{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T13:13:41Z","timestamp":1774876421722,"version":"3.50.1"},"edition-number":"2","reference-count":58,"publisher":"Oxford University PressOxford","isbn-type":[{"value":"0198834446","type":"print"},{"value":"9780198834441","type":"print"},{"value":"9780191873805","type":"electronic"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The next steps forward in suicide prevention are to learn (i) how to best combine single measures into a multilevel intervention in order to create additive and synergistic effects and (ii) how to implement them in the communities in different cultures and healthcare systems. A narrative review based on findings and experiences from existing community-based multilevel interventions which have provided some evidence for preventive effects on suicidal behaviour is presented. Most multilevel interventions combine training for primary care providers and gatekeepers, public awareness activities, restricting access to lethal means, engaging with the media, and support for high-risk groups. However, effects on completed suicides and\/or suicide attempts have only been reported for a few interventions. The best evaluated community-based intervention is the four-level programme offered by the European Alliance Against Depression (EAAD; implemented in over 115 regions in 15 countries by 2019).<\/jats:p>","DOI":"10.1093\/med\/9780198834441.003.0074_update_001","type":"book-chapter","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T13:30:33Z","timestamp":1761831033000},"page":"665-670","source":"Crossref","is-referenced-by-count":0,"title":["Multilevel approaches in adult suicide prevention"],"prefix":"10.1093","author":[{"given":"Ulrich","family":"Hegerl","sequence":"additional","affiliation":[]},{"given":"Ines","family":"Keita","sequence":"additional","affiliation":[]},{"given":"Juliane","family":"Hug","sequence":"additional","affiliation":[]},{"given":"Virg\u00ednia","family":"da Concei\u00e7\u00e3o","sequence":"additional","affiliation":[]},{"given":"Ricardo","family":"Gusm\u00e3o","sequence":"additional","affiliation":[]}],"member":"286","reference":[{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-1","article-title":"Depression awareness and self-management through the internet: protocol for an internationally standardized approach.","author":"","year":"2015","journal-title":"Journal of Medical Internet Research, Research Protocols"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-2","article-title":"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.","author":"","year":"2016","journal-title":"The International Journal of Social Psychiatry"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-3","article-title":"Roots of Hope: a uniquely Canadian approach to suicide prevention.","author":"","year":"2023","journal-title":"Journal of Community Safety and Well-Being"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-4","article-title":"What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies.","author":"","year":"2015","journal-title":"Psychological Medicine"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-5","article-title":"Preventing suicidal behaviours with a multilevel intervention: a cluster randomised controlled trial.","author":"","year":"2018","journal-title":"BioMed Central Public Health"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-6","article-title":"Effectiveness of community facilitator training in improving knowledge, attitudes, and confidence in relation to depression and suicidal behavior: results of the OSPI-Europe intervention in four European countries.","author":"","year":"2014","journal-title":"Journal of Affective Disorders"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-7","article-title":"Effectiveness of general practitioner training to improve suicide awareness and knowledge and skills towards depression.","author":"","year":"2018","journal-title":"Journal of Affective Disorders"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-8","article-title":"Public awareness campaigns about depression and suicide: a review.","author":"","year":"2009","journal-title":"Psychiatric Services (Washington, D.C.)"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-9","unstructured":"Europe Alliance Against Depression (EAAD) (2004). Background: EAAD project, EAAD. Retrieved 7 July 2019 from http:\/\/www.eaad.net\/mainmenu\/eaad-project\/."},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-10","unstructured":"Europe Alliance Against Depression (EAAD) (2023). Protecting mental health in times of change\u2014MentBest. Funded by the European Union under Grant Agreement No. 101080651. Retrieved from https:\/\/mentbest.com."},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-11","article-title":"Improving suicide prevention in Dutch regions by creating local suicide prevention action networks (SUPRANET): a study protocol.","author":"","year":"2017","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-12","article-title":"Developing social capital in implementing a complex intervention: a process evaluation of the early implementation of a suicide prevention intervention in four European countries.","author":"","year":"2013","journal-title":"BioMed Central Public Health"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-13","article-title":"Exploring synergistic interactions and catalysts in complex interventions: longitudinal, mixed methods case studies of an optimised multi-level suicide prevention intervention in four European countries (OSPI-Europe","author":"","year":"2016","journal-title":"BioMed Central Public Health"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-14","article-title":"Public attitudes towards treatment of depression: effects of an information campaign.","author":"","year":"2003","journal-title":"Pharmacopsychiatry"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-15","article-title":"The \u2018European Alliance Against Depression (EAAD)\u2019: a multifaceted, community-based action programme against depression and suicidality.","author":"","year":"2008","journal-title":"The World Journal of Biological Psychiatry: the Official Journal of the World Federation of Societies of Biological Psychiatry"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-16","article-title":"Optimizing Suicide Prevention Programs and their Implementation in Europe (OSPI Europe): an evidence-based multi-level approach.","author":"","year":"2009","journal-title":"BioMed Central Public Health"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-17","article-title":"Sustainable effects on suicidality were found for the Nuremberg alliance against depression.","author":"","year":"2010","journal-title":"European Archives of Psychiatry and Clinical Neuroscience"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-18","article-title":"Alliances against depression\u2014a community based approach to target depression and to prevent suicidal behaviour.","author":"","year":"2013","journal-title":"Neuroscience and Biobehavioral Reviews"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-19","article-title":"One followed by many?