Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-29T14:57:18.245Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychiatric and psycho-social characteristics of suicide completers: a comprehensive evaluation of psychiatric case records and postmortem findings

Published online by Cambridge University Press:  08 September 2014

J. Kielty ,
A. van Laar ,
M. Davoren ,
L. Conlon ,
A. Hillick ,
C. McDonald  and
B. Hallahan
J. Kielty
Affiliation:
Department of Psychiatry, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
A. van Laar
Affiliation:
Department of Psychiatry, University Hospital Galway, Galway, Ireland
M. Davoren
Affiliation:
Department of Psychiatry, University Hospital Galway, Galway, Ireland Central Mental Hospital, Dublin, Ireland
L. Conlon
Affiliation:
Department of Psychiatry, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland Department of Psychiatry, University Hospital Galway, Galway, Ireland
A. Hillick
Affiliation:
Department of Psychiatry, University Hospital Galway, Galway, Ireland
C. McDonald
Affiliation:
Department of Psychiatry, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland Department of Psychiatry, University Hospital Galway, Galway, Ireland
B. Hallahan*
Affiliation:
Department of Psychiatry, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland Department of Psychiatry, University Hospital Galway, Galway, Ireland
*
*Address for correspondence: Dr B. Hallahan, Department of Psychiatry, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To explore the demographic, psychosocial and clinical characteristics of individuals known to the mental health services, who died by probable suicide in the West of Ireland.

Methods

Postmortem reports between January 2006 and May 2012 detailed 153 individuals who died by probable suicide, 58 of whom attended the mental health services. Relevant socio-demographic and clinical data was extracted from individuals’ lifetime case notes.

Results

Recurrent depressive disorder (44%) was the most common diagnosis and hanging the most common method of death (58%). Of individuals who died by hanging, 79% previously attempted suicide by the same method. For individuals with a documented history of depression, only 32% had antidepressants detected in their toxicology reports. Similarly, only one individual (20%) with schizophrenia had antipsychotics detected in their toxicology report.

Conclusions

Individuals who died by probable suicide, most commonly died by hanging and drowning; with previous attempts of hanging particularly prevalent in the group who subsequently died by hanging. At the time of death, less than one-third of individuals according to toxicology reports were taking the medication that was last prescribed to them by the mental health services suggesting a high rate of treatment non-concordance in individuals who died by probable suicide.

