Lessons from the Gotland study on depression, suicide and education: Effects, shortcomings and challenges

Author(s): Walinder, J., Pihlgren, H., vonKnorring, L., Rihmer, Z.

Journal/Book: Int J Meth Psychiatr Res. 1996; 6: Baffins Lane, Chichester, W Sussex, England PO19 1UD. John Wiley & Sons Ltd. S9-S14.

Abstract: 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-treatment of depression. In 1982, the Swedish Committee for Prevention and Treatment 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 attended structured, interactive training workshops. As a result, the suicide rate, referrals to psychiatrists for depressive and melancholic states, 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 medication declined. The programme costs were 400,000 SEK, against an estimated cost saving of 140 million SEK. The effect on suicide, however, was mainly restricted to females, probably due to the failure of the healthcare system to reach depressed males. A new educational programme, recognizing the distinctive features of the male depressive syndrome, is being prepared in Gotland. Educational programmes aimed at general practitioners 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 complementary, gender-specific educational, diagnostic and therapeutic strategies.

Note: Article Rutz W, Visby Hosp, Dept Psychiat, S-62123 Visby, SWEDEN

Keyword(s): education; major depression; male depression; suicide; primary care

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