Suicide In England Research Articles

Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study

Little is known about the relative incidence of fatal and non-fatal self-harm in young people. We estimated the incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England. We used national mortality statistics (Jan 1, 2011, to Dec 31, 2013), hospital monitoring data for five hospitals derived from the Multicentre Study of Self-Harm in England (Jan 1, 2011, to Dec 31, 2013), and data from a schools survey (2015) to estimate the incidence of fatal and non-fatal self-harm per 100 000 person-years in adolescents aged 12-17 years in England. We described these incidences in terms of an iceberg model of self-harm. During 2011-13, 171 adolescents aged 12-17 years died by suicide in England (119 [70%] male and 133 [78%] aged 15-17 years) and 1320 adolescents presented to the study hospitals following non-fatal self-harm (1028 [78%] female and 977 [74%] aged 15-17 years). In 2015, 322 (6%) of 5506 adolescents surveyed reported self-harm in the past year in the community (250 [78%] female and 164 [51%] aged 15-17 years). In 12-14 year olds, for every boy who died by suicide, 109 attended hospital following self-harm and 3067 reported self-harm in the community, whereas for every girl who died by suicide, 1255 attended hospital for self-harm and 21 995 reported self-harm in the community. In 15-17 year olds, for every male suicide, 120 males presented to hospital with self-harm and 838 self-harmed in the community; whereas for every female suicide, 919 females presented to hospital for self-harm and 6406 self-harmed in the community. Hanging or asphyxiation was the most common method of suicide (125 [73%] of 171), self-poisoning was the main reason for presenting to hospital after self-harm (849 [71%] of 1195), and self-cutting was the main method of self-harm used in the community (286 [89%] of 322). Ratios of fatal to non-fatal rates of self-harm differed between males and females and between adolescents aged 12-14 years and 15-17 years, with a particularly large number of females reporting self-harm in the community. Our findings emphasise the need for well resourced community and hospital-based mental health services for adolescents, with greater investment in school-based prevention. UK Department of Health.

A Human Rights Perspective of Assisted Suicide: Accounting for Disparate Jurisprudence.

This article critically examines the decision of the New Zealand High Court in Seales v Attorney-General [2015] NZHC 1239, which rejected the claim that that country's blanket ban on assisted suicide violated various rights enshrined in the New Zealand Bill of Rights. That outcome runs contrary to the Canadian Supreme Court's decision in Carter v Canada (Attorney General) [2015] 1 SCR 331. This disparity in result arose despite overt similarities between the rights documents in each of the jurisdictions and, more significantly, notwithstanding the fact that the trial judge in Seales placed heavy reliance upon the decision in Carter. With two new challenges to the blanket ban on assisted suicide in England and Wales progressing through the lower courts, and given proposed amendments to the ban in both New Zealand and its antipodean neighbours - the Australian states of Victoria and New South Wales - it is a propitious time to consider the reasons for the disparate outcomes in Seales and Carter. This article will demonstrate that the trial judge's reasoning in Seales was wanting in a number of important respects, particularly in terms of the characterisation of the objective of the blanket ban. These limitations undermine the decision's utility as authority both domestically and internationally. This is particularly important given the high likelihood that reference will be made to the decision during debate in the New Zealand Parliament regarding amendments to the ban in that country and the possibility that the Legislatures in Victoria and New South Wales, as well as the English courts hearing the current challenges to the ban in that jurisdiction will, particularly given the shared common law background, refer to the judgment in Seales.

Analysis of trends in adolescent suicides and accidental deaths in England and Wales, 1972-2011.

BackgroundPrevious analyses of adolescent suicides in England and Wales have focused on short time periods.AimsTo investigate trends in suicide and accidental deaths in adolescents between 1972 and 2011.MethodTime trend analysis of rates of suicides and deaths from accidental poisoning and hanging in 10- to 19-year-olds by age, gender and deprivation. Rate ratios were estimated for 1982–1991, 1992–2001 and 2002–2011 with 1972–1981 as comparator.ResultsSuicide rates have remained stable in 10- to 14-year-olds, with strong evidence for a reduction in accidental deaths. In males aged 15–19, suicide rates peaked in 2001 before declining. Suicide by hanging is the most common method of suicide. Rates were higher in males and in 15- to 19-year-olds living in more deprived areas.ConclusionsSuicide rates in adolescents are at their lowest since the early 1970s with no clear evidence that changes in coroners' practices underlie this trend.

