Cork / Frankfurt am Main, 12.01.2026 - A landmark scientific article on an evidence-based programme to reduce depression and suicidal behaviour – the Community-Based 4-Level Intervention developed by the European Alliance Against Depression (EAAD) – was published in Nature Mental Health on Friday 9th January 2026. The EAAD approach provides a sustainable model for community-based mental health care that can be effectively adapted to various contexts, including current and future public health emergencies.
The European Alliance Against Depression approach: an evidence-based program to reduce depression and suicidal behavior | Nature Mental Health
Researchers from the National Suicide Research Foundation and the School of Public Health, University College Cork, led the publication, involving co-authors from the European Alliance Against Depression.
Tackling both depression and suicidal behaviour by intervening simultaneously at four levels (primary care providers, the public, community facilitators and people affected) creates incremental effects. For example, public awareness campaigns reduce stigma, making it easier for doctors to diagnose depression.
The EAAD Community-Based 4-Level Intervention has been adopted by more than 150 regions in Europe and beyond. It has found to be easily adaptable to different cultures and health care systems. A systematic review has singled out this program as the best community-based suicide preventive approach (Linskens et al., 2022).
The EAAD Community-Based 4-Level Intervention
The EAAD Community-Based 4-Level Intervention offers a structured, multi-component response to the dual challenges of depression and suicidal behaviour.
The four levels, include:
Training sessions and practice support mainly for primary care physicians and mental healthcare professionals.
Public awareness activities, kick-off event and media campaigns.
Training sessions for community facilitators and gatekeepers in contact with people with depression and suicidal behaviour in the community (for example, geriatric care givers, priests, pharmacists, health-care staffs, police, journalists), cooperation with journalists based on a media guide with the aim to reduce suicide contagion and clusters.
Support for patients with depression and suicide risk, as well as relatives. A digital self-management tool: iFightDepression Tool, has been developed, which requires minimal guidance by a health professional. Reducing access to lethal means as a suicide preventive element is integrated in the intervention levels 1 and 3.
Since the early 2000s, the EAAD Community-Based 4-Level Intervention has been tested in controlled trials in different countries. Preventive effects on suicidal behaviour were proven in several of these studies. This 4-Level Intervention has been identified as European good practice in mental health by the EU: Read more
The unique contribution of the EAAD 4-Level Intervention is that by increasing awareness of depression and improved assessment and treatment simultaneously, escalation to a first self-harm act can be prevented and this subsequently reduces risk of suicide. Therefore, EAAD is a typical ‘upstream approach’ to suicide prevention, which requires greater prioritisation in national suicide prevention strategies.
Professor Ella Arensman, Head of School of Public Health UCC, Chief Scientist, National Suicide Research Foundation and EAAD Vice-President
It is amazing to see how the 4-Level Intervention, first successfully evaluated in Nuremberg, is getting adopted in so many different regions worldwide. When implemented with sufficient intensity, an ownership feeling with the intervention is created in the community with positive effects on attitudes and knowledge concerning depression and suicide. All cities and communities interested to start an own 4-Level Intervention are cordially invited to contact or join EAAD.
Professor Dr. Ulrich Hegerl, Head of the European Alliance Against Depression
Sources:
Linskens, E. J., Venables, N. C., Gustavson, A. M., Sayer, N. A., Murdoch, M., MacDonald, R., Ullman, K. E., McKenzie, L. G., Wilt, T. J., & Sultan, S. (2023). Population- and community-based interventions to prevent suicide. Crisis, 44(4), 330–340. https://doi.org/10.1027/0227-5910/a000873
Media guidelines for reporting on suicide:
We encourage media professionals reporting on the topics of depression and suicidal behaviour to consider the media guidelines, outlined in the WHO publication:
Preventing suicide: a resource for media professionals: View publication
Press Contacts
National Suicide Research Foundation
Mr Niall McTernan
Western Gateway Building, Western Road, UCC
Tel: +353 21 420 5551
infonsrf@ucc.ie
School of Public Health, College of Medicine and Health, University College Cork
Ms Caroline Seacy
3rd Floor Erinville Hospital, Western Road, UCC
Tel: +353 21 420 5667
caroline.seacy@ucc.ie
European Alliance Against Depression e.V. (EAAD)
Dr. Pia Hauck
Goerdelerring 9, 04109, Leipzig
Tel: +49 175 9824 706
contact@eaad.net
About NSRF
The National Suicide Research Foundation (NSRF) is an independent, multi-disciplinary
research unit that investigates suicide and self-harm in Ireland. www.nsrf.ie
About UCC School of Public Health
The UCC School of Public Health’s vison is to prevent disease and to protect and promote the
health and wellbeing of the population. www.ucc.ie/en/publichealth/
About EAAD
The European Alliance Against Depression (EAAD) is an international, scientific, non-profit organization that speaks up for patients affected by depression. It conducts research, raises awareness and develops effective, evidence-based initiatives that improve access to care and treatment for people suffering from depression worldwide, to support those affected and their families, and to prevent suicide. The central offers include the EAAD Community-Based 4-Level Intervention and the online self-management programme iFightDepression. EAAD's network includes members in Europe, Australia, Canada, Africa and Chile.
www.eaad.net
