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Partners in life and in death: the suicide pact in England and Wales 1988-1992

PSYCHOLOGICAL MEDICINE 1999年第6期29卷 1299-1306页

作者： Brown, M Barraclough, B Univ Southampton Mental Hlth Grp Sch Med Southampton SO9 5NH Hants England

Background. We describe the epidemiology of suicide pacts in England and Wales and assess the health, circumstances and motivation of those who died in pacts;the first such account for 35 years. Methods. We have analysed the death certificates, coroners' records and medical notes of all people who died in suicide pacts in England and Wales between 1 January 1988 and 31 December 1992. Results. The 124 suicides in 62 pacts accounted for 0.6 % of all suicides giving a rate of 0.6 per million. The average age was 56 years. Poisoning by car exhaust or medicines caused 95 % of deaths, both members of each pair using the same method. Forty-eight pacts were between married couples, five between blood relatives. Mental disorder was present in half and medical illness in one-third. Motives were avoiding loss of a partner from ill-health in 26 pacts, euthanasia in nine, thwarted love in four. Conclusions. The findings are similar to those of 35 years ago except the incidence of pacts is less. Improved management of illness might avoid some pacts especially when partners in an enduring, affectionate relationship, with few social ties, are both ill.

关键词：居丧死亡原因英格兰/流行病学家庭/心理学家庭特征动机客体依恋疾病角色自杀/心理学自杀/统计学和数值数据威尔士/流行病学青少年成年人老年人女(雌)性人类男(雄)性中年人

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Suicide and unemployment in young people - Analysis of trends in England and Wales, 1921-1995

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BRITISH JOURNAL OF PSYCHIATRY 1999年第3期175卷 263-270页

作者： Gunnell, D Lopatatzidis, A Dorling, D Wehner, H Southall, H Frankel, S Univ Bristol Dept Social Med Bristol BS8 2PR Avon England Univ Bristol Sch Geog Sci Bristol BS8 2PR Avon England Queen Mary Univ London Dept Geog London E1 4NS England

Background The influence of the macro-economic climate on suicide is unclear. During the recent recession, rates have increased in young males but declined in females. Aims To investigate associations between unemployment and suicide in 15- to 44-year-old men and women over a period spanning two major economic recessions (1921-1995). To minimise confounding by changes in method availability, analyses are restricted to suicides using methods other than poisons and gases. Method Time-series analysis using routine mortality and unemployment data. Results There were significant associations between unemployment and suicide in both males and females. Associations were generally stronger at younger ages. Conclusions Secular trends in youth suicide may be influenced by unemployment or other factors associated with changes in the macroeconomic climate. These factors appear to affect women to the same extent as men. Although it is not possible to draw firm aetiological conclusions from time-trend data, our findings are in keeping with those of person-based studies. Declaration of interest None.

关键词：年龄分布死亡原因英格兰/流行病学前瞻性研究性别分布自杀/统计学和数值数据自杀/发展趋势失业/统计学和数值数据失业/发展趋势威尔士/流行病学青少年成年人女(雌)性人类男(雄)性

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Mortality and causes of death in a total national sample of patients with affective disorders admitted for the first time between 1973 and 1993

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BRITISH JOURNAL OF PSYCHIATRY 2000年第1期176卷 76-82页

作者： Hoyer, EH Mortensen, PB Olesen, AV Univ Aarhus Inst Basic Psychiat Res Dept Psychiat Demog Risskov Denmark

Background The high mortality from suicide in patients admitted to hospital with an affective disorder is well documented, although specific causes of mortality and changes in mortality are less well studied. Aims To describe the pattern of mortality in patients with affective disorder and to study changes in suicide risk during the study period. Method All patients (n=54103) admitted for the first time to a psychiatric hospital in Denmark du ring the period 1973-1993 because of affective disorder were included in this study The mortality rate was compared with that of the general population. Results Mortality from natural and unnatural causes was elevated in all subgroups of affective disorder. The risk of suicide among patients ill for one year or less after first admission increased during the period 1973-1993. Conclusions More attention should be paid to the risk of suicide and to physical illness in patients with affective disorders. Declaration of interest No conflict of interest. Financial support detailed in Acknowledgements.

