Can Suicide and Parasuicide be Prevented?

Suicide Prospects for preventive strategies are best viewed against the current epidemiological profile of suicide, and in relation to recent trends, in order to ascertain which aspects of the problem are of increasing or decreasing importance and hence to identify priorities for action. Much depends on how long a perspective one adopts: for present purposes we may focus on the past 30 years. Table 1 shows the rates for adult male suicides (excluding undetermined deaths) in 1955 and 1985 for England and Wales, ignoring the many interesting fluctuations that have occurred within that period. In 1955 male suicide rates increased almost linearly with age and was predominantly a problem of later life. By 1985 the picture had dramatically changed, with some increase in the rates of young men and a marked fall in those over age 65 years. There has been much talk of the increase in youth suicides, especially in the United States of America where young men up to age 25 years now carry the highest rates of all age groups, but in the United Kingdom the shift has been much less striking. Exactly which group has changed most depends upon whether the change is assessed in absolute or proportional terms: in absolute numbers it is the increase in 25-34 year age group which currently gives most concern. For women the pattern of change is different, with most age-specific rates having fallen somewhat, especially for those over 45 years (Table 1). Despite a great deal of epidemiological research the reasons for these changes have not been established. For men there is some evidence to suggest that the increase in the younger groups might be attributed particularly to an increase in suicide among those of social class V. From case studies, rather than from macrolevel data, the suggestion also emerges that unemployment may be particularly relevant, especially in view of the changes that occurred during the last phase of mass unemployment during the 1930s (Figure 1). Increasing alcohol consumption might be another major factor. It is paradoxical that at the other end of the age span the dramatic fall of the rates ofthe elderly has attracted little research, presumably because problems which are receding generate little interest despite their scientific importance. The changes in female rates also await explanation, as distinct from an excess of sociological speculation. Despite these gaps in our understanding of the basic epidemiology we must nevertheless consider what can be done to minimize suicide in our society . We may begin by considering what the clinicians can contribute.