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Cited by 212Suicide and Self-Harm StudiesMental Health Treatment and AccessHomicide, Infanticide, and Child Abuse

A Suicide Prevention Program in a Region With a Very High Suicide Rate

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Szanto, Katalin, Kalmar, Sandor, Hendin, Herbert, Rihmer, Zoltan, Mann, J. John·2007·Archives of General Psychiatry
DOI 10.1001/archpsyc.64.8.914
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Abstract

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 (P < .001 and P < .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 < .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 < .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.

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  • Repeated education sessions reduced suicide rates progressively for years.

    “Repeated education sessions reduced suicide rates progressively for years.(12, 21)”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [12]

    The Intervention Training section documents repeated education sessions, and the Primary Outcome section reports a lower mean annual suicide rate during the five intervention years than during the five preceding years. The paper does not establish that rates fell progressively year by year; the Comment section also says it cannot determine whether education, additional resources, or both accounted for the change. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • In areas with suicide rates 3-10 times higher than the U.S., screening for depression combined with referral for depression treatment by a primary care doctor or psychiatrist lowered suicide rates relative to a contemporaneous geographic control.

    “Areas with suicide rates 3–10 times higher than the U.S., have shown that screening for depression combined with referral for depression treatment by a primary care doctor or psychiatrist lowered suicide rates relative to a contemporaneous geographic control.(12, 15–17)”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [12]

    The Improving Access to Depression Treatment section describes GP depression screening and referral to a depression clinic. The Primary Outcome section reports a greater decline in suicide rates than in the surrounding county, but no overall difference in the change relative to the nearby local control region; the rural-women comparison was a trend (P=.07). The claim overstates the result if “contemporaneous geographic control” means that local control region. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Training primary care doctors and nurses to better screen and treat depression, with supplemental psychiatric help, lowered suicide rates.

    “Training primary care doctors and nurses at the local and state level to better screen and treat depression with supplemental help available from psychiatrists, lowered suicide rates,(12–19) nonfatal suicide attempts(20, 21) and ideation(22) (Table 2).”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [12]

  • Targeting internal stressors by training primary care providers in the management of major depressive episodes prevents suicide.

    “Targeting internal stressors by training primary care providers in the management of major depressive episodes prevents suicide (6).”

    From A brain-centric model of suicidal behavior (2020) · cites this paper as [6]

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Authors
Szanto, K., Kalmar, S., Hendin, H., Rihmer, Z., & Mann, J. J.
Affiliations
  • University of Pittsburgh (US)
  • New York State Psychiatric Institute (US)
ORCID
Mann, J. John
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2007-08-01
Volume
64
Issue
8
Pages
914
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.64.8.914
OpenAlex
W2132544997
Cited by
212
References
30
Citations by year
2026: 2 · 2025: 5 · 2024: 6 · 2023: 6 · 2022: 10 · 2021: 8 · 2020: 9 · 2019: 14 · 2018: 5 · 2017: 8 · 2016: 9 · 2015: 17 · 2014: 15 · 2013: 25 · 2012: 12
FWCI
17.03
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Foundation for Suicide Prevention
  • National Institute of Mental Health (K23MH070471)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
suicide prevention, suicide rates, depression treatment, general practitioners, depression education, antidepressant prescribing, rural suicide, sex differences in suicide, alcoholism
MeSH terms
Suicide Prevention, Adult, Antidepressive Agents, Curriculum, Depressive Disorder, Drug Utilization, Education, Medical, Continuing, Family Practice, Health Education, Humans, Hungary, Liver Diseases, Alcoholic, Middle Aged, Practice Patterns, Physicians', Drug Prescriptions, Psychiatry, Risk Factors, Sex Factors, Suicide, Program Evaluation, Comorbidity, Program Development, Remote Consultation

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