ognition and treatment of depressive disorders. Training included interactive seminars. A primary goal of the program was to increase general practitioners’ responsibility for treating depressive disorders. Several variables were monitored, including psychiatric referrals, sick leave for depression, psychiatric inpatient hospitalization, suicides, and prescriptions for antidepressant and anti-anxiety (anxiolytic) medications. When compared to suicide rates of the preceding 4 years, Rutz and colleagues (Rutz et al., 1989) found a significant decrease after the physician training. Referrals to psychiatry for depression decreased by over 50 percent and inpatient care for depression decreased by approximately 75 percent. The number of prescriptions for antidepressants increased, whereas the number of prescriptions for anxiolytics decreased. It should be mentioned that the analysis of the results was subsequently debated (Macdonald, 1995; e.g., Williams and Goldney, 1994), and the suicide rate increased again over time, coinciding with about half of the trained physicians leaving their positions (Rutz et al., 1992; see also discussion in Chapter 7).

Primary care provides a critical opportunity for suicide reduction in the United States as well (Chapter 9). However, significant barriers need to be addressed before primary care can serve as an effective conduit to mental health treatment including the treatment of suicidality. These include fractionation of services, lack of motivation of consumers and providers for mental health services, as well as economic barriers (DHHS 2002; see Chapter 9).

Support/Skills Training

The personal competency training program for youth in five urban high schools, Reconnecting Youth (RY) (Eggert et al., 1995a), serves as a model program for this review. Because approximately 35–40 percent of youth at risk for school failure are also at risk for suicide (Thompson and Eggert, 1999), potential high school dropouts are the targeted audience. This program is delivered in high school classrooms to small groups of 10 youths per teacher/ facilitator. The class was offered as an elective as part of the student’s school schedule. It was offered usually on a daily basis for 55 minutes over a full semester (90 sessions), or following the schedule used for other classes in the school’s time table.

All students participated in a comprehensive suicide-risk assessment (using the Measure of Adolescent Potential for Suicide [MAPS], Eggert et al., 1994) and social connections intervention, called Counselors-CARE (C-CARE). They were sorted into three groups: Group I youth participated in one semester of RY; Group II youth completed two semesters of RY; and Group III, the “usual care” comparison group, had the comprehensive assessment only. When at-risk youth participated in support/



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