Project: “Surveillance and Prevention of Acts of Self-harm”

Project partners

Ministry of Health and Social Affairs of the Republic of Croatia (Ministry)
Center for Disaster Management, Zagreb, Croatia (Center)
Croatian National Institute of Public Health (CNIPH)
Norwegian Institute of Public Health (NIPH)
Croatian Institute for Mental Health * (CIMH)
* included at later stage

Financing of the project:

The Ministry of Health and Social Welfare of the Republic of Croatia and the Norwegian Institute of Public Health applied to the Norwegian Royal Ministry of Foreign Affairs for financial and technical assistance to the project.

Duration of the project

This is a phased (three phases over three years) collaborative project. Each phase can be seen as an independent project with its own end report with recommendations to the involved parties.

  • 1st phase of the project - Project Number: 2050389
  • 2nd phase of the project - Project Number: 2060369
  • 3rd phase of the project - Project Number: 2070306

The project was approved in November, 2005 and the project activities officially started in December, 2005.

Start of the project:                         1st December 2005
Planned ending of the project:      31st December 2008

  • Duration of the first phase: 1st December 2005 – 31st December 2006
  • Duration of the second phase: 1st January 2006 – 31st December 2007
  • Duration of the third phase: 1st January 2007 - 31st December 2008

Aim of the project:

The project aim is:

  • To develop a surveillance system for capturing information about self-inflicted injuries that will be the base for rapid response actions to treat an underlying mental health condition.
  • To be integrated within the national program to strengthen community based mental health services as described in the draft of the Croatian Mental Health Policy.
The goals of the proposed activities are:
  • to develop registration module for registration of self-inflicted injuries in Croatia;
  • to pilot test collection of data using the registration module;
  • to develop and implement community-based follow-up for patients with self-harm behavior;
  • to integrate results into suicide prevention policies and activities.

Specific goals of the project within phases:

Findings from each phase can be used for further parallel activities in the field of suicide prevention.

Phase 1: Epidemiological surveillance system

  • Develop, test and pilot registration module/system for epidemiologic surveillance for self-inflicted injuries in Croatia
  • Train registration personnel and educate interventionists
Phase 2: Design of intervention program
  • Continuing registration of self-inflicted injuries and suicide attempts
  • Develop and pilot a system for follow-up of patients who commit acts of self-harm by the community-based mental health care team consisting of a psychiatrist and a mental health care nurse
Phase 3: Piloting of intervention and providing recommendations
  • Pilot implementation of the intervention
  • Evaluation of the pilot intervention
  • Development of recommendations for nation-wide implementation

Project Leader / Principal Investigator

Professor Branko Kopjar, MD, MS, PhD
Advisor with the Norwegian Institute of Public Health

Local Project Leader / Investigator

Assistant Professor Neven Henigsberg, MD, PhD
Center for Disaster Management

Collaborators in the project:

Ministry of Health and Social Welfare Work Group:

  • Neven Henigsberg, MD, Local Project Leader (Center)
  • Šarlota Foro, member (Center)
  • Veljko Đorđević, MD, (CIMH) member since 25th Oct, 2007
  • Dubravko Kužina, MD, member
  • Vlasta Dečković Vukres, MD, member (CNIPH)
  • Vlasta Hrabak-Zerjavić, MD, member (CNIPH)
  • Urelija Rodin, MD, member (CNIPH)
  • Marijan Erceg, MD, member (CNIPH)
  • Branimir Tomić, MD, member (CNIPH)
  • Tanja Ćorić, MD, member (CNIPH)
  • Maja Silobrčić – Radić, MD, member (CNIPH)
  • Tomislav Benjak, MD, member (CNIPH)
  • Branko Kopjar, MD, member (NIPH)
  • marija Coupe, MD, member (Ministry)

Representative of the Norwegian Institute of Public Health in Croatia:

Consilior Vita d.o.o.
PROJECT MANAGEMENT TEAM:
Dr. Tanja Potočki Karačić, Project Manager
Slavica Vladetić, Project Assistant
Nada Dražić-Stefanović, Project Assistant
Diana Maltar, Project Assistant

