BackgroundSuicide and non-fatal suicidal behaviour are significant public health issues in Europe requiring effective preventive interventions. However, the evidence for effective preventive strategies is scarce. The protocol of a European research project to develop an optimized evidence based program for suicide prevention is presented.MethodThe groundwork for this research has been established by a regional community based intervention for suicide prevention that focuses on improving awareness and care for depression performed within the European Alliance Against Depression (EAAD). The EAAD intervention consists of (1) training sessions and practice support for primary care physicians,(2) public relations activities and mass media campaigns, (3) training sessions for community facilitators who serve as gatekeepers for depressed and suicidal persons in the community and treatment and (4) outreach and support for high risk and self-help groups (e.g. helplines). The intervention has been shown to be effective in reducing suicidal behaviour in an earlier study, the Nuremberg Alliance Against Depression. In the context of the current research project described in this paper (OSPI-Europe) the EAAD model is enhanced by other evidence based interventions and implemented simultaneously and in standardised way in four regions in Ireland, Portugal, Hungary and Germany.The enhanced intervention will be evaluated using a prospective controlled design with the primary outcomes being composite suicidal acts (fatal and non-fatal), and with intermediate outcomes being the effect of training programs, changes in public attitudes, guideline-consistent media reporting. In addition an analysis of the economic costs and consequences will be undertaken, while a process evaluation will monitor implementation of the interventions within the different regions with varying organisational and healthcare contexts.DiscussionThis multi-centre research seeks to overcome major challenges of field research in suicide prevention. It pools data from four European regions, considerably increasing the study sample, which will be close to one million. In addition, the study will gather important information concerning the potential to transfer this multilevel program to other health care systems. The results of this research will provide a basis for developing an evidence-based, efficient concept for suicide prevention for EU-member states.

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The European Alliance Against Depression (EAAD) was formed in 2004 with funding from the European Commission. The EAAD, which is currently active in 17 countries, creates community-based networks that use an evidence-based approach to improving care for depressed persons and preventing suicidality. This column describes the creation of EAAD and the cornerstone of the alliance, which is a shared multilevel approach that includes interventions on four levels: education of primary care physicians, a professional public relations campaign, training of community facilitators, and interventions with affected persons and high-risk groups. Several countries have expanded their original model program into other regions or nationwide.

The European Alliance Against Depression (EAAD) was formed in 2004 with funding from the European Commission. The EAAD, which is currently active in 17 countries, creates community-based networks that use an evidence-based approach to improving care for depressed persons and preventing suicidality. This column describes the creation of EAAD and the cornerstone of the alliance, which is a shared multilevel approach that includes interventions on four levels: education of primary care physicians, a professional public relations campaign, training of community facilitators, and interventions with affected persons and high-risk groups. Several countries have expanded their original model program into other regions or nationwide.

Awareness campaigns and multilevel intervention programmes from different countries and continents, their effects on suicidality, as well as limitations of these programmes, are presented and discussed. Experiences from multilevel interventions, such as the Nuremberg Alliance Against Depression in Germany, show that awareness campaigns develop the strongest effect when combined with other measures to create a synergistic effect. Awareness campaigns draw the attention and interest of primary care providers to activities focusing on depression and suicidality, and make it easier for them to consult with patients with psychiatric diagnoses and motivate them concerning treatment, not least because awareness campaigns can contribute to improving community mental health knowledge. Finally, for those affected by depression or other mental disorders, public campaigns reduce the perceived stigma, thus, lessening the isolation which contributes to despair and suicide risk.