““Hungarian Hungarian Alliance Against Depression”Alliance Against Depression”Multi-level action plan for prevention of Multi-level action plan for prevention of

depression and suicidedepression and suicideSemmelweis University,Semmelweis University,

Institute of Behavioural Sciences Institute of Behavioural Sciences

Hungary Hungary Mária Kopp, Éva Susánszky, Erzsébet Németh, Mária Kopp, Éva Susánszky, Erzsébet Németh,

András Székely András Székely www.depressziostop.huwww.depressziostop.hu

IUHPE, Budapest, 2006. IUHPE, Budapest, 2006.

European Alliance Against Depression, European Alliance Against Depression, EAADEAAD

In In the first phase of EAAD, which started in the first phase of EAAD, which started in April 2004April 2004: :

the aim was to the aim was to initiateinitiate regional community- regional community-based interventionsbased interventions

This approach has been proven to be highly This approach has been proven to be highly effective in reducing the suicidality within effective in reducing the suicidality within the Nurthe Nurnnberg Alliance Against Depressionberg Alliance Against Depression (more than 20 %) (more than 20 %)

We started the Hungarian programme in We started the Hungarian programme in 2004 in the Szolnok sub-region2004 in the Szolnok sub-region

Second phase of EAAD:Second phase of EAAD: The The European CommissionEuropean Commission has decided has decided

to continue funding EAAD for the time to continue funding EAAD for the time period from 2005 to 2008period from 2005 to 2008

EAAD is aiming to improve the care of EAAD is aiming to improve the care of depressed patients and to prevent depressed patients and to prevent suicidality in the European countries. suicidality in the European countries.

A four-level community-based A four-level community-based intervention strategy, combining best intervention strategy, combining best practice materials, practice materials,

concepts and experiences from 16 concepts and experiences from 16 European countries has been European countries has been developed as a common intervention developed as a common intervention strategystrategy

Participating countries:Participating countries:

Germany,Germany, Ireland, Ireland, England, England, Estonia, Estonia, Belgium, Belgium, Austria, Austria, Finnland, Finnland,

France, France, Greece, Greece, Island, Island, Scotland, Scotland, Slovenia, Slovenia, Spain Spain ItalyItaly HungaryHungary

MeMental Health: New understanding, new hope, The ntal Health: New understanding, new hope, The World Health Report 2001, WHO, GenevaWorld Health Report 2001, WHO, Geneva, , Kopp MS Kopp MS (Advisory Group member, Central-Eastern-European (Advisory Group member, Central-Eastern-European

representative)representative)

Depression and suicide are the most important causes Depression and suicide are the most important causes

of working disability and death in the of working disability and death in the 15 to 44 years 15 to 44 years old populationold population

Unipolar depression is responsible for 10,3 % of DALY Unipolar depression is responsible for 10,3 % of DALY in the 15-44 years old population in the 15-44 years old population

Loss of human capital, increased risk of self-Loss of human capital, increased risk of self-destructive behavioural forms and chronic disorders of destructive behavioural forms and chronic disorders of great epidemiological significancegreat epidemiological significance

Depressive symptomatology (BDI) Depressive symptomatology (BDI) severity categories in the Hungarian severity categories in the Hungarian

populationpopulation

16,8

4,6 2,9

69,5

17,1

6,4 7,0

71,6

15,0

5,8 7,6

75,7

01020

30405060

7080

normal (0-9) mild (10-18) moderate (19-25) severe (26-)

BDI severity categories

% o

f cas

es

1988

1995

2002

According to Hungarostudy 2002 According to Hungarostudy 2002 survey:survey:

Among 12.600 persons, who represent the Hungarian Among 12.600 persons, who represent the Hungarian population according to age, sex and sub-regions above 18 population according to age, sex and sub-regions above 18 years of age years of age

Prevalence of severe depression Prevalence of severe depression in Hungary: 7,6%in Hungary: 7,6%

prevalence of moderate and prevalence of moderate and severe depression above 18 severe depression above 18

according to Beck Depression according to Beck Depression score: 13,4 %score: 13,4 %

Mortality rates of middle aged (45-64) Mortality rates of middle aged (45-64) men and women in 2001men and women in 2001

First iFirst intervention areantervention area

Selected area: Szolnok and it’s environment

Population: appr. 130 000

Suicide rate (in 2001):

•Men: 59,9

•Women: 17,7

75,6

70,6

56,6

47,1

59,9

36,534,6

27,3

1311,8

5,7

0

10

20

30

40

50

60

70

80

100.

000

főre

Sucide rate among men in Sucide rate among men in 20012001

16,1

14,1

13

17,7

11,9 11,9

10,9

9,8

4,1

3,3

1,6

1

3

5

7

9

11

13

15

17

19

100

.000

főre

Sucide rate among women Sucide rate among women in2001in2001

Cooperation with multipliersCooperation with multipliers

We established contact with We established contact with general practicioners, general practicioners, psychiatrists, psychologists, district nurses, psychiatrists, psychologists, district nurses, teachers, policeteachers, policemenmen, priests, social workers, priests, social workers, , media workers and provided them with media workers and provided them with information about depression and trained them to information about depression and trained them to be able to handle this problem in their community.be able to handle this problem in their community.