First phase of the project

Activities carried out

PATIENT REGISTRATION

  • Medical institutions selected to participate in the pilot project / patient registration are:
    • University Hospital of Traumatology, Zagreb,
    • Clinical Hospital Dubrava, Zagreb.
  • Approvals from the ethics committees of the selected hospitals (University Hospital of Traumatology and Dubrava University Hospital) were received and the pilot project / patient registration began.
  • The personnel for data collection / patient registration was selected and educated.
  • The team at each institution involved in the pilot project registration consisted of: a physician (coordinator in an institution), a medical nurse (collection of prospective data and checking new admissions) and four medical students (collection of historical data).
  • Registration questionnaire is based on the Norwegian model, and adapted during the pilot registration, within retrospective data collection, to be further used in prospective registration of patients with self-inflicting injuries and suicide attempts.
  • Retrospective data collection was performed within the hospitals’ databases as identification of the patients who were admitted to the hospital during the last couple of months preceding the start of the project.
  • After the adaptation of the registration module based on the retrospective registration a prospective patient registration started.
  • Database was developed for data collected by retrospective and further prospective registration of patients with self-inflicted injuries and suicide attempts. A safe central data depository site was established.
  • At the end of the first phase, within the 3 months of retrospective and further prospective patient registration around 600 registration forms were filled in, and among them data from around 350 were entered into the electronic database, belonging to the patients recognized and assessed as those who committed act of self-harm or suicide attempt. De-identified pilot data from the retrospective and prospective patient registration were prepared for analysis.
EPIDEMIOLOGICAL ANALYSIS
  • At the CNIPH epidemiological analysis of the existing data on suicide was performed. Database of hospitalized patients together with mortality bases was searched. Cross-matching between suicide register and hospitalization database was performed to identify frequency of previous acts of self-harm and see the patterns of the hospital services utilized one year prior to the suicidal act.
For each identified individual the information on discharge diagnosis, sex and age was registered. All hospitalizations preceding suicide were registered with admission and discharge data. Analysis was performed from 2002 to 2004. The year 2004 was used as a reference year. Data on suicidal acts regarding age and sex for time period between 2000 and 2004 were presented.
  • The Epidemiological Report as the 1st phase project output was prepared. It is planned to be published for dissemination.
  • A preparation of the first scientific paper based on some interesting topics from the CNIPH epidemiological analysis is in progress.
CME SEMINARS
  • Two CME (Continuing Medical Education) seminars were organized within the 1st phase of the project. The education was organized in cooperation with the Croatian Association for Clinical Psychiatry at the Croatian Medical Association.
Activities in progress
  • A preparation of the first scientific paper based on some interesting topics from the epidemiological analysis is in progress.
  • Preparation of the second scientific paper “Cross-matching of 5-year (2000-2004) data period” (by Croatian National Institute of Public Health, CDM and Norwegian Institute of Public Health) is in progress and the draft is prepared.
  • The third scientific paper: “Presentation of the Results of Pilot Project” is planned to be written.
  • Prospective patient registration is continuing.

Second phase of the project

Activities carried out and in progress

RESULTS OF THE 1ST PHASE – PATIENT REGISTRATION

  • The data and experiences from the pilot project (patient registration) were analyzed and the registration module was adapted.
  • Prospective patient registration is in progress.
EPIDEMIOLOGICAL ANALYSES
  • After the epidemiological analysis of the 1st phase of the project, a proposal was submitted by the CNIPH experts for an additional sub-project with the following title: “Regional differences in social and medical characteristics of persons who committed suicide in the Republic of Croatia 2002-2006”. Activities for the sub-project are in process. For the proposed sub-project activities additional members from the CNIPH were included in the Working Group of the Ministry of Health and Social Welfare.

CME SEMINARS

  • For the 2nd phase of the project two CME seminars were organized and carried out.
INTERVENTION
  • Design of intervention program:In the 2nd phase it is planned to develop intervention model for community-based patient follow-ups in order to use the information and experience from this project to improve suicide prevention policies and activities.
  • Following the patient registration an intervention is conducted: contact information is given to a patient to contact project associates if he/she agrees to be followed up. If the patient does not make contact on his own, he/she is going to be contacted by the project associates several times. If the patient is willing, he/she is invited to come for a follow-up with either a physician/psychiatrist or psychologist, at the Brain Research Institute or at the psychiatric hospital, and a series of follow-up meetings will be conducted.

Third phase of the project

It is foreseen that the third phase of the project will consist of piloting and evaluation of conducted intervention, and elaborating recommendations for the nation-wide suicide prevention action and of training of personnel. This phase is presently ongoing.

CONTACT:

Ministry of Health and Social Welfare of the Republic of Croatia:
Marija Coupe, Project Coordinator at the Ministry of Health and Social Welfare
Tel:      +385 (0)1 4698 481
E-mail: marija.coupe@mzss.hr

Center for Disaster Management:
Kneza Višeslava 11, 10.000 Zagreb, Hrvatska

Representatives of the Norwegian Institute of Public Health:
Project Management Team
Tel:      +385 (0)1 6550 120
Fax:     +385 (0)1 6542 123
Dr. Tanja Potočki Karačić, Project Manager
Mob:    +385 (0)98 457 781
E-mail: tanjapk@consilior-vita.com

Nada Dražić-Stefanović, Project Assistant
Mob:    +385 (0)98 231 814
E-mail: nadads@consilior-vita.com

Slavica Vladetić, Project Assistant
Mob:    +385 (0)98 981 72 23
E-mail: slavicav@consilior-vita.com

Last revised in Nov 2008 by Center for Disaster Management and Consilior Vita d.o.o. - Norwegian Institute for Public Health representative