LESSONS FROM THE GOTLAND STUDY ON DEPRESSION, SUICIDE AND EDUCATION -EFFECTS, SHORTCOMINGS AND CHALLENGES

In the 1970s and 1980s, the island of Gotland had a high suicide rate compared to the rest of Sweden. Specific antidepressant medication was relatively little used, indicating under-diagnosis and under-treatmen t of depression. In 1982, the Swedish Committee for Prevention and Tre atment of Depression designed an educational programme to increase the understanding and management of depression by general practitioners. Between 1983 and 1985, 94% of general practitioners in Gotland attende d structured, interactive training workshops. As a result, the suicide rate, referrals to psychiatrists for depressive and melancholic state s, sick leave for depression and in-patient care for depressive states were reduced by 50% to 85%. Specific antidepressants and lithium were used more frequently and the use of non-specific psychotropic medicat ion declined. The programme costs were 400,000 SEK, against an estimat ed cost saving of 140 million SEK. The effect on suicide, however, was mainly restricted to females, probably due to the failure of the heal thcare system to reach depressed males. A new educational programme, r ecognizing the distinctive features of the male depressive syndrome, i s being prepared in Gotland. Educational programmes aimed at general p ractitioners can improve the management of depression in the community and prevent suicides. Such programmes need to recognize the inherent differences between male and female depression and should adopt comple mentary, gender-specific educational, diagnostic and therapeutic strat egies.