Decreasing tendency of seasonality in suicide may indicate lowering rate of depressive suicides in the population.

The seasonality of suicide is well known and a repeatedly demonstrated phenomenon. The authors analyzed the seasonality of 148 suicide events on Gotland between 1981 and 1996. A marked and significant seasonality with a spring and summer peak was found between 1981 and 1989, when the prescription of antidepressants was relatively low and stable. However, this seasonality disappeared in the period between 1990 and 1996, when prescription of antidepressants increased dramatically, indicating that more and more depressed patients were pharmacologically treated. As the seasonality of suicide in the population is the reflection of the seasonal nature of depressive suicides, the result suggests that a decreasing tendency of seasonality in suicide may indicate the lowering rate of depressive suicides in the given population.

Prevention of depression and suicide by education and medication: impact on male suicidality. An update from the Gotland study.

Depression is an endemic disease with high morbidity, and a high mortality in depression-related suicide. Suicidal tendencies, especially among males, are increasing today in East European countries. General practitioners are considered to have a very important role in the prevention and treatment of depression. Matters of depression are more openly discussed in society. Patients showing up in primary care are nowadays less reluctant to see depression as a causative factor behind their symptoms. Taboos concerning the stigma of depression and suicidality are weaker. In spite of this, important problems still exist regarding poor diagnostic and treatment routines in primary care and the inability of depressive and suicidal men to seek for help or to be recognized. In the years 1983-1984, the Swedish Committee for Prevention and Treatment of Depression (PTD) offered an educational programme to all general practitioners (GPs) on the Swedish island of Gotland. During the 1980s this education was shown to lead to a significant decrease in inpatient care, morbidity, suicide, mortality and costs of depressive illness on the island. The use of anxiolytic and sedative medication decreased and that of antidepressant medication increased. This all showed that an educational programme in primary care on depression and suicide was effective. However, the effects faded and, unexpectedly, the number of male suicides was almost unaffected by the educational programme and by the GPs' ability to diagnose and treat depression. Repeated educational activities during the 1990s again led to a decrease in suicides, mainly in females. Also, the increase in antidepressant prescriptions following GP education in the 1990s was mostly in the treatment of female patients. One of the reasons was that few suicidal males are known to the medical services although many of these people are known to the police and social welfare services. The reasons why depressed and suicidal men do not show up in the medical services are discussed, and found to lie in the differences between the male and the female depressive syndrome, leading to difficulties in reaching, diagnosing and treating these patients. Strategies for finding and treating suicidal depressives are discussed. One conclusion is that males are as often depressed as females, but in different ways, and that one of the reasons behind the dramatic over-representation of males amongst suicide victims may be found in the low rate of diagnosis and treatment of the male depressive syndrome, (hit J Psych Clin Pract 1997; 1: 39-46).

Depression and suicide on Gotland. An intensive study of all suicides before and after a depression-training programme for general practitioners.

In 1983 and 1984, the Swedish Committee for the Prevention and Treatment of Depression (PTD) organised a postgraduate training programme on the diagnosis and treatment to all the general practitioners on Gotland, Sweden. In the following years, the frequency of suicide and inpatient care for depression decreased significantly, as well as the frequency of sick leave for depression. The results of the Gotland study have provided evidence for the view that early recognition and adequate treatment of depression is one essential method of suicide prevention (Rutz et al., 1989; Rutz et al., 1992). A detailed retrospective clinical analysis, of all 115 consecutive suicide victims on Gotland between 1981 and 1992 presented in this study, showed that male gender and violent methods were overrepresented. 50 suicides had a DSM-III-R axis I diagnosis and half of them (n = 25) had primary major depression. 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 that the significant decrease in the suicide rate after the PTD programme is a direct result of the robust decrease in depressive suicides of the area served by trained GPs. The practical importance of this finding is briefly discussed.