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Background Depression and other psychiatric disorders are the main cause for suicidal behaviour. The community based 4-level-intervention concept adapted by the “European Alliance against Depression” (www.EAAD.net) has been found to have preventive effects not only on depression but also on suicidal behavior in several but not all controlled studies. The 4-level intervention concept comprises training and support of primary care providers (level 1), a professional public relation campaign (level 2), training of community facilitators (teacher, priests, geriatric care givers, pharmacists, journalists) (level 3), and support for self-help of patients with depression and their relatives (level 4). Methods This 4-level intervention has in the meanwhile been implemented in more than 115 regions worldwide. A systematic assessment of the practical experiences, as well as a systematic process analysis and an implementation research were performed. Results Important findings of this research are: i) the relevance of a strong bottom-up element in the implementation process, ii) the synergistic and catalytic effects generated by becoming simultaneously active at the four different intervention levels, and iii) the crucial advantage of combining the partly overlapping topics of depression and prevention of suicidal behaviour. The latter approach is highly relevant having in mind the unclear risk-benefit-balance of anti-suicidal public campaigns, which are likely to result in a lowering of the threshold by normalization of suicidal behavior. More detailed information on these findings will be presented. Conclusions Systematic research on the on-going community based 4-level intervention program can add useful insights in suicide prevention strategies.

Practical lessons learnt from the worldwide implementation of 115 community-based interventions for suicidal prevention