Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1994 May 7;308(6938):1227–1233. doi: 10.1136/bmj.308.6938.1227

Prevention of suicide: aspirations and evidence.

D Gunnell 1, S Frankel 1
PMCID: PMC2540097  PMID: 8080520

Abstract

The Health of the Nation white paper set a target for 15% reduction in overall suicide rates by the year 2000. If the targets are to be achieved interventions must be identified which are of proved effectiveness. This paper examines the evidence on the available interventions and points of access to the population at risk. No single intervention has been shown in a well conducted randomised controlled trial to reduce suicide. The greatest potential seems to arise from limiting the availability of methods. In particular it is likely that the introduction of the catalytic convertor will lead to reduced lethality of care exhausts and reductions in suicide using this method. General practitioner education programmes, the effectiveness of lithium and maintenance antidepressants, and limits on the quantity of medicines available over the counter or on prescription should all be evaluated. Particular high risk groups include people recently discharged from psychiatric hospitals and those with a history of parasuicide. Many social processes affect suicide rates and these rather than specific interventions may help or hinder the ability to realise the Health of the Nation targets. Well conducted trials are essential to distinguish complex social processes from the effects of specific interventions for suicide prevention. This review of the available evidence offers little support for the aspiration that the posited targets can be achieved on the basis of current knowledge and current policy.

Full text

PDF
1227

Images in this article

1229p1229-a
on p.1229
1233p1233-a
on p.1233

Selected References

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

  1. Allebeck P., Allgulander C. Suicide among young men: psychiatric illness, deviant behaviour and substance abuse. Acta Psychiatr Scand. 1990 Jun;81(6):565–570. doi: 10.1111/j.1600-0447.1990.tb05500.x. [DOI] [PubMed] [Google Scholar]
  2. Appleby L. Suicide in psychiatric patients: risk and prevention. Br J Psychiatry. 1992 Dec;161:749–758. doi: 10.1192/bjp.161.6.749. [DOI] [PubMed] [Google Scholar]
  3. Apter A., Bleich A., King R. A., Kron S., Fluch A., Kotler M., Cohen D. J. Death without warning? A clinical postmortem study of suicide in 43 Israeli adolescent males. Arch Gen Psychiatry. 1993 Feb;50(2):138–142. doi: 10.1001/archpsyc.1993.01820140064007. [DOI] [PubMed] [Google Scholar]
  4. Arora R. C., Meltzer H. Y. Serotonergic measures in the brains of suicide victims: 5-HT2 binding sites in the frontal cortex of suicide victims and control subjects. Am J Psychiatry. 1989 Jun;146(6):730–736. doi: 10.1176/ajp.146.6.730. [DOI] [PubMed] [Google Scholar]
  5. Ashton J. R., Donnan S. Suicide by burning as an epidemic phenomenon: an analysis of 82 deaths and inquests in England and Wales in 1978-9. Psychol Med. 1981 Nov;11(4):735–739. doi: 10.1017/s0033291700041234. [DOI] [PubMed] [Google Scholar]
  6. Bagley C. The evaluation of a suicide prevention scheme by an ecological method. Soc Sci Med. 1968 Mar;2(1):1–14. doi: 10.1016/0037-7856(68)90097-8. [DOI] [PubMed] [Google Scholar]
