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Suicide Prevention: A US Perspective

  • Chapter
Preventing Disease

Part of the book series: Frontiers of Primary Care ((PRIMARY))

Abstract

Physicians have an excellent opportunity to assist in the reduction of suicide, especially since they often see persons while they are in the process of considering the act. In a study of 60 persons who had committed suicide, Murphy found that 82% were known to have seen a physician within six months, and among 53 the visit occurred within one month or less of their death.1 They had seen a total of 71 physicians. Over two thirds of the patients had histories of suicide attempts, but only 40 of the physicians were aware of the histories. In some cases, the physician had provided the means of suicide by prescribing lethal amounts of medication to the patient.2 The relatively high rate of suicide within the medical profession is another reason for physicians to be personally concerned.3 In order to be more effective in a preventive role, physicians must understand the distribution and determinants of suicide and be able to apply that knowledge in prevention strategies. This chapter reviews important risk factors for suicide and assesses the effectiveness of various modes of intervention.

The effectiveness of caregivers in preventing suicide turns out to be more a matter of speculation than of reliable scientific evidence. Therefore, the following two contributions may serve as blueprints for research as much as for specific action. Readers may question why US and Canadian viewpoints have been presented separately. For one thing, suicide rates vary significantly between countries and within national regions and population groups. Also, access to lethal weapons (gun control) differs significantly between Canada and the United States-a fact that may have greater importance for the prevention of homicide than of suicide. Both countries share the need for early detection and treatment of depression as steps toward reducing suicide rates.

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References

  1. Murphy GE. The physician’s responsibility for suicide: II. Errors of omission. Ann Int Med 1975; 82: 305–309.

    PubMed  CAS  Google Scholar 

  2. Murphy GE. The physician’s responsibility for suicide: I. An error of commission. Ann Int Med 1975; 82: 301–304.

    PubMed  CAS  Google Scholar 

  3. American Medical Association. Results and implications of the AMA-APA physician mortality project. JAMA 1987; 257: 2949–2954.

    Article  Google Scholar 

  4. Brown JH. Suicide in Britain: more attempts, fewer deaths, lessons for public policy. Arch Gen Psychiatry 1979; 36: 1119–1124.

    PubMed  CAS  Google Scholar 

  5. Shneidman E. Definitions of Suicide. New York: Wiley, 1985.

    Google Scholar 

  6. US Department of Health and Human Services. Health, United States, 1986. DHHS Publ No. PHS 87-1232. Washington: GPO, 1986.

    Google Scholar 

  7. Centers for Disease Control. Premature mortality due to suicide and homicide in the United States, 1983. MMWR 1986; 35: 357–360.

    Google Scholar 

  8. National Task Force on Suicide in Canada. Suicide in Canada. Ottawa: Department of National Health and Welfare, 1987.

    Google Scholar 

  9. Brent DA, Perper JA, Allman CJ. Alcohol, firearms and suicide among youth: Temporal trends in Allegheny County, Pennsylvania, 1960 to 1983. JAMA 1987; 257: 3369–3372.

    Article  PubMed  CAS  Google Scholar 

  10. Faberow N, MacKinnon DR, Nelson FL. Suicide: who’s counting? Public Health Rep 1977; 92: 223–232.

    Google Scholar 

  11. Jobes DA, Berman AL, Josselson AR. The impact of psychological autopsies on medical examiners’ determination of manner of death. J Forensic Soc Sci 1986; 31: 177–189.

    CAS  Google Scholar 

  12. Rosenberg ML. Violence: homicide, assault and suicide. In Amler R, Dull HB (eds). Closing the Gap: The Burden of Unnecessary Illness. Oxford: Oxford U Press, 1987.

    Google Scholar 

  13. US Department of Health and Human Services. Report of the Secretary’s Task Force on Black and Minority Health. Vol. 5. Homicide, Suicide and Unintentional Injuries. Washington: GPO, 1986.

    Google Scholar 

  14. World Health Organization. Prevention of Suicide. Public Health Papers No. 35. Geneva: 1982.

    Google Scholar 

  15. Monk M. Epidemiology of suicide. Epidemiol Rev 1987; 9: 51–69.

    PubMed  CAS  Google Scholar 

  16. Robins LN, Kulbok PA. Methodological strategies in suicide. In Psychobiology of suicidal behavior. Ann NY Acad Sci 1986; 487: 1 - 15.

