Suicide Verdicts Research Articles

Reassessing long-term risk of suicide after a first episode of psychosis

BackgroundThe long-term risk of suicide after a first episode of psychosis is unknown, because previous studies have often been based on prevalence cohorts, have been biased to more severely ill, hospitalised patients, have extrapolated from a short follow-up time, and have made a distinction between schizophrenia and other psychoses. The aim of this study was to determine the epidemiology of suicide in a clinically representative, retrospective inception cohort of patients with a first episode of psychosis. MethodsAll 2723 patients who presented for the first time to secondary care services with psychosis in three defined geographical catchment areas in London (1965–2004, n=2056), Nottingham (1997–1999, n=203), and Dumfries and Galloway (1979–1998, n=464) were traced after a mean follow-up of 11·5 years. The main outcome measure was number of deaths by suicide and open verdicts according to International Classification of Diseases, editions 7–10. FindingsCase fatality from suicide was considerably lower than expected from previous studies: 1·9% (53/2723); proportionate mortality was 11·9% (53/444). Although the rate of suicide was highest in the first year after presentation, risk persisted late into follow-up, with median time to suicide being 5·6 years. Suicide occurred nearly 12 times more than expected from the general population of England and Wales (standardised mortality ratio 11·65, 95%CI 8·73–15·24), and 49 of the 53 suicides were excess deaths. Even a decade after first presentation, suicide risk remained almost four times higher than in the general population (3·92, 95%CI 2·22–6.89), a time when there may be less intense clinical monitoring of risk. InterpretationThe highest risk of suicide after a psychotic episode occurs soon after presentation, yet clinicians should still be vigilant in assessing risk a decade or more after first contact. The widely held view that 10–15% die from suicide is misleading because it refers to proportionate mortality rather than lifetime risk. Nonetheless, after a first espisode of psychosis, risk of suicide is substantially increased compared with that in the general population. FundingUK Medical Research Council.

Suicidal ligature strangulation without an auxiliary mechanism. Reports of two cases with a cotton rope or a T-shirt and staining results of the brains using anti HSP-70, CIRBP, RBM3, HIF1-alpha, SIRT 1 and p53 antibodies

It is still often described in forensic textbooks that suicidal strangulation by ligature without auxiliary device to remain tightening the ligature after unconsciousness of the victim. We report two cases of suicidal ligature strangulation without auxiliary mechanism. One occurred in a closed room and other was carried out in a police cell. These two cases reveal that the suicidal ligature strangulation is possible without auxiliary mechanism, however it was difficult to distinguish from homicide only from forensic autopsy findings, although death scenes and existence of suicidal notes produced clear verdicts of suicide in two cases. The death mechanism in these cases was discussed. The nucleus of the neuronal cells showed good reactivity with hypoxia or ischemia related antibodies, such as cold inducible RNA-binding protein (CIRBP), RNA-binding motif protein 3(RBM3), heat shock protein 70(HSP-70) and hypoxia-inducible factor 1(HIF-1), however the cells showed no reactivity with anti Sirtuin 1(SIRT 1) and p53 antibodies which are related energy metabolism or apoptosis. This is the first report in which the expression of hypoxia and /or ischemic related antigens described above was confirmed even in post-mortem human brains.

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.

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.

Six-year follow-up of impact of co-proxamol withdrawal in England and Wales on prescribing and deaths: time-series study.