  7. Bancroft J., Skrimshire A., Casson J., Harvard-Watts O., Reynolds F. People who deliberately poison or injure themselves: their problems and their contacts with helping agencies. Psychol Med. 1977 May;7(2):289–303. doi: 10.1017/s0033291700029391. [DOI] [PubMed] [Google Scholar]
  8. Barraclough B. M., Shea M. Suicide and Samaritan clients. Lancet. 1970 Oct 24;2(7678):868–870. doi: 10.1016/s0140-6736(70)92035-0. [DOI] [PubMed] [Google Scholar]
  9. 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]
  10. Barraclough B., Shepherd D., Jennings C. Do newspaper reports of coroners' inquests incite people to commit suicide? Br J Psychiatry. 1977 Nov;131:528–532. doi: 10.1192/bjp.131.5.528. [DOI] [PubMed] [Google Scholar]
  11. Berglund M. Suicide in alcoholism. A prospective study of 88 suicides: I. The multidimensional diagnosis at first admission. Arch Gen Psychiatry. 1984 Sep;41(9):888–891. doi: 10.1001/archpsyc.1984.01790200070009. [DOI] [PubMed] [Google Scholar]
  12. Bray G. P. Liver failure induced by paracetamol. BMJ. 1993 Jan 16;306(6871):157–158. doi: 10.1136/bmj.306.6871.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Brown G. L., Goodwin F. K. Human aggression and suicide. Suicide Life Threat Behav. 1986 Summer;16(2):223–243. doi: 10.1111/j.1943-278x.1986.tb00353.x. [DOI] [PubMed] [Google Scholar]
  14. Buckley N. A., Dawson A. H., Whyte I. M., Henry D. A. Greater toxicity in overdose of dothiepin than of other tricyclic antidepressants. Lancet. 1994 Jan 15;343(8890):159–162. doi: 10.1016/s0140-6736(94)90940-7. [DOI] [PubMed] [Google Scholar]
  15. Busuttil A., Obafunwa J. O. Suicide. Lancet. 1993 Sep 18;342(8873):744–744. [PubMed] [Google Scholar]
  16. Cantor C. H., Hill M. A., McLachlan E. K. Suicide and related behaviour from river bridges. A clinical perspective. Br J Psychiatry. 1989 Dec;155:829–835. doi: 10.1192/bjp.155.6.829. [DOI] [PubMed] [Google Scholar]
  17. Cassidy S., Henry J. Fatal toxicity of antidepressant drugs in overdose. Br Med J (Clin Res Ed) 1987 Oct 24;295(6605):1021–1024. doi: 10.1136/bmj.295.6605.1021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Catford J. C. Health targets. BMJ. 1991 Apr 27;302(6783):980–981. doi: 10.1136/bmj.302.6783.980. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Clarke R. V., Lester D. Toxicity of car exhausts and opportunity for suicide: comparison between Britain and the United States. J Epidemiol Community Health. 1987 Jun;41(2):114–120. doi: 10.1136/jech.41.2.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Coppen A., Noguera R., Bailey J., Burns B. H., Swani M. S., Hare E. H., Gardner R., Maggs R. Prophylactic lithium in affective disorders. Controlled trial. Lancet. 1971 Aug 7;2(7719):275–279. doi: 10.1016/s0140-6736(71)91331-6. [DOI] [PubMed] [Google Scholar]
  21. Coppen A., Standish-Barry H., Bailey J., Houston G., Silcocks P., Hermon C. Long-term lithium and mortality. Lancet. 1990 Jun 2;335(8701):1347–1347. doi: 10.1016/0140-6736(90)91232-y. [DOI] [PubMed] [Google Scholar]
  22. Dashef S. S. Active suicide intervention by a campus mental health service: operation and rationale. J Am Coll Health. 1984 Dec;33(3):118–122. doi: 10.1080/07448481.1984.9936171. [DOI] [PubMed] [Google Scholar]
  23. Dew M. A., Bromet E. J., Brent D., Greenhouse J. B. A quantitative literature review of the effectiveness of suicide prevention centers. J Consult Clin Psychol. 1987 Apr;55(2):239–244. doi: 10.1037/0022-006X.55.2.239. [DOI] [PubMed] [Google Scholar]