Keywords

Postmortemsuicidetreatment concordance
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 32 , Issue 2 , June 2015 , pp. 167 - 176
Copyright
© College of Psychiatrists of Ireland 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akincigil, A, Bowblis, JR, Levin, C, Walkup, JT, Jan, S, Crystal, S (2007). Adherence to antidepressant treatment among privately insured patients diagnosed with depression. Medical Care 45, 363–369.Google Scholar
Appleby, L, Shaw, J, Amos, T, McDonnell, R, Harris, C, McCann, K, Kiernan, K, Davies, S, Bickley, H, Parsons, R (1999). Suicide within 12 months of contact with mental health services: national clinical survey. British Medical Journal 318, 1235–1239.CrossRefGoogle ScholarPubMed
Arsenault-Lapierre, G, Kim, C, Turecki, G (2004). Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry 4, 37.Google Scholar
Barraclough, B, Bunch, J, Nelson, B, Sainsbury, P (1974). A hundred cases of suicide: clinical aspects. The British Journal of Psychiatry 125, 355–373.CrossRefGoogle ScholarPubMed
Bartels, SJ, Coakley, E, Oxman, TE, Constantino, G, Oslin, D, Chen, H, Zubritsky, C, Cheal, K, Durai, UN, Gallo, JJ, Llorente, M, Sanchez, H (2002). Suicidal and death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. The American Journal of Geriatric Psychiatry 10, 417–427.Google Scholar
Beautrais, A (2007). Suicide by jumping. Crisis: The Journal of Crisis Intervention and Suicide Prevention 28, 58–63.Google Scholar
Berglund, M, Ojehagen, A (1998). The influence of alcohol drinking and alcohol use disorders on psychiatric disorders and suicidal behavior. Alcoholism: Clinical and Experimental Research 22 (Suppl. 7): 333S–345S.Google Scholar
Bertolote, JM, Fleischmann, A, De Leo, D, Wasserman, D (2004). Psychiatric diagnoses and suicide: revisiting the evidence. Crisis 25, 147–155.Google Scholar
Boardman, AP, Grimbaldeston, AH, Handley, C, Jones, PW, Willmott, S (1999). The North Staffordshire suicide study: a case-control study of suicide in one health district. Psychological Medicine 29, 27–33.CrossRefGoogle ScholarPubMed
Boenisch, S, Bramesfeld, A, Mergl, R, Havers, I, Althaus, D, Lehfeld, H, Niklewski, G, Hegerl, U (2010). The role of alcohol use disorder and alcohol consumption in suicide attempts – a secondary analysis of 1921 suicide attempts. European Psychiatry 25, 414–420.Google Scholar
Borges, G, Rosovsky, H (1996). Suicide attempts and alcohol consumption in an emergency room sample. Journal of Studies on Alcohol and Drugs 57, 543–548.CrossRefGoogle Scholar
Burgess, P, Pirkis, J, Morton, J, Croke, E (2000). Lessons from a comprehensive clinical audit of users of psychiatric services who committed suicide. Psychiatric Services 51, 1555–1560.CrossRefGoogle ScholarPubMed
Callanan, V, Davis, M (2012). Gender differences in suicide methods. Social Psychiatry and Psychiatric Epidemiology 47, 857–869.Google Scholar
Cantrell, CR, Eaddy, MT, Shah, MB, Regan, TS, Sokol, MC (2006). Methods for evaluating patient adherence to antidepressant therapy: a real-world comparison of adherence and economic outcomes. Medical Care 44, 300–303.CrossRefGoogle ScholarPubMed
Casey, P, Gemmell, I, Hiroeh, U, Fulwood, C (2012). Seasonal and socio-demographic predictors of suicide in Ireland: a 22 year study. Journal of Affective Disorders 136, 862–867.Google Scholar
Cavanagh, JT, Carson, AJ, Sharpe, M, Lawrie, SM (2003). Psychological autopsy studies of suicide: a systematic review. Psychological Medicine 33, 395–405.Google Scholar
Central Statistics Office (2013). Vital statistics – Fourth Quarter and Yearly Summary, Central Statistics Office, Cork, 53.Google Scholar
Chen, YY, Lee, MB, Chang, CM, Liao, SC (2009). Methods of suicide in different psychiatric diagnostic groups. Journal of Affective Disorders 118, 196–200.Google Scholar
Cherpitel, CJ, Borges, GL, Wilcox, HC (2004). Acute alcohol use and suicidal behavior: a review of the literature. Alcoholism: Clinical and Experimental Research 28 (Suppl. 5): 18S–28S.Google Scholar
Deisenhammer, EA, Huber, M, Kemmler, G, Weiss, EM, Hinterhuber, H (2007). Suicide victims’ contacts with physicians during the year before death. European Archives of Psychiatry and Clinical Neuroscience 257, 480–485.Google Scholar
