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Biomedical subjects

W Rutz

Publications and source records attributed to W Rutz.

At least 19 recordsLinked to original sources
PubMed2006

Social psychiatry and public mental health: present situation and future objectives. Time for rethinking and renaissance?

OBJECTIVE: To describe the social psychiatric challenges of modern psychiatry in European societies in the light of recent psychiatric research evidence and to show how these challenges could be conceptualized. METHOD: Reviewing aggregate morbidity and mortality data from the WHO European Health for All Database, and summarizing consultations and fact-finding missions to many European countries during the authors engagement as WHO Regional Advisor for Mental health from 1998 to 2004. RESULTS: Societal change in Europe is leading to stress and mental ill health for its populations. The consequence is a dramatic increase in burden due to mental illness and stress-related morbidity and mortality. CONCLUSION: A re-thought and re-conceptualized social and societal psychiatry with focus on public mental health must have a renaissance. Innovative efforts are of crucial and imperative importance seeing mental health in the light of recent experience and science as probably the most important public health issue.

Cause of Death↗
PubMed2001

Preventing suicide and premature death by education and treatment.

Suicide is a leading cause of mortality. It is, in principle, preventable - given the fact that we possess effective treatments for depressive illness, the major contributor to such mortality. Nonetheless, complex logistic problems have prevented the institution of successful suicide prevention programs. The present review summarizes the author's work on the island of Gotland in Sweden, where the small size of the population permitted the institution of an educational and treatment program aimed at the general medical practitioners. The program was successful in reducing suicide rates by 60%. This was accompanied by reduction of different indices measuring depressive morbidity. Prevention was successful for as long as the program was instituted. The author provides his reflections on the public health implications of his data - particularly for Eastern Europe which is experiencing widespread stress in the workplace and in economic situations. More hypothetically, he presents his views on a serotonin-mediated 'male suicide syndrome'.

Cause of Death↗
PubMed2001

Mental health in Europe: problems, advances and challenges.

OBJECTIVE: To describe mental health care needs and challenges across the WHO European region of 51 nations. METHOD: Based on morbidity and mortality data from HFA Statistical Database and Health2l, the policy framework of WHO Europe, major trends in mental health care needs, psychiatric reform and mental health promotion are discussed. RESULTS: There is a mortality crisis related to mental ill health in Eastern European populations of transition. Destigmatization is required to improve early intervention and humanization of services, and national mental health audits are needed to create the basis for national mental health planning, implementation and monitoring. There are both problems and advances in service restructuring, and comprehensive mental health promotion programmes, preventive and monitoring strategies are required. CONCLUSION: Partnerships between national and international organizations, especially WHO and the European Union, have to be strengthened to make progress on the way to integrated community mental health services.

Europe↗
PubMed1999

[Male depression--stress reaction combined with serotonin deficiency?].

An educational programme on depressive disorders, given to general practitioners on the Swedish island of Gotland, resulted in a statistically significant reduction of the suicide rate among women, though that among men was virtually unaffected. Further analysis showed the profile of depression among men to differ from that among women, the male pattern typically being more characterised by irritability, aggressiveness, acting out, antisocial behaviour and alcohol abuse, and reduced impulse control and stress tolerance. Predisposition to affective disorders, suicide and alcoholism seems to be genetically determined. The syndrome, which is not easily recognised and is seldom properly treated or prevented, seems to be related to central serotonin deficiency and hypercortisolaemia.

Aggression↗
PubMed1999

Improvement of care for people suffering from depression: the need for comprehensive education.