Suicide in children and young people in England: a consecutive case series

There is concern about the mental health of children and young people and a possible rise in suicidal behaviour in this group. We have done a comprehensive national multi-agency study of suicide in under 20s in England. We aimed to establish how frequently suicide is preceded by child-specific and young person-specific suicide risk factors, as well as all-age factors, and to identify contact with health-care and social-care services and justice agencies. This study is a descriptive examination of suicide in a national consecutive sample of children and young people younger than 20 years who died by suicide in England between Jan 1, 2014, and April 30, 2015. We obtained general population mortality data from the Office for National Statistics (ONS). We collected information about antecedents considered to be relevant to suicide (eg, abuse, bullying, bereavement, academic pressures, self-harm, and physical health) from a range of investigations and inquiries, including coroner inquest hearings, child death investigations, criminal justice system reports, and the National Health Service, including data on people in contact with mental health services in the 12 months before their death. 145 suicides in people younger than 20 years were notified to us during the study period, of which we were able to obtain report data about antecedents for 130 (90%). The number of suicides rose sharply during the late teens with 79 deaths by suicide in people aged 18-19 years compared with 66 in people younger than 18 years. 102 (70%) deaths were in males. 92 (63%) deaths were by hanging. Various antecedents were reported among the individuals for whom we had report data, including academic (especially exam) pressures (35 [27%] individuals), bullying (28 [22%]), bereavement (36 [28%]), suicide in family or friends (17 [13%]), physical health conditions (47 [36%]), family problems (44 [34%]), social isolation or withdrawal (33 [25%]), child abuse or neglect (20 [15%]), excessive drinking (34 [26%]), and illicit drug use (38 [29%]). Suicide-related internet use was recorded in 30 (23%) cases. In the week before death 13 (10%) individuals had self-harmed and 35 (27%) had expressed suicidal ideas. 56 (43%) individuals had no known contact with health-care and social-care services or justice agencies. Improved services for self-harm and mental health are crucial to suicide prevention, but the wide range of antecedents emphasises the roles of schools, primary care, social services, and the youth justice system. The Healthcare Quality Improvement Partnership.

Mental health service changes, organisational factors, and patient suicide in England in 1997–2012: a before-and-after study

Research into which aspects of service provision in mental health are most effective in preventing suicide is sparse. We examined the association between service changes, organisational factors, and suicide rates in a national sample. We did a before-and-after analysis of service delivery data and an ecological analysis of organisational characteristics, in relation to suicide rates, in providers of mental health care in England. We also investigated whether the effect of service changes varied according to markers of organisational functioning. Overall, 19 248 individuals who died by suicide within 12 months of contact with mental health services were included (1997-2012). Various service changes related to ward safety, improved community services, staff training, and implementation of policy and guidance were associated with a lower suicide rate after the introduction of these changes (incidence rate ratios ranged from 0·71 to 0·79, p<0·0001). Some wider organisational factors, such as non-medical staff turnover (Spearman's r=0·34, p=0·01) and incident reporting (0·46, 0·0004), were also related to suicide rates but others, such as staff sickness (-0·12, 0·37) and patient satisfaction (-0·06, 0·64), were not. Service changes had more effect in organisations that had low rates of staff turnover but high rates of overall event reporting. Aspects of mental health service provision might have an effect on suicide rates in clinical populations but the wider organisational context in which service changes are made are likely to be important too. System-wide change implemented across the patient care pathway could be a key strategy for improving patient safety in mental health care. The Healthcare Quality Improvement Partnership commissions the Mental Health Clinical Outcome Review Programme, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, Social Services and Public Safety, and the States of Jersey and Guernsey.