  24. Deykin E. Y., Hsieh C. C., Joshi N., McNamarra J. J. Adolescent suicidal and self-destructive behavior. Results of an intervention study. J Adolesc Health Care. 1986 Mar;7(2):88–95. doi: 10.1016/s0197-0070(86)80002-x. [DOI] [PubMed] [Google Scholar]
  25. Dooley E. Prison suicide in England and Wales, 1972-87. Br J Psychiatry. 1990 Jan;156:40–45. doi: 10.1192/bjp.156.1.40. [DOI] [PubMed] [Google Scholar]
  26. Etzersdorfer E., Sonneck G., Nagel-Kuess S. Newspaper reports and suicide. N Engl J Med. 1992 Aug 13;327(7):502–503. [PubMed] [Google Scholar]
  27. Farmer R. D. Assessing the epidemiology of suicide and parasuicide. Br J Psychiatry. 1988 Jul;153:16–20. doi: 10.1192/bjp.153.1.16. [DOI] [PubMed] [Google Scholar]
  28. Farmer R. D., Pinder R. M. Why do fatal overdose rates vary between antidepressants? Acta Psychiatr Scand Suppl. 1989;354:25–35. doi: 10.1111/j.1600-0447.1989.tb03044.x. [DOI] [PubMed] [Google Scholar]
  29. Farmer R., O'Donnell I., Tranah T. Suicide on the London Underground System. Int J Epidemiol. 1991 Sep;20(3):707–711. doi: 10.1093/ije/20.3.707. [DOI] [PubMed] [Google Scholar]
  30. Fox R. The suicide drop--why? R Soc Health J. 1975 Feb;95(1):9-13, 20. doi: 10.1177/146642407509500105. [DOI] [PubMed] [Google Scholar]
  31. Freeling P., Rao B. M., Paykel E. S., Sireling L. I., Burton R. H. Unrecognised depression in general practice. Br Med J (Clin Res Ed) 1985 Jun 22;290(6485):1880–1883. [PMC free article] [PubMed] [Google Scholar]
  32. Garnier R., Bismuth C. Liver failure induced by paracetamol. BMJ. 1993 Mar 13;306(6879):718–718. doi: 10.1136/bmj.306.6879.718. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Glatt K. M. Helpline: suicide prevention at a suicide site. Suicide Life Threat Behav. 1987 Winter;17(4):299–309. doi: 10.1111/j.1943-278x.1987.tb00070.x. [DOI] [PubMed] [Google Scholar]
  34. Goldacre M., Seagroatt V., Hawton K. Suicide after discharge from psychiatric inpatient care. Lancet. 1993 Jul 31;342(8866):283–286. doi: 10.1016/0140-6736(93)91822-4. [DOI] [PubMed] [Google Scholar]
  35. Goldstein R. B., Black D. W., Nasrallah A., Winokur G. The prediction of suicide. Sensitivity, specificity, and predictive value of a multivariate model applied to suicide among 1906 patients with affective disorders. Arch Gen Psychiatry. 1991 May;48(5):418–422. doi: 10.1001/archpsyc.1991.01810290030004. [DOI] [PubMed] [Google Scholar]
  36. Hawton K. By their own young hand. BMJ. 1992 Apr 18;304(6833):1000–1000. doi: 10.1136/bmj.304.6833.1000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. 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]
  38. Hawton K., McKeown S., Day A., Martin P., O'Connor M., Yule J. Evaluation of out-patient counselling compared with general practitioner care following overdoses. Psychol Med. 1987 Aug;17(3):751–761. doi: 10.1017/s0033291700025988. [DOI] [PubMed] [Google Scholar]
  39. Hawton K., Morgan H. G. Suicide prevention by general practitioners. Br J Psychiatry. 1993 Mar;162:422–422. doi: 10.1192/bjp.162.3.422a. [DOI] [PubMed] [Google Scholar]
  40. Holding T. A. The B.B.C. 'befrienders' series and its effects. Br J Psychiatry. 1974 May;124(0):470–472. doi: 10.1192/bjp.124.5.470. [DOI] [PubMed] [Google Scholar]
  41. Jennings C., Barraclough B. M., Moss J. R. Have the Samaritans lowered the suicide rate? A controlled study. Psychol Med. 1978 Aug;8(3):413–422. doi: 10.1017/s0033291700016081. [DOI] [PubMed] [Google Scholar]
