In 1983-1984 the Swedish Committee for Prevention and Treatment of Depression (PTD Committee) introduced an educational program for all general practitioners (GPs) on the Swedish island of Gotland The primary goal was to increase knowledge about diagnosis and treatment of patients with affective disorders The effects of the educational programs were evaluated in detail; GPs identified more patients with depressive disorders and treated them more accurately The suicide rate on Gotland was followed, primarily to ensure that the new treatment strategies did not include a risk for the individual patients However, it was also hoped that increased awareness of patients with affective disorders and better treatment routines could reduce the suicide rate The suicide rate dropped the year after the educational programs were introduced This was a statistically significant deviation both from the long-term trend on Gotland and from the trends in Sweden as a whole Programs aiming at giving GPs increased capacity and responsibility to treat patients with affective disorders do not increase the frequency of suicide Better primary treatment of patients with depressive disorders may reduce the suicide rate in a given area

Frequency of suicide on Gotland after systematic postgraduate education of general practitioners.

Data concerning all suicide cases in Denmark with a psychiatric history (1971-81) were compiled through computer record linkage between central registers. Cases of suicide during and up to 1 year after inpatient hospitalization were investigated. 21% of the suicides took place while the patient was still hospitalized. The overall suicide rates increased slightly faster than in the population without recent psychiatric hospitalization. There were few suicides in the groups over 65 and under 25 years of age. A sharp relative increase in suicide mortality in the provincial and particularly rural populations was noted. Approximately half of the patients were psychotic, mainly with major affective disorder. The percentage of patients with neurosis or personality disorder decreased. 37% of the men and 18% of the women were diagnosed as substance abusers. Fairly consistently, approximately 10% of the suicide victims were characterized by affective reactions or no psychiatric illness.

Suicide in psychiatric patients in Denmark, 1971-81. I. Demographic and diagnostic description.

In view of recent rises in suicide rates of males aged 15–29 years, the literature on the specialised clinical management of parasuicides presenting at hospital is reviewed. Few studies demonstrate reduction in suicidal behaviour with such services, although substantial psychosocial benefits have been shown. These negative results with respect to suicidal behaviour partly relate to methodological problems such as small sample sizes, the exclusion of high risk subjects, short follow-up and confusing outcome measures. We cannot be confident that existing clinical practices have been effective in reducing suicide. Hence this paper focuses on selected issues of critical importance. Clinically, risk assessment is a problematic area worthy of clear understanding. There is a continuing confusion over the nature of affective disturbance associated with parasuicide and whether it might benefit from pharmacotherapy. Recent studies on the prevalence of psychological disorder in suicidal youth are discussed. Child ab...

Clinical management of parasuicides: Critical issues in the 1990s

As the initial part of the development of a suicide prevention program in a county in northern Sweden, an epidemiologic study on all suicides in the Vasterbotten county 1961-1980 was performed. The study confirms other studies which differentiate between an urban-alienated pattern and a rural-traditional. There is a considerable increase in the suicide rate during the 1970's in the county alongside the development of a marked difference between different socio-economic regions. The highest suicide rates are now found in the most sparsely populated mountainous areas in the western part and in the most rapidly expanding urban area. Language: en

Epidemiology of suicide in a Swedish county (Västerbotten) 1961-1980.

In spite of their relative constancy over time, there are long-term shifts in the suicide rates like drops during wars and increases during periods of economic instability. Switzerland has traditionally a high total suicide rate, and during the last years there has even been a distinct tendency for it to rise: 1959–62: 18.8, 1969–72: 18.3, 1979–80: 25.2. The suicide rates of Canton of Berne exceed those of the whole country and a comparable increase has been registered. At the same time a considerable increase of clinical suicides also has been observed at the Psychiatric University Clinic of Berne.

To the Problem of an Institutional Suicide

The purpose of the study is to discover whether there is an association between changes in the psychiatric services offered by the largest psychiatric hospital in Iceland during the period 1955–1978 and changes in the rate of suicide. Marked changes occurred in the services after 1965. The rate of suicide in the patient population was significantly higher during 1965–1978 than during 1955–1964. It is concluded that the changes in the psychiatric services are associated with an increase in the rate of suicide and that this increase may to some extent be a side effect of therapeutic methods introduced after 1965. The conclusion is thought to imply the necessity for further evaluation of those therapeutic methods as applied in the hospital and increasing the application of measures for the prevention of suicide.

Oddur Bjarnason

Papers

Association between changes in psychiatric services and increases in suicide rates.