The analgesic co-proxamol (paracetamol/dextropropoxyphene combination) has been widely involved in fatal poisoning. Concerns about its safety/effectiveness profile and widespread use for suicidal poisoning prompted its withdrawal in the UK in 2005, with partial withdrawal between 2005 and 2007, and full withdrawal in 2008. Our objective in this study was to assess the association between co-proxamol withdrawal and prescribing and deaths in England and Wales in 2005-2010 compared with 1998-2004, including estimation of possible substitution effects by other analgesics. We obtained prescribing data from the NHS Health and Social Care Information Centre (England) and Prescribing Services Partneriaeth Cydwasanaethau GIG Cymru (Wales), and mortality data from the Office for National Statistics. We carried out an interrupted time-series analysis of prescribing and deaths (suicide, open verdicts, accidental poisonings) involving single analgesics. The reduction in prescribing of co-proxamol following its withdrawal in 2005 was accompanied by increases in prescribing of several other analgesics (co-codamol, paracetamol, codeine, co-dydramol, tramadol, oxycodone, and morphine) during 2005-2010 compared with 1998-2004. These changes were associated with major reductions in deaths due to poisoning with co-proxamol receiving verdicts of suicide and undetermined cause of -21 deaths (95% CI -34 to -8) per quarter, equating to approximately 500 fewer suicide deaths (-61%) over the 6 years 2005-2010, and -25 deaths (95% CI -38 to -12) per quarter, equating to 600 fewer deaths (-62%) when accidental poisoning deaths were included. There was little observed change in deaths involving other analgesics, apart from an increase in oxycodone poisonings, but numbers were small. Limitations were that the study was based on deaths involving single drugs alone and changes in deaths involving prescribed morphine could not be assessed. During the 6 years following the withdrawal of co-proxamol in the UK, there was a major reduction in poisoning deaths involving this drug, without apparent significant increase in deaths involving other analgesics.

Shakespeare under water

Shakespeare under water

Impact of the growing use of narrative verdicts by coroners on geographic variations in suicide: analysis of coroners' inquest data

Coroners' death certificates form the basis of suicide statistics in England and Wales. Recent increases in coroners' use of narrative verdicts may affect the reliability of local and national suicide rates. We used Ministry of Justice data on inquests held between 2008 and 2009 and Local Authority suicide data (2001–02 and 2008–09) to investigate variations between coroners in their use of narrative verdicts and the impact of these on suicide rates, using ‘other’ verdicts (79% of which are narratives) as a proxy for narrative verdicts. There was wide geographic variation in Coroners' use of ‘other’ (mainly narrative) verdicts—they comprised between 0 and 50% (median = 9%) of verdicts given by individual coroners in 2008–09. Coroners who gave more ‘other’ verdicts gave fewer suicide verdicts (r = − 0.41; P< 0.001). In the 10 English Coroners' jurisdictions where the highest proportion of ‘other’ verdicts were given, the incidence of suicide decreased by 16% between 2001–02 and 2008–09, whereas it did not change in areas served by the 10 coroners who used narratives the least. Variation in Coroners' use of narrative verdicts influences the validity of reported regional suicide rates. Small-area suicide rates, and changes in these rates over time in the last decade, should be interpreted with caution.

Suicide verdicts as opposed to accidental deaths in substance-related fatalities (UK, 2001–2007)

Substance-related deaths account for a great number of suicides. To investigate levels and characteristics of suicide verdicts, as opposed to accidental deaths, in substance misusers. Psychological autopsy study of cases from the UK National Programme on Substance Abuse Deaths (np-SAD) during the period 2001-2007. Between January 2001 and December 2007, 2108 suicides were reported to the np-SAD. Typical suicide victims were White and older than 50 (respectively 95% and 41% of cases). Medications, especially antidepressants (44%), were prescribed to 87% of victims. Significantly fewer suicide victims than controls presented positive blood toxicological results for illicit drugs (namely: cocaine, heroin, amphetamines, ecstasy-type drugs, cannabis, and GHB/GBL) and alcohol. Suicide prevention programmes should devote specific attention to deaths among substance misusers who are at high risk of fatal intentional self-harm. Specific characteristics distinguish those at risk; caregivers should be better educated as to what these factors are. Limitations of the current study included lack of provision of comprehensive information relating to the victims' psychosocial variables. Furthermore, no differentiation between different classes of antidepressants in terms of involvement in suicide was here provided.

Application of Commercial Software to the Classification of Suicide Cases: A Brief Report

Mosaic Profiler software was used to classify suicide and open verdict cases during 1996 to 1998 in England and within England, for the London and the North West regions. The classification system was based on the socioeconomic characteristics of the last place of residence of the cases at the level of postcode. The results highlighted that deprived areas and areas that contain elderly population or those areas that suffer from lack of social cohesion are overrepresented, whereas affluent areas are underrepresented. All of these, although in the larger scale, seem to support the results of other studies. Nevertheless, more studies would be required before one can fully evaluate the application of the Mosaic Profiler in the field of spatial epidemiology.