    Article  PubMed  CAS  Google Scholar 

  17. Lester D. Why People Kill Themselves. Springfield, 111: Thomas, 1983.

    Google Scholar 

  18. Schulsinger F, Kety SS, Rosenthal D, et al. A family study of suicide. In Schou M, Stromgren E (eds). Origin, Prevention and Treatment of Affective Disorders. London: Academic Press, 1979, 277–289.

    Google Scholar 

  19. Dorpat TL, Ripley HS. A study of suicide in the Seattle area. Compr Psychiatry 1060; 1: 349–359.

    Article  Google Scholar 

  20. Barraclough BM, Bunch J, Nelson B, et al. A hundred cases of suicide: clinical aspects. Br J Psychiatry 1974; 125: 355–373.

    Article  PubMed  CAS  Google Scholar 

  21. Robins E. The Final Months. New York: Oxford U Press, 1981.

    Google Scholar 

  22. Hagnell O, Lanke J, Rorsman B. Suicide rates in the Lundby study: mental illness as a risk factor for suicide. Neuropsycholobiology 1981; 7: 248–253.

    Article  CAS  Google Scholar 

  23. Rorsman B. Suicide in psychiatric patients: a comparative study. Soc Psychiatry 1973; 8: 55–66.

    Article  Google Scholar 

  24. Roy A. Risk factors for suicide in psychiatric patients. Arch Gen Psychiatry 1982; 39: 1089–1095.

    PubMed  CAS  Google Scholar 

  25. Pallis DJ, Barraclough BM, Levey AB, et al. Estimating suicide risk among attempted suicides: I. The development of new clinical scales. Br J Psychiatry 1962; 141: 37–44.

    Article  Google Scholar 

  26. Boyd JH. The increasing rate of suicide by firearms. N Engl J Med 1983; 308: 872–874.

    Article  PubMed  CAS  Google Scholar 

  27. Markush RE, Bartolucci AE. Firearms and suicide in the United States. Am J Public Health 1984; 74: 123–127.

    Article  PubMed  CAS  Google Scholar 

  28. Kreitman N. The coal gas story: United Kingdom suicide rates, 1960–1971. Br J Prev Soc Med 1976; 30: 86–93.

    PubMed  CAS  Google Scholar 

  29. Sainsbury P, Baer TA, Jenkins J. Suicide trends in Europe. In Proceedings of the 10th International Congress for Suicide Prevention, International Association for Suicide Prevention, Ottawa, 1979.

    Google Scholar 

  30. Oliver RG, Hetzel BS. Rise and fall of suicide rates in Australia: relation to sedative availability. Med J Aust 1972; 2: 919–923.

    PubMed  CAS  Google Scholar 

  31. Phillips DP, Paight DJ. The impact of televised movies about suicide, a replicative study. N Engl J Med 1987; 317: 809–811.

    Article  PubMed  CAS  Google Scholar 

  32. Reed J, Camus J, Last JM. Suicide in Canada: birth-cohort analysis. Can J Public Health 1985; 76: 43–47.

    PubMed  CAS  Google Scholar 

  33. Goldney RD, Katsikitis M. Cohort analysis of suicide rates in Australia. Arch Gen Psychiatry 1983; 40: 71–74.

    PubMed  CAS  Google Scholar 

  34. Durkheim E. Suicide. New York: Free Press, 1951.

    Google Scholar 

  35. Brenner MH. Mortality and the national economy: a review, and the experiences of England and Wales, 1936–1976. Lancet 1979; 2: 568–573.

    Article  PubMed  CAS  Google Scholar 

  36. Piatt S. Unemployment and suicidal behavior: a review of the literature. Soc Sci Med 1984; 192: 93–115.

    Google Scholar 

  37. Wasserman IM. The influence of economic business cycles on United States suicide rates. Suicide Life Threat Behav 1984; 14: 143–156.

