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Community-based 4-level approach: Background, implementation and evidence for efficacy

Published online by Cambridge University Press:  23 March 2020

U. Hegerl*
Affiliation:
University of Leipzig, Department of Psychiatry and Psychotherapy, Leipzig, Germany
E. Arensman
Affiliation:
NSRF, National Suicide Research Foundation, Cork, Ireland
C. van Audenhove
Affiliation:
LUCAS, Katholieke Universiteit Leuven, Leuven, Belgium
T. Baader
Affiliation:
Universidad Austral de Chile Facultad Medicina, Instituto Neurociencias Clinicas, Valdivia, Chile
R. Gusmão
Affiliation:
EUTIMIA, EUTIMIA, Lisbon, Portugal
A. Ibelshäuser
Affiliation:
Pro mente tirol, St. Pölten, Austria
Z. Merali
Affiliation:
University of Ottawa, Institute of Mental Health Research, Ottawa, Canada
C. Rummel-Kluge
Affiliation:
Stiftung Deutsche Depressionshilfe, University of Leipzig, Department of Psychiatry and Psychotherapy, Leipzig, Germany
V. Peréz Sola
Affiliation:
Parc de Salut Mar Barcelona, Institut de Neuropsiquiatria i Addicions, Barcelona, Spain
R. Pycha
Affiliation:
Krankenhaus Bruneck, Abteilung für Psychiatrie, Bruneck, Italy
A. Värnik
Affiliation:
ERSI, Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia
A. Székely
Affiliation:
Semmelweis University, Institute of Behavioural Science, Budapest, Hungary
*
* Corresponding author.

Abstract

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The community-based 4-level-intervention concept developed within the “European Alliance against Depression” (http://www.eaad.net/) combines two important aims: to improve the care and treatment of patients with depression and to prevent suicidal behavior. It has been shown to be effective concerning the prevention of suicidal behavior [14] and is worldwide the most broadly implemented community-based intervention targeting depression and suicidal behavior. The 4-level intervention concept comprises training and support of primary care providers (level 1), a professional public relation campaign (level 2), training of community facilitators (teacher, priests, geriatric caregivers, pharmacists, journalists) (level 3), and support for self-help of patients with depression and for their relatives (level 4). In order to deepen the understanding of factors influencing the effectiveness of the intervention, a systematic implementation research and process analysis was performed within the EU-funded study “Optimizing Suicide Prevention Programs and Their Implementation in Europe” (http://www.ospi-europe.com/; 7th Framework Programme) [5]. These analyses were based on data from four intervention and four control regions from four European countries. In addition to intervention effects on suicidal behaviour, a variety of intermediate outcomes (e.g. changes in attitude or knowledge in different populations) were considered. Strong synergistic as well as catalytic effects were identified as a result of being active simultaneously at four different levels. Predictable and unpredictable obstacles to a successful implementation of such community-based programs will be discussed. Via the EAAD, the intervention concept and materials (available in eight different languages) are offered to interested region in and outside of Europe.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
S42
Copyright
Copyright © European Psychiatric Association 2016

References

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