荷兰北布拉班特省数字支持区域系统干预预防自杀的效果（SUPREMOCOL）。
Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands.
机构信息
Mental Health and Addiction Research Group, Department of Health Sciences, Hull York Medical School, University of York, York, UK; Institute of Health Informatics, University College London, London, United Kingdom.
Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands.
出版信息
Gen Hosp Psychiatry. 2023 Sep-Oct;84:73-81. doi: 10.1016/j.genhosppsych.2023.06.010. Epub 2023 Jun 23.
OBJECTIVE
We evaluated the effect of a digitally supported systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands.
METHOD
Non-randomized stepped wedge trial design (SWTD). Stepwise implementation in the five subregions of the systems intervention. Pre-post analysis for the whole province (Exact Rate Ratio Test, Poisson count). SWTD Hazard Ratios of suicides per person-years for subregional analysis of control versus intervention conditions over five times three months. Sensitivity analysis.
RESULTS
Suicide rates dropped 17.8% (p = .013) from 14.4 suicides per 100,000 before the start of implementation of the systems intervention (2017), to 11.9 (2018) and 11.8 (2019) per 100, during implementation; a significant reduction (p = .043) compared to no changes in the rest of the Netherlands. Suicide rates dropped further by 21.5% (p = .002) to 11.3 suicides per 100,000 during sustained implementation in 2021. Sensitivity analysis confirmed the reduction (p = .02). The SWTD analysis over 15 months in 2018-2019 did not show a significant association of this reduction with implementation per subregional level, probably due to insufficient power given the short SWTD timeframe for implementation and low suicide rates per subregion.
CONCLUSIONS
During the SUPREMOCOL systems intervention, over four years, there was a sustained and significant reduction of suicides in Noord-Brabant.
目的
我们评估了荷兰北布拉班特省一项数字化支持的自杀预防系统干预（SUPREMOCOL）的效果。
方法
非随机阶梯式楔形试验设计（SWTD）。系统干预的五个子区域逐步实施。对全省进行前后分析（精确率比值检验，泊松计数）。SWTD 对自杀率的危害比，对子区域分析中干预条件与对照条件在五个三倍三个月时间段内进行分析。敏感性分析。
结果
自杀率从干预实施前的 14.4 例/每 10 万人下降了 17.8%（p=0.013），至 11.9 例（2018 年）和 11.8 例（2019 年）/每 10 万人；与荷兰其他地区相比，这是一个显著的减少（p=0.043）。在 2021 年持续实施期间，自杀率进一步下降了 21.5%（p=0.002），至每 10 万人 11.3 例。敏感性分析证实了这一减少（p=0.02）。2018 年至 2019 年 15 个月的 SWTD 分析并没有表明这种减少与每个子区域的实施水平有显著关联，可能是由于实施的 SWTD 时间框架较短且每个子区域的自杀率较低，导致统计功效不足。
结论
在 SUPREMOCOL 系统干预的四年期间，北布拉班特省的自杀率持续显著下降。
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