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Suicide within 12 months of mental health service contact in different age and diagnostic groups: National clinical survey

  • Isabelle M. Hunt (a1), Navneet Kapur (a1), Jo Robinson (a1), Jenny Shaw (a1), Sandra Flynn (a1), Hayley Bailey (a1), Janet Meehan (a1), Harriet Bickley (a1), Rebecca Parsons (a1), James Burns (a1), Tim Amos (a1) and Louis Appleby (a1)...

Abstract

Background

Suicide prevention is a health service priority but the most effective approaches to prevention may differ between different patient groups.

Aims

To describe social and clinical characteristics in cases of suicide from different age and diagnostic groups.

Method

A national clinical survey of a 4-year (1996–2000) sample of cases of suicide in England and Wales where there had been recent (< 1 year) contact with mental health services (n=4859).

Results

Deaths of young patients were characterised by jumping from a height or in front of a vehicle, schizophrenia, personality disorder, unemployment and substance misuse. In older patients, drowning, depression, living alone, physical illness, recent bereavement and suicide pacts were more common. People with schizophrenia were often in-patients and died by violent means. About athird of people with depressive disorder died within a year of illness onset. Those with substance dependence or personality disorder had high rates of disengagement from services.

Conclusions

Prevention measures likely to benefit young people include targeting schizophrenia, dual diagnosis and loss of service contact; those aimed at depression, isolation and physical ill-health should have more effect on elderly people.

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Copyright

Corresponding author

Professor Louis Appleby, Centre for Suicide Prevention, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK. E-mail: Louis.appleby@manchester.ac.uk

Footnotes

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See pp. 129–134 and 143–147, this issue.

Declaration of Interest

L.A. is the National Director of Mental Health for England. Funding detailed in Acknowledgements.

Footnotes

References

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Appleby, L., Shaw, J., Amos, T., et al (1999) Safer Services: Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. London: Department of Health.
Appleby, L., Shaw, J., Sherratt, J., et al (2001) Safety First: Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. London: Department of Health.
Cattell, H. R. (1988) Elderly suicide in London: an analysis of coroners’ inquests. International Journal of Geriatric Psychiatry, 3, 251261.
Chiu, H. F., Yip, P. S., Chi, I., et al (2004) Elderly suicide in Hong Kong – a case-controlled psychological autopsy study. Acta Psychiatrica Scandinavica, 109, 299305.
Conwell, Y., Duberstein, P. R., Cox, C., et al (1996) Relationships of age and axis I diagnoses in victims of completedsuicide: apsychological autopsystudy. American Journal of Psychiatry, 153, 10011008.
Cooper, J., Appleby, L. & Amos, T. (2002) Life events precedingsuicide by youngpeople. Social Psychiatry and Psychiatric Epidemiology, 37, 271275.
De Hert, M., McKenzie, K. & Peuskens, J. (2001) Risk factors for suicide in young people suffering from schizophrenia: along-term follow-up study. Schizophrenia Research, 47, 127134.
Department of Health (2002) National Suicide Prevention Strategy for England. London: Stationery Office.
Harris, E. C. & Barrowclough, B. (1997) Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry, 170, 205228.
Harwood, D. M. J., Hawton, K., Hope, T., et al (2000) Suicidein older people: mode of death, demographic factors, and medical contact before death. International Journal of Geriatric Psychiatry, 15, 736743.
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Suicide within 12 months of mental health service contact in different age and diagnostic groups: National clinical survey

  • Isabelle M. Hunt (a1), Navneet Kapur (a1), Jo Robinson (a1), Jenny Shaw (a1), Sandra Flynn (a1), Hayley Bailey (a1), Janet Meehan (a1), Harriet Bickley (a1), Rebecca Parsons (a1), James Burns (a1), Tim Amos (a1) and Louis Appleby (a1)...
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eLetters

Suicide in psychiatric patients... we can only �prevent� what we can �predict�

Emad Salib, Consultant Psychiatrist
01 February 2007

We read with interest the paper by Hunt et al (2006). The paper presented social and clinical characteristics of suicide by mentally ill patients within 12 months of mental health services contact. The paper did not address the question as to whether the mentally ill victims, differed from the total suicide population in their age groups, sex and method of suicide. Therefore, we examined, the April 1996- March 2000suicide and open verdict data from the Office of National statistics (ONS), totalling 26,787 from which the study sample of 4859 (18 %) was selected to see whether there were any differences.

1.There was an almost identical age distribution in the categories used in the study in the 2 groups, except in the age group of 75 and over,8.4% in the total suicide population compared to 4% in the mentally ill elderly (P<. 05)2.Male: female ratio in the study was 2:1 and became 1:1 in older age groups while in the total suicide population the ratio was 3.5:1 and became 1.6:1 in the over 65 groups. The difference was statistically significant (P<. 01).3.Mentally ill people within the age categories applied in the study used, almost exactly the same methods of suicide (P>.05) with only on interesting exception. Significantly fewer suicide victims, who were mentally ill, used C0 poisoning as a method of fatal self-harm compared tothe suicide population in England and Wales during the same period. The use of CO poisoning was four times more likely to be used by other victimscompared to the mentally ill group. This is probably due to a much lowerprobability of owning a car in psychiatric patients.

The results clearly show that there are some differences between suicide victims with history of mental illness, who constitute 24% of total suicide in England & Wales (DoH 1999) and the general suicide population in respect of age groups, sex and method of suicide. Thereis another major difference between the two groups which is the simple fact that all the mentally ill group are expected to have had detailed risk assessment at some stage within 12 months prior to the fatal act compared to the 76% of victims who did not.

It is interesting to note that the paper shows that clinical diagnosis did not have any real impact on the choice of method of suicide as can be easily deduced from distribution of methods of suicide age groups and gender.

Identifying suicide predictors is the only way to increase the likelihood of future prevention of suicide in psychiatric patients. Detailed descriptive analysis of suicide data is interesting but has limited clinical value, either in prediction or prevention. If we cannot predict, then how can we prevent?

References:

Hunt I., Kapur N., Robinson J., Shaw J., Flynn S., Bailey H., Meehan J., Bickley H., Parsons R., Burns J, Amos T., Appleby L (2006) Suicide within 12 months of mental health service contact in different age and diagnostic groups British Journal of Psychiatry 188, 135-142

Appleby L., Shaw J., Amos T., et al (1999) Safer Services: Report of the National Confidential Inquiry into Suicide and Homicide by People withMental Illness. London Department of Health

Conflict of interest: none

Emad Salib Consultant in Old Age psychiatryLavanya Sebastian SHO in PsychiatryFracnces Lindon Consultant in Old Age PsychiatryMark Theouphanous Consultant in Old age Psychiatry

Peasley Cross HospitalSt Helens, Merseyside
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Conflict of interest: None Declared

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