The German Alliance Against Depression and suicide rates: A retrospective analysis

  • Supported by the German Alliance Against Depression, 82 regions in Germany launched their own community-based multi-level intervention programs targeting both depression and suicidal behavior prior to January 2016. Sixteen of these regions have implemented the full 4-level intervention program comprising 1) training of General Practitioners, 2) a public awareness campaign, 3) training of community facilitators and 4) support for depressed patients and their relatives for at least three years. The aim of the study was to examine possible suicide prevention effects in these sixteen 4-level intervention regions (comprising a population of 6,976,309) by 1) comparing the annual suicide rates during the 3-year intervention period to a 10-year baseline and 2) comparing these differences to corresponding trends in Germany after excluding all intervention regions (Germany-IR). Primary outcome was the annual rate of suicides. Analyses included negative binomial regression models. When examining differences between suicide rates during the intervention period compared to the baseline period, only a trend towards a significant reduction was found. This reduction of suicides in the sixteen 4-level intervention regions did not differ from that in Germany-IR as control. The interpretation of these findings has to take into account that the training of General Practitioners, police and other community facilitators might have improved the recognition of suicides, thus increasing detection rates. Furthermore, destigmatizing effects of the public awareness campaigns might have increased the number of suicides by lowering suicide threshold (“normalization”) for those at risk and by decreasing the rate of suicides deliberately hidden by suicide victims or their relatives.
Author:Judith KöhlerORCiD, Ines HeinzORCiDGND, Roland MerglORCiDGND, Anne Elsner, Ulrich HegerlORCiDGND
Parent Title (English):PLOS ONE
Place of publication:San Francisco, California, US
Document Type:Article
Date of Publication (online):2021/07/01
Date of first Publication:2021/07/01
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2023/10/09
Tag:Behavior; Cities; Community based intervention; Depression; Germany; Police; Preventive medicine; Suicide
Issue:7, art. e0254133
Article Number:e0254133
Page Number:11
First Page:1
Last Page:11
YES UH received financial funding (grant ZMVI1-2517FSB142) from the Federal Ministry of Health ( for a project which included this analysis.
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - CC BY - Namensnennung 4.0 International