关键词：死亡原因/发展趋势丹麦/流行病学情绪障碍/死亡率自杀/统计学和数值数据女(雌)性人类男(雄)性

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Suicide among psychiatric in-patients with schizophrenia in an Australian mental hospital

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MEDICINE SCIENCE AND THE LAW 1999年第3期39卷 251-259页

作者： Shah, A Ganesvaran, T Charing Cross & Westminster Med Sch London W6 8RF England Peter James Ctr Melbourne Vic Australia

Psychiatric in-patient suicides are associated with schizophrenia. In this paper, 62 suicides in patients with schizophrenia, over a 21-year period in a large psychiatric hospital in Melbourne, Australia, were examined. The characteristics, including demographic and clinical data, for the suicides were compared with a comparison group of 22 'alive' inpatients with schizophrenia. Suicide among in-patients with schizophrenia was associated with previous deliberate self-harm, a greater number of episodes of previous deliberate self-harm, pre-admission and intra-admission suicidal thoughts, intra-admission suicidal attempts, fluctuating suicidal ideation, longer length of stay, a greater number of ward transfers, and prescription of a greater number of neuroleptics and antidepressants. Over 40% of suicides occurred after absconding from hospital and a similar number during periods of approved leave. Violent methods (including jumping in front of trains, trams and road traffic, jumping off buildings, hanging and drowning) were most frequently used. It is concluded that psychiatric units should be developed away from readily available methods of suicide. In-patients at high risk should be observed carefully to avoid absconding and suicide. Suicide risk should be examined carefully in patients prior to approving leave, particularly if they have fluctuating suicidal ideation.

关键词：病例对照研究医院死亡率医院精神病回顾性研究危险因素精神分裂症/死亡率精神分裂症心理学统计学非参数自杀/预防和控制自杀/统计学和数值数据维多利亚/流行病学青少年成年人女(雌)性人类男(雄)性中年人

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Violent mortality patterns in immigrants in Israel (1990-95)

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MEDICINE SCIENCE AND THE LAW 1999年第2期39卷 173-181页

作者： Karasik, D Yakovenko, K Lipstein, E Hiss, J Tel Aviv Univ Sackler Fac Med Dept Anat & Anthropol IL-69978 Tel Aviv Israel Inst Forens Med IL-61490 Tel Aviv Israel

Since 1989, a large number of immigrants, mostly from the former Soviet Union, have arrived in Israel, increasing the local population (c. 5 million) by 700,000. The morbidity and mortality of this immigant population have been the concern of many investigations. In the present study we examine the mortality pattern of a sample of 1,000 immigrants, whose deaths occurred during the years 1990-95 and were examined at the L. Greenberg (National) Institute of Forensic Medicine. The sample was divided into two subgroups, natural and unnatural, according to manner of death. Seventy-five per cent of the victims in the violent death subgroup were males with a mean age of 44.6 (SD 17.3) years, while the females of the same category were 52.7 years old on average (SD 19.9). The age distribution of the whole sample showed peaks in the 25-34-year-old group for males and the 35-44-year-old group for females. The most frequent causes of death were accident (44.1%), suicide (12.6%) and homicide (7%). In 5% of cases the cause of death could not be determined. The pattern of mortality from violent causes in the immigrant population differed from that of the country of origin in all parameters. The incidence of unnatural death in immigrants resembled the local pattern in Israel, and was significantly lower than that of their homeland.

关键词：事故/统计学和数值数据死亡原因独立国家联合体/人种学杀人/统计学和数值数据以色列/流行病学死亡率自杀/统计学和数值数据暴力/统计学和数值数据成年人老年人女(雌)性人类男(雄)性中年人

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Suicide in young people - Study of 174 cases, aged under 25 years, based on coroners' and medical records

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BRITISH JOURNAL OF PSYCHIATRY 1999年第3期175卷 271-276页

作者： Hawton, K Houston, K Shepperd, R Univ Oxford Warneford Hosp Dept Psychiat Oxford OX3 7JX England Abingdon Mental Hlth Ctr Dept Child & Adolescent Psychiat Abingdon Oxon England

Background Suicide rates in young males in the UK have risen markedly in recent years. Aims To investigate the characteristics of a series of consecutive suicides in under-25-year-olds. Method We studied coroners' inquest notes, general practitioners' records and psychiatric case notes of 174 individuals (148 males and 26 females) whose deaths received a verdict of suicide or an open or accidental verdict (excluding traffic accidents) where the circumstances strongly suggested suicide. Results More individuals were of lower social class and unemployed than in the local population. Hanging and carbon monoxide poisoning were the most frequent methods of suicide, and co-proxamol was the drug most often used in overdoses. Previous self-harm had occurred in 44.8%, nearly half of these having carried out multiple episodes and 80% having self-harmed within the previous year. Little support was found for an earlier finding of increasing frequency of general practitioner visits shortly before death. Only 22.4% of individuals were in the care of psychiatric services. Conclusions Diverse strategies are required to prevent suicide in the very young. Declaration of interest Support received from the former Oxford Regional Health Authority and the Anglia and Oxford Research and Development Committee.

