Prevention of depression and suicide by education and medication: Impact on male suicidality. An update from the Gotland study

Wolfgang Rutz, Jan Wålinder, Lars Von Knorring, Z. Ríhmer, Hans Pihlgren

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Depression is an endemic disease with high morbidity, and a high mortality in depression-related suicide. Suicidal tendencies, especially among males, are increasing today in East European countries. General practitioners are considered to have a very important role in the prevention and treatment of depression. Matters of depression are more openly discussed in society. Patients showing up in primary care are nowadays less reluctant to see depression as a causative factor behind their symptoms. Taboos concerning the stigma of depression and suicidality are weaker, in spite of this, important problems still exist regarding poor diagnostic and treatment routines in primary care and the inability of depressive and suicidal men to seek for help or to be recognized. In the years 1983-1984, the Swedish Committee for Prevention and Treatment of Depression (PTD) offered an educational programme to all general practitioners (GPs) on the Swedish island of Gotland. During the 1980s this education was shown to lead to a significant decrease in inpatient care, morbidity, suicide, mortality and costs of depressive illness on the island. The use of anxiolytic and sedative medication decreased and that of antidepressant medication increased. This all showed that an educational programme in primary care on depression and suicide was effective. However, the effects faded and, unexpectedly, the number of male suicides was almost unaffected by the educational programme and by the GPs' ability to diagnose and treat depression. Repeated educational activities during the 1990s again led to a decrease in suicides, mainly in females. Also, the increase in antidepressant prescriptions following GP education in the 1990s was mostly in the treatment of female patients. One of the reasons was that few suicidal males are known to the medical services although many of these people are known to the police and social welfare services. The reasons why depressed and suicidal men do not show up in the medical services are discussed, and found to lie in the differences between the male and the female depressive syndrome, leading to difficulties in reaching, diagnosing and treating these patients. Strategies for finding and treating suicidal depressives are discussed. One conclusion is that males are as often depressed as females, but in different ways, and that one of the reasons behind the dramatic over-representation of males amongst suicide victims may be found in the low rate of diagnosis and treatment of the male depressive syndrome.

Original languageEnglish
Pages (from-to)39-46
Number of pages8
JournalInternational Journal of Psychiatry in Clinical Practice
Volume1
Issue number1
Publication statusPublished - Mar 1997

Fingerprint

Suicide
Depression
Education
General Practitioners
Primary Health Care
Depressive Disorder
Islands
Antidepressive Agents
Taboo
Morbidity
Therapeutics
Endemic Diseases
Cost of Illness
Aptitude
Mortality
Social Welfare
Anti-Anxiety Agents
Police
Social Work
Hypnotics and Sedatives

Keywords

  • Antidepressants
  • Education
  • Gotland study
  • Helplessness
  • Major depression
  • Males
  • Suicide

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Prevention of depression and suicide by education and medication : Impact on male suicidality. An update from the Gotland study. / Rutz, Wolfgang; Wålinder, Jan; Von Knorring, Lars; Ríhmer, Z.; Pihlgren, Hans.

In: International Journal of Psychiatry in Clinical Practice, Vol. 1, No. 1, 03.1997, p. 39-46.

Research output: Contribution to journalArticle

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