Railway suicide in England and Wales 2000-2013: a time-trends analysis.

BackgroundIn 2010, the “Tackling Suicide on the Railways” programme was launched as a joint initiative among Network Rail, the Samaritans and other key organisations such as the British Transport Police and train operators to achieve a 20 % reduction in railway suicides from 2010 to 2015 in Great Britain. We report the most recent age and sex specific trends in railway suicide in England and Wales from 2000 to 2013 and examine whether the initiative’s target reduction in railway suicides is likely to be achieved.MethodsPopulation data and suicide mortality data (all methods combined and railway) for England and Wales were obtained from the Office for National Statistics (ONS) and used to calculate age and gender specific rates for deaths registered from 2000 to 2013. Data on railway suicides were also obtained from the Rail Safety and Standards Board (RSSB) and compared with ONS data. We used joinpoint regression to identify changes in suicide trends across the study period.ResultsThe railway was used in 4.1 % of all suicides in England and Wales (RSSB data were similar to ONS data for most years). Suicides in all persons from all causes decreased from 2000 to 2007, with small increases from 2008 until 2013; this rise was entirely due to an increase in male suicides. Railway suicide rates increased over the entire study period; the proportion of railway suicides in all persons increased from 3.5 to 4.9 % during the study period. This trend was also mainly driven by increases in male suicides as female railway suicide rates remained steady over time. The highest age specific railway suicide rates were observed in middle aged men and women. Although there was no conclusive evidence of an increase in ONS railway suicides, RSSB data showed a statistically significant increase in railway suicides in males from 2009 onwards.ConclusionThe continued rise in male railway suicide in England and Wales is concerning, particularly due to the high economic costs and psychological trauma associated with these deaths. The initiative’s target of a 20 % reduction in railway suicide is unlikely to be achieved.

The timing of general population and patient suicide in England, 1997–2012

BackgroundThere have been conflicting findings on temporal variation in suicide risk and few have examined the phenomenon in clinical populations. The study investigated seasonal and other temporal patterns using national data. MethodsData on 73,591 general population and 19,318 patient suicide deaths in England between 1997 and 2012 were collected through the National Confidential Inquiry into Suicide examining suicide rates in relation to month of the year, day of the week, and individual days of national or religious significance. ResultsSuicide incidence fell over successive months of the year and there was evidence of an overall spring peak. Monday was associated with the highest suicide rates and in the patient population this effect appeared to be more pronounced in those aged over 50 or those who lived alone. Suicide risk was significantly lower during Christmas, particularly for women. There was a peak in suicide on New Year's Day in the general population. Other ‘special days’ were not associated with a change in suicide incidence. LimitationsWe were limited to identifying associations between the variables investigated and were unable to explore causal mechanisms. We did not carry out comprehensive multi-variable adjustment in our regression models. ConclusionsThere is substantial seasonal and temporal variation in suicide deaths, and there appears to be some evidence in the clinical as well as the general population in England. Clinical services should be aware of the risk of suicide just after the weekend, especially in people who live alone, and the potential need for closer supervision during this period.

Suicide rates for different religious groups in the South Asian origin population in England and Wales: a secondary analysis of a national data set

Purpose– The purpose of this paper is to calculate the rate of suicide in different religious groups in people of South Asian origin in the UK.Design/methodology/approach– A cross-sectional, secondary analysis of a national data set. A name recognition algorithm was used to identify people of South Asian origin and their religion. Standardized mortality ratios (SMRs) were calculated using this data and data from the national census. Setting: a population study of all those who died by suicide in England and Wales in 2001. Participants: all cases of suicide and undetermined intent identified by the Office for National Statistics for England and Wales.Findings– There were 4,848 suicides in the UK in 2001 of which 125 (2.6 percent) were identified as people of South Asian origin by the algorithm. The suicide rate for all people of South Asian origin was 5.50/100,000 compared to 9.31/100,000 for the population of England and Wales. The age SMR for those whose names were of Hindu, Muslim or Sikh origin were 0.88, 0.47 and 0.85, respectively. Female South Asians have lower rates of suicide, than their South Asian male counterparts.Research limitations/implications– Religious classification by the computerized program does not guarantee religious affiliation. The data set were confined to one year because religion was not collected prior to the 2001 census.Originality/value– The rates of suicide for South Asian sub-populations in the UK differ by gender and religion.