关键词：年龄分布死亡原因英格兰/流行病学家庭医学精神卫生服务/利用病人接受卫生保健的程度自我伤害行为/流行病学性别分布自杀/统计学和数值数据失业/统计学和数值数据青少年成年人女(雌)性人类男(雄)性

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Effect of death of Diana, Princess of Wales on suicide and deliberate self-harm

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BRITISH JOURNAL OF PSYCHIATRY 2000年第5期177卷 463-466页

作者： Hawton, K Harriss, L Appleby, L Juszczak, E Simkin, S McDonnell, R Amos, T Kiernan, K Parrott, H Univ Oxford Warneford Hosp Dept Psychiat Ctr Suicide Res Oxford OX3 7JX England Inst Hlth Sci Ctr Stat Med NHS Imperial Canc Res Fund Oxford England Univ Manchester Withington Hosp Sch Psychiat & Behav Sci Manchester M20 8LR Lancs England John Radcliffe Hosp Dept Med Psychol Oxford OX3 9DU England

Background The death of the Princess of Wales in 1997 was followed by widespread public mourning. Such major events may influence suicidal behaviour. Aims To assess the impact of the Princess's death on suicide and deliberate self-harm (DSH). Method Analysis, using Poisson regression, of the number of suicides and open verdicts ('suicides') in England and Wales following the Princess's death compared to the 3 months beforehand, and the equivalent periods in 1992-1996. Similar analysis on DSH presentations to a general hospital. Results Suicides increased during the month following the Princess's funeral (+ 17.4%). This was particularly marked in females (+33.7%), especially those aged 25-44 years (+45.1%). Suicides did not fall in the week between the death and the funeral. Presentations for DSH increased significantly during the week following the death (+44.3%), especially in females (+65.1%). Examination of case notes suggested that the influence of the death was largely through amplification of personal losses or exacerbation of existing distress. Conclusions The death of a major public figure can influence rates of suicidal behaviour. For DSH, the impact may be immediate, but for suicide it may be delayed. Declaration of interest None.

关键词：对死亡的态度猝死英格兰/流行病学名人危险因素自我伤害行为/流行病学自我伤害行为/病因学自我伤害行为/心理学性别因素自杀/心理学自杀/统计学和数值数据自杀未遂/心理学自杀未遂/统计学和数值数据威尔士/流行病学青少年成年人老年人女(雌)性人类男(雄)性中年人

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Suicide among drug addicts in the UK

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BRITISH JOURNAL OF PSYCHIATRY 1999年第3期175卷 277-282页

作者： Oyefeso, A Ghodse, H Clancy, C Corkery, JM Univ London St Georges Hosp Sch Med Dept Psychiat Addict Behav Res Evaluat & Monitoring Unit London SW17 0RE England

Background The extent of suicide among addicts in the UK has not been sufficiently examined. Aims To examine suicide trends among registered addicts in the UK over a 25-year period. Method We quantified suicide using International Classification of Diseases (ICD) external death codes E950-959, calculated annual age-standardised suicide rates, standardised mortality ratios (SMRs) and described trends in methods of suicide and drug overdose suicides in five successive cohorts of registered addicts. Results Male and female suicide rates are 69.0 and 44.8 per 100 000 person-years, respectively. There was a consistent decline in suicide rate throughout the 25-year period. Among males, the SMR for suicide declined from 17.2 in 1968-1972 to 4.4 in 1988-1992 (SMR ratio=3.9, 95% Cl=2.5-6.1);among females it declined from 52.6 to 11.3 in the same period (SMR ratio=4.7, 95% Cl=1.9-10.8). Drug overdose was the most common method of suicide, accounting for 45% of cases. Significant increase in antidepressant (percentage difference=23.5%, 95% Cl=15.2-31.8) and methadone (percentage difference=11.0%, 95% Cl=0.5, 21.5) overdose in 1988-1992 compared with 1968-1972 was reported. Conclusions The findings confirm that addicts are still at higher risk of suicide than the general population and that prescribed drugs, notably antidepressants and methadone. influence this heightened risk. Declaration of interest None.

