SUICIDE
Epidemiology
Sex ratio
Commoner in males.
Age
Commoner in those aged over 45 years.
Marriage
Highest rates in those who are divorced, single or widowed. Those who are married have the lowest rate.
Social class
Highest rates in social classes I and V.
Employment
Associated with lack of employment, including both unemployment and retirement.
Season
Highest rates in spring and early summer.
Aetiology
Psychiatric disorder
This is present in 90% of those who commit suicide, particularly:
• Alcohol dependence
• Illicit drug abuse
• Personality disorder
• Chronic neuroses
• Schizophrenia, particularly in young men with low mood.
Physical illness
Suicide is associated with:
• Chronic painful illnesses
• Epilepsy.
Parasuicide
Following an act of parasuicide, the risk of committing suicide in the following year is approximately 100 times that in the general population.
Assessment
It is important to ask about any suicidal thoughts (there is no evidence that such questions might introduce the idea of suicide and precipitate such action). If there is any evidence of such thoughts the reasons for them and the methods being considered should be explored.
Any statement to the effect that there is no future or that suicide is being considered should be taken very seriously. The majority of those who commit suicide have told someone beforehand of their thoughts; two-thirds have seen their GP in the previous month. A quarter are psychiatric outpatients at the time of death; half of them will have seen a psychiatrist in the previous week.
Evidence of the psychiatric and physical illnesses mentioned above should be looked for, as should evidence of loneliness and reduced or no social contacts. Relatives and friends should also be interviewed and information obtained about any losses, such as the break-up of a relationship, death of a relative or close friend, loss of job, financial loss or loss of status in society (e.g. after being arrested for shoplifting).
Management
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