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Research on Depression in the Workplace.

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Mental Health Matters Journal for Psychiatrists & GP's

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Literacy is a luxury that many of us take for granted.  We depend on written communication for information, guidance, and access to heath care information That is why SADAG created SPEAKING BOOKS and revolutionized the way information is delivered to low literacy communities. It's exactly what it sounds like.a book that talks to the reader in his or her local  language, delivering critical information in an interactive, and educational way.

The customizable 16-page book, accompanied by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood..

We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 30 titles, such as TB, Malaria, Polio, Vaccines for over 30 countries.

suicide speaking book

As soon as the Depression and Anxiety Support Group in South Africa was made aware of the GAMIAN Depression Awareness and Suicide Prevention programme we couldn’t wait to obtain a copy. From what we had heard from the chairman of GAMIAN, Mary Guardino and Donna Zembrod from Eli Lilly, the sponsors, we felt sure that we would be able to make full use of it immediately.

Having received an advance set we decided South Africa’s greatest need at this time was to build awareness of depression and its potential for suicide at GP level. Although a relatively new group, we have tremendous support from most of South Africa’s psychiatrists (there are only 250 for the whole of South Africa), and felt it would be an ideal programme to persue for 1999.

On considering the programme with its 79 slides we had to choose which would be the most relevant and appropriate for doctors. We selected 28 slides from the Depression section and most of the slides relating to suicide in adolescents and the elderly. We planned to make it last about 90 minutes, and to devote at least one third to suicide.

The kit is so comprehensive in its slide and overhead format that even in very underprivileged areas we have been able to make overheads and take along a portable projector.

The accompanying workbooks are so well thought out and concise that even a small regional group with no prior experience of presenting an educational campaign would find it easy to do so, whether targeting professionals or the public.

The only major change we made to the programme was to have additional slides and overheads made showing South Africa’s own statistics on suicide. Although these figures are very out of date it was really necessary to show how vital a problem this is in South Africa.


Giyani – A grade 12 pupil hanged himself on Wednesday morning at his home in Malamulele village when his mother told him she could not afford R30 ($5) to buy him a school textbook.

Donald Maluleke, a pupil at Nkantini High School, was found hanging from a rope in his bedroom by his mother, who is a pensioner and a single parent.

Maluleke requested the money, and hanged himself when she said she did not have it,” police spokesperson Captain Thomas Ramatseba said yesterday. – African Eye News Service.


We have now completed over 11 of these programmes (1 or 2 per week) and the results are very encouraging. The turn out of doctors varies from a low of 12 to an average of 35 to a high of over 50 – which shows the incredible interest in suicide prevention. Like most countries in the world our South African GPs have only 1 or maximum 2 lectures on suicidal patients during their medical training.

In order to obtain a list of doctors in all the areas (the populations of which vary from 12 000 to over 1 million), we concentrated on doctor groups, hospitals, sponsors, Pharmaceutical Companies, medical reference books, Family Practice Associations, etc.

Subsequently we have decided to expand the programme to other professionals at the same meetings. We have included Gyneacologists (due to Post Natal Depression), Psychologists and Psychiatric Nurses who also are likely to come across potential suicide patients.

We initially felt that the success of the presentation would rely heavily on the speaker, but due to all the work having being done for them and the accompanying manual being so comprehensive, we have realised that even a very shy or inexperienced speaker can handle the content very well and we are now undertaking a further campaign where we are training our own counselors and Regional Co-ordinators to present this project to school teachers. In South Africa we have significant numbers of children who contemplate and often attempt suicide particularly towards September, October and November when our year end exams start taking place.

We felt that in order to further identify our Support Group to the doctors, we would prepare an opening slide depicting the South African Depression and Anxiety Support Group and GAMIAN’s logo which is in place as the doctors arrive at each meeting.


We also produced slides highlighting our major sponsors which go up at the end of the meeting whilst we thank our guest psychiatrist and sponsors for making it possible for the meeting to take place.

We have also prepared an introductory welcome speech to the appropriate psychiatrist presenting this course, and which thanked the pharmaceutical sponsor who has funded the evening.

We discovered that in South Africa there is a huge disparity of knowledge on Depression. Our urban areas attend meetings frequently and keep up to date, whereas rural doctors do not have the same opportunity and the speaker can expect many more questions. Questions varied from how to certify (institutionalise) suicidal patients, to which are the most effective medications, the success of therapy and medication combined, post-partum Depression, safety of medication in pregnant women, etc.

As an advocacy group The Depression and Anxiety Support Group has been particularly delighted by the many questions asked about our group, the work we do, local support groups, how the public can get involved with us, etc. We found it a wonderful opportunity to showcase our brochures, newsletters, and promotional material, and to introduce our local regional co-ordinator. In some areas it has led to doctors volunteering to start Support Groups where there are currently none available.

Prior to the meetings we undertake 3 additional duties. Firstly, we try and get press placed in the local media in order to highlight the need for everyone to become more aware of the incidence of suicide in South Africa, particularly amongst teenagers. We also ask doctors to complete a questionnaire asking very basic questions pertaining to their current knowledge of Depression, its symptoms and treatment. We are just starting now to fill in a follow-up questionnaire which means we can assess not only the content of the programme, but the quality of the speaker, the length of the presentations and most importantly, if they are now identifying more patients than they were three months ago.

We also applied for CPD (CME points) as an additional incentive to encourage doctors to attend, and in recognising the very professional nature of the programme, we were awarded them. This is South Africa’s first year of CPD points, so it is really an incentive.

We also prepared accompanying notes to the presentation for doctors to scribble on. The slide information was printed on the left-hand side and a blank space on the right. This was fine providing the presenter did not decide to change his slide order at the last moment, which happened to us!!!

It has been debatable whether our current format of 75 minutes talking followed by questions and a light snack or supper is the most ideal, or to consider a break for refreshments in the middle. We are still completing the programme in a single sitting, but a break after 45 minutes may be more suitable for certain audiences.

Overall, the programme has been very well received by many different parties. The psychiatrists who presented it felt honored to be associated with a programme of such high quality and extensive content. The doctors believe it to be truly valuable, and have requested similar programmes to be presented. The sponsors have been very supportive and after completing one with us have agreed to fund more (currently we have 7 pharmaceutical companies participating). It gives our regional co-ordinators the opportunity to raise their profile in their local community and talk to a large number of doctors about our activities.

According to Dr. Danie Du Plessis, Central Nervous System Director at Eli Lilly, South Africa, “Eli Lilly is delighted to be able to support the Depression Awareness and Suicide Prevention Programme and to continue its commitment to patients, families, support groups and healthcare providers in assisting to bring about a reduction in the number of needless and tragic deaths resulting from suicide.” Dr. Franco Colin, a prominent Pretoria Psychiatrist, believes that, “awareness and education are imperative to reduce or control the increasing rate of suicide in South Africa. Early recognition of mental disorders in general is vital to detecting signs of suicidal behaviour.” He adds, “educating both professionals and the public to behaviour indicative of suicide is necessary to alleviate the problem and reach out to those who are suffering.”

Sincere thanks are to be extended to GAMIAN, Mary Guardino and all involved in the presentation, and to Eli Lilly for their funding which will be appreciated throughout the world. This programme I can honestly recommend as requiring minimum work for an amazingly successful pay off. In terms of time management, when all charities are stretched for every minute of the day, remarkably little time will bring a very much appreciated / needed response.


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