Pathways to Suicide Among People With a Diagnosed Mental Illness in Victoria, Australia
Abstract
Abstract.Background: People who have mental illness are at increased risk of suicide. Therefore, identifying "typical" trajectories to suicide in this population has the potential to improve the effectiveness of suicide prevention strategies. Aim: The aim of this study was to explore the pathways to suicide among a sample of Victorians with a diagnosed mental illness. Method: Victorian Suicide Register (VSR) data were used to generate life charts and identify typical life trajectories to suicide among 50 Victorians. Results: Two distinct pathways to suicide were identified: (1) where diagnosis of mental illness appeared to follow life events/stressors; and (2) where diagnosis appeared to precede exposure to life events/stressors. Some events acted as distal factors related to suicide, other events were more common as proximal factors, and still others appeared to act as both distal and proximal factors. Limitations: The data source might be biased because of the potential for incomplete information, or alternatively, the importance of some factors in a person's life may have been overstated. Conclusion: Strategies to reduce suicide need to consider the chronology of exposure to stressors in people's lives and clearly need to be different depending on whether proximal or distal risk factors are the target of a given strategy or intervention.
References
2009). The relationship between child abuse, parental divorce, and lifetime mental disorders and suicidality in a nationally representative adult sample. Child Abuse and Neglect, 33(3), 139–147. 10.1016/j.chiabu.2008.12.009
(2002). Familial, psychiatric, and socioeconomic risk factors for suicide in young people: Nested case-control study. BMJ (Clinical research ed.), 325(74), 1–5. 10.1136/bmj.325.7355.74
(2004). Psychiatric diagnoses in 3275 suicides: A meta-analysis. BMC Psychiatry, 4(37), 1–11. 10.1186/1471-244x-4-37
(2014). Adverse conditions at the workplace are associated with increased suicide risk. Journal of Psychiatric Research, 57, 90–95. 10.1016/j.jpsychires.2014.06.007
(2002). A case control study of suicide and attempted suicide in older adults. Suicide and Life-Threatening Behavior, 32(1), 1–9. 10.1521/suli.32.1.1.22184
(2002). Suicide and psychiatric diagnosis: A worldwide perspective. World Psychiatry, 1(3), 181–185.
(2005). Are cancer patients at higher suicide risk than the general population? Scandinavian Journal of Public Health, 33(3), 208–214. 10.1080/14034940410019226
(1994). Suicide and violence risk: Relationship to coping styles. Acta Psychiatrica Scandinavica, 89, 92–96.
(2002). Health consequences of intimate partner violence. The Lancet, 359(9314), 1331–1336. 10.1016/s0140-6736(02)08336-8
(2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13, 153–160. 10.1002/wps.20128.
(2019). Relative risk of suicide following exposure to recent stressors, Victoria, Australia. Australian & New Zealand Journal of Public Health, 43(3), 254–260. 10.1111/1753-6405.12886
(2002). Risk factors for suicide in later life. Biological Psychiatry, 52, 193–204. 10.1016/S0006-3223(02)01347-1
(2011). Violence against women is strongly associated with suicide attempts: Evidence from the WHO multi-country study on women's health and domestic violence against women. Social Science and Medicine, 73(1), 79–86. 10.1016/j.socscimed.2011.05.006
(2008). Long-term effects of childhood abuse on the quality of life and health of older people: Results from the Depression and Early Prevention of Suicide in General Practice Project. Journal of the American Geriatrics Society, 56(2), 262–271. 10.1111/j.1532-5415.2007.01537.x
. (2008). Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: An observational study. The Lancet, 371(9619), 1165–1172. 10.1016/s0140-6736(08)60522-x
(2016). Physical compared to mental diseases as reasons for committing suicide: A retrospective study. BMC Palliative Care, 15(1), 14. 10.1186/s12904-016-0088-5
(2007). Suicide in adolescents: Using life charts to understand the suicidal process. Journal of Affective Disorders, 100(1–3), 199–210. 10.1016/j.jad.2006.10.022
(2011). Adverse life events proximal to adult suicide: A synthesis of findings from psychological autopsy studies. Archives of Suicide Research, 15(1), 1–15. 10.1080/13811118.2011.540213
(1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence, 14, 99–132. 10.1023/A:1022079418229
(1997). Suicide as an outcome for mental disorders: A meta-analysis. British Journal of Psychiatry, 170, 205–228. 10.1192/bjp.170.3.205
(2007). Repetition of deliberate self-harm: A study of the characteristics and subsequent deaths in patients presenting to a general hospital according to extent of repetition. Suicide and Life-Threatening Behavior, 37(4), 379–396. 10.1521/suli.2007.37.4.379
(2005). Schizophrenia and suicide: Systematic review of risk factors. British Journal of Psychiatry, 187, 9–20. 10.1192/bjp.187.1.9
(2017). Suicide and mental disorders: A discourse of politics, power, and vested interests. Death Studies, 41(8), 481–492. 10.1080/07481187.2017.1332905
(2010). Separation as an important risk factor for suicide: A systematic review. Journal of Family Issues, 31(12), 1689–1716. 10.1177/0192513x10365317
(2001). Psychological autopsy studies - a review. European Psychiatry, 16(7), 379–385. 10.1016/S0924-9338(01)00594-6
(2006). Mental health and alcohol, drugs and tobacco: A review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug and Alcohol Review, 25(6), 515–536. 10.1080/09595230600944461
(2004). Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: A population-based follow-up. Psychological Medicine, 34(8), 1431–1441. 10.1017/s0033291704002740
(2017). Pathways to suicide in australian farmers: A life chart analysis. International Journal of Environmental Research and Public Health, 14(4), 352. 10.3390/ijerph14040352
(2007). Police contact within 3 months of suicide and associated health service contact. British Journal of Psychiatry, 190, 170–171. 10.1192/bjp.bp.106.021857
(2009). STUDY-70 Workgroup. Bullying behavior is related to suicide attempts but not to self-mutilation among psychiatric inpatient adolescents. Psychopathology, 42, 131–138. 10.1159/000204764
(1981). Pathways to suicide: A survey of self-destructive behaviors. Baltimore, MD: Johns Hopkins University Press.