Dube, SR, Anda, RF, Felitti, VJ, Chapman, DP, Williamson, DF, Giles, WH (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the adverse childhood experiences study. Journal of the American Medical Association 286, 3089–3096.Google Scholar
Dumais, A, Lesage, AD, Lalovic, A, Seguin, M, Tousignant, M, Chawky, N, Turecki, G (2005). Is violent method of suicide a behavioral marker of lifetime aggression? The American Journal of Psychiatry 162, 1375–1378.CrossRefGoogle ScholarPubMed
Evans, J (1994). The health service contacts of 87 suicides. Psychiatric Bulletin 18, 548–550.CrossRefGoogle Scholar
Fleischmann, A, Bertolote, JM, Belfer, M, Beautrais, A (2005). Completed suicide and psychiatric diagnoses in young people: a critical examination of the evidence. American Journal of Orthopsychiatry 75, 676–683.Google Scholar
Fushimi, M, Sugawara, J, Shimizu, T (2005). Suicide patterns and characteristics in Akita, Japan. Psychiatry and Clinical Neurosciences 59, 296–302.Google Scholar
Geddes, JR, Juszczak, E, O'Brien, F, Kendrick, S (1997). Suicide in the 12 months after discharge from psychiatric inpatient care, Scotland 1968–92. Journal of Epidemiology and Community Health 51, 430–434.CrossRefGoogle ScholarPubMed
Gonzalez, A, Boyle, MH, Kyu, HH, Georgiades, K, Duncan, L, MacMillan, HL (2012). Childhood and family influences on depression, chronic physical conditions, and their co-morbidity: findings from the Ontario child health study. Journal of Psychiatric Research 46, 1475–1482.Google Scholar
Grossi, V, Violato, C (1992). Attempted suicide among adolescents: a stepwise discriminant analysis. Canadian Journal of Behavioral Science 24, 410–413.Google Scholar
Guertin, T, Lloyd-Richardson, E, Spirito, A, Donaldson, D, Boergers, J (2001). Self-mutilative behavior in adolescents who attempt suicide by overdose. Journal of the American Academy of Child & Adolescent Psychiatry 40, 1062–1069.CrossRefGoogle ScholarPubMed
Gunnell, D, Frankel, S (1994). Prevention of suicide: aspirations and evidence. British Medical Joural 308, 1227–1233.CrossRefGoogle ScholarPubMed
Gunnell, D, Nowers, M (1997). Suicide by jumping. Acta Psychiatrica Scandinavica 96, 1–6.CrossRefGoogle ScholarPubMed
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorders: a meta-analysis. The British Journal of Psychiatry 170, 205–228.Google Scholar
Hawton, K, Sutton, L, Haw, C, Sinclair, J, Deeks, JJ (2005). Schizophrenia and suicide: systematic review of risk factors. The British Journal of Psychiatry 187, 9–20.Google Scholar
Hepp, U, Ring, M, Frei, A, Rössler, W, Schnyder, U, Ajdacic-Gross, V (2010). Suicide trends diverge by method: Swiss suicide rates 1969–2005. European Psychiatry 25, 129–135.Google Scholar
Health Service Executive (2010). National Office for Suicide Prevention: Annual Report, 2010, Dublin.Google Scholar
Health Service Executive (2012). National Office for Suicide Prevention: Annual Report, 2012, Dublin.Google Scholar
Hirokawa, S, Matsumoto, T, Katsumata, Y, Kitani, M, Akazawa, M, Takahashi, Y, Kawakami, N, Watanabe, N, Hirayama, M, Kameyama, A, Takeshima, T (2012). Psychosocial and psychiatric characteristics of suicide completers with psychiatric treatment before death: a psychological autopsy study of 76 cases. Psychiatry and Clinical Neurosciences 66, 292–302.Google Scholar
Ho, TP (2003). Psychiatric care of suicides in Hong Kong. Journal of Affective Disorders 76, 137–142.Google Scholar
Holley, HL, Fick, G, Love, EJ (1998). Suicide following an inpatient hospitalization for a suicide attempt: a Canadian follow-up study. Social Psychiatry and Psychiatric Epidemiology 33, 543–551.Google Scholar
Holmgren, A, Jones, AW (2010). Demographics of suicide victims in Sweden in relation to their blood–alcohol concentration and the circumstances and manner of death. Forensic Science International 198, 17–22.Google Scholar
Houston, K, Hawton, K, Shepperd, R (2001). Suicide in young people aged 15–24: a psychological autopsy study. Journal of Affective Disorders 63, 159–170.CrossRefGoogle ScholarPubMed
Hoyer, EH, Olesen, AV, Mortensen, PB (2004). Suicide risk in patients hospitalised because of an affective disorder: a follow-up study, 1973–1993. Journal of Affective Disorders 78, 209–217.Google Scholar
Huisman, A, van Houwelingen, CAJ, Kerkhof, AJFM (2010). Psychopathology and suicide method in mental health care. Journal of Affective Disorders 121, 94–99.Google Scholar
