Background

By the year 2020, depression is projected to reach 2nd place of the ranking of Disability Adjusted Life Years (DALYs) in the age category 15-44 years for both sexes combined (WHO, 2011). Based on the European Social Survey (ESS), women report higher levels of depression than men do in all European countries, but there is significant cross-national variation in this gender gap, with the largest gender differences in Eastern and Southern European countries and the smallest in Ireland, Slovakia and Nordic countries (Van de Velde et al, 2010).

Depression and suicidality, especially completed and attempted suicides, are two important and largely overlapping public health problems in Europe (Lönnqvist, 2009; Ystgaard et al, 2009). Because of this overlap, it is not surprising that improving the care of depressed patients is also considered to be an effective approach to prevent suicidality (Mann et al, 2005). Evidence for this has been provided by the poineering Gotland study (Rutz et al, 1995) and more recently by the carefully evaluated Nuremberg Alliance against Depression (Hegerl et al, 2006; 2009). In the latter study, a 2-year community based four level intervention was associated with a significant reduction of the number of suicidal acts (- 24%).

The basic principle of the model project was picked up and further complemented by new intervention materials within the European Alliance Against Depression (EAAD) funded by the European Commission. Cooperation with General Practitioners (GPs), awareness campagins concerning depression, training of community facilitators (e.g. social workers, teachers, priests, pharmacists) and support for patients and their relatives including support for self-help activities are the four intervention levels of EAAD, which have been implemented in more than 100 regions in 17 different European countries (Hegerl et al, 2008; Scheerder et al, 2010). The EAAD training materials were optimised as part of the EC FP7 funded study: Optimising Suicide Prevention Programmes and their Implementation in Europe.

The EAAD activities revealed two major problems that have been addressed by PREDI-NU:
1) The alliances against depression intend to motivate depressed patients to seek help, but patients are often confronted with the difficulty of limited access to psychotherapy and pharmacotherapy. 2) Many of the intervention materials used within EAAD do not sufficiently relate to adolescents, and networks providing care for adolescents and young adults with depression and possibly suicidal behaviour are not well established.<br> It is therefore a key priority to increase depression awareness and implement innovative interventions for treatment of depression that also match young peoples' needs.

A Euorpean e-mental health guided self-help approach could be a practical way of providing ready access to effective psychosocial interventions for mild depression and have potential to impact on suicidal thoughts and behaviours. Millions of people access the interent each year for health-related information and more users search for information on depression than any other condition. However, despite strong evidence endorsing self-help materials based on Cognitive Behavioural Thearpy techniques, the adoption of self-help approaches and support by professionals is limited in many countries to date.