Reassessing the Long-term Risk of Suicide After a First Episode of Psychosis

The long-term risk of suicide after a first episode of psychosis is unknown because previous studies often have been based on prevalence cohorts, been biased to more severely ill hospitalized patients, extrapolated from a short follow-up time, and have made a distinction between schizophrenia and other psychoses. To determine the epidemiology of suicide in a clinically representative cohort of patients experiencing their first episode of psychosis. Retrospective inception cohort. Geographic catchment areas in London, England (between January 1, 1965, and December 31, 2004; n = 2056); Nottingham, England (between September 1, 1997, and August 31, 1999; n = 203); and Dumfries and Galloway, Scotland (between January 1, 1979, and December 31, 1998; n = 464). All 2723 patients who presented for the first time to secondary care services with psychosis in the 3 defined catchment areas were traced after a mean follow-up period of 11.5 years. Deaths by suicide and open verdicts according to the International Classification of Diseases (seventh through tenth editions). The case fatality from suicide was considerably lower than expected from previous studies (1.9% [53/2723]); the proportionate mortality was 11.9% (53/444). Although the rate of suicide was highest in the first year after presentation, risk persisted late into follow-up, with a median time to suicide of 5.6 years. Suicide occurred approximately 12 times more than expected from the general population of England and Wales (standardized mortality ratio, 11.65; 95% confidence interval, 8.73-15.24), and 49 of the 53 suicides were excess deaths. Even a decade after first presentation-a time when there may be less intense clinical monitoring of risk-suicide risk remained almost 4 times higher than in the general population (standardized mortality ratio, 3.92; 95% confidence interval, 2.22-6.89). The highest risk of suicide after a psychotic episode occurs soon after presentation, yet physicians should still be vigilant in assessing risk a decade or longer after first contact. The widely held view that 10% to 15% die of suicide is misleading because it refers to proportionate mortality, not lifetime risk. Nevertheless, there is a substantial increase in risk of suicide compared with the general population.

Self-poisoning suicide deaths in England: could improved medical management contribute to suicide prevention?

Suicide by self-poisoning is a major cause of death worldwide. Few studies have investigated the medical management of fatal self-poisoning. To describe the characteristics and management of a national sample of individuals who died by intentional self-poisoning in hospital and assess the quality of care that they received. National population-based descriptive study and confidential inquiry. Adults (aged ≥ 16 years) who had died by self-poisoning in English hospitals in 2005 and received a coroner's verdict of suicide or undetermined death at inquest were included. Socio-demographic and clinical data were collected through detailed questionnaires sent to clinicians at the treating hospitals. A panel of three expert assessors rated each case with respect to quality of care and likely contribution to the fatal outcome. We obtained information on 121 cases (response rate for questionnaires 77%). Expert assessors rated 41/104 cases [39% (95% CI 30-49%)] as having received inadequate care; in the majority (38/41-93%) of these, this poor care was felt to have potentially contributed to the patient's death. The most common reason for a rating of inadequate care was poor airway management (recorded in over half of inadequate care cases). In three cases, the receipt of inadequate care was associated with the presence of some form of advance directive. In as many as 39% of in-hospital self-poisoning fatalities, the care received may be in some way sub-optimal. The challenge for clinical services is to ensure that optimal management strategies are implemented in practice.

Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose

Self-poisoning is a common method of suicide and often involves ingestion of antidepressants. Information on the relative toxicity of antidepressants is therefore extremely important. To assess the relative toxicity of specific tricyclic antidepressants (TCAs), a serotonin and noradrenaline reuptake inhibitor (SNRI), a noradrenergic and specific serotonergic antidepressant (NaSSA), and selective serotonin reuptake inhibitors (SSRIs). Observational study of prescriptions (UK), poisoning deaths involving single antidepressants receiving coroners' verdicts of suicide or undetermined intent (England and Wales) and non-fatal self-poisoning episodes presenting to six general hospitals (in Oxford, Manchester and Derby) between 2000 and 2006. Calculation of fatal toxicity index based on ratio of rates of deaths to prescriptions, and case fatality based on ratio of rates of deaths to non-fatal self-poisonings. Fatal toxicity and case fatality indices provided very similar results (rho for relative ranking of indices 0.99). Case fatality rate ratios showed greater toxicity for TCAs (13.8, 95% CI 13.0-14.7) than the SNRI venlafaxine (2.5, 95% CI 2.0-3.1) and the NaSSA mirtazapine (1.9, 95% CI 1.1-2.9), both of which had greater toxicity than the SSRIs (0.5, 95% CI 0.4-0.7). Within the TCAs, compared with amitriptyline both dosulepin (relative toxicity index 2.7) and doxepin (2.6) were more toxic. Within the SSRIs, citalopram had a higher case fatality than the other SSRIs (1.1, 95% CI 0.8-1.4 v. 0.3, 95% CI 0.2-0.4). There are wide differences in toxicity not only between classes of antidepressants, but also within classes. The findings are relevant to prescribing decisions, especially in individuals at risk, and to regulatory policy.