(2011).
(Schizophrenia, other psychotic disorders, and suicidal behaviour. In R. C. O'ConnorS. PlattJ. GordonEds., International handbook of suicide prevention: Research, policy and practice (pp. 75–94). Chichester, UK: Wiley-Blackwell.2010). Bullying victimisation, self harm and associated factors in Irish adolescent boys. Social Science and Medicine, 71(7), 1300–1307. 10.1016/j.socscimed.2010.06.034
(1995). Epidemiology of suicidal behavior. Suicide and Life-Threatening Behavior, 25(1), 22–35. 10.1111/j.1943-278X.1995.tb00390.x
(1997). Identification of suicide risk factors using epidemiologic studies. Psychiatric Clinics of North America, 20(3), 499–517. 10.1016/S0193-953X(05)70327-0
(2018). Early life sexual abuse is associated with increased suicide attempts: An update meta-analysis. Journal of Psychiatric Research, 99, 129–141. 10.1016/j.jpsychires.2018.02.001
(2018). The increase of suicide rates: The need for a paradigm shift. The Lancet, 392(10146), 474–475. 10.1016/s0140-6736(18)31498-3
(2016). Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. Journal of Public Health (Oxford, England), 38(3), e282–e291. 10.1093/pubmed/fdv148
(2003). The impact of parental status on the risk of completed suicide. Archives of General Psychiatry, 60(8), 797–802. 10.1001/archpsyc.60.8.797
(2013). Suicide following the death of a sibling: A nationwide follow-up study from Sweden. BMJ Open, 3(4), e002618. 10.1136/bmjopen-2013-002618
(1984). Increased rate of suicide among patients with Huntington's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 47, 1283–1287. 10.1136/jnnp.47.12.1283
(2007). Depression-anxiety relationships with chronic physical conditions: Results from the World Mental Health Surveys. Journal of Affective Disorders, 103(1-3), 113–120. 10.1016/j.jad.2007.01.015
(2016). Pathways to suicide in lesbian and gay populations in Australia: A life chart analysis. Archives of Sexual Behavior, 46(5), 1481–1489. 10.1007/s10508-016-0827-y
(2015). Recency of divorce, depression, and suicide risk. Journal of Family Issues, 36(6), 695–715. 10.1177/0192513x13494824
(2007). Economic strain and suicide risk: A qualitative analysis. Suicide and Life-Threatening Behavior, 37(1), 103–112. 10.1521/suli.2007.37.1.103
(2018). Implementation and evaluation of the Victorian Suicide Register. Australian and New Zealand Journal of Public Health, 42(3), 296–302. 10.1111/1753-6405.12725
(2011). Suicides in late life. Current Psychiatry Reports, 13(3), 234–241. 10.1007/s11920-011-0193-3
(1999). Suicidal feelings in the last year of life in elderly people who commit suicide. The Lancet, 354(9182), 917–918. 10.1016/s0140-6736(99)93099-4
(1986).
(Suicide and physical illness. In A. RoyEd., Suicide (pp. 151–170). Baltimore, MD: Williams and Wilkins.2009). Separation as a suicide risk factor. Journal of Affective Disorders, 116(3), 208–213. 10.1016/j.jad.2008.11.007
(2008). Suicidal risk factors and completed suicide: Meta-analyses based on psychological autopsy studies. Environmental Health and Preventive Medicine, 13(5), 243–256. 10.1007/s12199-008-0037-x
(