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Katalin Szanto, MD; Sandor Kalmar, MD; Herbert Hendin, MD; Zoltan Rihmer, MD, PhD, DSc; J. John Mann, MD

Arch Gen Psychiatry. 2007;64(8):914-920.

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.

Author Affiliations: University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania (Dr Szanto); Semmelweis Hospital, Kiskunhalas (Dr Kalmar), and National Institute of Psychiatry and Neurology, Budapest (Dr Rihmer), Hungary; and Suicide Prevention International (Dr Hendin) and Department of Psychiatry, Division of Neuroscience, Columbia University and New York State Psychiatric Institute (Dr Mann), New York.

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