Child Suicide, Family Environment, and Economic Crisis

Suicide among children is considered to be a rare event, although it is still one of the leading causes of death in children younger than 15 years of age worldwide (Pelkonen & Marttunen, 2003; Vajani, Annest, Crosby, Alexander, & Mille, 2007). Compared to other age groups, the prevalence of suicide in children is more likely to be underestimated (Beautrais, 2001; Crepeau-Hobson, 2010; Fortune & Hawton, 2007; McClure, 2001). Possible reasons for this underestimation may be the social stigma and shame surrounding suicide in general, the reluctance by officials or coroners to determine a verdict of suicide in a child, disparities in death classification systems, and/or the misconception that children are precluded from engaging in suicidal acts due to cognitive immaturity (Crepeau-Hobson, 2010; Schmidt, Muller, Dettmeyer, & Madea, 2002; Shaw, Fernandes, & Rao, 2005; Pritchard & Hansen, 2005). However, research has indicated that, from the age of 8 on, children understand the concept of suicide (Mishara, 1998; Fortune & Hawton, 2007) and are capable of carrying it out. Research in adolescent and youth suicide is growing. While previous studies provided a broad overview of the phenomenon, few focused specifically on suicide in children. There appears to be some empirical support for the notion that children may be less exposed to common suicide risk factors, such as mental illness and substance abuse, and less likely to display predictive factors, such as prior suicidal behavior (Beautrais, 2001; Groholt, Ekeberg, Wichstrom, & Haldorsen, 1998; Pelkonen & Marttunen, 2003; Schmidt et al., 2002). Groholt et al. (1998) suggested that the low suicide incidence in children might be related to fewer risk factors rather than to their resilience to these risk factors. Interpersonal family conflicts, especially parent-child conflicts, are important suicide risk factors in children and younger adults and appear more frequently compared to older adults. Beautrais (2001) reported that 70.5% of child suicides aged 9–14 years had a family conflict as a triggering factor. Furthermore, it has been reported that parental divorce or a stepparent in the family increases the risk of suicidal behaviors in children and adolescents (Pelkonen & Marttunen, 2003; Samm et al., 2010). A growing body of research indicates that the risk of child and adolescent suicide and attempted suicides increases when family psychopathology is involved, such as parental mental health problems or a history of suicidal behavior (King, 2009). However, the existence and impact of shared genetic risk factors, the level of influence of an adverse family environment, and whether these influences can be mediated remain unknown in the context of child suicide (Brent & Mann, 2006; King, 2009). It also appears that the family environment – parenting style, physical abuse, and parental mental health problems – can be greatly influenced by economic pressure (Yoder & Hoyt, 2005). Since the beginning of the global financial crisis, several editorials and papers have indicated the possible impact the economic recession may have on morbidity (Catalano, 2009; Uutela, 2010), mortality (Simms, 2009), and, more specifically, suicide (Gunnell, Platt, & Hawton, 2009). Indeed, based on past experiences and from a public health perspective, it is very important to notify professionals and politicians about the possible consequences (Stuckler, Basu, Suhrcke, Coutts, &McKee, 2009). Meanwhile, speculations continue about eventual scenarios, as it is too early to see the impact the global financial crisis might have on overall suicide mortality and morbidity rates. The effects of an economic recession on children, general child mortality and morbidity, violence against children, schooling, quality of care, and emotional well-being also need to be considered (Harper, Jones, McKay, & Espey, 2009). Yet, how much do we know about the possible fallouts of an economic crisis on children, their suicidal behaviors, and child suicides? The impact of an economic recession can be measured both on an aggregated and an individual level. In a recent paper, Apter, Bursztein, Bertolote, Fleischmann, and Wassermann (2009) considered that turmoil following rapid changes in the economy has been

Suicide among male regular UK Armed Forces personnel, 1984–2007

Objective: To examine the number of suicide and open verdict deaths in the regular UK Armed Forces and to make comparisons with the UK general population. Methods: Age and calendar...

