DEPRESSION AND SUICIDE ON GOTLAND - AN INTENSIVE STUDY OF ALL SUICIDES BEFORE AND AFTER A DEPRESSION-TRAINING PROGRAM FOR GENERAL-PRACTITIONERS

In 1983 and 1984, the Swedish Committee for the Prevention and Treatme nt of Depression (PTD) organised a postgraduate training programme on the diagnosis and treatment of depression to all the general practitio ners on Gotland, Sweden. In the following years, the frequency of suic ide and inpatient care for depression decreased significantly, as well as the frequency of sick leave for depression. The results of the Got land study have provided evidence for the view that early recognition and adequate treatment of depression is one essential method of suicid e prevention (Rutz et al., 1989; Rutz et al., 1992). A detailed retros pective clinical analysis, of all 115 consecutive suicide victims on G otland between 1981 and 1992 presented in this study, showed that male gender and violent methods were overrepresented. 50 suicides had a DS M-III-R axis I diagnosis and half of them (n = 25) had primary major d epression. Bipolar II disorder was relatively overrepresented in this sample. After the PTD programme, the proportion of depressive suicides was significantly lower than before. This finding strongly suggests t hat the significant decrease in the suicide rate after the PTD program me is a direct result of the robust decrease in depressive suicides of the area served by trained GPs. The practical importance of this find ing is briefly discussed.