Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1990 Jun 1;142(11):1223–1230.

Prevention of suicide.

J E McNamee 1, D R Offord 1
PMCID: PMC1452573  PMID: 2134157

Abstract

We reviewed the epidemiologic features of suicide in Canada and evaluated suicide prevention programs. Three groups were found to be at increased risk for suicide: men aged 70 years or more, women aged 65 to 69 and men aged 20 to 24. The other groups, in decreasing order of risk, were the mentally ill, people who have attempted suicide, those with a life-threatening illness, native people, people with a family history of suicide and prisoners. Studies that evaluated suicide prevention programs showed that none significantly reduced the incidence of suicide; however, the studies were found to be methodologically inadequate or used noncomparable systems of data collection. On the basis of our findings we recommend that primary care physicians routinely evaluate suicide risk among patients in high-risk groups and that intervention include counselling, follow-up and, if necessary, referral to a psychiatrist. Close follow-up is recommended for newly discharged psychiatric patients and those who recently attempted suicide.

Full text

PDF
1223

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adam K. S. Attempted suicide. Psychiatr Clin North Am. 1985 Jun;8(2):183–201. [PubMed] [Google Scholar]
  2. Adam K. S., Valentine J., Scarr G., Streiner D. Follow-up of attempted suicide in Christchurch. Aust N Z J Psychiatry. 1983 Mar;17(1):18–25. doi: 10.3109/00048678309159982. [DOI] [PubMed] [Google Scholar]
  3. Allebeck P., Allgulander C., Fisher L. D. Predictors of completed suicide in a cohort of 50,465 young men: role of personality and deviant behaviour. BMJ. 1988 Jul 16;297(6642):176–178. doi: 10.1136/bmj.297.6642.176. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Barraclough B., Bunch J., Nelson B., Sainsbury P. A hundred cases of suicide: clinical aspects. Br J Psychiatry. 1974 Oct;125(0):355–373. doi: 10.1192/bjp.125.4.355. [DOI] [PubMed] [Google Scholar]
  5. Barraclough B. Suicide prevention, recurrent affective disorder and lithium. Br J Psychiatry. 1972 Oct;121(563):391–392. doi: 10.1192/bjp.121.4.391. [DOI] [PubMed] [Google Scholar]
  6. Beck A. T., Kovacs M., Weissman A. Hopelessness and suicidal behavior. An overview. JAMA. 1975 Dec 15;234(11):1146–1149. [PubMed] [Google Scholar]
  7. Beneteau R. Trends in suicide. Can Soc Trends. 1988;(11):22–24. [PubMed] [Google Scholar]
  8. Blazer D. G., Bachar J. R., Manton K. G. Suicide in late life. Review and commentary. J Am Geriatr Soc. 1986 Jul;34(7):519–525. doi: 10.1111/j.1532-5415.1986.tb04244.x. [DOI] [PubMed] [Google Scholar]
  9. Brent D. A., Perper J. A., Allman C. J. Alcohol, firearms, and suicide among youth. Temporal trends in Allegheny County, Pennsylvania, 1960 to 1983. JAMA. 1987 Jun 26;257(24):3369–3372. [PubMed] [Google Scholar]
  10. Brent D. A., Perper J. A., Goldstein C. E., Kolko D. J., Allan M. J., Allman C. J., Zelenak J. P. Risk factors for adolescent suicide. A comparison of adolescent suicide victims with suicidal inpatients. Arch Gen Psychiatry. 1988 Jun;45(6):581–588. doi: 10.1001/archpsyc.1988.01800300079011. [DOI] [PubMed] [Google Scholar]
  11. Buglass D., Horton J. The repetition of parasuicide: a comparison of three cohorts. Br J Psychiatry. 1974 Aug;125(0):168–174. doi: 10.1192/bjp.125.2.168. [DOI] [PubMed] [Google Scholar]
  12. Cain A. C., Fast I. Children's disturbed reactions to parent suicide. Am J Orthopsychiatry. 1966 Oct;36(5):873–880. doi: 10.1111/j.1939-0025.1966.tb02416.x. [DOI] [PubMed] [Google Scholar]
  13. Chang G., Warner V., Weissman M. M. Physicians' recognition of psychiatric disorders in children and adolescents. Am J Dis Child. 1988 Jul;142(7):736–739. doi: 10.1001/archpedi.1988.02150070050024. [DOI] [PubMed] [Google Scholar]
