EAAD-Best builds on a strong base of both evidence and implementation practice established by the European Alliance Against Depression and its partners.
EAAD is best practice
In 2019, European Union Members states voted the EAAD 4-level intervention concept and the iFightDepression®-tool as mental health best practice.
The European Commission has over the past fifteen years undertaken and supported many actions on mental health. This includes the identification and implementation of actions recognised as best practice.
The European Framework for Action on Mental Health and Wellbeing as the main outcome document of the previous EU Joint Action on Mental Health and Wellbeing in 2016, resulted in the Commission creating the EU Compass for Mental Health with the goal of supporting implementation resulting in – for instance – good practice exchange and capacity building. Best practice identified through this process can be found in the Commission’s Best Practice Portal.
In progressing health objectives across Member States, the Steering Group on Promotion and Prevention and Management of Non-Communicable Diseases (SGPP) is the central mechanism, this includes a particular focus on the implementation of best-in-class approaches.
In late 2018, the Steering Group set mental health as a priority for the identification of best practices and implementable research. A selection of practices resulting from projects funded by the EU Health Programme or Horizon 2020 were then show-cased to Member States’ representatives at the European Commission’s Joint Research Centre in Ispra in May 2019.
At this event, EU Member States voted the 4-level intervention concept and the iFightDepression®-tool as mental health best practice.
- WHO Report on Suicide Prevention (2014) – 4-level intervention concept named as a best practice intervention programme for suicide prevention
- European Health Forum Award (2007) – EAAD wins the European Health Award
- European Commission Green Paper on Mental Health (2005) – 4-level intervention concept recommended as best practice to effectively prevent suicide.
Based on the experiences from the model region” Nuremberg Alliance against Depression” which showed that suicidal acts can be reduced (-24% in two years compared to the baseline year) by implementing a specific 4-level approach, the European Alliance Against Depression was established financed by the European Commission (Executive Agency for Health and Consumers), with the aim to spread and implement this successful approach in other European regions and countries.
Since 2008 when the European Alliance became an independent not-for profit organisation, the 4-level intervention concept has been implemented on all continents, except for Asia, namely in more than 120 regions within and outside of Europe.
Extensive practical experience with the implementation of these community-based interventions in different countries and thus health care systems has been accumulated.
To date, 120 regions from 12 countries in Europe (Austria, Belgium, Germany, Hungary, Ireland, Italy, Luxembourg, The Netherlands, Norway, Poland, Portugal and Spain) have successfully implemented EAAD-s 4-level intervention concept. In recent years, regions in non-EU countries have joined the EAAD (Australia, Canada, Chile and New Zealand), and have adapted the intervention materials and started their own regional 4-level interventions.
Experience has shown that the 4-level intervention concept can be adapted to different cultures and health care systems, thereby meeting the needs of target groups in all four levels.
Partners in EAAD-Best experienced with the implementation of the 4-level intervention concept will, together the EAAD Coordination Centre, support partners from the new, implementation countries with continuous advice.
Concerning the transfer to other countries not yet involved, EAAD will continue to be active after the EAAD-Best funding period in order to gain the cooperation of further European countries.
Evidence Base and Key Publications
European Alliance Against Depression and the 4-level intervention conception concept
- Hegerl, U., Wittmann, M., Arensman, E., van Audenhove, C., Bouleau, J. H., van der Feltz-Cornelis, C., Gusmao, R., Kopp, M., Löhr, C., Maxwell, M., Meise, U., Mirjanic, M., Oskarsson, H., Sola, V. P., Pull, C., Pycha, R., Ricka, R., Tuulari, J., Värnik, A., & Pfeiffer-Gerschel, T. (2008). The “European Alliance Against Depression (EAAD)”: A multifaceted, community-based action programme against depression and suicidality. World Journal of Biological Psychiatry, 9(1), 51–58. https://doi.org/10.1080/15622970701216681
- Hegerl, U., Wittenburg, L., Arensman, E., Van Audenhove, C., Coyne, J. C., McDaid, D., Feltz-Cornelis, C. M. V. Der, Gusmão, R., Kopp, M., Maxwell, M., Meise, U., Roskar, S., Sarchiapone, M., Schmidtke, A., Värnik, A., & Bramesfeld, A. (2009). Optimizing Suicide Prevention Programs and Their Implementation in Europe (OSPI Europe): An evidence-based multi-level approach. BMC Public Health, 9(3), 1–8. https://doi.org/10.1186/1471-2458-9-428
- Hegerl, U., Rummel-kluge, C., Värnik, A., Arensman, E., & Koburger, N. (2013). Alliances against depression – A community based approach to target depression and to prevent suicidal behaviour. Neuroscience and Biobehavioral Reviews, 37(10), 2404–2409. https://doi.org/10.1016/j.neubiorev.2013.02.009
- Arensman, E., Coffey, C., Griffin, E., Van Audenhove, C., Sheerder, G., Gusmao, R., Costa, S., Larkin, C., Koburger, N., Maxwell, M., Harris, F., Postuvan, V, & Hegerl, U. (2016). Effectiveness of Depression-Suicidal Behaviour Gatekeeper Training among police officers in three European regions: Outcomes of the Optimising Suicide Prevention Programmes and Their Implementation in Europe (OSPI-Europe) Study. International Journal of Psychiatry, 62(7), 651-660. https://journals.sagepub.com/doi/abs/10.1177/0020764016668907
