Multicenter Projects

    Topic Progress:

    Multicenter projects pool data to achieve wider epidemiological profiles of persons engaging in suicide attempts and self-harm, and to compare incidence rates between geographical areas and countries. Data on suicide attempts and self-harm are usually drawn from general hospital records, registries and vital statistics.

    The WHO European regional multicenter study on suicidal behaviors has been conducted over the longest time period (1989−2005) and has covered the largest number of geographical areas in European countries (7).

    Based on the experiences of the WHO European regional multicenter study, and in cooperation with the WHO European Regional Network on Suicide Research and Prevention, the MONitoring SUicidal behavior in Europe study project (MONSUE) was established in 2006. The aim of the study, which involved nine European countries, was to investigate hospital-presented suicide attempts based on intent and lethality. Two subgroups were defined – one on non-serious suicidal behavior (NSSB) including those whose intent to die was considered minimal or absent, and one on serious suicidal behavior (SSB). A further aim was to determine differences, if any, between these subgroups (8).

    The WHO Western Pacific regional study on Suicide Trends in At-Risk Territories (START) is an international multisite initiative, established in 2001, that aims to stimulate suicide research and prevention in the WHO Western Pacific Region. The central component of the study is the development of registration systems for fatal and non-fatal suicidal behaviors (9).

    The Council of Ministers of Health of Central America (COMISCA) has mandated to improve public health in this region by joining forces, combining resources and agreeing on a collective public health blueprint. COMISCA is the political body of the Central American Integration System (SICA), which aims to identify and prioritize regional health problems and is composed of each of the ministers of health of eight countries (Belize, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Panama). CDC is one of COMISCA’s main partners.

    WHO’s Suicide Prevention – Multisite Intervention Study on Suicidal Behaviours (SUPRE-MISS) was launched in 2000 to examine suicidal behaviors and interventions at culturally diverse sites. A community survey and hospital-based case registration of suicide attempters for the clinical trial component of the study provided very valuable results (10).

    Multicenter projects provide an epidemiological overview of wider trends and provide good practice frameworks and information on the planning, development and maintenance of multisite surveillance systems. Findings have provided new knowledge (e.g. importance of self-poisoning by pesticides as a method, identification of different levels of intent) and have informed research and national suicide prevention strategies.

    Figure 5.2