Background. The aim of the study was to identify sociodemographic
and clinical risk factors for
death from suicide and undetermined injury in residents of one health district.Method. Data were collected on all cases of suicide (ICD-9
E950–959) and undetermined injury
(ICD-9 E980–989) for residents in North Staffordshire Health District
between 1991 and 1995.
Controls, identified from the Coroner's inquest register, who died
from other causes, were matched
for age and sex.Results. Two hundred and twelve pairs of cases and matched
controls were identified. Multivariate
analysis (conditional logistic regression) showed that the risk of death
due to suicide and
undetermined death was associated with: recent separation, relationship
difficulties, experience of
financial difficulties, history of past criminal charges or contact with
the police, a past history of
deliberate self-harm, being on psychotropic medication at the time of death
and a diagnosis of
bipolar affective disorder. For sociodemographic variables, a univariate
analysis found associations
between the cases and being separated, living alone, having a past history
of criminal charges and
unemployment. Cases were more likely to have a psychiatric disorder, past
history of deliberate self-harm
and a past history of psychiatric contact for themselves or a family member.
Controls were
more likely to have a current medical disorder. Cases were more likely
than controls to be on any
form of medication at the time of death and to have received a prescription
for psychotropic or non-psychotropic
medication in the week and month before death. Cases were more likely than
controls
to have had contact with medical services in the week and month before
death, with the general
practitioner in the week before death and with psychiatric services at
any time in the year before
death. Strong associations were found between suicide and undetermined
injury and life events such
as recent separation and bereavement, and financial and relationship difficulties.Conclusions. The study provides an analytical investigation
utilizing a dead control group, data
gathered from several sources and adequate numbers of cases. It confirms
many of the risk factors
identified in other studies and highlights the high proportion of suicides
who have been in recent
contact with the criminal justice system or have been prescribed medication
shortly before death.
Training and supervision of deliberate self-harm assessments