PREVENTION OF SUICIDE AND DEPRESSION

In the years 1983-84, the Swedish Committee for the Prevention and Tre atment of Depression (PTD) offered an educational programme to all gen eral practitioners (GP:s) on the Swedish island of Gotland. The educat ion has been shown to lead to a significant decrease in inpatient care , morbidity, mortality and costs caused by depressive illness on the i sland. Unspecific medication decreased and specific anti-depressive me dication increased. A scrutiny of all suicides on Gotland during the 1 980s revealed that the overall decrease in suicides as a result of the educational programme was caused mainly by the decrease in suicides c ommitted by female suicidants with recognized major depression and in contact with general practitioners. This was expected. However, the nu mber of male suicides was almost unaffected by the educational program me, as well as improvement in the GPs ability to diagnose and treat de pression. This was unexpected. We believe that the reason for this is that male depressive suicidants are possibly not reached by the medica l health care system. This might be due to males' alexithymic incapaci ty to seek help and/or their atypical depressive, acting out, or abusi ve behaviour leading to rejection or misdiagnosis in the health care s ystem. Consequently, underdiagnosis and undertreatment of male depress ion exist and may explain the paradoxical fact that men in Sweden are only half as often depressed as females but commit suicide up to five times more. New sex-specific diagnostic and therapeutic tools as well as sex-specific research concerning depression and suicidality are nee ded.