Hunt, IM, Kapur, N, Robinson, J, Shaw, J, Flynn, S, Bailey, H, Meehan, J, Bickley, H, Burns, J, Appleby, L, Parsons, R (2006). Suicide within 12 months of mental health service contact in different age and diagnostic groups: national clinical survey. The British Journal of Psychiatry 188, 135–142.CrossRefGoogle ScholarPubMed
Hunt, IM, Swinson, N, Palmer, B, Turnbull, P, Cooper, J, While, D, Windfuhr, K, Shaw, J, Appleby, L, Kapur, N (2010). Method of suicide in the mentally ill: a national clinical survey. Suicide And Life Threatening Behaviour 40, 22–34.Google Scholar
Hunt, IM, Windfuhr, K, Swinson, N, Shaw, J, Appleby, L, Kapur, N (2011). Electroconvulsive therapy and suicide among the mentally ill in England: a national clinical survey. Psychiatry Research 187, 145–149.Google Scholar
Isomesta, ET, Henriksson, MM, Heikkinen, ME, Aro, HM, Marttunen, MJ, Kuoppasalmi, KI, Lonnqvist, JK (1996). Suicide among subjects with personality disorders. The American Journal of Psychiatry 153, 667–673.Google Scholar
Jenkins, GR, Hale, R, Papanastassiou, M, Crawford, MJ, Tyrer, P (2002). Suicide rate 22 years after parasuicide: cohort study. British Medical Journal 325, 1155.Google Scholar
Johnsson, E, Fridell, M (1997). Suicide attempts in a cohort of drug abusers: a 5-year follow-up study. Acta Psychiatrica Scandinavica 96, 362–366.Google Scholar
Jones, GT, Power, C, Macfarlane, GJ (2009). Adverse events in childood and chronic widespread pain in adult life: results from the 1957 british birth cohort study. Pain 143, 92–96.Google Scholar
Karvonen, K, Hakko, H, Koponen, H, Meyer-Rochow, VB, Rasanen, P (2009). Suicides among older persons in Finland and time since hospitalization discharge. Psychiatric Services 60, 390–393.CrossRefGoogle ScholarPubMed
King, EA, Baldwin, DS, Sinclair, JM, Baker, NG, Campbell, MJ, Thompson, C (2001). The Wessex Recent In-Patient Suicide Study, 1. Case-control study of 234 recently discharged psychiatric patient suicides. The British Journal of Psychiatry 178, 531–536.CrossRefGoogle ScholarPubMed
Law, YW, Wong, PW, Yip, PS (2010). Suicide with psychiatric diagnosis and without utilization of psychiatric service. BMC Public Health 10, 431.Google Scholar
Lee, HC, Lin, HC, Liu, TC, Lin, SY (2008). Contact of mental and nonmental health care providers prior to suicide in Taiwan: a population-based study. The Canadian Journal of Psychiatry 536, 377–383.CrossRefGoogle Scholar
Lin, JJ, Chang, SS, Lu, TH (2010). The leading methods of suicide in Taiwan, 2002-2008. BMC Public Health 10, 480.Google Scholar
Liu, RT, Jager-Hyman, S, Wagner, CA, Alloy, LB, Gibb, BE (2012). Number of childhood abuse perpetrators and the occurrence of depressive episodes in adulthood. Child Abuse and Neglect 36, 323–332.Google Scholar
Luoma, JB, Martin, CE, Pearson, JL (2002). Contact with mental health and primary care providers before suicide: a review of the evidence. The American Journal of Psychiatry 159, 909–916.Google Scholar
Maniglio, R (2011). The role of child sexual abuse in the etiology of suicide and non-suicidal self-injury. Acta Psychiatrica Scandinavica 124, 30–41.Google Scholar
Mann, JJ (2003). Neurobiology of suicidal behaviour. Nature Reviews of Neuroscience 4, 819–828.Google Scholar
Manschreck, TC, Boshes, RA (2007). The CATIE schizophrenia trial: results, impact, controversy. Harvard Review of Psychiatry 15, 245–258.Google Scholar
Melartin, TK, Rytsala, HJ, Leskela, US, Lestela-Mielonen, PS, Sokero, TP, Isometsa, ET (2005). Continuity is the main challenge in treating major depressive disorder in psychiatric care. Journal of Clinical Psychiatry 66, 220–227.Google Scholar
Muehlenkamp, JJ, Gutierrez, PM (2007). Risk for suicide attempts among adolescents who engage in non-suicidal self-injury. Archives of Suicide Research 11, 69–82.Google Scholar
Neeleman, J (2001). A continuum of premature death. Meta-analysis of competing mortality in the psychosocially vulnerable. International Journal of Epidemiology 30, 154–162.CrossRefGoogle ScholarPubMed
Park, S, Kim, CY, Hong, JP (2013). Unnatural causes of death and suicide among former adolescent psychiatric patients. Journal of Adolescent Health 52, 207–211.CrossRefGoogle ScholarPubMed
Ping QinMortensen, PB (2001). Specific characteristics of suicide in China. Acta Psychiatrica Scandinavica 103, 117–121.Google Scholar
