No abstract

TTENTION TO DEPRESSION AND suicide in physicians is long overdue. As early as 1858, physicians in England observed that a higher suicide rate exists among physicians than the general population. 1 Since the 1960s, research confirmed physicians' higher suicide rate and identified depression as a major risk factor. 2,3 Most strikingly, suicide is a disproportionately high cause of mortality in physicians, 4 with all published studies 5,6 indicating a particularly high suicide rate in female physicians.Inattention to depression and suicide in physicians sharply contrasts with heightened attention to physicians' smoking-related mortality. Since the 1960s, declines of 40% to 60% have oc-Author Affiliations: Employment Law Center and the

The objective of this investigation was to examine suicidal ideation and depression in undergraduate college students who participated in the American Foundation for Suicide Prevention-sponsored College Screening Project at Emory University. The principal measure of depressive symptoms was the nine-item depression module from the Patient Health Questionnaire (PHQ-9). Additional questions were focused on current suicidal ideation, past suicide attempts, and episodes of deliberate self-harm and on symptoms of anxiety and distress. Seven hundred and twenty-nine students participated over a 3-school-year interval (2002-2005). Most notably, 11.1% of the students endorsed current (past 4 weeks) suicidal ideation and 16.5% had a lifetime suicide attempt or self-injurious episode. Students with current suicidal ideation had significantly higher depression symptom severity than those without suicidal ideation (t = -9.34, df = 706, P<.0001, d = 1.9), and 28.5% of the students with PHQ-9 scores of 15 or higher reported suicidal ideation compared to 5.7% of those with lower scores (chi(2) = 56.29, df = 1, P<.0001, two-tailed). Suicidal ideation was prominently associated with symptoms of desperation (odds ratio 2.6, 95% CI 1.5-4.6, P<.001). The vast majority of students with moderately severe to severe depression (85%) or current suicidal ideation (84%) were not receiving any psychiatric treatment at the time of assessment. These results suggest that there is a strong relationship between severity of depressive symptoms and suicidal ideation in college students, and that suicidal feelings and actions are relatively common in this group. This underscores the need to provide effective mental health outreach and treatment services to this vulnerable population. As this analysis was based on data collected at a single institution, the results may not be representative of all college students or young adults.

Clinicians felt they learned from participating in the project and that it was therapeutic for them. Review of such cases by a disinterested independent group with no institutional ties to the therapists seems desirable.

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...