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Abstract
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A contemporary, scientific understanding of suicide is required to devise a meaningful prevention strategy in Northern Ireland. Psychological autopsy (PA) suicide studies comprise sensitive interviews with bereaved informants and clinicians (GPs, psychiatrists, etc), combined with meticulous scrutiny of records (coronial, healthcare, social care, etc).1 For more than six decades these studies have contributed immensely to appreciation of the biopsychosocial complexity of suicide. The low incidence of suicide means that a case-control PA is the most pragmatic research design to identify risk/protective factors.
In the sole case-control PA study in Northern Ireland (suicides 1992-1993)2 there was an estimated 38-fold increased risk of suicide linked to the presence of at least one current DSM-III-R3 Axis I nemtal disorder (depressive disorders, primary non-affective psychoses, psychoactive substance use disorders). Other risk factors were: presence of at least one Axis II (personality) disorder; previous self-harm; mental health service contact ever, particularly current; current unemployment; manual social class; GP contact within 26 weeks; occurrence of at least one adverse life event during the previous 52, 26, 12 and 4 weeks, notably a "serious problem with close friend, neighbour or relative" (also "broke off a steady relationship", "problems with police or court appearance" and a "serious illness, injury or assault").4 Axis I-Axis II comorbidity conferred a much higher risk compared with Axis I disorder(s) only. Exposure to civil disorder ("the Troubles") did not increase suicide risk. Higher religious commitment was protective against suicide.
Apart from the contributions of prevention, early diagnosis and effective treatment of mental disorders to suicide risk reduction, the Northern Ireland Suicide Study findings indicated that suicide prevention necessitated 1) high quality self-harm services; 2) minimisation/mitigation of unemployment; 3) public education/intervention regarding interpersonal problems; 4) recurrent suicide risk assessment/mitigation training for multidisciplinary practitioners within healthcare especially primary care, mental health services and general hospitals; and 5) recurrent suicide awareness/intervention training within the police service, the court service and the third sector. All of these remain relevant now...
Language: en |