  42. Kellermann A. L., Rivara F. P., Somes G., Reay D. T., Francisco J., Banton J. G., Prodzinski J., Fligner C., Hackman B. B. Suicide in the home in relation to gun ownership. N Engl J Med. 1992 Aug 13;327(7):467–472. doi: 10.1056/NEJM199208133270705. [DOI] [PubMed] [Google Scholar]
  43. Kimberley M. D., Chapdelaine A., Viau L., Samson E. Prevention of firearm-related injuries in Canada. CMAJ. 1991 Nov 15;145(10):1211–1213. [PMC free article] [PubMed] [Google Scholar]
  44. Kragh-Sørensen P. Pharmacotherapy of the suicidal patient. Acta Psychiatr Scand Suppl. 1993;371:57–59. doi: 10.1111/j.1600-0447.1993.tb05376.x. [DOI] [PubMed] [Google Scholar]
  45. Krieger G. Common errors in the treatment of suicidal patients. J Clin Psychiatry. 1978 Aug;39(8):649–652. [PubMed] [Google Scholar]
  46. Lester D. Restricting methods for suicide as a means of preventing suicide: the case of drugs. Percept Mot Skills. 1989 Feb;68(1):273–274. doi: 10.2466/pms.1989.68.1.273. [DOI] [PubMed] [Google Scholar]
  47. Lester D. State initiatives in addressing youth suicide: evidence for their effectiveness. Soc Psychiatry Psychiatr Epidemiol. 1992 Mar;27(2):75–77. doi: 10.1007/BF00788509. [DOI] [PubMed] [Google Scholar]
  48. Lester D. The availability of firearms and the use of firearms for suicide: a study of 20 countries. Acta Psychiatr Scand. 1990 Feb;81(2):146–147. doi: 10.1111/j.1600-0447.1990.tb06468.x. [DOI] [PubMed] [Google Scholar]
  49. Linehan M. M., Armstrong H. E., Suarez A., Allmon D., Heard H. L. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991 Dec;48(12):1060–1064. doi: 10.1001/archpsyc.1991.01810360024003. [DOI] [PubMed] [Google Scholar]
  50. Litman R. E. Anti-suicide program conducts controlled study. Evaluation. 1976;3(1-2):36–37. [PubMed] [Google Scholar]
  51. Low A. A., Farmer R. D., Jones D. R., Rohde J. R. Suicide in England and Wales: an analysis of 100 years, 1876-1975. Psychol Med. 1981 May;11(2):359–368. doi: 10.1017/s003329170005217x. [DOI] [PubMed] [Google Scholar]
  52. Mann J. J., Kapur S. The emergence of suicidal ideation and behavior during antidepressant pharmacotherapy. Arch Gen Psychiatry. 1991 Nov;48(11):1027–1033. doi: 10.1001/archpsyc.1991.01810350067011. [DOI] [PubMed] [Google Scholar]
  53. Marzuk P. M., Leon A. C., Tardiff K., Morgan E. B., Stajic M., Mann J. J. The effect of access to lethal methods of injury on suicide rates. Arch Gen Psychiatry. 1992 Jun;49(6):451–458. doi: 10.1001/archpsyc.1992.01820060031005. [DOI] [PubMed] [Google Scholar]
  54. Marzuk P. M., Tardiff K., Hirsch C. S., Leon A. C., Stajic M., Hartwell N., Portera L. Increase in suicide by asphyxiation in New York City after the publication of Final Exit. N Engl J Med. 1993 Nov 11;329(20):1508–1510. doi: 10.1056/NEJM199311113292022. [DOI] [PubMed] [Google Scholar]
  55. 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]
  56. McCormick A. Unrecognised HIV related deaths. BMJ. 1991 Jun 8;302(6789):1365–1367. doi: 10.1136/bmj.302.6789.1365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. 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]
  58. Moens G. F., Loysch M. J., van de Voorde H. The geographical pattern of methods of suicide in Belgium: implications for prevention. Acta Psychiatr Scand. 1988 Mar;77(3):320–327. doi: 10.1111/j.1600-0447.1988.tb05128.x. [DOI] [PubMed] [Google Scholar]
