Suicide prevention and mental illnessBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8201 (Published 03 December 2012) Cite this as: BMJ 2012;345:e8201
- Rich Braithwaite, consultant psychiatrist1
Is Kamerow as guilty of lacking specificity and focus as the US surgeon general he criticises?1 “Psychiatric disorders” may be present in around 90% of people who kill themselves, but what does this actually mean?
Meta-analysis of North American autopsies of patients with psychiatric disorders shows that substance misuse, present in 40%, predominates.2 However, this includes “harmful use” of substances, including binge drinking, and even simple alcohol intoxication; no sensible person would consider these phenomena psychiatric disorders.
Mental illness, such as depressive disorder (34%) and schizophrenia (4%), is represented,2 but even these figures warrant closer observation. Depressive disorder is hugely overdiagnosed in life,3 and this is probably true in death. Recent prescription of antidepressants or retrospective reports of insomnia, lethargy, and low mood from family members do not automatically equate to a true diagnosis of depressive disorder. Yet the pragmatic methodology of psychological autopsy studies dictates precisely that.
In reality, a small minority of people who commit suicide are mentally ill. Most are people encountering difficult life circumstances, to whom suicide seems a logical solution at the time; acts are often carried out impulsively and while intoxicated. This is borne out by the close association between suicide rates over the past century and international economic trends, exemplified by the recent increase in the US during the current recession.4
We must not be complacent in managing people who are unwell, but any suicide reduction policy that targets psychiatric or primary care services is bound to fail, as in the US. Successful policies in the UK, such as restriction of analgesic sales,5 have restricted access to means.
The US national suicide rate will not dramatically fall until radical gun law is introduced. Kamerow may be waiting some time.
Cite this as: BMJ 2012;345:e8201
Competing interests: None declared.