    PubMed  CAS  Google Scholar 

  38. Piatt S, Kreitman N. Parasuicide and unemployment among men in Edinburgh, 1968–1982. Psychol Med 1985; 15: 113–123.

    Article  Google Scholar 

  39. Comstock GW, Partridge KB. Church attendance and health. J Chronic Dis 1972; 25: 665–672.

    Article  PubMed  CAS  Google Scholar 

  40. MacMahon B, Pugh TF. Suicide in the widowed. Am J Epidemiol 1965; 81: 23–31.

    PubMed  CAS  Google Scholar 

  41. Bunch J, Barraclough B, Nelson B, et al. Suicide following bereavement of parents. Soc Psychiatry 1971; 6: 193–199.

    Article  Google Scholar 

  42. Ramsay R, Bagley C. The prevalence of suicidal behaviors, attitudes and associated experiences in an urban population. Suicide Life Threat Behav 1985; 15: 151–167.

    PubMed  CAS  Google Scholar 

  43. Burdick BM, Holmes CB, Wain RF. Recognition of suicide signs by physicians in different areas of specialization. J Med Educ 1983; 58: 716–721.

    PubMed  CAS  Google Scholar 

  44. Pierce DW. A predictive validation of a suicide intent scale: a five-year follow-up. Br J Psychiatry 1981; 139: 391–396

    Article  PubMed  CAS  Google Scholar 

  45. Greer S, Bagley C. Effect of psychiatric intervention in attempted suicide: a controlled study. Br Med J 1971; 1: 310–313.

    Article  PubMed  CAS  Google Scholar 

  46. Morris JB, Beck AT. The efficacy of antidepressant drugs: a review of research. Arch Gen Psychiatry 1974; 30: 667–674.

    PubMed  CAS  Google Scholar 

  47. Zung W, King RE. Identification and treatment of masked depression in a general medical practice. J Clin Psychiatry 1983; 44: 365–368.

    PubMed  CAS  Google Scholar 

  48. Avery D, Winokur G. Mortality in depressed patients treated with electroconvulsive therapy and antidepressants. Arch Gen Psychiatry 1976; 33: 1029–1037.

    PubMed  CAS  Google Scholar 

  49. Martin RL, Cloninger R, Guze SB, et al. Mortality in a follow-up of 500 psychiatric outpatients: cause-specific modality. Arch Gen Psychiatry 1985; 42: 58–66.

    PubMed  CAS  Google Scholar 

  50. Barraclough BM, Shea M. Suicide and Samaritan clients. Lancet 1970; 2: 868–870.

    Article  PubMed  CAS  Google Scholar 

  51. Jennings C, Barraclough BM, Moss JR. Have the samaritans lowered the suicide rates? A controlled study. Psychol Med 1978; 8: 413–422.

    Article  PubMed  CAS  Google Scholar 

  52. Miller HL, Combs DW, Leeper JD, et al. An analysis of the effects of suicide prevention facilities on suicide rates in the United States. Am J Public Health 1984; 74: 340–343.

    Article  PubMed  CAS  Google Scholar 

  53. Pfeffer CR. Suicide prevention: current efficacy and future promise. In Psychobiology of suicidal behavior. Ann NY Acad Sc 1986; 487: 341–350.

    Article  CAS  Google Scholar 

  54. Diekstra RFW. The significance of Nico Speijer’s suicide: how and when should suicide be prevented? Suicide Life Threat Behav 1986; 16: 13–15.

    PubMed  CAS  Google Scholar 

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Authors
  1. M. Alfred Haynes
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Editors and Affiliations

  1. The Izaak Walton Killam Hospital for Children, Dalhousie University, B3J 3G9, Halifax, Nova Scotia, Canada

    Richard B. Goldbloom M.D. (Professor of Pediatrics) (Professor of Pediatrics)

  2. The Cambridge Hospital, Harvard Medical School, 02139, Cambridge, Massachusetts, USA

    Robert S. Lawrence M.D. (Charles S. Davidson Associate Professor of Medicine, Chief of Medicine) (Charles S. Davidson Associate Professor of Medicine, Chief of Medicine)

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© 1990 Springer-Verlag New York Inc.

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Haynes, M.A. (1990). Suicide Prevention: A US Perspective. In: Goldbloom, R.B., Lawrence, R.S. (eds) Preventing Disease. Frontiers of Primary Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-3280-3_16

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  • DOI: https://doi.org/10.1007/978-1-4612-3280-3_16

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7948-8

  • Online ISBN: 978-1-4612-3280-3

  • eBook Packages: Springer Book Archive

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