Citation

von Knorring L. Nord. J. Psychiatry 1991; 45(S24): 47-56.

Copyright

(Copyright © 1991, Informa - Taylor and Francis Group)

DOI

10.3109/08039489109096681

PMID

unavailable

Abstract

In Sweden, with about 8,500,000 inhabitants, it has been estimated that around 200,000 inhabitants have death thoughts every year, about 20,000 make suicide attempts, 2,000 commit suicide, and about 200 of these commit suicide while in psychiatric treatment. During the past 30 years, the suicide rate has been rather stable. However, by means of a birth cohort analysis it has been demonstrated that the risk for suicide in young men 20-24 years old has increased 3.5 times, and the corresponding risk for females 15-19 years old has increased 3 times. The male to female ratio has also decreased, from 3.4 to 2.6. However, suicides are still most common in elderly men. As in many other countries, the number of suicides during psychiatric treatment has increased dramatically from about 30 a year in the beginning of the fifties to around 200 a year. There are many reasons for this. Dramatic decreases in the number of hospital beds in combination with an increasing number of patients admitted and changing patterns of antidepressive treatment seem to have been important. However, administrative changes have also been of importance and it has been demonstrated that there was a pronounced increase in the number of suicides during psychiatric inpatient care when the sectorization of the psychiatric services was installed in the county of Vasterbotten. In several studies it has been demonstrated that adequate diagnosis of depressive disorders, adequate antidepressive treatment, and adequate choice of antidepressants are of great importance for the survival rate of depressed patients. In Sweden, the Swedish PTD Committee has undertaken a comprehensive evaluation of the effects of postgraduate medical training given to medical practitioners on the island of Gotland during the years 1983-1984. The educational program resulted in increased prescriptions of antidepressant drugs and decreasing prescriptions of major tranquilizers and benzodiazepines. The rate of sick leave for depressive disorders decreased as did the number of patients in inpatient treatment for depressive disorders. At the same time the suicide rate, earlier on the same level as that in Sweden as whole, decreased significantly. The year after the last educational program was given, the suicide rate on Gotland was the lowest in Sweden, about a third of that in Sweden as a whole. © 1991 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

Language: sv

Keywords

Education; Evaluation; human; suicide; Suicide; depression; Antidepressants; conference paper; amitriptyline; clomipramine; imipramine; mianserin; maprotiline