Suicide, psychiatric reform, and the provision of psychiatric services in Italy.

Abstract

An ecological approach has been adopted to study the effect on suicide of the 1978 psychiatric reform in Italy. Using regional data, the trend in suicide during the pre-reform quinquennium (1973–1977) is compared with that during the postreform quinquennium (1979–1983). The results show that the suicide rate in Italy as a whole has increased consistently over the past 10–15 years and that the increase is largely confined to the north-central parts of the country. No clear time trend emerged with respect to the proportion of suicides classified as being due to mental illness. The difference between the two 5-year trends (1973–1977 and 1979–1983) was positive (i.e., an increase in the suicide rate) for 10 of the 19 regions in Italy. This difference correlated negatively with the provision of general hospital psychiatric beds, a finding which persisted when controlled for the pre-reform trend in suicide. The post-reform regional provision of mental hospital beds (which have declined considerably in recent years) was not related to changes in the suicide rate. The usefulness of comparing trends in rates, rather than averaged rates, in the investigation of the effect of a new service on suicide is stressed.