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choose life: A National Strategy and Action Plan to Prevent Suicide in Scotland

APPENDIX 1 FACTS AND FIGURES

Introduction

This appendix contains facts and figures on completed, and attempted, suicides. It makes distressing reading and highlights why this Strategy and Action Plan is so vital.

Amongst the General Population

• In the general population 13% reported suicidal thoughts, 4% attempted suicide and 2% deliberate self-harm at sometime in their lives. ²

People with Experience of a Diagnosis of 'Psychotic Illness'

• Over two-thirds (70%) of the sample of people with a diagnosis of a psychotic illness had thought about suicide at some time in their lives and 45% had attempted suicide. In addition, 21% had harmed themselves without intending to commit suicide. ²

Factors Associated with Suicidal Thoughts

• Events or factors for which the prevalence of suicidal thoughts was particularly high include having a major financial crisis (29%), having a problem with the police or a court appearance (27%) and having looked for work for one month or over (23%). ¹

• Higher rates of lifetime suicidal thoughts were found among groups who reported ever having been homeless (48%), running away from home (45%), experiencing violence in the home (44%) and being expelled from school (41%). ¹

• Over half of those who reported experience of sexual abuse also reported having had suicidal thoughts during their lifetime. ¹

• Compared with people who had never experienced a stressful life event, those who reported three or more events were over three times more likely to have had suicidal thoughts and the group who had experienced six or more events were over nine times more likely to have had such thoughts. ¹

Attempted Suicide - Some Major Risk Factors

• Twelve per cent of people who had experienced a problem with the police or a court appearance, 10% of those who had experienced a major financial crisis and 8% of those who had looked for work for one month or more had attempted suicide at some time in their life. ¹

• Around a quarter of people who reported running away from home, being homeless, having experienced sexual abuse and having experienced violence in the home had attempted suicide at some time in their life (between 22% and 26%). ¹

• Women with a severe lack of social support were over five times more likely than those with social support to have attempted suicide in their lifetime (16% compared with 3%) and twice as likely to have attempted suicide than men (8%). ¹

• Twelve per cent of all respondents with a primary support group of three or less had attempted suicide in their lifetime, compared with only 3% with a social group of nine or more people. ¹

Substance Misuse

• In a recent survey (2002), carried out by the Office for National Statistics, 4% of people who were non-alcohol dependent had at one time thought about suicide. This proportion increased to 9% among those moderately dependent on alcohol and rose to 27% of the severely alcohol dependent group. ¹

• Those who were dependent on drugs (other than cannabis) were around five times more likely than the non-dependent group to have ever attempted suicide, 20% compared with 4%. ¹

• Of 332 drug-related deaths in Scotland in 2001, 34 (10%) were as a result of intentional self-poisoning: in a further 52 deaths (16%), it was not clear if the death was accidental or suicide. ³

People Who Experience Neurosis

• The presence of significant levels of neurotic symptoms, as shown by a CIS-R ^** score of 12 or over, was associated with a four-fold increase in the likelihood of reporting suicidal thoughts at some time. In contrast, having a long-standing physical health problem was associated with a decreased likelihood of reporting suicidal thoughts once other factors had been taken into account. High levels of neurotic symptoms were also associated with suicide attempts and in this case the number of stressful life events also showed a very strong association. ²

Completed Suicides by People in Contact with Mental Health Services

• Approximately one-quarter of people who completed suicide in England and Wales, Scotland and Northern Ireland had been in contact with mental health services in the year before death; this represents around 1,500 people per year in the UK. ⁴

• The commonest methods of suicide were hanging and self-poisoning by overdose. ⁴

• Younger people who were in contact with services and who completed suicide, more often had a history of schizophrenia, personality disorder, drug or alcohol misuse, and violence. ^*4

• Most people with schizophrenia who committed suicide were unemployed and unmarried. ^*4

• Four per cent of people in contact with mental health services who completed suicide were the lone carers of children. ^*4

• Mental health teams in England and Wales regarded 22% of completed suicides as preventable, with lower figures in Scotland (62 cases, 13%) and Northern Ireland (19%), but around three-quarters identified factors that could have reduced risk, mainly improved patient compliance with medication and closer supervision. ⁴

Completed Suicides by People in Psychiatric In-patient Units

• Sixteen per cent of suicide Inquiry cases in England and Wales, 12% in Scotland and 10% in Northern Ireland were psychiatric in-patients. ⁴