  59. Monk M. Epidemiology of suicide. Epidemiol Rev. 1987;9:51–69. doi: 10.1093/oxfordjournals.epirev.a036308. [DOI] [PubMed] [Google Scholar]
  60. Montgomery S. A., Montgomery D. Pharmacological prevention of suicidal behaviour. J Affect Disord. 1982 Dec;4(4):291–298. doi: 10.1016/0165-0327(82)90026-x. [DOI] [PubMed] [Google Scholar]
  61. Morgan H. G., Hawton K. Suicide prevention. Br J Psychiatry. 1994 Jan;164(1):126–127. doi: 10.1192/bjp.164.1.126. [DOI] [PubMed] [Google Scholar]
  62. Morgan H. G., Jones E. M., Owen J. H. Secondary prevention of non-fatal deliberate self-harm. The green card study. Br J Psychiatry. 1993 Jul;163:111–112. doi: 10.1192/bjp.163.1.111. [DOI] [PubMed] [Google Scholar]
  63. Morgan H. G., Priest P. Suicide and other unexpected deaths among psychiatric in-patients. The Bristol confidential inquiry. Br J Psychiatry. 1991 Mar;158:368–374. doi: 10.1192/bjp.158.3.368. [DOI] [PubMed] [Google Scholar]
  64. Morgan H. G. Suicide prevention. Hazards on the fast lane to community care. Br J Psychiatry. 1992 Feb;160:149–153. doi: 10.1192/bjp.160.2.149. [DOI] [PubMed] [Google Scholar]
  65. Moser K. A., Goldblatt P. O., Fox A. J., Jones D. R. Unemployment and mortality: comparison of the 1971 and 1981 longitudinal study census samples. Br Med J (Clin Res Ed) 1987 Jan 10;294(6564):86–90. doi: 10.1136/bmj.294.6564.86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Motto J. A. Suicide prevention for high-risk persons who refuse treatment. Suicide Life Threat Behav. 1976 Winter;6(4):223–230. [PubMed] [Google Scholar]
  67. Mulder A. M., Methorst G. J., Diekstra R. F. Prevention of suicidal behavior in adolescents: the role and training of teachers. Crisis. 1989 Apr;10(1):36–51. [PubMed] [Google Scholar]
  68. 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]
  69. Müller-Oerlinghausen B., Ahrens B., Grof E., Grof P., Lenz G., Schou M., Simhandl C., Thau K., Volk J., Wolf R. The effect of long-term lithium treatment on the mortality of patients with manic-depressive and schizoaffective illness. Acta Psychiatr Scand. 1992 Sep;86(3):218–222. doi: 10.1111/j.1600-0447.1992.tb03255.x. [DOI] [PubMed] [Google Scholar]
  70. Nordentoft M., Breum L., Munck L. K., Nordestgaard A. G., Hunding A., Laursen Bjaeldager P. A. High mortality by natural and unnatural causes: a 10 year follow up study of patients admitted to a poisoning treatment centre after suicide attempts. BMJ. 1993 Jun 19;306(6893):1637–1641. doi: 10.1136/bmj.306.6893.1637. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. O'Carroll P. W., Mercy J. A., Steward J. A., Centers for Disease Control (CDC) CDC recommendations for a community plan for the prevention and containment of suicide clusters. MMWR Suppl. 1988 Aug 19;37(6):1–12. [PubMed] [Google Scholar]
  72. O'Donnell I., Farmer R. D. Suicidal acts on metro systems: an international perspective. Acta Psychiatr Scand. 1992 Jul;86(1):60–63. doi: 10.1111/j.1600-0447.1992.tb03227.x. [DOI] [PubMed] [Google Scholar]
  73. Oliver R. G., Hetzel B. S. An analysis of recent trends in suicide rates in Australia. Int J Epidemiol. 1973 Spring;2(1):91–101. doi: 10.1093/ije/2.1.91. [DOI] [PubMed] [Google Scholar]
  74. Ovenstone I. M., Kreitman N. Two syndromes of suicide. Br J Psychiatry. 1974 Apr;124(0):336–345. doi: 10.1192/bjp.124.4.336. [DOI] [PubMed] [Google Scholar]
