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One in 10 suicides is among people with a physical illness

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d5464 (Published 26 August 2011) Cite this as: BMJ 2011;343:d5464
  1. Anne Gulland
  1. 1London

A report on the link between suicide and physical ill health has found that one in 10 people who take their own life is chronically or terminally ill.

The report, by think tank Demos, is one of the first such comprehensive studies to look at the links between suicide and physical ill health. It says that the figure, which came from coroners and primary care trusts (PCTs), is likely to be a substantial underestimate because coroners do not always include the relevant health information with their inquest reports.

Demos believes that the findings provide strong evidence that people with chronic and terminal illnesses should be regarded as a high risk group for suicide and should be given better “medical, practical, and psychological support.”

Researchers sent freedom of information requests to all PCTs in England on the relationship between physical ill health and suicide and conducted interviews with coroners. PCTs are meant to carry out suicide audits but 10 trusts told Demos that they did not conduct such an audit. Demos recommends that because suicide is such a serious public health matter the audits “should not be optional” and PCTs—and the forthcoming health and wellbeing boards—should be required to compile annual reports that detail the characteristics of people who die by suicide.

Demos also found that coroners’ policies on collecting and sharing information on suicides vary widely. The report stated, “This is an issue of national importance and it should not be left to individual coroners to decide their policies locally.”

The government launched a consultation on suicide in July which identified five high risk groups for suicide: people in the care of mental health services (1200 suicides a year); people in the criminal justice system (80 suicides in prison a year); adult men aged under 50 (2000 suicides a year); people with a history of self harm (950 suicides a year), and occupational groups such as doctors, nurses, and farmers. There were 4390 suicides in England in 2009, which, using Demos’s calculation, would mean that more than 400 of these were among people with a chronic or terminal illness. Demos believes that this group should be identified as high risk.

The report calls on GPs and others in the primary care team to ensure that appropriate local services are available to respond to the emotional and practical needs of people who are coping with painful or limiting illness.

Louise Bazalgette, author of the report, said it was important that doctors treating people with a chronic or terminal illness were aware of the issue.

“Doctors should be thinking about the possibility that a person with chronic health problems may be depressed and struggling. They should ask them if they ever feel suicidal,” she said.

The report includes extracts from suicide notes. “It’s impossible to tell whether these people were receiving good healthcare or not from their doctors. It may be that some people aren’t able to discuss these issues with their doctors,” she said.

She added, “PCTs tend to focus on high risk groups identified nationally. It’s important that the national strategy is comprehensive and ambitious and that it provides support to local agencies such as PCTs and health and wellbeing boards,” she said.

Simon Gillespie, chief executive of the Multiple Sclerosis Society, said: “There is a big difference between someone wanting to end their life having explored and received every care option, and someone giving up hope because they feel they have nothing available to them. The right care and support can make a huge difference to an individual’s life.”

Clare Wyllie, head of policy and research at the Samaritans, said it was important that a suicide prevention strategy was implemented locally. “It is vital that commissioners of local NHS, social care and public health services recognise that poor physical health and poor mental health are often closely linked [and] that depression is often undiagnosed in people with poor physical health,” she said.

Notes

Cite this as: BMJ 2011;343:d5464

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