• In-patient suicides, particularly those occurring on the ward, were most likely to be by hanging, most commonly from a curtain rail and using a belt as a ligature. ⁴

• Around one-quarter of in-patient suicides died during the first week of admission. ⁴

• Around one-fifth of in-patient suicides were under non-routine observation (constant or intermittent). ⁴

• Around one-third of in-patient suicides in England and Wales and Scotland, and almost half of in-patient suicides in Northern Ireland, were on agreed leave from the hospital at the time of death. ⁴

• Mental health teams more often regarded in-patient suicides as preventable. ⁴

Completed Suicides within Three Months of Discharge from a Psychiatric In-patient Unit

• Twenty-three per cent of suicide Inquiry cases in England and Wales, 26% of cases in Scotland and 30% of cases in Northern Ireland died within three months of discharge from in-patient care. ⁴

• Post-discharge suicides were at a peak in the first 1-2 weeks following discharge. ⁴

• Forty per cent of post-discharge suicides in England and Wales, 35% in Scotland and 66% in Northern Ireland, occurred before the first follow-up appointment. ⁴

• Compared to all community cases, post-discharge suicides were associated with final admissions lasting less than seven days, re-admissions within three months of previous discharge and self-discharge. ^*4

Completed Suicides by Children and Young People

• In an analysis of the circumstances of 50 looked after children who died between 1997 and the end of 2001, 11 were completed suicides. ⁶

Graphs and Charts

Listed below are graphs and charts which show general suicide figures for Scotland and Internationally.

NUMBER OF SUICIDES OVER LAST 20 YEARS

This graph breaks down completed male suicides and undetermined deaths in Scotland from 1982 to 2001 by age group.

This graph breaks down completed female suicides and undetermined deaths in Scotland from 1982 to 2001 by age group.

Note: The figures above include deaths from international self-harm (suicides) and events of undetermined intent (undetermined deaths). It is believed that the majority of undetermined deaths are hidden suicides (though this is less likely to be the case for the small numbers of cases aged under 15 - not shown here).

INTERNATIONAL COMPARISON OF TOTAL SUICIDE RATES

This graph shows male and female international comparisons for suicide rates using the last available figures from the World Health Organization for each country.

PERCENTAGE OF SUICIDES (MALE AND FEMALE) WITH A PSYCHIATRIC HISTORY, OVER LAST 11 YEARS

This graph shows the percentage of suicides in Scotland comparing male, female and both, who have a psychiatric history since 1990.

NUMBER OF ADMISSIONS TO HOSPITAL RESULTING FROM EPISODES OF SELF-HARM

This graph shows the number of admissions to/discharges from hospital in Scotland resulting from episodes of self-harm.

About 3% of those admitted to hospital after deliberate self-harm die by suicide within 5-10 years of initial admission. ⁵

1% die by suicide or undetermined cause within a year after admission. ⁵

Footnotes

1 Office for National Statistics, Non-fatal Suicidal Behaviour Among Adults 16 to 74 in Great Britain, The Stationery Office, 2002
2 Office for National Statistics, Adults with a Psychotic Disorder Living in Private Households, 2000, The Stationery Office, 2002
3 General Register Office for Scotland, Occasional Paper No. 8, Drug-Related Deaths in Scotland in 2001, General Register Office, 2002
4 Department of Health, Safety First, Report of the National Confidential Inquiry (NCI) Into Suicide And Homicide By People With Mental Illness, Department of Health, 2001
5 Hall D., O'Brien F., Stark C., Pelosi A., Smith H. Thirteen-year follow-up of deliberate self-harm using linked data. British Journal of Psychiatry. 1998; 172: 239 - 242.
6 The Scottish Executive, It's Everyone's Job to Make Sure I'm Alright: Report of the Child Protection and Audit Review, The Stationery Office, 2002
* Refers to findings that apply to England and Wales only.
** CIS-R (Clinical Interview Schedule - revised version) The CIS-R is an instrument designed to measure neurotic symptoms and disorders, such as anxiety and depression. It compromises 14 sections each covering a particular type of neurotic symptoms. Scores are obtained for each symptom based on frequency, duration and severity in the past week. Individual symptom scores can be summed to provide an overall score for the level of neurotic symptoms. A score of 12 or over indicates the presence of significant levels of neurotic symptoms.

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