Hawai'i is among the states with the fewest depressed residents and suicides per 100,000 people, according to a national report released yesterday.

Hawai'i's suicide rate places it 41st in the country, and it is the second-least depressed state, reports Mental Health America, a nonprofit that promotes mental wellness.

"It's a positive ranking but we can't see this as a time to relax and say 'Gee, we're rated petty good,' " said Dr. Thomas Hester, chief of the Adult Mental Health Division at the Hawai'i Department of Health. "The overall message is to redouble our effort in reducing suicides in Hawai'i. We shouldn't feel comforted by this report. Currently, we have one suicide every three days in Hawai'i. We can do better."

The study ranked depression based on the percentage of the adults and adolescents experiencing at least one major depressive episode in the past year, the percentage of adults experiencing serious psychological distress and the average number of days in the last 30 days in which the population reported that their mental health was not good.

South Dakota ranked as the "least depressed" state, followed by Hawai'i, New Jersey, Iowa, Maryland, Minnesota, Louisiana, Illinois, North Dakota and Texas. The "most depressed" state is Utah, followed by West Virginia, Kentucky, Rhode Island, Nevada, Oklahoma, Idaho, Missouri, Ohio and Wyoming.

The District of Columbia has the lowest suicide rate, followed by New York, Massachusetts, New Jersey, Rhode Island, Illinois, Connecticut, Maryland and Hawai'i. The highest suicide rates are in Alaska, Nevada, New Mexico, Montana, Wyoming, Idaho and Utah.

The study, "Ranking America's Mental Health: An Analysis of Depression Across the States," said states with better access to care had lower suicide and depression rates.

ACCESS TO CARE IS KEY

Hester called Hawai'i's ranking "encouraging" but said it doesn't tell the whole story of suicide and depression in the state.

"It's encouraging to see we have better access to services than most states," Hester said. "Now we need to see a communitywide effort to reduce suicides and depression and deal with it like we would in teaching someone CPR or the Heimlich Maneuver. Give people the tools to deal with both."

The Mental Health America study said factors contributing to lower suicide and depression rates included access to psychiatrists, psychologists and social workers; lower healthcare costs; more people receiving mental health treatment; and more people with health insurance. The study was supported through an unrestricted educational grant from Wyeth Pharmaceuticals.

More than 21 million people in America are affected by depression each year and it is the principal cause of 30,000 suicides annually, according to Mental Health America. Many of those suicides could have been prevented with early identification of depression, prevention and treatment, the group said. It released the rankings so states would review their approaches to mental health coverage.

Marya Grambs, executive director of Mental Health America of Hawai'i, was cautious about Hawai'i's rankings.

"The fact that we have more access to healthcare than most states is a big factor in our rankings," Grambs said. "In many, many ways we're in good shape and this report shows it, but I also think it masks some real concerns here.

"We have some cultural issues that contribute to getting a complete read. In some Asian cultures, for example, it's viewed as shameful to have depression or mental problems and dishonorable to talk about it, so they go undiagnosed. They also may view suicide differently. Another factor in our lower suicide rate is that we have some of the strictest gun laws in the country. That helps significantly."

HIGH-RISK POPULATIONS

Both Hester and Grambs are concerned that the report doesn't acknowledge that Native Hawaiians have a higher suicide rate or that Hawai'i teens, particularly high school freshmen, have either thought about or attempted suicide at a higher rate than anywhere else in the country, according to a 2005 study by the Department of Health and Department of Education.

The Youth Risk Behavior Surveillance Study showed that 17 percent of Hawai'i's students reported making a suicide plan, nearly 20 percent seriously considered attempting suicide and 13 percent reported having attempted suicide.

Reach Dave Dondoneau at ddondoneau@honoluluadvertiser.com.