Transcript No Slide Title

Northern Ireland
Suicide
Prof. Patricia R. Casey
Mater Misericordiae
Hospital/UCD
Suicide Rates/100,000
2004
Male
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Scotland
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Female
30
10
Wales
22.4
6
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N. Ireland
18.3
5.6
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England
16.7
5.4
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R. of Ireland 17.7
4.97
Northern Ireland
psychological
autopsy study
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Foster, Gillespie,
McClelland 1997 British
Journal of Psychiatry, 170,
447-452.
96% of suicides had a
current psychiatric
diagnosis:
– Axis I 86%
– Axis II 44%.
Suicides under 30 less
likely to have a psychiatric
diagnosis (68%).
Northern Ireland
psychological
autopsy study
contd
Principal axis I diagnosis
Males %
Females %
Depressive disorders
28
60
Alcohol abuse/dependence 28
28
Other drug
misuse/dependence
2
2
Schizophrenic disorders
13
4
Anxiety disorders
5
4
Adjustment disorders
3
4
Co-morbidity
%
Axis I/axis I
31
Axis I/axis II
41
Psychiatric
disorder and
suicide
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90% of suicide victims have
psychiatric illness.
Depressive illness 65%.
Alcohol and drug abuse 20%.
Schizophrenia 5%.
Co-occurrence of depressive
illness and physical illness a
particular risk factor.
Particular risk – males,
young or elderly and those
who are isolated.
Risk factors in Foster study
(BJP 1999.175. p175-179)
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Personality problems
Life events in previous year
Unemployment
History deliberate self harm
Problems with friend,
neighbour etc
Profile
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Men. 3:1
<30; >60.
Single/widowed/separated.
Relationship to
unemployment uncertain.
380 deaths per year =
11.5/100,000.
Increased throughout Europe
in 1990.
Recent decline in some
countries.
Greatest increase in Ireland
due to increase in young
male suicides.
Risk factors
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Previous attempts.
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Under-treatment.
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Social isolation.
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Increasing age.
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Physical illness.
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Widowed/divorced/separated.
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Impulsivity.
Why men?
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More violent means
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Less help seeking behaviour
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Changes to male role
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Women greater permission
to leave
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Protective role of
motherhood
Predicting suicide
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High risk populations.
Pokorney 1983 Archives of
General Psychiatry – outpatients.
Goldstein et al 1991 Archives
of General Psychiatry – outpatients with affective
disorders.
Powell et al 2000 British
Journal of Psychiatry –
psychiatric in-patients.
Predicting rare events.
High sensitivity.
Low specificity.
Why is suicide
increasing?
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.
Is psychiatric disorder
increasing?
Is psychiatric disorder more
incapacitating?
Are there social changes
driving the increase
independent of psychiatric
disorder?
Durkheim’s theory
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Anomic – normative values
of a community lose their
force.
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Egoistic – individual
separated from their social
group.
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Altruistic – directed towards
an ideal.
Other sociological
theories
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Whitley et al 1999 BMJ:
– Social Fragmentation using
Congdon score.
– Deprivation score using Townsend
score.
Demonstrated that suicide rates in
London (1981-1992) were more
closely linked to fragmentation
whereas deaths from other causes
more closely linked to deprivation.
Constituencies with increases in both
scores had greatest increase in suicide
and in those, the relation between
fragmentation and suicide was
independent of deprivation score.
Small area rates
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Applied to changes across small
geographic areas.
Ethnic minority suicides.
Derives from amplification of deviancy
model.
Neeleman et al 1999 Psychological
Medicine.
329 coroners records of ethnic
suicides in London.
Findings:
– Minority suicide rates are higher
where minority groups are smaller.
Not due to confounding effects of
age, gender, deprivation.
Depending on address a risk factor
in one indigent person may protect
a minority individual and vice versa.
– Risk factors in one population may
protect in another.
Copy-cat suicide
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Overall 5%
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UP to 15% among young
people
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Most likely when glorified
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Most likely when similarities
present e.g. age,,sex,
problems
The effects of a celebrity suicide on
suicide rates in Hong Kong. Yip et al
JAD. 2006 93 (1-3). 245-252
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BACKGROUND: Deaths of celebrities, especially by
suicide, can be followed by an increase in population
suicide rates, particularly where there is extensive media
reporting. Examined the impact on suicides following the
death of a famous Hong Kong pop singer whose death
from suicide by jumping from a height, occurred on 1st
April 2003, and resulted in extensive and often dramatic
media coverage. METHODS: Data on suicides were
obtained from the Hong Kong Census and Statistics
Department and the Coroner's Court. The numbers of
suicides in 2003 before and after the death of celebrity
were compared to the same period in 1998-2002. The
case files and suicide notes of people who died by suicide
in 2003 were also studied qualitatively.
RESULTS: There was a significant increase in suicides
following the celebrity death, compared with the average
over the preceding three months as well as the
corresponding monthly average during 1998-2002. It was
particularly marked in a subgroup comprising males,
aged 25-39 years, many of whom died by jumping. The
name of the celebrity was often mentioned in case files
and suicide notes. CONCLUSIONS: This study provides
further confirmation of the potential harmful
consequences of sensational and excessive reporting of
celebrity deaths.
Media portrayal of suicidal
behaviour
Hawton et al. BMJ. 1999. 318. 972-977.
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Objectives: To determine whether a serious paracetamol
overdose in the medical television drama Casualty altered
the incidence and nature of general hospital presentations
for deliberate self poisoning.
Subjects: 4403 self poisoning patients; questionnaires
completed for 1047.
Results: Presentations for self poisoning increased by
17% (95% confidence interval 7% to 28%) in the week
after the broadcast and by 9% (0 to 19%) in the second
week. Increases in paracetamol overdoses were more
marked than increases in non-paracetamol overdoses.
Thirty two patients who presented in the week after the
broadcast and were interviewed had seen the episode
20% said that it had influenced their decision to take an
overdose, and 17% said it had influenced their choice of
drug. The use of paracetamol for overdose doubled
among viewers of Casualty after the episode (rise of
106%; 28% to 232%).
Conclusions: Broadcast of popular television dramas
depicting self poisoning may have a short term influence
in terms of increases in hospital presentation for overdose
and changes in the choice of drug taken.
Religious beliefs
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Is suicide related to religious
beliefs/practice?
What is the mechanism by which
religious beliefs reduce suicide –
suicide intolerance or social
cohesion provided by religion?
Do the effects apply to at an
individual level as well as at a
societal level?
Neeleman et al 1997
Psychological Medicine.
19 Western countries including
USA.
Face to face interviews with
28,085 individuals.
Religious beliefs
contd
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Ecological findings: Higher rates
among females associated with lower
levels of religious beliefs and less
strongly religious attendance. Less
strong among men.
Individual level: At an individual level,
stronger religious beliefs associated
with lower tolerance of suicide.
Personal religious beliefs for men and
women and for men exposure to a
religious environment also, protect
against suicide. Mediated by tolerance
of suicide rather than social support of
religious beliefs.
Confirms findings of other studies of
association between personal religious
beliefs rather than denominational
affiliation (Stack USA) and of
relationship to suicide tolerance.
Reducing suicide
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Medical – adequate treatment of
psychiatric disorder. Evidence
that increased antidepressant
usage in NI has helped reduce
suicide in elderly but not the
young (Kelly 2003 European
Psychiatry).
Personal – encourage helpseeking behaviour.
Voluntary sector – Samaritans.
Church/state – values certainty.
Media – responsible reporting.