  14. Cohen J. Statistical approaches to suicidal risk factor analysis. Ann N Y Acad Sci. 1986;487:34–41. doi: 10.1111/j.1749-6632.1986.tb27883.x. [DOI] [PubMed] [Google Scholar]
  15. Crumley F. E. Adolescent suicide attempts. JAMA. 1979 Jun 1;241(22):2404–2407. [PubMed] [Google Scholar]
  16. Dyck R. J., Newman S. C., Thompson A. H. Suicide trends in Canada, 1956-1981. Acta Psychiatr Scand. 1988 Apr;77(4):411–419. doi: 10.1111/j.1600-0447.1988.tb05143.x. [DOI] [PubMed] [Google Scholar]
  17. Fowler R. C., Rich C. L., Young D. San Diego Suicide Study. II. Substance abuse in young cases. Arch Gen Psychiatry. 1986 Oct;43(10):962–965. doi: 10.1001/archpsyc.1986.01800100056008. [DOI] [PubMed] [Google Scholar]
  18. Garfinkel B. D., Golombek H. Suicide and depression in childhood and adolescence. Can Med Assoc J. 1974 Jun 8;110(11):1278–1281. [PMC free article] [PubMed] [Google Scholar]
  19. Gould M. S., Shaffer D., Kleinman M. The impact of suicide in television movies: replication and commentary. Suicide Life Threat Behav. 1988 Spring;18(1):90–99. doi: 10.1111/j.1943-278x.1988.tb00144.x. [DOI] [PubMed] [Google Scholar]
  20. Greer S., Bagley C. Effect of psychiatric intervention in attempted suicide: a controlled study. Br Med J. 1971 Feb 6;1(5744):310–312. doi: 10.1136/bmj.1.5744.310. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Guze S. B., Robins E. Suicide and primary affective disorders. Br J Psychiatry. 1970 Oct;117(539):437–438. doi: 10.1192/bjp.117.539.437. [DOI] [PubMed] [Google Scholar]
  22. Hawton K., Fagg J. Suicide, and other causes of death, following attempted suicide. Br J Psychiatry. 1988 Mar;152:359–366. doi: 10.1192/bjp.152.3.359. [DOI] [PubMed] [Google Scholar]
  23. Hawton K., O'Grady J., Osborn M., Cole D. Adolescents who take overdoses: their characteristics, problems and contacts with helping agencies. Br J Psychiatry. 1982 Feb;140:118–123. doi: 10.1192/bjp.140.2.118. [DOI] [PubMed] [Google Scholar]
  24. Hislop T. G., Threlfall W. J., Gallagher R. P., Band P. R. Accidental and intentional violent deaths among British Columbia native Indians. Can J Public Health. 1987 Jul-Aug;78(4):271–274. [PubMed] [Google Scholar]
  25. Hoberman H. M., Garfinkel B. D. Completed suicide in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1988 Nov;27(6):689–695. doi: 10.1097/00004583-198811000-00004. [DOI] [PubMed] [Google Scholar]
  26. Jarvis G. K., Boldt M. Death styles among Canada's Indians. Soc Sci Med. 1982;16(14):1345–1352. doi: 10.1016/0277-9536(82)90030-2. [DOI] [PubMed] [Google Scholar]
  27. Joffe R. T., Offord D. R., Boyle M. H. Ontario Child Health Study: suicidal behavior in youth age 12-16 years. Am J Psychiatry. 1988 Nov;145(11):1420–1423. doi: 10.1176/ajp.145.11.1420. [DOI] [PubMed] [Google Scholar]
  28. Kessler R. C., Downey G., Milavsky J. R., Stipp H. Clustering of teenage suicides after television news stories about suicides: a reconsideration. Am J Psychiatry. 1988 Nov;145(11):1379–1383. doi: 10.1176/ajp.145.11.1379. [DOI] [PubMed] [Google Scholar]
  29. Kresse-Hermsdorf M., Müller-Oerlinghausen B., Ibe K. Poisoning with antidepressive drugs: a five-year retrospective study. Int J Clin Pharmacol Ther Toxicol. 1985 Oct;23(10):540–547. [PubMed] [Google Scholar]
  30. Large R. G., Epston A., Kirker J. M., Kydd R. R. Self poisoning: who supplies the drugs? 100 examples. N Z Med J. 1980 Mar 26;91(656):218–221. [PubMed] [Google Scholar]
  31. Marshall J. R., Burnett W., Brasure J. On precipitating factors: cancer as a cause of suicide. Suicide Life Threat Behav. 1983 Spring;13(1):15–27. doi: 10.1111/j.1943-278x.1983.tb00002.x. [DOI] [PubMed] [Google Scholar]
  32. Martin R. L., Cloninger C. R., Guze S. B., Clayton P. J. Mortality in a follow-up of 500 psychiatric outpatients. II. Cause-specific mortality. Arch Gen Psychiatry. 1985 Jan;42(1):58–66. doi: 10.1001/archpsyc.1985.01790240060006. [DOI] [PubMed] [Google Scholar]