In the years 1983-1984, the Swedish Committee for Prevention and Treatment of Depressions (PTD) offered an educational programme to all general practioners (GPs) on the Swedish island of Gotland. This education has led to a significant decrease in inpatient care, morbidity, mortality and costs incurred by depressive illness on the island. Unspecific medication decreased and specific antidepressive medication increased. Recent scrutiny of all suicides on Gotland during the 1980s showed that the overall decrease due to the educational programme was mainly in those committed by females with recognized major depression who had been in contact with GPs. This was expected. However, the number of male suicides was almost unaffected by the educational programme nor by the GPs' improved ability to diagnose and treat depressions. We believe that male depressive suicidants may not be reached by the medical health care system. This might be due to mens' alexithymic incapacity to ask for help and/or their atypical depressive symptoms, manifested by aggressive or abusive behaviour that leads to rejection or mis-diagnosis in the health care system. Consequently, there is underdiagnosis and undertreatment of male depressions which may explain the paradoxical fact that men in Sweden and elsewhere are only half as often depressed but commit suicides up to five times more often than females in Sweden. New sex-specific diagnostical and therapeutical tools as well as sex specific research and comprehensive educational programs concerning depression and suicidality are needed.

Depressive Disorder↗
PubMed1998

Decreasing tendency of seasonality in suicide may indicate lowering rate of depressive suicides in the population.

The seasonality of suicide is well known and a repeatedly demonstrated phenomenon. The authors analyzed the seasonality of 148 suicide events on Gotland between 1981 and 1996. A marked and significant seasonality with a spring and summer peak was found between 1981 and 1989, when the prescription of antidepressants was relatively low and stable. However, this seasonality disappeared in the period between 1990 and 1996, when prescription of antidepressants increased dramatically, indicating that more and more depressed patients were pharmacologically treated. As the seasonality of suicide in the population is the reflection of the seasonal nature of depressive suicides, the result suggests that a decreasing tendency of seasonality in suicide may indicate the lowering rate of depressive suicides in the given population.

Adolescent↗
PubMed1995

Depression and suicide on Gotland. An intensive study of all suicides before and after a depression-training programme for general practitioners.

In 1983 and 1984, the Swedish Committee for the Prevention and Treatment of Depression (PTD) organised a postgraduate training programme on the diagnosis and treatment to all the general practitioners on Gotland, Sweden. In the following years, the frequency of suicide and inpatient care for depression decreased significantly, as well as the frequency of sick leave for depression. The results of the Gotland study have provided evidence for the view that early recognition and adequate treatment of depression is one essential method of suicide prevention (Rutz et al., 1989; Rutz et al., 1992). A detailed retrospective clinical analysis, of all 115 consecutive suicide victims on Gotland between 1981 and 1992 presented in this study, showed that male gender and violent methods were overrepresented. 50 suicides had a DSM-III-R axis I diagnosis and half of them (n = 25) had primary major depression. Bipolar II disorder was relatively overrepresented in this sample. After the PTD programme, the proportion of depressive suicides was significantly lower than before. This finding strongly suggests that the significant decrease in the suicide rate after the PTD programme is a direct result of the robust decrease in depressive suicides of the area served by trained GPs. The practical importance of this finding is briefly discussed.

Adolescent↗
PubMed1994

[Regional distribution of working physicians, diagnosed cases of depression and suicide mortality in Hungary].

Based on the well-known and strong relationship between suicide and depression, the authors investigated the regional distribution of the suicide rates, rates of diagnosed depressions and rates of working physicians in Hungary. It was found a strong significant positive correlation between the of working doctors and rate of diagnosed depressions, and both the mentioned parameters showed a strong significant negative correlation with the suicide rates. The more is the number of doctors/100,000 inhabitants, the better is the recognition of depression and the lower is the suicide rate in the given region. The rate of working doctors was significantly higher in the countries located in the western part of Hungary, which may have a role in the lower suicide mortality of this area of the country.

Depression↗
PubMed1993

Suicide rate, prevalence of diagnosed depression and prevalence of working physicians in Hungary.

Based on the well-known relationship between depression and suicide, we investigated the regional distribution of the suicide rate, rate of diagnosed depression and prevalence of working physicians in Hungary. A strong significant positive correlation was found between the rate of working physicians and rate of diagnosed depression, and both parameters showed a strong significant negative correlation with the suicide rate. The more physicians per 100,000 inhabitants, the better is the recognition of depression and the lower is the suicide rate in the given region. The rate of working doctors was significantly higher in the counties located in western Hungary, which may have a role in the lower suicide mortality in this area of the country.

Depressive Disorder↗