Preventing suicides: developing a strategy.

John Tingle discusses the cross-government outcomes strategy report on preventing suicides in England. He also discusses the World Health Organization report on preventing suicide.

Suicide prevention for the LGBT community: A policy implementation review

Preventing Suicide in England identifies increased mental health needs and an increased risk of suicide in the lesbian, gay, bisexual and transgendered (LGBT) community. It promotes interventions and service developments aimed at improving the mental health of people in this group as well as in other communities. However, the evidence surrounding the mental health needs of people who identify themselves as LGBT—particularly in relation to suicide—are complex and very few new services are being considered by commissioners at a time of recession and reform within the NHS. This review discusses the context in which the policy was developed, and explores barriers to the implementation of the second area for action within the strategy, in relation to preventing suicide among LGBT people. The need for sustained change is identified, while recognising that service development and evaluation may prove difficult when people often choose not to disclose their sexuality to healthcare practitioners. The Stonewall Health Champion Programme is given as an example to support recommendations in policy, practice, research and commissioning.

Factors influencing coroners' verdicts: an analysis of verdicts given in 12 coroners' districts to researcher-defined suicides in England in 2005.

To investigate the variation between coroners in the verdicts given to deaths thought by researchers to be probable suicides and analyse factors associated with the coroners' verdict. Data were collected from 12 English coroner districts on all deaths in 2005 given a suicide, open, accidental or narrative verdict where suicide was considered a possibility. The data were reviewed by three experienced suicide researchers. Regression models were used to investigate factors associated with the coroners' verdict. The researchers classified 593 deaths as suicide, of which 385 (65.4%) received a suicide verdict from the coroner. There was marked variation between coroner districts in the verdicts they gave. The suicide method was associated strongly with the coroners' verdict; deaths from poisoning and drowning were the least likely to be given suicide verdicts. The other factors strongly associated with a coroner's verdict of suicide were: whether a note was left, age over 60 years and being married or widowed compared with being single. Coroners vary considerably in the verdicts they give to individuals who probably died by suicide. This may compromise the usefulness of suicide statistics for assessing area differences in rates for public health surveillance.

A Contact-Based Intervention for People Recently Discharged from Inpatient Psychiatric Care: A Pilot Study

People recently discharged from inpatient psychiatric care are at high risk of suicide and self-harm, with 6% of all suicides in England occurring in the 3 months after discharge. There is some evidence from a randomized trial carried out in the United States in the 1960s–70s that supportive letters sent by psychiatrists to high-risk patients in the period following hospital discharge resulted in a reduction in suicide. The aim of the current pilot study was to assess the feasibility of conducting a similar trial, but in a broader group of psychiatric discharges, in the context of present day UK clinical practice. The intervention was piloted on 3 psychiatric inpatient wards in southwest England. On 2 wards a series of 8 letters were sent to patients over the 12 months after discharge and 6 letters were sent from the third ward over a 6 month period. A total of 102 patients discharged from the wards received at least 1 letter, but only 45 (44.1%) received the full series of letters. The main reasons for drop-out were patient opt-out (n = 24) or readmission (n = 26). In the context of a policy of intensive follow-up post-discharge, qualitative interviews with service users showed that most already felt adequately supported and the intervention added little to this. Those interviewed felt that it was possible that the intervention might benefit people new to or with little follow-up from mental health services but that fewer letters should be mailed.

Preventing suicide in England: saving lives.

John Tingle discusses a recent report by the Department of Health on suicide prevention in hospitals and elsewhere.

A conditional model for estimating the increase in suicides associated with the 2008–2010 economic recession in England

BackgroundAlthough evidence of the effects of the economic crisis on suicides is quite low, a recent article shows that the increase in suicides in England between 2008 and 2010 could...