Suicide after Leaving the UK Armed Forces —A Cohort Study

BackgroundFew studies have examined suicide risk in individuals once they have left the military. We aimed to investigate the rate, timing, and risk factors for suicide in all those who had left the UK Armed Forces (1996–2005).Methods and FindingsWe carried out a cohort study of ex-Armed Forces personnel by linking national databases of discharged personnel and suicide deaths (which included deaths receiving either a suicide or undetermined verdict). Comparisons were made with both general and serving populations. During the study period 233,803 individuals left the Armed Forces and 224 died by suicide. Although the overall rate of suicide was not greater than that in the general population, the risk of suicide in men aged 24 y and younger who had left the Armed Forces was approximately two to three times higher than the risk for the same age groups in the general and serving populations (age-specific rate ratios ranging from 170 to 290). The risk of suicide for men aged 30–49 y was lower than that in the general population. The risk was persistent but may have been at its highest in the first 2 y following discharge. The risk of suicide was greatest in males, those who had served in the Army, those with a short length of service, and those of lower rank. The rate of contact with specialist mental health was lowest in the age groups at greatest risk of suicide (14% for those aged under 20 y, 20% for those aged 20–24 y).ConclusionsYoung men who leave the UK Armed Forces were at increased risk of suicide. This may reflect preservice vulnerabilities rather than factors related to service experiences or discharge. Preventive strategies might include practical and psychological preparation for discharge and encouraging appropriate help-seeking behaviour once individuals have left the services.

Effect of Restricting Access to a Suicide Jumping Site

The road to a headland that had become a suicide jumping hotspot was temporarily closed because of construction work. This created an opportunity to assess whether loss of vehicular access would lead to a reduction in suicides and emergency police callouts for threatened suicide at the site. Deaths at the headland were ascertained for a 10 year period before road closure and for 2 years following closure using records from the local police inquest officer, the coroner's pathologist and Marine Search and Rescue. Police provided a list of police callouts for threatened suicide at the site for a 4 year period before closure and for 2 years following closure. Simple rates were compared and incident rate ratios were calculated where possible. There were 13 deaths at the headland involving suicide or open verdicts in the 10 years before access was restricted, and none in the 2 years following road closure. This difference was statistically significant (incident rate difference = 1.3 deaths per year, 95% confidence interval (CI) = 0.6-2.0). No jumping suicides occurred elsewhere in the police district following the road closure. Police callouts for threatened suicide also fell significantly, from 19.3 per year in the 4 years prior to road closure to 9.5 per year for the following 2 years (incident rate ratio = 2.0, 95% CI = 1.2-3.5). Preventing vehicular access to a suicide jumping hotspot was an effective means of suicide prevention at the site. There was no evidence of substitution to other jumping sites.

Re‐presentation and suicide rates in emergency department patients who self‐harm

To investigate adult presentations to North Shore Hospital, Auckland, New Zealand, following deliberate self-harm, determine re-presentation and suicide rates and investigate the characteristics of those patients who re-present. Retrospective review of a cohort of adult patients presenting to North Shore Hospital Emergency Care Centre in Auckland, New Zealand, with deliberate self-harm between 1 January 2001 and 31 August 2002, using data from the National Minimum Data Set and Hospital Discharge Database. The re-presentation rate was calculated as the percentage of patients presenting a second time within 1 year of their index presentation. The suicide rate was calculated as the percentage of patients with a coroner's verdict of suicide within 1 year of their index presentation of deliberate self-harm. There were 1055 presentations by 754 people during the presentation period. Of these 754 people, 136 presented for a second time within a year of the index case (136/754 [18.0%, 95% CI 15.5-21.0]). Eight of the seven hundred and fifty-four people went on to commit suicide within 1 year (8/754 [1.1%, 95% CI 0.5-2.1]). Self-poisoning was the most common method of self-harm. Minor tranquillizers were used more commonly in the group who re-presented. Re-presentation and suicide rates in our study were similar to previously published rates. Further research is needed to identify strategies to reduce re-presentations and excess mortality in all people who deliberately self-harm.

