Suicide and mental disorders: Do we know enough

Australian Institute for Suicide Research and Prevention, Griffith University, Southport, Queensland, Australia
The British Journal of Psychiatry (Impact Factor: 7.99). 12/2003; 183:382-3. DOI: 10.1192/bjp.183.5.382
Source: PubMed

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    • "It rarely considers contexts, motivations, or the easy availability of means for suicidal behaviour (both non-fatal DSH and fatal suicides). Community studies are needed in order that complementary community and hospital studies may guide strategies for suicide prevention [11] [12] [13] [14]. "
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    ABSTRACT: The toxicological impact and intentional ingestion of pesticides are major public health concerns globally. This study aimed to estimate the extent of deliberate self-harm (DSH) and suicides (suicidal behaviour) and document pesticide practices in Namkhana block of the Sundarban region, India. A cross-sectional study was conducted in 1680 households (21 villages) following a mixed random and cluster design sampling. The survey questionnaire (Household Information on Pesticide Use and DSH) was developed by the research team to elicit qualitative and quantitative information. The Kappa statistic and McNemar's test were used to assess the level of agreement and association between respondents' and investigators' opinions about safe storage of pesticides. Over five years, 1680 households reported 181 incidents of suicidal behaviour. Conflict with family members was the most frequently reported reason for suicidal behaviour (53.6%). The Kappa statistic indicated poor agreement between respondents and investigators about safe storage of pesticides. The pesticide-related annual DSH rate was 158.1 (95% CI 126.2-195.5), and for suicide it was 73.4 (95% CI 52.2-100.3) per 100,000. Unsafe pesticide practice and psychosocial stressors are related to the high rates of suicidal behaviour. An intersectoral approach involving the local governments, agricultural department and the health sector would help to reduce the magnitude of this public health problem.
    Full-text · Article · Oct 2013
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    • "In general, studies report that at least 90% of suicide completers present some kind of mental illness (Arsenault-Lapierre et al., 2004; Fleischmann et al., 2005; Isometsa, 2001; Tidemalm et al., 2008). In agreement with the literature (Angst et al., 1999; Bertolote et al., 2003), we found Major Depressive Disorder to be a risk factor for suicide completion . However, other comparative studies of attempted and completed suicides have reported that although Major Depressive Disorder was the most frequent diagnosis, it did not differentiate between the two suicide populations (DeJong et al., 2010; Fushimi et al., 2006). "
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    ABSTRACT: BACKGROUND: Suicide attempters and suicide completers are two overlapping but distinct suicide populations. This study aims to present a more accurate characterization by comparing populations of suicide attempters and completers from the same geographical area. METHODS: Samples and procedure: All cases of attempted suicide treated at the emergency room of the Corporacio Sanitària i Universitària Tauli Parc de Sabadell in 2008 (n=312) were compared with all completed suicides recorded in the same geographical area from 2008 to 2011 (n=86). Hospital and primary care records were reviewed for sociodemographic and clinical variables. Statistical analysis: Chi-square, ANOVA, and Mann-Whitney U tests were used to identify characteristics related to suicide completion. RESULTS: Compared to suicide attempters, suicide completers were more likely to be male (73.3% vs. 37.8%; p<0.001), pensioners (73.7% vs. 23.4%; p<0.001), and people living alone (31.8% vs. 11.4%; p=0.006). Suicide completers more frequently presented somatic problems (71.7 vs. 15.7; p<0.001), Major Depressive Disorder (54.7% vs. 27.9%; p<0.001), and made use of more lethal methods (74.1 vs. 1.9; p<0.001). Suicide completers were more likely to have been followed by a primary care provider (50.0% vs. 16.0%; p<0.001). 92.3% of the suicides committed were completed during the first or second attempt. LIMITATIONS: Suicide completers were not evaluated using the psychological autopsy method. CONCLUSIONS: Despite presenting a profile of greater social and clinical severity, suicide completers are less likely to be followed by Mental Health Services than suicide attempters. Current prevention programs should be tailored to the specific profile of suicide completers.
    Full-text · Article · Apr 2013 · Journal of Affective Disorders
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    • "If the information is just summarized, that is, if some of the diagnostic criteria are found in journals, some from the interview of one informant and others from other informants, this can hardly be considered a valid way of assigning diagnoses. To compare diagnoses from interviews with diagnoses found in psychiatric records has also proven difficult (Bertolote et al., 2003; Gustafsson & Jacobsson, 2000). We have, however , not disproven that there might be a relationship between mental disorders and suicide; we simply argue that the results of PA studies do not constitute a valid evidence base for such a relationship. "
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    ABSTRACT: One of the most established "truths" in suicidology is that almost all (90% or more) of those who kill themselves suffer from one or more mental disorders, and a causal link between the two is implied. Psychological autopsy (PA) studies constitute one main evidence base for this conclusion. However, there has been little reflection on the reliability and validity of this method. For example, psychiatric diagnoses are assigned to people who have died by suicide by interviewing a few of the relatives and/or friends, often many years after the suicide. In this article, we scrutinize PA studies with particular focus on the diagnostic process and demonstrate that they cannot constitute a valid evidence base for a strong relationship between mental disorders and suicide. We show that most questions asked to assign a diagnosis are impossible to answer reliably by proxies, and thus, one cannot validly make conclusions. Thus, as a diagnostic tool psychological autopsies should now be abandoned. Instead, we recommend qualitative approaches focusing on the understanding of suicide beyond mental disorders, where narratives from a relatively high number of informants around each suicide are systematically analyzed in terms of the informants' relationships with the deceased.
    Full-text · Article · Aug 2012 · Death Studies
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