European Alliance Against Depression: Person centered care for depression and prevention of suicidal behaviour
Keywords:depression, suicide prevention, community-based, multi-level interventions, self-management
AbstractBackground: Depression is a prevalent and severe disorder and a major cause for attempted and completed suicides in Europe. Objectives: The community-based 4-level-intervention concept developed within the “European Alliance against Depression” (EAAD; www.eaad.net) combines two important objectives: to improve the care and treatment of patients with depression and to prevent suicidal behavior. Methods: The EAAD community-based 4-level intervention comprises training and support of primary care providers (level 1), a professional public awareness campaign (level 2), training of community facilitators (teachers, priests, geriatric care givers, pharmacists, journalists) (level 3), and support for self-help of persons suffering from depression and for their relatives (level 4). Results: Several studies evaluated different aspects of the 4-level community-based intervention concept over the past years and showed a significant reduction in suicidal behavior and various changes in intermediate outcomes (e.g. changes in attitude or knowledge in different populations). Systematic process evaluation was helpful to identify several predictable and unpredictable obstacles to a successful implementation of such community-based programs as well as synergistic and catalytic effects.Conclusions: The EAAD community-based interventionhas been shown to be effective concerning the prevention of suicidal behavior and is the most broadly implemented community-based intervention targeting depression and suicidal behavior world-wide. Via the EAAD and partners from currently 22 countries from in- and outside of Europe, the intervention concept and materials (available in many different languages) are offered to interested regions.
WHO. The global burden of disease: 2004 update.; 2008.
World Health Organization (WHO). Preventing suicide: A global imperative. Geneva, Switzerland: World Health Organization; 2014. Available from: URL:http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1.
Cavanagh JTO, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychological medicine 2003; 33(3):395–405.
Lönnqvist J. Major psychiatric disorders in suicide and suicide attempters. In: Wasserman D, Wasserman C, editors. Oxford Textbook of Suicidology and Suicide Prevention: A Global Perspective. New York: Oxford University Press .
Hegerl U, Koburger N, Hug J. Depression und Suizidalität. Nervenheilkunde 2015; 34(11):900–5.
Hegerl U, Wittenburg L, Arensman E, van Audenhove C, Coyne JC, McDaid D et al. Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidence-based multi-level approach. BMC public health 2009; 9:428.
Arensman E, Koburger N, Larkin C, Karwig G, Coffey C, Maxwell M et al. Depression Awareness and Self-Management Through the Internet: Protocol for an Internationally Standardized Approach. JMIR research protocols 2015; 4(3):e99.
Hegerl U, Althaus D, Schmidtke A, Niklewski G. The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality. Psychological medicine 2006; 36(9):1225–33.
Hegerl U, Mergl R, Havers I, Schmidtke A, Lehfeld H, Niklewski G et al. Sustainable effects on suicidality were found for the Nuremberg alliance against depression. European archives of psychiatry and clinical neuroscience 2010; 260(5):401–6.
Hubner-Liebermann B, Neuner T, Hegerl U, Hajak G, Spiessl H. Reducing suicides through an alliance against depression? General hospital psychiatry 2010; 32(5):514–8.
Hegerl U, Rummel-Kluge C, Varnik A, Arensman E, Koburger N. Alliances against depression - A community based approach to target depression and to prevent suicidal behaviour. Neuroscience and biobehavioral reviews 2013; 37(10 Pt 1):2404–9.
Szekely A, Konkoly Thege B, Mergl R, Birkas E, Rozsa S, Purebl G et al. How to decrease suicide rates in both genders? An effectiveness study of a community-based intervention (EAAD). PloS one 2013; 8(9):e75081.
Aromaa E, Tolvanen A, Tuulari J, Wahlbeck K. Personal stigma and use of mental health services among people with depression in a general population in Finland. BMC psychiatry 2011; 11(1):52.
Wang J, Lai D. The relationship between mental health literacy, personal contacts and personal stigma against depression. Journal of affective disorders 2008; 110(1-2):191–6.
Coppens E, van Audenhove C, Scheerder G, Arensman E, Coffey C, Costa S et al. Public attitudes toward depression and help-seeking in four European countries baseline survey prior to the OSPI-Europe intervention. Journal of affective disorders 2013; 150(2):320–9.
Scheerder G, van Audenhove C, Arensman E, Bernik B, Giupponi G, Horel A et al. Community and health professionals' attitude toward depression: a pilot study in nine EAAD countries. The International journal of social psychiatry 2011; 57(4):387–401.
Arensman E, Coffey C, Griffin E, van Audenhove C, Scheerder G, Gusmao R et al. Effectiveness of Depression – Suicidal Behaviour Gatekeeper Training among Police Officers in Three European regions: Outcomes of the OSPI-Europe study. International Journal of Social Psychiatry; in press.
Fleischmann A, Arensman E, Berman A, Carli V, Leo D de, Hadlaczky G et al. Overview evidence on interventions for population suicide with an eye to identifying best-supported strategies for LMICs. Glob. Ment. Health 2016; 3.
Hegerl U, Kohls E. Synergistic effects of multi-level suicide preventive interventions: Important, but difficult to disentangle. The Australian and New Zealand journal of psychiatry 2016; 50(2):178–9.