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Suicides in ethnic minorities within 12 months of contact with mental health services: National clinical survey

  • Isabelle M. Hunt (a1), Jo Robinson (a1), Harriet Bickley (a1), Janet Meehan (a1), Rebecca Parsons (a1), Kerry McCann (a1), Sandra Flynn (a1), James Burns (a1), Jenny Shaw (a1), Navneet Kapur (a1) and Louis Appleby (a1)...
Abstract
Background

Information on suicide by psychiatric patients from ethnic minority groups is scarce.

Aims

To establish the number of patients from ethnic minorities who kill themselves; to describe their suicide methods, and their social and clinical characteristics.

Method

A national clinical survey was based on a 4-year sample of suicides in England and Wales. Detailed data were collected on those who had been in contact with mental health services in the year before death.

Results

In total 282 patients from ethnic minorities died by suicide – 6% of all patient suicides. The most common method of suicide was hanging; violent methods were more common than in White patient suicides. Schizophrenia was the most common diagnosis. Ethnic minority patients were more likely to have been unemployed than White patients and to have had a history of violence and recent non-compliance. In around half, this was the first episode of self-harm. Black Caribbean patients had the highest rates of schizophrenia (74%), unemployment, living alone, previous violence and drug misuse.

Conclusions

In order to reduce the number of suicides byethnicminority patients, services should address the complex health and social needs of people with severe mental illness.

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Copyright
Corresponding author
Professor Louis Appleby, Centre for Suicide Prevention, University of Manchester, 7th Floor, Williamson Building, Oxford Road, Manchester M13 9PL, UK
Footnotes
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See editorial, pp. 100–101, this issue.

Declaration of interest

None.

Footnotes
References
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  • ISSN: 0007-1250
  • EISSN: 1472-1465
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Suicides in ethnic minorities within 12 months of contact with mental health services: National clinical survey

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

Suicide: Is it still unexplored fully?

Dr.Naseem A. Qureshi, Consultant Psychiatrist
26 August 2003

Hunt and associates study makes for very interesting reading. However, at the same time, a retrospective recollection of huge amounts of available data derived from research conducted on biopsychosociology of suicide across cultures - minorities or otherwise, largely makes this study superfluous. Although this is a first national survey of suicides in minorities living in UK, the team of researchers comletely failed to find any new findings and moreover reported results are nothing but replication of previously reported findings. Since the most influential description of suicide by Durkheim, there are hundred of books and innumerable published peer-reviewed papers on suicide and attempted self-harm covering multiple issues including epidemiology, etiology, pattern, treatment and prevention, yet the prevalence of suicide is not declining steadily worldwide. I as a mental health professional ask myself, why is it so? Theanswer lies in the fact that the mental health professionals have inappropriately addressed the issue of suicide, in particular the sociocultural dynamics of suicide, and no major efforts have been directed towards its prevention.Indeed, suicide is a social curse and by and large this curse is preventable. Further, sociocultural factors are comparatively most important determinants of suicide. Therefore, it is high time that the mental health professionals, state governmental authorities and social organizations should indiscriminately provide basic physical, mental, sociocultural and economic services not only to patients with mild to severe mental illnesses but normal people at large. In the first place, these are the normal people who during unusual, adverse, social circumstances tend to develop from neurotic to psychotic breakdowns. For example, kill the poverty, suicide rate will decrease considerably. Further, provide suitable employment to all people irrespective of race, suicide will decrease a lot. And provide easy access to mental health services to all, suicide rate will decline meaningfully. Remove stigma against mental illnesses and mental patients, suicide will also decrease. And finally provide viable milieu with good family bonds, suicide rate will come down to nearly zero. We are taught and have known these real facts about suicide for along time but nothing useful is done to prevent suicide. National surveys like the one conducted by Hunt et al are nothing but simple reminders for relevant authorities to take concrete measures for preventing suicide not only among minorities but also majorities. ... More

Conflict of interest: None Declared

Write a reply

Impulsivity and suicide risk

Sudhir Kumar, Consultant Neurologist, Department of Neurological Sciences
26 August 2003

Sir,I read with interest the recent article by Hunt et al (2003). Based on a well-conducted study, they conclude that schizophrenia and affective disorders are common psychiatric disorders in those committing suicide. Social risk factors such as alcohol and drug misuse/abuse, unemployment, unmarried status and living alone have also been highlighted. The purpose of this letter is to highlight another risk factor- impulsive behaviour.

Suicidal attempts are considered to be impulsive if the patient committing suicide spends less than five minutes between decision to attempt suicide and the actual attempt (Simon et al, 2001). Simon et al (2001) found 24% of suicidal attempts to be impulsive. Impulsive behaviourwas more common in those engaged in physical fight as compared to those who were depressed. In a study of deliberate self-burning in Iran, 62% hadan impulsive ideation (Zarghami et al, 2002). The commonest underlying diagnosis was adjustment disorder (95% of cases) and the major motive for suicidal attempt was marital conflict. Presence of impulsive traits in patients with depressive disorders increases the risk of suicide attempts (Lecrubier, 2001). Among psychiatric inpatients, impulsive behaviour was significantly more common among suicidal patients as compared with nonsuicidal patients (Horesh et al, 1997).

In conclusion, impulsive behaviour in the presence or absence of schizophrenia, depression or other mental disorders is associated with a higher risk of suicide. Therefore, impulsivity should be assessed in patients attending our practice.

References

Horesh N, Rolnick T, Iancu I, et al (1997) Anger, impulsivity and suicide risk. Psychother Psychosom; 66: 92-6.

Hunt IM, Robinson J, Bickley H, et al (2003) Suicides in ethnic minorities within 12 months of contact with mental health services. National clinical survey. Br J Psychiatry; 183: 155-60

Lecrubier Y. (2001) The influence of comorbidity on the prevalence ofsuicidal behaviour. Eur Psychiatry; 16: 395-9.

Simon OR, Swann AC, Powell KE, Potter LB, Kresnow MJ, O'Carroll PW. (2001) Characteristics of impulsive suicide attempts and attempters. Suicide Life Threat Behav; 32(1 Suppl): 49-59.

Zarghami M, Khalilian A. (2002) Deliberate self-burning in Mazandaran, Iran. Burns; 28: 115-9.
... More

Conflict of interest: None Declared

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