A perspective on suicides in the ‘90s

Abstract

There has been renewed interest in suicide with the Royal College of Psychiatrists' con fidential enquiry into suicides, and the publication of the government White Paper The Health of the Nation (Department of Health, 1992). Prevention of suicide depends on accurate understanding of the factors leading to suicide. Barraclough et als (1974) influential study found that the vast majority of completed suicides were mentally ill and most had had some contact with a doctor in the previous month, so that there was "no lack of opportunities for their suicidal intentions to be recognised and treated". However, since that study there have been changes in the structure of the population and increases in the numbers of younger men committing suicide (McClure, 1987). We therefore set out to obtain a more up-to-date view by examining all suicides within our catchment area, looking at their consulting behaviour, and whether there was any alienation from partners, rela tives or others. The studyWe searched the coroners' records from 1988 to 1991 inclusive, for all suicide, open and misadventure verdicts of residents of our catchment area, and made summaries. The population of 305000 lives mainly in small towns, with a third being rural agricultural. As a cross-check we also had available a list of suicides and undetermined injury (ICD E950-959 + E980-989) obtained from death certifi cate returns to the Director of Public Health. Hospital records were obtained for all those known to psychiatric services, and general practitioner notes were obtained through the relevant Family Health Service Authorities for 101 of the 112 suicides. These were searched for details of contacts with services in the year before death. The main clinical feature of each case was classed as either psychiatric disor der, physical illness or social distress. This was a subjective consensus of all eight con sultant psychiatrists. Cases in which social problems were associated with conditions such as chronic depression, alcoholism or personality disorder were classed as psychia tric disorder. We examined the coroners' records for any indications of alienation, look ing for breakdown or lack of relationships with family, friends or professionals. Examples included ending of a relationship, divorce proceedings, having no friends, or other evi dence of rejection of or by others.Two control cases were obtained for each suicide for whom we had obtained the GPs' notes. They were drawn from the same prac tices by searching the age-sex registers for the two closest in age and of the same sex. The notes were searched for the number of face-toface consultations in the year before the death of the index case together with the main symptoms at the latest consultation before the index case date of death. FindingsIn 87 cases the coroners' verdict was suicide and 25 open verdicts appeared clinically to be suicides, a total of 112 (or 9.2 per IO5 total population per year). There were 82 men and 666

Risk Assessment and Suicide Prevention in Primary Care

“…Contact with a patient prior to the completion of suicide remains a rare event in primary care and is estimated to be around 1 in 52,000 consultations [Macdonald, 1992]. Nonetheless, there are high levels of service contact with GPs by suicidal patients [Meats & Solomka, 1995]. They are more likely to consult their GP if they have had a psychiatric diagnosis or a history of psychiatric contact [Vassilas & Morgan, 1993; Power et al, 1997], although these constitute a minority of the total number of suicides.…”

Improving Detection of Suicidal Ideation Among Depressed Patients in Primary Care

“…4 Primary care physicians have an important role in detecting patients at higher risk for suicide, and for prevention. Many [11][12][13][14] but not all 15 studies report that individuals make primary care visits before completing suicide. Improving primary care for suicidal patients poses several critical challenges.…”

‘The Health of the Nation’, suicide and the general hospital doctor

“…In the month prior to death 21% saw either a psychiatrist or another hospital practitioner. Meats & Solomka (1995) A large proportion of suicides therefore do not make use of their GP prior to death. The general (i.e.…”