Time trends in coroners' use of different verdicts for possible suicides and their impact on officially reported incidence of suicide in England: 1990–2005

Official suicide statistics for England are based on deaths given suicide verdicts and most cases given an open verdict following a coroner's inquest. Previous research indicates that some deaths given accidental verdicts are considered to be suicides by clinicians. Changes in coroners' use of different verdicts may bias suicide trend estimates. We investigated whether suicide trends may be over- or underestimated when they are based on deaths given suicide and open verdicts. Method Possible suicides assessed by 12 English coroners in 1990/91, 1998 and 2005 and assigned open, accident/misadventure or narrative verdicts were rated by three experienced suicide researchers according to the likelihood that they were suicides. Details of all suicide verdicts given by these coroners were also recorded. In 1990/91, 72.0% of researcher-defined suicides received a suicide verdict from the coroner, this decreased to 65.4% in 2005 (p trend<0.01); equivalent figures for combined suicide and open verdicts were 95.4% (1990/91) and 86.7% (2005). Researcher-defined suicides with a verdict of accident/misadventure doubled over that period, from 4.6% to 9.1% (p<0.01). Narrative verdict cases rose from zero in 1990/91 to 25 in 2005 (4.2% of researcher-defined suicides that year). In 1998 and 2005, 50.0% of the medicine poisoning deaths given accidental/misadventure verdicts were rated as suicide by the researchers. Between 1990/91 and 2005, the proportion of researcher-defined suicides given a suicide verdict by coroners decreased, largely due to an increased use of accident/misadventure verdicts, particularly for deaths involving poisoning. Consideration should be given to the inclusion of 'accidental' deaths by poisoning with medicines in the statistics available for monitoring suicides rates.

Suicide has a devastating effect—but can be prevented

British Journal of Healthcare AssistantsVol. 6, No. 10 PolicySuicide has a devastating effect—but can be preventedRhidian HughesRhidian HughesSearch for more papers by this authorRhidian HughesPublished Online:16 Aug 2013https://doi.org/10.12968/bjha.2012.6.10.514AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Barr B, Taylor-Robinson D, Scott-Samuel Aet al. (2012) Suicides associated with the 2008-10 economic recession in England: time trend analysis. BMJ 345:e5142. doi: 10.1136/bmj.e5142 Crossref, Google ScholarCentre for Mental Health and Risk (2012) Twelve Points to a Safer Service. www.medicine.manches-ter.ac.uk/cmhr/centreforsuicideprevention/nci/saferservices (accessed 2 October 2012) Google ScholarDepartment of Health (2002) National Suicide Prevention Strategy for England. http://bit.ly/azTX1 (accessed 2 October 2012) Google ScholarDepartment of Health (2012) Preventing Suicide in England: A Cross-Government Outcomes Strategy to Save Lives. http://bit.ly/RNmhgT (accessed 2 October 2012) Google ScholarMcLean J, Maxwell M, Plattet al. (2008) Risk and Protective Factors for Suicide and Suicidal Behaviour: A Literature Review. www.scotland.gov.uk/Resource/Doc/251539/0073687.pdf (accessed 2 October 2012) Google ScholarNational Institute for Health and Clinical Excellence (NICE) (2012) Self Harm. http://pathways.nice.org.uk/pathways/self-harm Google ScholarOffice for National Statistics (2012) Suicide Rates in the United Kingdom, 2006 to 2010. http://bit.ly/RwLKee (accessed 2 October 2012) Google ScholarSamaritans (2012) Suicide Prevention Strategy 2012. www.samaritans.org/news/press-release-suicide-prevention-strategy-2012 (accessed 2 October 2012) Google Scholar FiguresReferencesRelatedDetailsCited bySuicide: connect to the clinical, social and mental health aspects of care in a joined-up way12 September 2014 | British Journal of Healthcare Assistants, Vol. 8, No. 9 1 October 2012Volume 6Issue 10ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 16 August 2013 Published in print 1 October 2012 Information© MA Healthcare LimitedPDF download

Suicides associated with the 2008-10 economic recession in England: time trend analysis

Objective To determine whether English regions worst affected by the economic recession in the United Kingdom in 2008-10 have had the greatest increases in suicides. Design Time trend analysis comparing...

