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Suicide and suicide attempts in the Netherlands: the role of general practitioners.

Marquet, R.L., Bartelds, A.I.M., Zee, J. van der, Schellevis, F.G. Suicide and suicide attempts in the Netherlands: the role of general practitioners. European Journal of Public Health: 2004, 14(4 Suppl.) 14. Abstract. 12 th Annual EUPHA meeting: Urbanisation and health: new challenges in health promotion and prevention in Oslo, Norway, 7-9 october 2004.
Similarly as in most Western countries, suicide (S) and suicide attempts (SA) are major health
problems because of many years of life lost. Many patients committing S or SA consult their GP in
the period preceding S/SA, suggesting thar GPs may play a key role in prevention. Aim: We used data
from the Dutch Sentinel GP Network over the period 1983-2003 to delineate typical characteristics of
S/SA patients and to analyse the role of GPs with regard to care, referral and recognition
of vulnerable persons. Methods: The data were derived from the Sentinel Network, which constitutes a
sample of about 60 GPs, covers 1% of the Dutch population and is fairly representative with regard
to age, sex, geographical
distribution and urbanisation. Gps reported on the incidence of S and SA and provided additional
data on sex, age, household, method, place, contact with GP, depression, medication, referral and
whether the GP had foreseen S or SA.
Results: From 1983-2003 the number of S steadily decreased from 11/100.000 to 6/100.000; SA declined
from 53/100.000 to 27/100.000, 1998-2001 appeared a crucial turning point for decline. Most suicides
were first attempts (75%). About 50% of S and 70% of SA was committed between the age of 20 and 50
years, with prominent peaks for S in the age groups 30-39 and >60. Suicides were more common in
persons living alone, SA occurred more frequently in households consisting of 3 or more persons. A
majority of S/SA patients was treated for depression (60%). Only 7% of them ever mentioned thoughts
about committing S. Nearly all depressed patients (90%) were treated with an antidepressant; from
1993 onward SSRIs prevailed. GPs referred 65% of their depressed patients to a psychiatrist. About
half of the S/SA patients had contacted their GP in the 30-day period preceding S or SA; GPs
reported that they had foreseen S/SA in 31% of these cases. Conclusions: The number of S and SA
occurring in Dutch general practice has declined over the years. Depression is the major underlying
disease for which most patients are referred to a psychiatrist. Especially in young and older
depressed persons, living alone, GPs should ask for suicidal ideation, making it debatable, to
enhance recognition and
improve prevention.