Mental disorders in young and middle aged men who commit suicide
BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6991.1366 (Published 27 May 1995) Cite this as: BMJ 1995;310:1366
- Erkki Isometsa, senior researchera,
- Markus Henriksson, senior lecturerb,
- Mauri Marttunen, senior lecturerb,
- Martti Heikkinen, senior researchera,
- Hillevi Aro, professora,
- Kimmo Kuoppasalmi, acting associate professorb,
- Jouko Lonnqvist, research professora
- a Department of Mental Health, National Public Health Institute, FIN-00300, Helsinki, Finland
- b Department of Psychiatry, Helsinki University, Helsinki
- Correspondence to: Dr Isometsa.
- Accepted 17 February 1995
In most European countries men account for about three quarters of people who commit suicide. Suicide rates have generally risen among men under 35 but remained more stable among older men. To our knowledge, no studies specifically compare mental disorders among men of different ages who have committed suicide, although the association between mental disorders and suicide is strong and different secular trends in suicide rates have been reported. We compared the prevalences of mental disorders central to suicide—depressive syndromes, alcoholism, personality disorders, and non-affective psychotic disorders—in men of 20-34 and 35-59 who committed suicide in Finland.
Subjects, methods, and results
In the research phase of the national suicide prevention project in Finland all deaths between 1 April 1987 and 31 March 1988 that were officially classified as suicide (n=1397) were recorded and carefully analysed retrospectively by the psychological autopsy method.1 The definition of suicide was based on Finnish law—in every case of violent, sudden, or unexpected death the possibility of suicide is assessed by police and medicolegal examination. Data for psychological autopsies were collected from comprehensive interviews with relatives and health care staff; psychiatric, medical, and social agency records; police investigations; medicolegal examinations at necropsy and toxicological analyses; and suicide notes. Details of the methods have been published.1
Mental disorders were retrospectively examined, according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) in the diagnostic study of a random sample of 229 (16.4%) of the people who committed suicide.1 The diagnostic evaluation was based on weighing and integrating all evidence and took place in two stages. Firstly, two pairs of psychiatrists independently gave provisional diagnoses, the reliability of which was tested with the (kappa) coefficient and found to be good or at least moderate in the relevant diagnostic categories ((kappa)=0.52-0.94).1 Secondly, all cases of diagnostic disagreement were reanalysed by a third psychiatrist to achieve consensus for the final best estimate diagnoses. All men aged 20 to 59 from the random sample were included in the study, those aged 20-34 being compared with those aged 35-59. The table shows that the prevalence of psychotic disorders was significantly higher in the younger men and the prevalence of alcoholism significantly higher in the older.
Comment
Our study effectively accounted for all cases of suicide in Finland among men aged 20-59 over a year; methodological limitations have been discussed.1 As applies generally,1 2 suicide among both young and middle aged men was almost always associated with mental disorders, and complicated comorbid conditions were common. At death the younger men more often suffered from some psychotic disorder and the middle aged men from alcoholism.
Comparison of retrospective best estimate diagnoses according to DSM-III-R in young and middle aged men from random sample of people who committed suicide in Finland
The prevalence of psychotic disorders among the younger men (25%) was higher than that found in a similar age group in Greater Montreal and Quebec City (9%; men who committed suicide in hospital were excluded)3 and in two studies of suicide among young people in San Diego and Gothenburg (17% in both studies).2 4 The prevalence of personality disorders among the younger men (43%, or 56% when undetermined cases were excluded) accords with other studies (36% and 42%) among young adult victims5 and 57% among young men with axis II disorders.3 Overall, these results suggest that about half of the young people (35%2 and 64%4) or young men (59% and 60%)3 who commit suicide are suffering from a depressive syndrome. The notable exception to the rather uniform view of mental disorders among suicide victims in all these studies is the prevalence of psychoactive substance use disorders other than alcoholism. The prevalence of such disorders was high in San Diego (66%)2 but lower in Quebec (28%)3 and Gothenburg (16%).4 It was rare in our study (5%), reflecting the relatively low prevalence of drug misuse in Finland, particularly in rural areas.
Suicide among the older men was typically related to alcohol dependence (56%) or depressive syndromes (64%), or both, and more severe forms of these diagnoses (major depression and alcohol dependence) were more common than among the younger men. The distribution of mental disorders among the middle aged men accords more with earlier psychological autopsy studies of suicide. These differences between men of different ages have implications for the planning of treatment programmes aimed at suicide prevention.
This study was supported by a grant from the Academy of Finland.