  75. Paykel E. S., Myers J. K., Lindenthal J. J., Tanner J. Suicidal feelings in the general population: a prevalence study. Br J Psychiatry. 1974 May;124(0):460–469. doi: 10.1192/bjp.124.5.460. [DOI] [PubMed] [Google Scholar]
  76. 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]
  77. Pierce James I. Suicide and mortality amongst heroin addicts in Britain. Br J Addict Alcohol Other Drugs. 1967 Dec;62(3):391–398. doi: 10.1111/j.1360-0443.1967.tb05374.x. [DOI] [PubMed] [Google Scholar]
  78. Platt S. The aftermath of Angie's overdose: is soap (opera) damaging to your health? Br Med J (Clin Res Ed) 1987 Apr 11;294(6577):954–957. doi: 10.1136/bmj.294.6577.954. [DOI] [PMC free article] [PubMed] [Google Scholar]
  79. 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]
  80. ROBINS E., MURPHY G. E., WILKINSON R. H., Jr, GASSNER S., KAYES J. Some clinical considerations in the prevention of suicide based on a study of 134 successful suicides. Am J Public Health Nations Health. 1959 Jul;49(7):888–899. doi: 10.2105/ajph.49.7.888. [DOI] [PMC free article] [PubMed] [Google Scholar]
  81. Rich C. L., Young D., Fowler R. C. San Diego suicide study. I. Young vs old subjects. Arch Gen Psychiatry. 1986 Jun;43(6):577–582. doi: 10.1001/archpsyc.1986.01800060071009. [DOI] [PubMed] [Google Scholar]
  82. Rich C. L., Young J. G., Fowler R. C., Wagner J., Black N. A. Guns and suicide: possible effects of some specific legislation. Am J Psychiatry. 1990 Mar;147(3):342–346. doi: 10.1176/ajp.147.3.342. [DOI] [PubMed] [Google Scholar]
  83. Rihmer Z., Barsi J., Veg K., Katona C. L. Suicide rates in Hungary correlate negatively with reported rates of depression. J Affect Disord. 1990 Oct;20(2):87–91. doi: 10.1016/0165-0327(90)90121-n. [DOI] [PubMed] [Google Scholar]
  84. Ross T. E., Lester D. Suicides at Niagara Falls. Am J Public Health. 1991 Dec;81(12):1677–1678. doi: 10.2105/ajph.81.12.1677-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  85. Rouillon F., Phillips R., Serrurier D., Ansart E., Gérard M. J. Rechutes de dépression unipolaire et efficacité de la maprotiline. Encephale. 1989 Nov-Dec;15(6):527–534. [PubMed] [Google Scholar]
  86. Roy A., De Jong J., Linnoila M. Cerebrospinal fluid monoamine metabolites and suicidal behavior in depressed patients. A 5-year follow-up study. Arch Gen Psychiatry. 1989 Jul;46(7):609–612. doi: 10.1001/archpsyc.1989.01810070035005. [DOI] [PubMed] [Google Scholar]
  87. Rutz W., Carlsson P., von Knorring L., Wålinder J. Cost-benefit analysis of an educational program for general practitioners by the Swedish Committee for the Prevention and Treatment of Depression. Acta Psychiatr Scand. 1992 Jun;85(6):457–464. doi: 10.1111/j.1600-0447.1992.tb03212.x. [DOI] [PubMed] [Google Scholar]
  88. Rutz W., Wålinder J., Eberhard G., Holmberg G., von Knorring A. L., von Knorring L., Wistedt B., Aberg-Wistedt A. An educational program on depressive disorders for general practitioners on Gotland: background and evaluation. Acta Psychiatr Scand. 1989 Jan;79(1):19–26. doi: 10.1111/j.1600-0447.1989.tb09229.x. [DOI] [PubMed] [Google Scholar]
  89. Rutz W., von Knorring L., Wålinder J. Frequency of suicide on Gotland after systematic postgraduate education of general practitioners. Acta Psychiatr Scand. 1989 Aug;80(2):151–154. doi: 10.1111/j.1600-0447.1989.tb01318.x. [DOI] [PubMed] [Google Scholar]
