The 4-level approach: A community-based intervention targeting depression and suicidal behaviour

Abstract

Multilevel community-based interventions are considered the most efficient way to target diagnostic and treatment gaps concerning depression and to prevent suicidal behaviour. The 4-level intervention approach of the European Alliance against Depression (EAAD) combines the two partly overlapping aims of improving care for people with depression and preventing suicidal behavior. After forming a local stakeholder network in a certain region and a preparation phase, intervention activities start at four levels: i) Primary health care, ii) General public, iii) Community facilitators, iv) Affected individuals' and their relatives. This 4-level approach has been successfully adapted to different cultures and health care systems in more than 120 regions in and from outside of Europe. A systematic review recently has singled out this 4-level approach as the most promising community-based suicide preventive intervention worldwide. In this paper, the 4-level approach, it´s evidence base, and lessons learnt concerning implementation are presented.