ABSTRACTS - World Psychiatric Association

those following birth. Very little is known about the sequelae for the
mother of relinquishing a child for adoption by another family. Treating
women who have had abortions requires a review of the circumstances
that led to the abortion, the experience of the abortion, and
the reactions of friends and relatives. Women who have borne children
of unwanted pregnancies may need psychotherapeutic help to
resolve the feelings inherent in that situation.
US9.3.
GENDER DIFFERENCES IN TREATMENT SEEKING
FOR MENTAL DISORDERS IN THREE COUNTRIES
WITH DIFFERENT SOCIOECONOMIC STATUS
M.B. Rondon
Department of Psychiatry and Mental Health, Universidad
Peruana Cayetano Heredia, Lima, Peru
Health seeking is a complex process, the dynamics of which depend
on a series of socio-demographic and socio-cultural factors. Race and
gender have been found to influence help seeking behavior, in addition
to social economic status and educational level. A study comparing
gender sensitive mental health indicators in Canada, Colombia
and Peru found that women that perceive their mental health is
poor are less likely than other women to seek treatment. Men in
Colombia, who have surprisingly high rates of depression and anxiety,
are more prone to seek treatment than women under the same circumstances.
These findings prompt us to reconsider the usual determinants
of treatment seeking behavior and to give consideration to
inequities determined by the submissive position of women in each of
these countries. Consideration should be given to the existence of
stigma towards mental illness, as well the common perceptions that
there are no effective treatments for mental diseases and that available
health services are of poor quality.
US10.
SUICIDE PREVENTION: INTEGRATION OF PUBLIC
HEALTH AND CLINICAL ACTIONS
US10.1.
SUICIDE CAN BE PREVENTED THROUGH CLINICAL
AND PUBLIC HEALTH APPROACHES
D. Wasserman
National Prevention of Suicide and Mental Ill-Health (NASP)
at Karolinska Institute, Stockholm, Sweden
Suicide prevention strategies can be directed at the general population
or the health care services. For maximum overall impact, it is
advisable for a public health approach to go hand in hand with a
health care approach. Suicide-preventive effects of treatment with
antidepressants, lithium, antipsychotics, dialectical behavioural therapy
and cognitive behavioural therapy to date are encouraging. Suicide
risk is high among psychiatric patients and suicide attempters,
particularly after their discharge from hospital. Careful follow-up and
rehabilitation plans should be provided. Adequate treatment of psychiatric
disorders and improved detection of psychiatric illnesses in
the general population are also essential. Successful public health
preventative measures to reduce the number of suicides also include
programmes which restrict access to guns, agricultural chemicals,
pesticides, and raticides. Perestroika in the former USSR was history’s
most effective suicide-preventive programme for men, where strict
alcohol limitations were imposed and reduced consumption was
actively promoted. An example of an effective strategy for combating
mental illness and associated suicides in young people is the
WPA/WHO initiative “Global Child Mental Health”, which aims to
increase mental health awareness amongst students, teachers and
other school staff, and parents, as well as to promote early diagnosis
and treatment of psychiatric diseases and psychological problems. We
outline how this initiative is to be used in the European Union
research program SAYLE (SAving Young Lives in Europe).
US10.2.
THE ROLE OF HEALTH CARE WORKERS
IN SUICIDE PREVENTION: FOCUS ON MOOD
DISORDERS
Z. Rihmer
Department of Clinical and Theoretical Mental Health, Faculty
of Medicine, Semmelweis University, Budapest, Hungary
Suicidal behaviour is a relatively rare event in the community, but it is
quite common among psychiatric patients, who contact different levels
of health care services some weeks or months before the suicidal
event. Over 90 percent of suicide victims have at least one current Axis
I mental disorder, most frequently severe major depressive episode
(56-87%), which, in the majority of cases, is unrecognized or untreated.
As up to 66% of suicide victims (two-thirds of them with current
depression) contact their general practitioner or psychiatrist 4 weeks
before their death, health care workers play a priority role in suicide
prediction and prevention. Following the pioneering Swedish Gotland
Study, some large-scale community studies (like the Nuremberg
Alliance Against Depression, the Swedish Jamtland Study and the
recent Hungarian Kiskunhalas Suicide Prevention Study) demonstrated
that education of general practitioners on the diagnosis and treatment
of depression, particularly in combination with psychosocial
interventions and public education, improved the correct identification
and treatment of depressive disorders and reduced the frequency
of suicidal behaviour in the areas served by trained practitioners. Clinical
follow-up studies on severely ill formerly hospitalized patients
with unipolar and bipolar major mood disorders, performed in the
frame of outpatient psychiatry, also have shown that long-term pharmacotherapy
with antidepressants and/or mood stabilizers markedly
reduced the risk of attempted and completed suicide in this high-risk
population. Although appropriate pharmacotherapy of mood disorders
is essential for suicide prevention, the importance of comorbid
substance-related and personality disorders as well as other psychiatric
and psychosocial suicide risk factors should be also considered.
US10.3.
FROM THE NUREMBERG TO THE EUROPEAN
ALLIANCE AGAINST DEPRESSION: PREVENTING
SUICIDALITY BY COMMUNITY BASED
INTERVENTIONS
U. Hegerl, and the European Alliance Against Depression team
Department of Psychiatry, University Hospital, Leipzig, Germany
Improving the care of depressed patients, reducing access to lethal
means and avoiding the Werther effect (imitation suicide) are the
most promising means to reduce suicide rates. The Nuremberg
Alliance against Depression has provided evidence for the effectiveness
of a four-level community based intervention concept. The fourlevel
intervention comprised cooperation with general practitioners,
a public relations campaign, cooperation with community facilitators
and local media, and support of self help activities. Careful evaluation
with respect to both a baseline year and a control region revealed a
significant effect concerning the number of suicidal acts (completed +
14 World Psychiatry 8:S1 - February 2009