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Suicide and attempted suicide among people of Caribbean origin with psychosis living in the UK

  • K. McKenzie (a1), J. Van Os (a2), C. Samele (a3), E. Van Horn (a4), T. Tattan (a5) and Robin Murray (a3)...
Abstract
Background

A report from a 1980s cohort claimed that suicidal behaviour was four times less common in UK-resident people of Caribbean origin with psychosis than in British Whites. Since then, evidence has accumulated that the rate of suicide and suicidal ideation has been increasing.

Aims

To compare rates of suicidal behaviour in people of Caribbean and British White origin in a large multi-centre sample of patients with psychosis.

Method

A secondary analysis of 708 patients with psychosis followed up for 2 years. Outcome measures of reported suicide and attempted suicide were adjusted for socio-economic and clinical differences between groups at baseline.

Results

People of Caribbean origin had a lower risk of suicidal behaviour than British Whites (odds ratio adjusted for age and gender 0.49, 95% C1 0.26–0.92). There was a strong negative interaction between ethnic group and age: suicidal acts were four times less likely in people of Caribbean origin aged over 35 years compared with British Whites, but there was no large or significant difference in those under 35.

Conclusions

The previously reported lower relative risk of suicidal behaviour in people of Caribbean origin with psychosis is restricted to those over 35 years, suggesting that the protective effect of Caribbean origin is disappearing in younger generations.

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Copyright
Corresponding author
Dr Kwame McKenzie, Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
Footnotes
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Declaration of interest

None.

Footnotes
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Suicide and attempted suicide among people of Caribbean origin with psychosis living in the UK

  • K. McKenzie (a1), J. Van Os (a2), C. Samele (a3), E. Van Horn (a4), T. Tattan (a5) and Robin Murray (a3)...
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eLetters

No protective factor need to be invoked.be explained

Thomas J P Verberne, clinical neuropsychologist
29 July 2003

This is a revised version of the letter that was originally printed online - Correspondence Editor, 30th July 2003

McKenzie et al. (2003) concluded that Caribbean origin seemingly confers a degree of protection against suicide. They also noted that thisprotective effect had nearly disappeared in younger generations. The investigators did not consider the possibility that their findings might be explainable without having resort to a protective factor.

On basis of the assumption that birth cohorts each have their quota of those predisposed to lethal self-harm (Lester, 1988; Murphy & Wetzel, 1980), and the apparent fact that death from lethal self-harm is not preventable, intergenerational differences in suicide rates areparsimoniously explainable as the outcome of intergenerational differencesin health care experience. Improvements in health care experience will reduce death from preventable diseases. This will drive up the death rates of diseases that are not yetpreventable, such as apredisposition to lethal self-harm.

Younger UK-resident people of Caribbean origin are likely to have experienced better health care than their elders, if their proportion of UK-born is higher than that of their elders. If so, their suicide rate would be expected to be higher.

To the extent that intergenerational differences in health care experiencetend to favour younger generations generally, it is nevertheless expectedthat these differences have been larger in the case of UK-resident peopleof Caribbean origin, relative to British Whites.

Lester, D. (1988) Birth cohort suicide rates in Canada. Suicide and Life-Threatening behavior, 18, 372-378.

McKenzie K., Van Os J., Samele C., et al. (2003) Suicide and attempted suicide among people of Caribbean origin with psychosis living in the UK The British Journal of Psychiatry, 183, 40-44.

Murphy G.E., Wetzel R.D. (1980) Suicide risk by birth cohort in the U.S., 1949-1974. Archives of General Psychiatry,37, 519-523.

____________________________________________________________

Thomas J. P. Verberne Rosanna, Victoria, Australia'phone: 61 3 9459 7303
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Conflict of interest: None Declared

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