Pirkola, SP, Isometsa, ET, Heikkinen, ME, Lonnqvist, JK (2000). Suicides of alcohol misusers and non-misusers in a nationwide population. Alcohol and Alcoholism 35, 70–75.Google Scholar
Qin, P, Agerbo, E, Mortensen, PB (2002). Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case-control study based on longitudinal registers. Lancet 360, 1126–1130.Google Scholar
Qin, P, Agerbo, E, Mortensen, PB (2003). Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981-1997. The American Journal of Psychiatry 160, 765–772.CrossRefGoogle ScholarPubMed
Qurashi, I, Kapur, N, Appleby, L (2006). A prospective study of noncompliance with medication, suicidal ideation, and suicidal behavior in recently discharged psychiatric inpatients. Archives of Suicide Research 10, 61–67.Google Scholar
Read, J, McGregor, K, Coggan, C, Thomas, DR (2006). Mental health services and sexual abuse: the need for staff training. Journal of Trauma Dissociation 7, 33–50.Google Scholar
Rebholz, CM, Dongfeng, G, Wenjie, Y, Jing, C, Xigui, W, Jian-feng, H, Ji-chun, C, Chung-Shiuan, C, Kelly, TN, Xiufang, D, Bazzano, LA, Jiang, H (2011). Mortality from suicide and other external cause injuries in China: a prospective cohort study. BMC Public Health 11, 56–65.CrossRefGoogle Scholar
Reinhertz, HZ, Giaconia, RM, Silverman, AB, Friedman, A, Pakiz, B, Frost, AK (1995). Early psychosocial risks for adolescent suicidal ideation and attempts. Journal of the American Academy of Child and Adolescent Psychiatry 34, 599–611.Google Scholar
Rossow, I, Amundsen, A (1995). Alcohol abuse and suicide: a 40-year prospective study of Norwegian conscripts. Addiction 90, 685–691.Google Scholar
Roy, A (1982). Risk factors for suicide in psychiatric patients. Archives of General Psychiatry 39, 1089–1095.Google Scholar
Runeson, B, Tidemalm, D, Dahlin, M, Lichenstein, P, Langstrom, N (2010). Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study. British Medical Journal 340, 3222.Google Scholar
Sawada, N, Uchida, H, Suzuki, T, Watanabe, K, Kikuchi, T, Handa, T, Kashima, H (2009). Persistence and compliance to antidepressant treatment in patients with depression: a chart review. BMC Psychiatry 9, 38.Google Scholar
Schneider, B, Schnabel, A, Sargk, D, Maurer, K, Weber, B, Wetterling, T (2005). Detection of alcohol consumption in suicides. European Archives of Psychiatry and Clinical Neuroscience 255, 1–5.Google Scholar
Shen, X, Hackworth, J, McCabe, H, Lovett, L, Aumage, J, O'Neil, J, Bull, M (2006). Characteristics of suicide from 1998-2001 in metropolitan area. Death Studies 30, 859–871.Google Scholar
Sher, L, Oquendo, MA, Galfalvy, HC, Grunebaum, MF, Burke, AK, Zalsman, G, Mann, JJ (2005). The relationship of aggression to suicidal behavior in depressed patients with a history of alcoholism. Addictive Behaviours 30, 1144–1153.CrossRefGoogle ScholarPubMed
Sinclair, JMA, Harriss, L, Baldwin, DS, King, EA (2005). Suicide in depressive disorders: a retrospective case-control study of 127 suicides. Journal of Affective Disorders 87, 107–113.CrossRefGoogle ScholarPubMed
Skeem, JL, Silver, E, Aippelbaum, PS, Tiemann, J (2006). Suicide-related behavior after psychiatric hospital discharge: implications for risk assessment and management. Behavioral Sciences and the Law 24, 731–746.Google Scholar
Stanley, B, Gameroff, MJ, Michalsen, V, Mann, JJ (2001). Are suicide attempters who self-mutilate a unique population? The American Journal of Psychiatry 158, 427–432.Google Scholar
Swinson, N, Ashim, B, Windfuhr, K, Kapur, N, Appleby, L, Shaw, J (2007). National Confidential Inquiry into Suicide and Homicide by People with Mental Illness: new directions. Psychiatric Bulletin 31, 161–163.Google Scholar
Thong, JY, Su, AH, Chan, YH, Chia, BH (2008). Suicide in psychiatric patients: case-control study in Singapore. Australian New Zealand Journal of Psychiatry 42, 509–519.Google Scholar
Ward, A, Ishak, K, Proskorovsky, I, Caro, J (2006). Compliance with refilling prescriptions for atypical antipsychotic agents and its association with the risks for hospitalization, suicide, and death in patients with schizophrenia in Quebec and Saskatchewan: a retrospective database study. Clinical Therapeutics 28, 1912–1921.Google Scholar
Yim, PH, Yip, PS, Li, RH, Dunn, EL, Yeung, WS, Miao, YK (2004). Suicide after discharge from psychiatric inpatient care: a case-control study in Hong Kong. Australian and New Zealand Journal of Psychiatry 38, 65–72.Google Scholar