关键词：年龄分布死亡原因大不列颠/流行病学服药过量/流行病学危险因素性别分布物质相关性障碍/流行病学自杀/统计学和数值数据自杀/发展趋势青少年成年人女(雌)性人类男(雄)性中年人

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Long-term prognosis after partial gastrectomy for gastroduodenal ulcer

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WORLD JOURNAL OF SURGERY 2000年第3期24卷 307-314页

作者： von Holstein, CS Univ Lund Hosp Dept Surg S-22185 Lund Sweden

The decline in duodenal ulcer disease and the established relation of peptic ulcer to Helicobacter pylori have virtually abolished the need for elective ulcer surgery, However, a substantial proportion of the population around retirement age has previously been subjected to partial gastric resection due to peptic ulcer, and the long-term outcome of these patients is of continuing relevance, Patients subjected to elective surgery could represent a selected group of healthy subjects with a lower overall morbidity, but reports indicate that patients operated on for peptic ulcer have more advanced disease associated with excess smoking and a different pattern of social behavior, The surgical procedure induces enterogastric reflux, leading to profound changes in the remnant mucosa and the formation of carcinogens in the gastric juice, In addition, metabolic abnormalities are common, especially fat malabsorption. Evaluation of the impact of these factors on morbidity and mortality is difficult. Increased mortality in gastrointestinal tumors (especially gastric stump carcinoma), respiratory diseases and other smoking-related malignancies, and suicide are found in the long-term follow-up after partial gastric resection due to peptic ulcer. However, these hazards to life are offset by a decreased mortality in cardiovascular disease. Preventive measures against suicide and especially tobacco smoking are recommended to improve the outcome for this cohort.

关键词：胆汁返流/并发症心血管疾病/死亡率胃切除术/副作用胃泌素类/缺乏螺杆菌感染/并发症幽门螺杆菌营养障碍/病因学消化性溃疡/并发症消化性溃疡/代谢消化性溃疡/死亡率消化性溃疡/外科学预后危险因素性别因素吸烟/副作用胃肿瘤/病因学胃肿瘤/死亡率自杀/统计学和数值数据时间因素女(雌)性人类男(雄)性

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Suicide and attempted suicide among older adults in Western Australia

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PSYCHOLOGICAL MEDICINE 2000年第4期30卷 813-821页

作者： Lawrence, D Almeida, OP Hulse, GK Jablensky, AV Holman, CDJ Univ Western Australia Dept Psychiat & Behav Sci Queen Elizabeth II Med Ctr Perth WA 6009 Australia Univ Western Australia Dept Publ Hlth Perth WA 6009 Australia

Background. Suicide rates are high in later life. Risk factors include male sex and depressive illness. This study investigated the relationship between suicidal behaviour and contact with mental health services among the elderly in Western Australia. Methods. Record linkage was used to obtain records of hospital admissions and mental health service contacts for all suicide attempts and deaths in the period 1980-95. Standardized incidence ratios were calculated for the elderly, general population and people with mental health service contacts. Cox regression was used to evaluated potential risk factors for elderly people who were in contact with mental health services. Results. People over 60 years of age accounted for 15 % of suicides and 4.6 % of attempted suicides. Suicide rates were 3.3 times higher in males and 4.4 times higher in females when compared to the general population of elderly people. For attempted suicide, the rate was 5.8 times higher in males and 6.6 times higher in females with prior contact with mental health services. Highest risk of suicide was found in patients with diagnoses of affective psychoses (RR = 3.7), adjustment reaction (RR = 3.2) or depressive disorder (RR = 2.8). The diagnosis of cancer was associated with decreased risk of suicide (RR = 3.6) and attempted suicide (RR = 1.9). Conclusions. Suicide rates are high among the elderly in Western Australia. Suicide is significantly associated with the diagnosis of mood disorder. Suicide attempts are less common, and are associated most strongly with mood and personality disorders. The decreased risk of self-harm behaviour among patients with cancer warrants further investigation.

关键词：年龄分布社区精神卫生服务/统计学和数值数据老年人保健服务/统计学和数值数据发病率情绪障碍/流行病学情绪障碍/心理学肿瘤/流行病学肿瘤/心理学人格障碍/流行病学人格障碍/心理学人群监测比例危险度模型危险危险因素性别分布自杀/心理学自杀/统计学和数值数据自杀未遂/心理学自杀未遂/统计学和数值数据西澳大利亚/流行病学老年人老年人 80以上女(雌)性人类男(雄)性中年人

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