-Long-term effects of a celebrity suicide on the number of suicidal acts on the German railway net.","author":"","year":"2013","journal-title":"Journal of Affective Disorders"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-20","article-title":"The 4-level approach: prevention of suicidal behaviour through community-based intervention.","author":"","year":"2021","journal-title":"European Archives of Psychiatry and Clinical Neuroscience"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-21","article-title":"Increased antidepressant use and fewer suicides in J\u00e4mtland county, Sweden, after a primary care educational programme on the treatment of depression.","author":"","year":"2006","journal-title":"Acta Psychiatrica Scandinavica"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-22","article-title":"Reducing suicides through an alliance against depression?","author":"","year":"2010","journal-title":"General Hospital Psychiatry"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-23","article-title":"What are complex interventions in suicide prevention? A scoping review.","author":"","year":"2022","journal-title":"Psychiatry Research"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-24","article-title":"Utilisation and application of implementation science in complex suicide prevention interventions: a systematic review.","author":"","year":"2023","journal-title":"Journal of Affective Disorders"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-25","article-title":"Towards development of guidelines for harnessing implementation science for suicide prevention: an international Delphi expert consensus study.","author":"","year":"2025","journal-title":"BMJ Public Health"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-26","article-title":"The impact of beyondblue: the national depression initiative on the Australian public's recognition of depression and beliefs about treatments.","author":"","year":"2005","journal-title":"The Australian and New Zealand Journal of Psychiatry"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-27","article-title":"Rationale and methods of the iFightDepression study: a double-blind, randomized controlled trial evaluating the efficacy of an internet-based self-management tool for moderate to mild depression.","author":"","year":"2017","journal-title":"BMC Psychiatry"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-28","article-title":"Population- and community-based interventions to prevent suicide.","author":"","year":"2023","journal-title":"Crisis"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-29","article-title":"Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: cohort study.","author":"","year":"2003","journal-title":"British Medical Journal (Clinical Research Ed"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-30","article-title":"Public attitudes toward depression and help-seeking: impact of the OSPI-Europe depression awareness campaign in four European regions.","author":"","year":"2017","journal-title":"Journal of Affective Disorders"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-31","article-title":"Measuring the tail of the dog that doesn't bark in the night: the case of the national evaluation of Choose Life (the national strategy and action plan to prevent suicide in Scotland","author":"","year":"2007","journal-title":"BioMed Central Public Health"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-32","article-title":"Police and suicide prevention: evaluation of a training program.","author":"","year":"2016","journal-title":"Crisis"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-33","article-title":"A decrease in suicide rates in Japanese rural towns after community-based intervention by the health promotion approach.","author":"","year":"2007","journal-title":"Suicide & Life-Threatening Behavior"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-34","article-title":"Role of media reports in completed and prevented suicide: Werther v. 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Alliance Against Depression. WAPHA. Retrieved 7 July 2019 from https:\/\/phexchange.wapha.org.au\/AAD."},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-55","unstructured":"WHO (2014). Preventing Suicide: A Global Imperative. World Health Organization, Geneva. Retrieved from http:\/\/gbv.eblib.com\/patron\/FullRecord.aspx?p=1810127."},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-56","unstructured":"World Health Organization (2024). WHO Global Health Estimates: Suicide Rates, Age-standardized. Retrieved from https:\/\/www.who.int\/data\/gho\/data\/themes\/mental-health\/suicide-rates."},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-57","article-title":"Suicide prevention strategies revisited: 10-year systematic review.","author":"","year":"2016","journal-title":"The Lancet Psychiatry"},{"key":"2026033008032968700_med-9780198834441-chapter-74-bibItem-58","article-title":"Understanding the process of multilevel suicide prevention research trials.","author":"","year":"2020","journal-title":"Evaluation and Program Planning"}],"container-title":["Oxford Textbook of Suicidology and Suicide Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/book\/31744\/chapter\/538351401","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T12:09:01Z","timestamp":1774872541000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/book\/31744\/chapter\/538351401"}},"subtitle":[],"editor":[{"given":"Danuta","family":"Wasserman","sequence":"first","affiliation":[]},{"given":"Camilla","family":"Wasserman","sequence":"additional","affiliation":[]}],"short-title":[],"issued":{"date-parts":[[2021,1]]},"ISBN":["0198834446","9780198834441","9780191873805"],"references-count":58,"URL":"https:\/\/doi.org\/10.1093\/med\/9780198834441.003.0074_update_001","relation":{"replaces":[{"id-type":"doi","id":"10.1093\/med\/9780198834441.003.0074","asserted-by":"subject"}]},"subject":[],"published":{"date-parts":[[2021,1]]}}}