Prevention of suicide and depression

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Abstract
In the years 1983–84, the Swedish Committee for the Prevention and Treatment of Depression (PTD) offered an educational programme to all general practitioners (GP:s) on the Swedish island of Gotland. The education has been shown to lead to a significant decrease in inpatient care, morbidity, mortality and costs caused by depressive illness on the island. Unspecific medication decreased and specific anti-depressive medication increased. A scrutiny of all suicides on Gotland during the 1980s revealed that the overall decrease in suicides as a result of the educational programme was caused mainly by the decrease in suicides committed by female suicidants with recognized major depression and in contact with general practitioners. This was expected. However, the number of male suicides was almost unaffected by the educational programme, as well as improvement in the GPs ability to diagnose and treat depression. This was unexpected. We believe that the reason for this is that male depressive suicidants are possibly not reached by the medical health care system. This might be due to males' alexithymic incapacity to seek help and/or their atypical depressive, acting out, or abusive behaviour leading to rejection or misdiagnosis in the health care system. Consequently, underdiagnosis and undertreatment of male depression exist and may explain the paradoxical fact that men in Sweden are only half as often depressed as females but commit suicide up to five times more. New sex-specific diagnostic and therapeutic tools as well as sex-specific research concerning depression and suicidality are needed.