EPMA Journal

, 5:A93 | Cite as

Building a public health network for prevention of suicides in Macedonia in accordance to the German model - “Nuernberg Alliance Against Depression”: “Macedonian Alliance Against Depression”- MAAD

  • Kneginja Richter
  • Mirjana Polazarevska
  • Günter Niklewski
Open Access
Meeting abstract


General Practitioner Depressive Disorder Suicide Attempt Suicide Rate Suicide Prevention 
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Goal of the project

The main goal of the program is prevention of suicide through early prediction and detection of depression. For the sustainability of the program a national centre for prevention and treatment of depression and suicide shell be established in the country. The Macedonian alliance against depression should be a network of experts with the aim to promote the healthcare of depressed patients and to reduce the number of suicide and suicide attempts in Macedonia.


Every year almost one million people die from suicide; a global mortality rate of 16 per 100,000, or one death every 40 seconds [1]. In the last 45 years suicide rates have increased by 60% worldwide. Suicide is among the three leading causes of death among people aged 15 - 44 years in some countries, and the second leading cause of death in the 10-24 years age group [1].

A major proportion of the suicides are committed in the context of depression. Obviously, among the group of general practitioners there is a deficit in the recognition and therapy of depressive syndromes [2]. Therefore the importance of primary care for an efficient suicide prevention program is evident. This was already shown in the Gotland Study [2]. In this study an educational programme for general practitioners was carried out to improve the diagnosis and treatment of depressive disorders and suicidality. The evaluation showed an impressive decrease (nearly 50 %) of suicides.

The Rate of Suicides in Year 2010 was 6, 7 for Macedonia and 9, 9 for Germany, per 100.000 inhabitants. The epidemiological data on suicide attempts during a 10-year-period (1999-2008) based on 1683 participants who attempted suicides in the Region of Skopje, Macedonia showed a stable trend over the last decade. It has also shown female predominance of suicide attempts with a greater number of attempts during the summer months [3]. During 2001/ 2002 an intervention programme on four intervention levels has been conducted in the city of Nuremberg, Germany („Nuremberg Alliance Against Depression“), to improve the care for individuals suffering from depressive disorders. The project was funded by the German Federal Ministry for Education and Research in the framework of the German Research Network on Depression and Suicidality. The “Nuremberg Alliance Against Depression” leads to a decrease in overall suicidality (suicides and suicide attempts) of more than 20 % in Nuremberg and the region. Meanwhile 14 regions in Germany initiated similar projects under the common roof of the „Alliance Against Depression“, another 30 – 40 other German regions are in an early stage of preparation [4]. Since 2001, there is an active cooperation between Nuremberg (Germany) and Skopje (Macedonia) supported by WHO, Municipalities, Ministry of Health and two biggest state Universities in Macedonia. The well established cooperation can be used as a tool for further research projects [5].


  1. 1.
  2. 2.
    Rihmer Z, Rutz W, Pihlgren H: Depression and suicide on Gotland. An intensive study of all suicides before and after a depression-training programme for general practitioners. J Affect Disord. J Affect Disord. 1995, 35 (4): 147-52. 10.1016/0165-0327(95)00055-0.CrossRefPubMedGoogle Scholar
  3. 3.
    M Polazarevska, S Manchevska, A Filipovska, V Gerazova: Ten-year Epidemiological Study on Suicide Attempts in Skopje, Republic of Macedonia. Med Arh. 2011, 65 (1): 38-41.PubMedGoogle Scholar
  4. 4.
    Hegerl U, Althaus D, Schmidtke A, Niklewski G: The Alliance against Depression: two year evaluation of a community based intervention to reduce suicidality. Psychol Med. 2006, 36: 1225-1234. 10.1017/S003329170600780X.CrossRefPubMedGoogle Scholar
  5. 5.
    Baumann A, Richter K, Belevska D, Zäske H, Gaebel W, Niklewski G, Bajraktarov S, Ortakov V, Wahlberg H: Attitudes of the public towards people with schizophrenia: comparison between Macedonia and Germany. World Psychiatry. 2005, 4 (1): 55-57.Google Scholar

Copyright information

© Richter et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Kneginja Richter
    • 1
    • 2
    • 3
  • Mirjana Polazarevska
    • 4
  • Günter Niklewski
    • 1
    • 3
  1. 1.Clinic for Psychiatry and PsychotherapyNurembergGermany
  2. 2.Georg Simon Ohm Technical University for applied sciencesNurembergGermany
  3. 3.Medical FacultyUniversity Goce Delcev, StipMacedonia FYROM
  4. 4.Clinic for Psychiatry, Medical FacultyUniversity Cyril and MethodusSkopjeMacedonia, FYROM

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