MENTAL HEALTH

Health Evidence Bulletins - Wales
Team Leader: Dr Lyn Harris

Date of completion: 4.6.98

SUICIDE

The risk for suicide is increased for most mental disorders where patients require treatment, mainly in a hospital setting, except for those with mental retardation, dementia and agoraphobia i. The best available evidence is the systematic review conducted by Gunnell ii. The document itself is a comprehensive summary of the literature and has not been reproduced in detail here. Those wishing to draw up suicide prevention strategies are strongly recommended to refer to the original document and studies carried out since the review was published in 1994.
i. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 1997; 170: 205-228.
ii. Gunnell D.The Potential for Preventing Suicide. A review of the literature on the effectiveness of interventions aimed at preventing suicide. H.C.E.U. University of Bristol: Department of Epidemiology and Public Health Medicine, 1994.

This document is a supplement to, not a substitute for, professional skills and experience. Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation
The Statements The Evidence
9a. Ecological studies reveal that fluctuations, both in overall and method specific suicide rates, do occur as a result of alterations in the availability of commonly used methods of suicide. Owing to the paucity of clear evidence of effectiveness, many of the suggested preventive measures are based on intuition rather than established evidencei. i. Gunnell D.The Potential for Preventing Suicide. A review of the literature on the effectiveness of interventions aimed at preventing suicide. H.C.E.U. University of Bristol Department of Epidemiology and Public Health Medicine. 1994
(Type III evidence-systematic review not including RCTs)
9b. Community Mental Health Team (CMHT) management is associated with fewer deaths by suicide and in suspicious circumstances i. i. Tyrer P, Coid J, Simmonds S, Joseph P, Marriot S. Community Mental Health Team management for those with severe mental illness and disordered personality. Cochrane Database of Systematic Reviews. Cochrane Library 1998 Issue 2
(Type I evidence-systematic review)
9c. At least 1% of suicide attempters referred to general hospitals in the UK die by suicide within a year of an attempt, and 3-5% within 5-10 yrs. A review is underway of specific treatments for those who have attempted suicidei. i. Hawton K, Arensman E, Townsend E. Deliberate self-harm: the efficacy of psychosocial and pharmacological treatments [Protocol]. Cochrane Database of Systematic Reviews. Cochrane Library 1998 Issue 2. Review in progress.

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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk