Suicidal behaviour in childbearing women

The first postnatal year is a period when the rate of psychiatric disorder is high, and a correspondingly high rate of suicide might be expected. Age-adjusted mortality ratios for suicide by women in the first postnatal year were therefore calculated from population data for England and Wales for a twelve-year period. The overall mortality ratio was found to be 17 - that is, the actual total was one sixth of that expected. The low rate was not found after stillbirth which was associated with a rate of suicide six times that in all women after childbirth. Women who committed suicide after childbirth most often did so in the first postnatal month and there was a tendency to use violent methods. One explanation of the low rate of suicide is that motherhood exerts a protective effect, and further studies were carried out to explore this possibility. In study two, the age-standardised mortality ratio for suicide during pregnancy was calculated by the same method to be 5 - that is, the actual rate was one twentieth of that expected. In study three, the rate of parasuicide by women in the first postnatal year was calculated from catchment area data to be less than half that of age-matched women (odds ratio 0.43). In study four, a cognitive explanation for these results was studied. Women with postnatal depression were found to score less on a questionnaire measuring cognitions related to worthlesness, hopelessness and self-harm than women with depression arising at other times. This result suggests that childbearing women, despite their risk of psychiatric disorder, are protected against suicide and self-harm by their relative absence of suicide-related cognitions, and that such cognitions should be a focus for the treatment of other groups at risk of suicide

Support for Relatives Bereaved by Psychiatric Patient Suicide: National Confidential Inquiry Into Suicide and Homicide Findings

OBJECTIVES: International suicide prevention strategies recommend providing support to families bereaved by suicide. The study objectives were to measure the proportion of cases in which psychiatric professionals contact next of kin after a patient’s suicide and to investigate whether specific, potentially stigmatizing patient characteristics influence whether the family is contacted. METHODS: Annual survey data from England and Wales (2003–2012) were used to identify 11,572 suicide cases among psychiatric patients. Multivariate regression analysis was used to describe the association between specific covariates (chosen on the basis of clinical judgment and the published literature) and the probability that psychiatric staff would contact bereaved relatives of the deceased. RESULTS: Relatives were not contacted after the death in 33% of cases. Contrary to the hypothesis, a violent method of suicide was independently associated with greater likelihood of contact with relatives (adjusted odds ratio=1.67). Four patient factors (forensic history, unemployment, and primary diagnosis of alcohol or drug dependence or misuse) were independently associated with less likelihood of contact with relatives. Patients’ race-ethnicity and recent alcohol or drug misuse were not associated with contact with relatives. CONCLUSIONS: Four stigmatizing patient-related factors reduced the likelihood of contacting next of kin after patient suicide, suggesting inequitable access to support after a potentially traumatic bereavement. Given the association of suicide bereavement with suicide attempt, and the possibility of relatives’ shared risk factors for suicide, British psychiatric services should provide more support to relatives after patient suicide

Child suicide rates during the COVID-19 pandemic in England

BACKGROUND: There is concern about the impact of COVID-19, and the control measures to prevent the spread, on children's mental health. The aim of this work was to identify if there had been a rise of childhood suicide during the COVID pandemic. METHOD: Using data from England's National Child Mortality Database (NCMD) the characteristics and rates of children dying of suicide between April to December 2020 were compared with those in 2019. In a subset (1(st) January to 17(th) May 2020) further characteristics and possible contributing factors were obtained. RESULTS: A total of 193 likely childhood deaths by suicide were reported. There was no evidence overall suicide deaths were higher in 2020 than 2019 (RR 1.09 (0.80-1.48), p=0.584) but weak evidence that the rate in the first lockdown period (April to May 2020) was higher than the corresponding period in 2019 (RR 1.56 (0.86-2.81), p=0.144). Characteristics of individuals were similar between periods. Social restrictions (e.g. to education), disruption to care and support services, tensions at home and isolation appeared to be contributing factors. LIMITATIONS: As child suicides are fortunately rare, the analysis is based on small numbers of deaths with limited statistical power to detect anything but major increases in incidence. CONCLUSION: We found no consistent evidence that child suicide deaths increased during the COVID-19 pandemic although there was a possibility that they may have increased during the first UK lockdown. A similar peak was not seen during the following months, or the second lockdown

Substance use and self-poisoning in schizophrenia: 11-year findings from a national clinical survey of suicide in mental health patients in the UK

Suicide is the leading cause of unnatural death among people with schizophrenia. Substance use is a highly prevalent comorbid feature of schizophrenia and a modifiable risk factor for suicide. However, no studies have examined changes in the frequency of substance use or self-poisoning in those who died by suicide over time. Knowing this could support more tailored approaches to reducing specific risk factors and access to means in those with schizophrenia who are at risk of suicide. We conducted an 11-year observational study on a clinical survey of people with schizophrenia in the UK who died by suicide within 12 months of contact with mental health services between 2010 and 2020 (n = 2718). Overall, alcohol, cannabis and stimulants were the most frequently reported substances. The odds of lifetime use significantly increased over time for cannabis, stimulants, heroin, and benzodiazepines. There were differences in socio-demographic, behavioural and clinical factors between those with recent and historical alcohol and drug use before death. Deaths by hanging, jumping and self-poisoning were the most common suicide methods. Though deaths by hanging significantly increased over time, deaths by self-poisoning significantly decreased, especially by means of psychotropic medication and opioids. To improve risk management, clinical efforts should focus on identifying and treating people with schizophrenia using specific substances. Nationwide initiatives for improving safety in prescribing could be contributing to reduced risks of suicide via self-poisoning in this group

Intimate Partner Violence, Suicidality, and Self-Harm: A Probability Sample Survey of the General Population in England

Background: Intimate partner violence (IPV) is a recognised risk factor for psychiatric disorder. This study examines IPV and self-harm and suicidality, for which there is little current evidence. Methods: Analysis of a 2014 probability sample survey of 7058 adults (16+) in the English general population. Multivariable logistic regression models quantified associations between different indicators of lifetime and past year IPV with past-year non-suicidal self-harm, suicidal thoughts, and suicide attempts. Outcomes: A fifth (21·4%, n=1702) of adults reported lifetime experience of IPV; 27.2% of women (n=1243) and 15.3% of men (n=459). Among women, 19.6% had ever experienced emotional IPV, 18.7% physical, 8.5% economic, and 3.7% sexual. Prevalence in men was lower (8.6%, 9.3%, 3.6%, 0.3%, respectively). 15.9% of women and 5.0% of men had ever experienced more than one type of IPV. Lifetime prevalence of IPV was higher in those living in rented accommodation or deprived neighbourhoods. Among people who had attempted suicide in the past year 49·7% had ever experienced IPV, 23·1% experienced IPV in the past year (39·6% of women, 9·4% of men). After adjusting for demographics, socioeconomics, and lifetime experience of adversities, the odds of a past-year suicide attempt were 2·82 (95%CI:1·54-5·17) times higher in lifetime IPV victims than non-victims. Adjusted odds ratios for past-year self-harm (2·20, 1·37-3·53) and suicidal thoughts (1·85, 1·39-2·46) were also raised in those who had ever experienced IPV. Lifetime experience of sexual IPV was ten times more common in women than men, and an IPV type associated with particularly high odds self-harm and suicidality. Interpretation: IPV is common in England (especially among women) and strongly associated with self-harm and suicidality (especially sexual IPV). People presenting to services in suicidal distress or after self-harm should be asked about IPV. Interventions designed to reduce the prevalence and duration of IPV may protect and improve the lives of people at risk of suicide and self-harm