Depression (NAD) is to establish and to assess the effectiveness of a four-level intervention program for improving the care of patients with depression. METHOD: A 2-year intervention program was performed in Nuremberg (480000 inhabitants) at four levels: training of family doctors and support through different methods; a public relations campaign informing about depression; cooperation with community facilitators (teachers, priests, local media, etc.); and support for self-help activities as well as for high-risk groups. The effects of the 2-year intervention on the number of suicidal acts (completed suicides plus suicide attempts, main outcome criterion) were evaluated with respect to a 1-year baseline and a control region (Wuerzburg, 270,000 inhabitants). RESULTS: Compared to the control region, a reduction in frequency of suicidal acts was observed in Nuremberg during the 2-year intervention (2001 v. 2000: -19.4%; p< or =0.082; 2002 v. 2000: -24%, p< or =0.004). Considering suicide attempts only (secondary outcome criterion), the same effect was found (2001 v. 2000: -18.3%, p< or =0.023; 2002 v. 2000: -26.5%, p<0.001). The reduction was most noticeable for high-risk methods (e.g. hanging, jumping, shooting). Concerning completed suicides, there were no significant differences compared to the control region. CONCLUSIONS: The NAD appeared to be effective in reducing suicidality. It provides a concept as well as many methods that are currently being implemented in several other intervention regions in Germany and in other countries.

[Media coverage on suicide in Nuremberg's daily papers--frequency and form of the reporting before and during media-intervention with guidelines]. / Suizidberichte in Nürnberger Printmedien--Häufigkeit und Form der Berichterstattung vor und nach der Implementierung eines Medienguides.

BACKGROUND: As one of its suicide preventive actions, the "Nuremberg Alliance Against Depression" has started cooperation with local media in 2001 by implementing a 14-item-mediaguide concerning a more sensible way of suicide-reporting to prevent copy-cat suicides. The effects of this mediaguide on the reporting are being evaluated. METHODS: A systematic recording of all suicide reports during 2000 (Baseline) and 2001 (first intervention year) was performed for three regional dailies in Nuremberg. A comparison of the reporting regarding the frequency, distribution and some qualitative aspects between baseline and intervention year as well as to a control-medium from Würzburg was carried out. RESULTS: Two out of three dailies in Nuremberg show a noticeable reduction in the numbers of articles on suicides. Compared to the baseline and control-medium one of the decreases is statistically significant. The results of the third newspaper, however, indicated an opposite direction, stating a significant increase in the number of reports. CONCLUSIONS: Crucial criterion for a mediaguide's favourable influence on the suicide-reporting is the willingness of the main editors in charge at the local dailies to be engaged and willing to cooperate. This can be achieved only through good personal contact and relationship to the project.