Landmark Scientific Article on Prevention of Depression and Suicidal Behaviour Published in Nature Mental Health

12 Jan 2026

Published in Nature Mental Health on Friday 9th January 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:
1. Training sessions and practice support mainly for primary care physicians and 
mental healthcare professionals.

2. Public awareness activities, kick-off event and media campaigns.

3. 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.     

4. 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: Community-Based 4-Level Intervention

Professor Ella Arensman, Head of School of Public Health UCC, Chief Scientist, National Suicide Research Foundation and EAAD Vice-President said: “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 Dr. Ulrich Hegerl, Head of the European Alliance Against Depression, said: “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”.

Download the PDF Nature Mental Health. The European Alliance Against Depression. here.

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:
Preventing suicide: a resource for media professionals, update 2023