Changes in commonly used methods of suicide in England and Wales from 1901–1907 to 2001–2007

To investigate changes in the range of suicide methods used in two time periods a century apart (1901-1907 and 2001-2007) in England and Wales. Suicide mortality and population data were obtained for England and Wales from the ONS and used to calculate gender and method-specific mortality rates. There have been striking changes in the methods of suicide used since the 1900s. Hanging was the most commonly used method during both time periods. However suicides involving drowning (22.5% of suicides in 1901-1907) and weapons (e.g. firearms and razors, 24.2% of suicides in 1901-1907) were rarely used in 2001-2007 (2.6% and 5.8% respectively). Although the use of poisons was popular in both time periods, the types of poisons used differed substantially over time. Household cleaning products and disinfectants accounted for almost half of poisoning suicides in the early 1900s whereas self-poisoning with medicines accounted for most poisoning suicides in 2001-2007. There were changes in the coding of suicides over time. Additionally, deaths by drowning and poisoning are more difficult to confirm as suicides than those that occur due to hanging or the use of weapons. The changes in popularity of some suicide methods can be mainly attributed to changes in the physical availability (access) of these methods over time. Other methods which remain readily available have fallen out of fashion in recent times, suggesting a contributory role of other factors such as cognitive availability and personal preference/acceptability in influencing the choice of suicide method.

A Proper, Fitting Explanation?

As in several other countries, inquiries after a suspected suicide in England and Wales now routinely seek to include both medico-legal and family perspectives on the character and motivations of the person who died. Little research attention, however, has been paid to the reactions of the bereaved to the coroner's verdict. To explore people's accounts of their acceptance or resistance to the verdict and the resources they draw upon in explaining their perspectives, especially when these contraindicate the coroner's verdict. Indepth interviews with 40 people who had been bereaved by suicide, followed by qualitative analysis, combining thematic analysis with constant comparison. Bereaved relatives who saw the suicide verdict as a correct reflection of events drew on the conventional constructions of suicide used by coroners, and (thus) the media. Relatives who resisted a suicide verdict referred to their privileged knowledge and beliefs about the person who had died, producing claims about their character, relationships, and motivations which often contradicted the conventional cues, such as a diagnosis of mental illness, previous attempts at suicide, method used, and suicide notes. For some relatives an open verdict was acceptable, even desirable, while for others it left too much uncertainty. The findings have implications for coroner's practice, understanding varied responses of people bereaved by suicide, and for future research.

The use of the Internet by people who die by suicide in England: A cross sectional study

There is widespread concern regarding the possible influence of the Internet on suicidal behaviour. The aim of this study was to estimate the prevalence and characteristics of Internet-related suicide in England. Cross sectional study based on detailed review of the inquest reports of suicides occurring in the areas served by 12 Coroners in England. Evidence of Internet use in relation to the suicide was sought for each death. Altogether inquest reports for 593 suicides (all methods) in 2005 and 166 suicides using specific methods in 2006-7 were assessed. There was evidence of a direct Internet contribution in nine (1.5% 95%CI 0.7 to 2.9%) of the 593 suicides in 2005. In seven (77.8%) of the cases the individuals had used the Internet to research the methods of suicide they used. Five (55.6%) individuals had used 'unusual' high-lethality methods, whereas such methods were only used in 1.7% of all suicides (p<0.001). There was evidence of Internet involvement in 2.4% (0.7% to 6.1%) of the suicides in 2006-2007. None of the Internet-related suicides appeared to occur as part of a suicide pact. The contribution of the Internet to suicide rates may be under-estimated in this analysis as Coroners are unlikely to comprehensively pursue the possibility of Internet involvement in all the deaths they investigate. Easy access to information about suicide methods and pro-suicide web sites on the Internet appears to contribute to a small but significant proportion of suicides. A key impact of the Internet appears to be in relation to information concerning suicide methods.