Suicide rate 22 years after parasuicide: cohort study
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7373.1155 (Published 16 November 2002) Cite this as: BMJ 2002;325:1155
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My understanding of a 'consecutive' sample of patients would include
weekend admissions. Do weekend admissions differ from weekday admissions,
will this affect your findings?
Only 12 'probable suicides' were included in the analysis; however
the Kaplan Meier curve has 15 steps, please explain this.
The authors say they have presented hazard ratios, but where are
they? Has a table been omitted?
Competing interests:
None declared
Competing interests: No competing interests
The increased risk of actual suicide among people who have at some
prior time attempted suicide is understood by clinicians in the field. The
rate (100 %) is impressive but not surprising. The likelihood that
clinicians working with parasuicide will suffer as a result of " treatment
failure " is significant but never addressed. Though it is not the
function of the research to address this issue, is there a cross
referenced resource that speaks to the affect of doing work with this
population upon clinicians doing that work? Has anyone looked at the
incidence of suicide among this group of clinicians?
Competing interests:
None declared
Competing interests: No competing interests
Editor - The results of the study by Jenkins et al [1] into the risks
of suicide in people with a history of parasuicide are very interesting
and may add to our understanding of the long-term suicide risks in this
group of patients.
However it would have been more clinical relevant had the authors
reported the proportions of patients receiving ongoing treatment for their
mental illness, frequency of deliberate self harm, types and intensity of
treatment received, the rate of loss to treatment follow-up in both groups
of patients, and the interval from first contact with the mental health
services to suicide. This would provide evidence of effectiveness of
various treatment options.
1. Jenkins GR, Hale R, Papanastassiou M, Crawford MJ, Tyrer P.
Suicide rate 22 years after parasuicide: cohort study. BMJ 2002;325:1155.
Competing interests:
None declared
Competing interests: No competing interests
Would you please define the term "parasuicide"? I get a sense of its
meaning from its context, but nowhere do you define it. Furthermore, I
cannot find it defined in either the Merck Manual nor Stedman's Medical
Dictionary (both on-line).
Competing interests:
None declared
Competing interests: No competing interests
The authors say: "The figure illustrates the rate of survival from
suicide plus probable suicide during the period of follow up. The rate was
5.9/1000/year in the first five years, 0/1000/year between five and 10
years, 4.7/1000/year between 10 and 15 years, . . .". But inspection of
the figure shows a step in the survival curve around 8 years, so there was
presumably a death between 5 and 10 years. The rate should be greater
than zero. Perhaps there is a typographical error here, which the authors
would like to correct.
Competing interests:
None declared
Competing interests: No competing interests
Important to consider other causes of death
Sir,
Jenkins et al report on continuing suicide risk after deliberate self
-harm. They use their findings to argue that clinicians should pay close
attention to continuing suicide risk in people with a history of
deliberate self-harm. Their findings, in a cohort from the late 1970’s,
are similar to findings from a 1981 Scottish discharge cohort. We followed
a cohort of 8,304 people discharged from Scottish General Hospitals after
deliberate self-harm for 13 years using the Scottish linked dataset. We
found that the greatest number of deaths from suicide or undetermined
cause were in the five years after discharge. In the third five year
period, however, the Observed/Expected ratio was 5.33 (95% CI 3.26 – 8.23)
for males, and 9.46 (95% CI 5.61 – 14.95) for females. Homicides and
accidental deaths were also elevated.
We endorse their advice that clinicians should pay attention to
suicide risk, but suggest that their method may have concealed another
important clinical implication. They note that people who had consumed
alcohol at the time of the initial episode were less likely to be traced.
They also censored the thirteen deaths in their cohort that were not
attributed to definite or probably suicide.
In the Scottish cohort, we examined deaths by suicide and
undetermined cause, and deaths by other causes. 214 people died by suicide
or undetermined death during the follow-up period, 196 deaths more than
expected. Nine other categories of illness, however, accounted for 780
deaths, 344 more deaths than would have been expected at general
population rates. Natural causes, therefore, were responsible for more
excess deaths than were suicides.
We identified a higher risk of digestive system disease, respiratory
and circulatory disease, and cancers. The pattern suggests to us that
alcohol, as well as unhealthy lifestyles and possibly impaired access to
medical care, may be important in this group of people. We suggest that
clinicians should pay attention to alcohol use and physical health as well
as suicide risk in people with a history of deliberate self-harm.
References
Hall D J, O’Brien F, Stark C, Pelosi A, Smith H. Thirteen year follow
-up of deliberate self-harm, using linked data. British Journal of
Psychiatry 1998; 172: 239 – 42.
Jenkins G R, Hale R, Papanastassiou M, Crawford M J, Tyrer P. Suicide
rate 22 years after parasuicide: cohort study. BMJ 2002; 325:1155.
Cameron Stark
Honorary Senior Lecturer Highlands and Islands Health
Research Institute,
Beechwood Business Park North
Inverness
IV2 3ED
crs@hihri.abdn.ac.uk
David Hall
Consultant Psychiatrist
Dumfries and Galloway Primary Care NHS Trust
Anthony Pelosi
Consultant Psychiatrist
Lanarkshire Primary Care NHS Trust
Competing interests:
None declared
Competing interests: No competing interests