  33. Marzuk P. M., Tierney H., Tardiff K., Gross E. M., Morgan E. B., Hsu M. A., Mann J. J. Increased risk of suicide in persons with AIDS. JAMA. 1988 Mar 4;259(9):1333–1337. [PubMed] [Google Scholar]
  34. Miller H. L., Coombs D. W., Leeper J. D., Barton S. N. An analysis of the effects of suicide prevention facilities on suicide rates in the United States. Am J Public Health. 1984 Apr;74(4):340–343. doi: 10.2105/ajph.74.4.340. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Murphy G. E. The physician's responsibility for suicide. I. An error of commission. Ann Intern Med. 1975 Mar;82(3):301–304. doi: 10.7326/0003-4819-82-3-301. [DOI] [PubMed] [Google Scholar]
  36. Murphy G. E., Wetzel R. D. Suicide risk by birth cohort in the United States, 1949 to 1974. Arch Gen Psychiatry. 1980 May;37(5):519–523. doi: 10.1001/archpsyc.1980.01780180033003. [DOI] [PubMed] [Google Scholar]
  37. Pfeffer C. R. Suicide prevention. Current efficacy and future promise. Ann N Y Acad Sci. 1986;487:341–350. doi: 10.1111/j.1749-6632.1986.tb27912.x. [DOI] [PubMed] [Google Scholar]
  38. Phillips D. P., Carstensen L. L. Clustering of teenage suicides after television news stories about suicide. N Engl J Med. 1986 Sep 11;315(11):685–689. doi: 10.1056/NEJM198609113151106. [DOI] [PubMed] [Google Scholar]
  39. Pokorny A. D. Prediction of suicide in psychiatric patients. Report of a prospective study. Arch Gen Psychiatry. 1983 Mar;40(3):249–257. doi: 10.1001/archpsyc.1983.01790030019002. [DOI] [PubMed] [Google Scholar]
  40. Rich C. L., Fowler R. C., Fogarty L. A., Young D. San Diego Suicide Study. III. Relationships between diagnoses and stressors. Arch Gen Psychiatry. 1988 Jun;45(6):589–592. doi: 10.1001/archpsyc.1988.01800300087012. [DOI] [PubMed] [Google Scholar]
  41. Robbins D. R., Alessi N. E. Depressive symptoms and suicidal behavior in adolescents. Am J Psychiatry. 1985 May;142(5):588–592. doi: 10.1176/ajp.142.5.588. [DOI] [PubMed] [Google Scholar]
  42. Roy A. Risk factors for suicide in psychiatric patients. Arch Gen Psychiatry. 1982 Sep;39(9):1089–1095. doi: 10.1001/archpsyc.1982.04290090071014. [DOI] [PubMed] [Google Scholar]
  43. Sainsbury P. Clinical aspects of suicide and its prevention. Br J Hosp Med. 1978 Feb;19(2):156, 158, 161-2 passim. [PubMed] [Google Scholar]
  44. Schoenfeld M., Myers R. H., Cupples L. A., Berkman B., Sax D. S., Clark E. Increased rate of suicide among patients with Huntington's disease. J Neurol Neurosurg Psychiatry. 1984 Dec;47(12):1283–1287. doi: 10.1136/jnnp.47.12.1283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Schou M., Weeke A. Did manic-depressive patients who committed suicide receive prophylactic or continuation treatment at the time? Br J Psychiatry. 1988 Sep;153:324–327. doi: 10.1192/bjp.153.3.324. [DOI] [PubMed] [Google Scholar]
  46. Shaffer D., Garland A., Gould M., Fisher P., Trautman P. Preventing teenage suicide: a critical review. J Am Acad Child Adolesc Psychiatry. 1988 Nov;27(6):675–687. doi: 10.1097/00004583-198811000-00001. [DOI] [PubMed] [Google Scholar]
  47. Simon W. Suicide among physicians: prevention and postvention. Crisis. 1986 Mar;7(1):1–13. [PubMed] [Google Scholar]
  48. Streiner D. L., Adam K. S. Evaluation of the effectiveness of suicide prevention programs: a methodological perspective. Suicide Life Threat Behav. 1987 Summer;17(2):93–106. doi: 10.1111/j.1943-278x.1987.tb01023.x. [DOI] [PubMed] [Google Scholar]
  49. Weissman M. M. The epidemiology of suicide attempts, 1960 to 1971. Arch Gen Psychiatry. 1974 Jun;30(6):737–746. doi: 10.1001/archpsyc.1974.01760120003001. [DOI] [PubMed] [Google Scholar]
  50. Winokur G., Tsuang M. The Iowa 500: suicide in mania , depression, and schizophrenia. Am J Psychiatry. 1975 Jun;132(6):650–651. doi: 10.1176/ajp.132.6.650. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES