OSPI-Europe aims to provide the EU-member states with realistic evidence-based recommendations and decision-support regarding the design and implementation of effective programs to reduce suicidality. The concrete focus on implementation allows to study the efficiency of the prevention program, as well as a process evaluation of the implementation itself. Further, the practicability of the developed materials and instruments, possible shortcomings, potentials for improvement will be identified and improvements will be made based on lessons learned. Thereby, the OSPI-Europe project seeks to bridge the gap between theoretical recommendations and practical application.
The limitations of the study design originate in the challenges of simultaneously implementing comparable interventions in four different countries and health systems. However, process evaluation will entail the collection of important information regarding the transferability of the intervention to different health systems. The close monitoring of the implementation process will help to control and explain differences in implementation that might occur at the four intervention sites.
The existence of different health care systems may also complicate evaluation of the intervention. Availability of health services and specialised mental health care, access to psychotherapy, as well as requirements for out of pocket payments for medication and health services differ in the four intervention countries. Data for antidepressant prescriptions are available in some countries as health insurance data (Germany), and in others as IMS (Intercontinental Marketing Services) data. Close cooperation, harmonisation of terms and definitions as well as consenting on minimum standards within the project consortium are needed to address the challenges with simultaneous data collection.
Further challenges emerge by conducting research within real world local environments where it is impossible to control other intervening activities such as the introduction of National Suicide Prevention strategies (which may or may not include specific prevention activities) or other local initiatives on depression. Other intervention factors, such as the current economic downturn, which may, for instance, lead to significant job losses in some study areas, may also blur the effectiveness of the intervention. Monitoring of intermediate effects, as well as precisely documenting environmental conditions prior to and during the study within intervention and control regions, should allow for more robust interpretation and understanding of primary and secondary outcomes.
The strengths of the design relate to its being grounded in an intervention and evaluation concept that has previously been shown to be effective . Moreover, the European Alliance Against Depression (EAAD) has demonstrated that it is possible to implement basic elements of the OSPI-Europe intervention in different European countries and health systems according to a standardised procedure . Finally, the OSPI-Europe consortium is built on the foundations of the EAAD, and thus draws on the networks, expertise, prior collaboration and knowledge exchange culture that has been developed in the different EAAD countries and during EAAD co-operations since its foundation in 2004.
For OSPI-Europe to make a contribution to suicide prevention in the European Community, OSPI-Europe needs not only to construct a strong intervention and conduct high level research, but it also needs to disseminate results effectively. Dissemination strategies, which are not presented in detail in the context of this paper, remain a key component of the project. Strategies tailored to different audiences can help facilitate the translation of research results into policies and action. This article is meant to be a contribution to this dissemination strategy.