Cooperation with multipliers

First training, discussion table2005.04.16. and 2005.04.20

180-200 participants

Second training2005.08.27.

National Association of Mental Crises Telephone Hotline Services25 participants

Public campaignPublic campaign

We delivered posters, videos, brochures, flyers and We delivered posters, videos, brochures, flyers and a web-page to the population. We used the a web-page to the population. We used the electronic media and the press as well to forward electronic media and the press as well to forward the materials.the materials.

The aim was to inform the population about the The aim was to inform the population about the basic basic prevention and prevention and treatment treatment possibilities possibilities of of depression anddepression and suicide and suicide and decrease the decrease the stigmatisstigmatisationation of th of the mental disorderse mental disorders

Public campaign Public campaign

Public information events: Press conference and press releases

49 occurence in the press (interviews, articles),

24 occurence in the next three weeks following the press conference, several replays

Two thematic editions in scientific journals: Teaching and Health- Communication

Public campaign Posters:

300 pieces:

Flyers, Emergency cards:10 000 db.

Placed in:GP’s officesHospitalDistric NursesSocial workersPolice

Public campaignPublic campaignVideosVideos Presentations, trainingsPresentations, trainings Media (local television)Media (local television)

Web-pageWeb-pageSince the beginning of the campaign Since the beginning of the campaign many patients referred to the many patients referred to the informations received from the web-informations received from the web-pagepage

Reports, surveysReports, surveys 1. 1.

Attitude survey by phone in the local populationAttitude survey by phone in the local population

Random sample from the phone book (50 persons) Random sample from the phone book (50 persons) 34% 34% graduated in high school, 43% had university degreegraduated in high school, 43% had university degree 30 men, 70% women30 men, 70% women Age (mean): 48Age (mean): 48

49% said they have a relative, friend or 49% said they have a relative, friend or someone in their environment having someone in their environment having depressiondepression

23% said that suicide occured in their family 23% said that suicide occured in their family or environmentor environment

Reports, surveysReports, surveys 2. 2.

Attitude survey by Attitude survey by self-administered questionnaireself-administered questionnaire amongamong local local helping professionalshelping professionals

78 local helpers78 local helpers 65% had university degree65% had university degree 13 men, 87% women13 men, 87% women Age (mean): 47Age (mean): 47

71% said they have a relative, friend or 71% said they have a relative, friend or someone in their environment having someone in their environment having depressiondepression

42% said that suicide occured in their family 42% said that suicide occured in their family or environmentor environment

OpinionOpinions of s of the public and the helpersthe public and the helpers signifcantly differ:signifcantly differ:

It is easy to find a reason for suicide It is easy to find a reason for suicide (58%, 35%).(58%, 35%).

I would I would be ready tobe ready to talk to people being talk to people being in suicide crisis to help them (55%, 91%).in suicide crisis to help them (55%, 91%).

The The personperson who talks about suicide will who talks about suicide will rarely try it (40%, 12%).rarely try it (40%, 12%).

If someone makes up his/her mind to If someone makes up his/her mind to commit suicide, nothing can stop it commit suicide, nothing can stop it (30%, 13%)(30%, 13%)

A lakosság és a segítők véleménye

Actual problem:Actual problem:

The financing of the National Association The financing of the National Association of Mental Crises Telephone Hotline of Mental Crises Telephone Hotline Services is not in the health care financing Services is not in the health care financing systemsystem

After 30 years of service since April 2005 After 30 years of service since April 2005 no salary for the staff of the servicesno salary for the staff of the services

Most active, well trained helpers, need for Most active, well trained helpers, need for crisis interventioncrisis intervention

170-200.000 call pro year on national 170-200.000 call pro year on national level, 25-30 %-alevel, 25-30 %-a, 50.000 cases suicide , 50.000 cases suicide and other crisis situationsand other crisis situations

Second stage of the programme:Second stage of the programme:National programme:National programme:New centers:New centers:KiskunhalasKiskunhalasSzékesfehérvárSzékesfehérvárBudapest, JózsefvárosBudapest, JózsefvárosMass media participation, local Mass media participation, local

network building network building

ExperiencesExperiences Important to strengthen the cooperation between Important to strengthen the cooperation between

different areasdifferent areas There aren’t exact competence-definitionsThere aren’t exact competence-definitions There is no financing for health promotion and There is no financing for health promotion and

mental health prevention in the health care systemmental health prevention in the health care system The German The German methodmethod cannot be adopted in every cannot be adopted in every

situation situation (ie.(ie.:: differences in prescription practices differences in prescription practices,, cessation of governmental funding for the crisis cessation of governmental funding for the crisis hotlineshotlines););

The population needs more informationThe population needs more information The sociThe socieety ty and the media and the media – on the personal and – on the personal and

organization level too – is openorganization level too – is open to thisto this issue issue..