Pure elderly suicide rates versus combined pure elderly suicide, accidental and undetermined death rates: methodological issues in cross-national studies

The verdict of suicide depends upon local legal definitions, culture, and reporting practices and procedures (Shah and Ganesvaran, 1994). Legal definitions of suicide vary across countries. In Austria, officers of the Federal Statistics Division may count a death as suicide if it is suspected as such, even without legal evidence. In Luxembourg, a suicide note is required for a verdict of suicide. In the U.K. and Australia, the verdict of suicide is reached by the coroner, who must be satisfied that suicide has been proved beyond reasonable doubt; if there is reasonable doubt, then a verdict of undetermined death or an open verdict is returned. Owing to the possibility of some probable suicides being misclassified as accidental and undetermined deaths (Chishti et al., 2003), it has been suggested that accidental and undetermined deaths should also be utilized in suicide research (O'Donnell and Farmer, 1995). However, there is evidence from European Union countries that misclassification contributes to only a minor proportion of the variation in general population suicide rates (Chishti et al., 2003), although this has not been specifically examined for elderly suicide rates.

Inquest verdicts: youth suicides lost

Aims and MethodTo investigate how much reliance on suicide verdicts underestimates probable suicides. All unnatural deaths of those 8–18 years of age in West Yorkshire during a 6-year period were identified from the death register. Deaths which had verdicts other than killed him- or herself and were not obviously accidental were reviewed by a panel of three consultant child and adolescent psychiatrists to determine whether they were probable suicides.ResultsOf 40 deaths reviewed by the panel, 13 were identified as probable suicides, of which 6 had an open verdict, 6 were death by self-hanging classified as misadventure and 1 was an overdose with a verdict of accidental death. These 13 deaths and the 7 with a coroner's verdict of suicide gave a total of 20 probable suicides.Clinical ImplicationsSuicide statistics and targets need to take into account the fact that by current methods a significant proportion of suicides by adolescents will not be included in official figures. This underestimation would have been 65% if only suicides were identified and 35% when open verdicts were combined with suicides. Underestimating the youth suicide rate has consequences for the priority and resources allocated to preventing these deaths, and suicide deaths that are not recognised as such will not be included in relevant research and audit.

To a question of optimization of the medical and psycological help to patients with GID

Background: The suicide rate in young people in the United Kingdom has increased over the last decade. As there is a paucity of information about the characteristics of young suicides we have undertaken a detailed investigation of suicides in people aged 15–24 years by means of the psychological autopsy approach. Methods: The sample consisted of 27 subjects (25 males, two females) whose deaths received a verdict of suicide (N=24) or undetermined cause (N=3). Information was collected from informant interviews, coroners’ inquest notes, medical records and psychiatric case notes. A sub-sample of 22 male subjects was compared with an age-matched sample of male deliberate self-harm (DSH) patients. Results: Psychiatric disorders were diagnosed in 19 (70.4%) subjects. These were most commonly depressive disorders (55.5%). Very few individuals were receiving treatment for their disorders. Substance abuse disorders were uncommon but a substantial proportion of individuals had problems with alcohol or drug misuse. Personality disorders were present in 29.6% of subjects and disorders or personality trait accentuation in 55.6%. Comorbidity of psychiatric disorders was found in a third of subjects. The suicides were often the end-point of long-term difficulties extending back to childhood or early adolescence. In addition to mental disorders, relationship and legal difficulties were identified as relatively common contributory factors to the suicides. In comparison to deliberate self-harm patients, male suicides were more likely to use dangerous methods and live alone. Limitations: Several potential informants could not be interviewed and there was no general population control sample. Conclusions: The process leading to suicide in young people is often long term, with untreated depression in the context of personality and/or relationship difficulties being a common picture at the time of death. The prevention of suicide in the young clearly requires multiple strategies.