A Suicide Prevention Program in a Region With a Very High Suicide Rate

Abstract

Context: Suicide is a major cause of mortality worldwide. Rates vary widely within and between countries. A suicide prevention program has never been tested in a region with a very high suicide rate in comparison with control regions without such intervention over the same period.Objective: To determine the effectiveness of a depression-management educational program for general practitioners (GPs) on the suicide rate in a region with a high suicide rate in Hungary.Design: Effects were compared with a control region, the larger surrounding county, and Hungary.Setting: Southwest Hungary.Participants: Twenty-eight GPs servicing 73 000 inhabitants participated in the educational program. Intervention:A 5-year depression-management educational program for GPs and their nurses was implemented together with establishment of a Depression Treatment Clinic and psychiatrist telephone consultation service in the intervention region. Main Outcome Measures:The primary study outcome measure was annual suicide rate. The secondary outcome measure was antidepressant prescription use. Results:The annual suicide rate in the intervention region decreased from the 5-year preintervention average of 59.7 in 100 000 to 49.9 in 100 000. The decrease was comparable with the control region but greater than both the county and Hungary (PϽ .001 and PϽ .001, respectively). In rural areas, the female suicide rate in the intervention region decreased by 34% and increased by 90% in the control region (P Ͻ.07). The increase in antidepressant treatment was greater in the intervention region compared with the control region, the county, and Hungary and in women compared with men (P Ͻ.002).Conclusions: A GP-based intervention produced a greater decline in suicide rates compared with the surrounding county and national rates. Increases in patients with depression treated and of dosing were modest and may require additional measures such as depression-care managers. The importance of alcoholism in local suicides was unanticipated and not addressed. Optimal suicide prevention plans must consider major local risk factors. Arch Gen Psychiatry. 2007;64(8):914-920A LTHOUGH SUICIDE HAS many causes, 80% to 95% of suicide decedents, including adolescents and elderly individuals, have a psychiatric illness. [1][2][3][4] The most common psychiatric disorder in suicide is a mood disorder, mostly untreated major depression.3,5 General practitioners (GPs) have a key role in identifying and treating major depression and thereby in lowering community suicide rates. 6 This approach can be productive partly because 18% to 40% of individuals who die by suicide visited their GPs within 1 week of death. 7 A Hungarian study showed an inverse correlation between the number of practicing GPs and the suicide rate in counties. In the United States, antidepressant medication prescription volumes and mean income level, perhaps reflecting access to health care, are inversely correlated with suicide rates at the county level. 9A 1983-1984 educational program in the Swedish islan...

Temperature-associated suicide mortality: contrasting roles of climatic warming and the suicide prevention program in Finland

“…In Hungary a depression-management educational program for general practitioners resulted in a significant decrease in suicide rates [42]. Although the annual suicide rate in Finland has decreased by 40 % between 1990 and 2005 [9], we report here that suicide rates would have been expected to actually rise along with the climatic warming seen over the same period.…”

Practical Suicide-Risk Management for the Busy Primary Care Physician

“…As noted earlier, initial research [12][13][14][15]41 raised hopes that improving identification and treatment of depression could prevent suicides. This prevention effort focused on intensive education of primary care physicians.…”

“…[12][13][14][15] Some research shows that educating primary care clinicians can help protect against suicide, primarily by improving the recognition of depression and leading to the increased prescribing of antidepressants. [12][13][14][15] These effects are stronger when collaborative care models of depression treatment are used. 16,17 pATIEnT GroUpS AT rISk Years of research on suicide show those with current psychiatric illness are the most common group dying by sui-…”

Is there a role for suicide research in modern Ireland?

“…While large-scale reviews of suicide prevention evaluations are yet to find universal, replicable approaches, Szanto et al 18 emphasised the importance of consideration of major local risk factors in any development of suicide prevention. We must focus on those aspects of the international literature which do show some promise for response to prevention and through application of high-quality research on suicide in modern Ireland and the needs of specific communities and population groups, we can implement and rigorously evaluate tailored prevention efforts.…”