- Hegerl, U., Maxwell, M., Harris, F., Koburger, N., Mergl, R., Székely, A., Arensman, E., van Audenhove, C., Larkin, C., Toth, M. D., Quintão, S., Värnik, A., Genz, A., Sarchiapone, M., McDaid, D., Schmidtke, A., Purebl, G., Coyne, J. C., & Gusmão, R. (2019). Prevention of suicidal behaviour: Results of a controlled community-based intervention study in four European countries. PLoS ONE, 14(11), 1–26. https://doi.org/10.1371/journal.pone.0224602
- Harris, F. M., Maxwell, M., Oconnor, R. C., Coyne, J., Arensman, E., Székely, A., Gusmão, R., Coffey, C., Costa, S., Cserháti, Z., Koburger, N., Van Audenhove, C., McDaid, D., Maloney, J., Värnik, P., & Hegerl, U. (2013). Developing social capital in implementing a complex intervention: A process evaluation of the early implementation of a suicide prevention intervention in four European countries. BMC Public Health, 13(1). https://doi.org/10.1186/1471-2458-13-158
- Arensman, E., Koburger, N., Larkin, C., Karwig, G., Coffey, C., Maxwell, M., Harris, F., Rummel-Kluge, C., van Audenhove, C., Sisask, .M, Alexandrova-Karamanova, A., Perez, V., Purebl, G., Cebria, A., Palao, D., Costa, S., Mark, L., Toth, MD., Gecheva, M., Ibelshauser, A., Gusmao, R., Hegerl, U. (2015). Depression Awareness and Self-Management Through the Internet: Protocol for an Internationally Standardized Approach. JMIR Res Protoc, 4(3), e99. https://www.researchgate.net/publication/280730503_Protocol_Depression_Awareness_and_Self-Management_Through_the_Internet_Protocol_for_an_Internationally_Standardized_Approach
- Oehler, C., Görges, F., Böttger, D., Hug. J., Koburger, N., Kohls, E., Rummel-Kluge, C. (2019). Efficacy of an internet-based self-management intervention for depression or dysthymia – a study protocol of an RCT using an active control condition. BMC Psychiatry, 19, 90. https://pubmed.ncbi.nlm.nih.gov/30871544/
- Oehler, C., Görges, F., Rogalla, M., Rummel-Kluge, C., & Hegerl, U. (2020). Efficacy of a Guided Web-Based Self-Management Intervention for Depression or Dysthymia: Randomized Controlled Trial With a 12-Month Follow-Up Using an Active Control Condition. Journal of Medical Internet Research, 22(7), e15361. https://doi.org/10.2196/15361
Current projects – involving the 4-level intervention concept and/or the iFightDepression® Tool
- MENTUPP – Improving workplace mental health in the construction, health and ICT sectorsHorizon 2020 project. 01/01/2020 – 31/12/2023 The project’s primary aim is to improve mental health in the workplace by developing, implementing and evaluating a multilevel intervention targeting mental health difficulties in Small and Medium Enterprises (SMEs) in the construction, health and ICT sectors. The secondary aim is to reduce depression and suicidal behaviour. EAAD-Best partners participating MENTUPP project are: EAAD, NSRF, KU Leuven and VEA. Click here for further information on MENTUPP.
Previous Projects – involving the 4-level intervention concept and/or the iFightDepression® Tool
- OSPI Europe: Optimizing suicide prevention programs and their implementation in Europe (2008-2012).The aim of OSPI-Europe was to provide EU Member States with an evidence-based prevention concept, concrete materials and instruments for running and evaluating these interventions and recommendations for the proper implementation of the intervention.EAAD-Best partners that participated in the PREDI-NU project are: EAAD, NSRF, KU Leuven and ERSI. Click here for further information on OSPI Europe.
- PREDI-NU: Preventing Depression and Improving Awareness through Networking in the EU (2011-2014)The goal of the project was to develop an internet-based guided self-management tool for mild to moderate depression. This led to the development of the iFightDepression® – tool and awareness website, which will be used in the EAAD-Best project.EAAD-Best partners that participated in the PREDI-NU project are: EAAD, NSRF and ERSI. Click here for further information on PREDI-NU.
- MasterMind: (Management of mental health diSorders Through advancEd technology and servicEs – telehealth for the MIND (2014-17).The project aimed to make high quality treatment for depression more widely available for adults suffering from the illness by the use of internet-based psychotherapy. Through implementation at large scale (almost 5.000 patient overall), the impact of cCBT (computerised Cognitive Behavioural Therapy) was assessed across 11 EU and Associated Countries.EAAD-Best partners that participated in the MasterMind project are: EAAD, ASLTO3 and ERSI Click here for further information MasterMind.
- MooDFOOD: Multi‐country collaborative project on the rOle of Diet, Food‐related behaviour, and Obesity in the prevention of Depression (2014-2018).Using an integrative approach, MooDFOOD has combined expertise in nutrition, preventive psychology, consumer behaviour and psychiatry to investigate the potential of food in the prevention of depression. Commencing in 2014, the MooDFOOD project has undertaken extensive research into the potential of nutrients, dietary patterns, weight loss and food related behaviours in preventing depression. This has included a randomized controlled trial of 1025 participants, behavioural intervention studies and extensive literature reviews to examine the relationship between dietary factors and risk of depression.EAAD-Best partners who have participated in the MooDFOOD project are: EAAD. Click here for further information MooDFOOD.
- ImpleMentAll: (Towards Evidence-based Tailored Strategies for e-Health (2017-2021) In recent decades, large amounts of time and money have been put into the development, testing, and implementation of eHealth for a wide range of health problems, in the physical as well as the mental domains. Nevertheless, very few eHealth interventions make it into routine care, and those that do take many years to get there. ImpleMentAll aimed to provide an evidence-based answer to this problem through the development, application, and evaluation of tailored implementation strategies in a natural laboratory of on-going eHealth implementation initiatives in the EU and beyond.EAAD-Best partners who are participating in the project were: EAAD, ASLTO3. Click here for further information on ImpleMentAll.