S-02-01

F. Rouillon. Hopital Albert Chenevier, Creteil Cedex, France

Objective: Depression is a life-threatening condition which is expected to play an even more important role in terms of burden of disease during the next years. The DALY's (“Disability Adjusted Life Years”, see Murray & Lopez 1996) increased from 3.3% to 4.6% during the last decade. The prevalence of affective disorders in France is amongst the highest in European Union: 5.8% (one year) and 20.9% (life time) for major depression and 1.6% and 7.5% respectively for dysthymia. Despite the high number of psychiatrists (N=13,000) and high prescription rates of antidepressants the French suicide rate is still one of the highest in Europe (N=11,500 or 20/100,000 inhabitants per year)

Methods: Embedded within European initiatives targeting at depression, the French programme is composed of combined actions on six levels: - increasing public understanding of affective disorders (uni- and bipolar) and awareness among different target groups • improving the screening of depressive disorders in primary care • offering an effective access to primary care, psychiatrists and specialised clinics, more effective utilisation of pharmacotherapy and psychotherapy in different settings referring to International Practice Guidelines-prevention of recurrence and chroniflcation by promotion of long term treatment • establishment of a network of collaborating centres being active in the field of research on depression

Results: This Program will begin in 2005. After five years it will be evaluated with respect to four indicators: suicide rate, prescription rates of individual psycho-pharmaceuticals, prevalence of depressives disorders within the general population (with or without treatment) and the ratio of patients treated with good or bad clinical practice.

S-02-02

A. Vänik. Estonian-Swedish Suicidology, Tallin, Estonia

Objective: Anti-alcohol policy during the perestroika in the former Soviet Union, between 1985-88, influenced an overall decline of 35.2% in suicide rates throughout the USSR. Regression analysis suggested that around 60% of male and 26% of female suicides in the Baltic republics, and 70% and 24% respectively in the Slavic republics, were attributable to alcohol. The purpose of the study was to test our previous findings on individual level.

Methods: 1) Ninety-one percent of suicides (n=427/469) committed during one calendar year were investigated by the psychological autopsy method in Estonia. Living controls matched with suicide victims by region, gender, age and nationality. Alcohol abuse or dependence was diagnosed according to DSM-IV criteria. 2) Alcohol concentration in blood of suicide victims (n=5059) for the years 1981-1992 was observed in Estonia.

Results: 1) Alcohol abuse and dependence were found in 60.8% of suicide victims and in 21.4% of controls (OR=8.0). Middle-aged male had the highest risk. 2) Before and after the years of strict alcohol limitation approximately in a half of suicidents' bodies alcohol was found in blood at medico-legal autopsy. The percentage decreased to 30% for the years of alcohol restriction and correlated with fall in suicide rates.

Conclusion: Our previous findings on aggregate level were confirmed on an individual level. More than half of male suicides (PAR=57.1%), and especially for males aged 35-59 (PAR=74.3%), were attributable to alcohol abuse and dependence. Role of alcohol intake as a provoking factor was confirmed. These findings contribute to the tailoring of suicide prevention programmes.

S-02-03

Depression and suicidality

J. Lönnqvist. National Public Health Inst. Dept. of Mental Health and Alc, Helsinki, Finland

Persons at the greatest suicide risk often suffer from co-morbid depression. Most have previously contacted health care, and/or communicated their suicidal tendencies. In major depression the risk of suicide is about 20-fold, and in other mood disorders 10-15 times higher than expected. In psychological autopsy studies depression is found in 29-88% of all suicides. The vast majority of depressive suicide victims have received inadequate or no specific treatment for depression. Only about one third have received antidepressant therapy, and very few regular psychotherapy, or ECT. Studies on attempted suicides give similar findings: co-morbidity and under-treatment is a fact. Population studies show that a large majority of all depressed individuals in society are under-recognized and under-treated. Although the efficacy of psychotherapy in suicide prevention is still an open question, the improvement in intermediate outcomes such as depressive symptoms, hopelessness, and in suicidal ideation with interpersonal psychotherapy, DBT, and CBT have been reported. Also antidepressants am effective in alleviating depression. Higher prescription rates of antidepressants am related to declines in suicide rates in several countries. In addition, there is some evidence of an anti-suicidal effect with lithium in mood disorders and clozapine in schizophrenia. A crucial issue for suicide prevention is the ability of society to establish and foster depression awareness campaigns, and to detect and properly treat depression in all health care setting.

S-02-04

The Nuremberg alliance against depression: Effects on suicidality

D. Althaus, G. Niklewski, A. Schmidtke, U. Hegerl, Department of Psychiatry, Ludw, Munich, Germany

Objective: Recent studies showed the increasing importance of depressive disorders. Despite good treatment possibilities (pharmacological treatment and psychotherapy) only a minority of patients receive adequate treatment. One of the most dramatic consequences is a big number of suicides. The aim of the Nuremberg Alliance against Depression (NAD) is to establish and to assess the effectiveness of a 4-level intervention program for improving the care of depressed patients.

Methods: In 2001 and 2002 a two-year community based intervention program was performed in Nuremberg (480,000 inhabitants). The program comprised four levels: 1. Training of family doctors and support thiough different materials 2. Public relations campaign informing about depression 3. Cooperation with community facilitators (teachers, priests, local media etc). 4. Support for self-help activities as well as for high risk groups The effects of the two-year intervention on the number of suicidal acts (completed suicides + suicide attempts, main outcome criterion) were evaluated with respect to a one-year baseline (2000) and a control region (Wuerzburg, 270,000 inhabitants).

Results: As compared to the control region, a reduction of suicidal acts was observed in Nuremberg during the two-year intervention (2001 vs. 2000: -19.4%; p ≤ 0.082; 2002 vs. 2000: - 24%; p ≤ 0.004). Considering suicide attempts only (secondary outcome criterion), the same effect was found (2001 vs. 2000:- 18,3%, p ≤ 0.023; 2002 vs. 2000: -26.5%; p ≤ 0.001). The reduction was most noticeable for high-risk methods (e.g. hanging, jumping, shooting). Concerning completed suicides there were no significant differences compared to the control region.

Conclusion: The NAD appeared to be effective in reducing suicidality. It provides a concept as well as many materials, which are presently implemented in several other intervention regions in Germany and other countries.