  90. Rutz W., von Knorring L., Wålinder J. Long-term effects of an educational program for general practitioners given by the Swedish Committee for the Prevention and Treatment of Depression. Acta Psychiatr Scand. 1992 Jan;85(1):83–88. doi: 10.1111/j.1600-0447.1992.tb01448.x. [DOI] [PubMed] [Google Scholar]
  91. Rutz W., von Knorring L., Wålinder J., Wistedt B. Effect of an educational program for general practitioners on Gotland on the pattern of prescription of psychotropic drugs. Acta Psychiatr Scand. 1990 Dec;82(6):399–403. doi: 10.1111/j.1600-0447.1990.tb03068.x. [DOI] [PubMed] [Google Scholar]
  92. Salkovskis P. M., Atha C., Storer D. Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide. A controlled trial. Br J Psychiatry. 1990 Dec;157:871–876. doi: 10.1192/bjp.157.6.871. [DOI] [PubMed] [Google Scholar]
  93. Schmidtke A., Häfner H. The Werther effect after television films: new evidence for an old hypothesis. Psychol Med. 1988 Aug;18(3):665–676. doi: 10.1017/s0033291700008345. [DOI] [PubMed] [Google Scholar]
  94. 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]
  95. Schwartz A. J., Reifler C. B. College student suicide in the United States: incidence data and prospects for demonstrating the efficacy of preventative programs. J Am Coll Health. 1988 Sep;37(2):53–59. doi: 10.1080/07448481.1988.9939042. [DOI] [PubMed] [Google Scholar]
  96. Seager C. P., Flood R. A. Suicide in Bristol. Br J Psychiatry. 1965 Oct;111(479):919–932. doi: 10.1192/bjp.111.479.919. [DOI] [PubMed] [Google Scholar]
  97. 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]
  98. Sherman L. G., Morschauser P. C. Screening for suicide risk in inmates. Psychiatr Q. 1989 Summer;60(2):119–138. doi: 10.1007/BF01064939. [DOI] [PubMed] [Google Scholar]
  99. Smialek J. E., Spitz W. U. Death behind bars. JAMA. 1978 Dec 1;240(23):2563–2564. [PubMed] [Google Scholar]
  100. Soni Raleigh V., Balarajan R. Suicide and self-burning among Indians and West Indians in England and Wales. Br J Psychiatry. 1992 Sep;161:365–368. doi: 10.1192/bjp.161.3.365. [DOI] [PubMed] [Google Scholar]
  101. Souza F. G., Goodwin G. M. Lithium treatment and prophylaxis in unipolar depression: a meta-analysis. Br J Psychiatry. 1991 May;158:666–675. doi: 10.1192/bjp.158.5.666. [DOI] [PubMed] [Google Scholar]
  102. Surtees S. J. Suicide and accidental death at Beachy Head. Br Med J (Clin Res Ed) 1982 Jan 30;284(6312):321–324. doi: 10.1136/bmj.284.6312.321. [DOI] [PMC free article] [PubMed] [Google Scholar]
  103. Television and suicide. N Engl J Med. 1987 Apr 2;316(14):876–878. doi: 10.1056/NEJM198704023161412. [DOI] [PubMed] [Google Scholar]
  104. Turner R. J., Morgan H. G. Patterns of health care in non-fatal deliberate self-harm. Psychol Med. 1979 Aug;9(3):487–492. doi: 10.1017/s0033291700032037. [DOI] [PubMed] [Google Scholar]
  105. Vassilas C. A., Morgan H. G. General practitioners' contact with victims of suicide. BMJ. 1993 Jul 31;307(6899):300–301. doi: 10.1136/bmj.307.6899.300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  106. Vieland V., Whittle B., Garland A., Hicks R., Shaffer D. The impact of curriculum-based suicide prevention programs for teenagers: an 18-month follow-up. J Am Acad Child Adolesc Psychiatry. 1991 Sep;30(5):811–815. [PubMed] [Google Scholar]
  107. Wagg A. S., Aylwin S. J. Catalytic converter and suicide risk. Lancet. 1993 Nov 20;342(8882):1295–1295. doi: 10.1016/0140-6736(93)92383-5. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES