GENERAL DISCUSSION

More men in the S groups than in the C groups have had psychiatric disorders measured through medically certified sick-leave (tables 9:4-7) or psychiatric care (tables 10:5-11). Differences are found for voluntary and compulsory care at psychiatric hospitals and psychiatric departments during all time periods investigated. During their lifetimes. as many as 63 % of the men in the US group and 48 % in the RS group had had some f o p of psychiatric care, compared with 19 % and 9 % in the control groups. The quotients between the number of men with psychiatric care in the S and in the C groups, which for their lifetimes are 3.4 and 5.3 in the US and RS group respectively increase with diminishing intervals to the S-date, so that during the last six months they are 12.5 in the urban and 30 in the rural area. Simultaneously, the percentages of those men receiving psychiatric care in the S groups decrease to 29 and 27 %, respectively, and during the last month of their lives only 14 and 17 %have had some form of contact with psychiatric care. These comparisons show that the greater part of the men who subsequently committed suicide had been in need of psychiatric care during their lifetimes but for various reasons this need had not been satisfied for many of them when they entered into their final crisis. Obviously they had neither access to other kind of help. It may be added, that since 9 10 % committed suicide while at psychiatric in-patient wards psychiatric care cannot be a guarantee against completed suicide. Seen from another point of view, most of the men who had contact with a psychiatrist during the last 6 months of their lives also had had it previously. Rarely was there psychiatric contact only during the last six months, 4 % and 13 %, (in the US group three men with in-patient care and four with out-patient care only, in the RS group six men with in-patient care and eight men with out-patient care only, see Ch 11). These figures are in line with the findings of Seager and Flood 1965, and Barraclough et al 1974, that psychiatric patients who commit suicide usuallyhave long-lasting disorders. This implies that psychiatric care should especially take into consideration the possibility of suicide in chronic or recurrent disorders which have not been substantially helped by the treatment. The protracted nature of illness, that subsequently lead to suicide is also evident from the social insurance data, Thus, in the S groups there were twice as many disability pensioners (13 14 % compared with 6 7 % in the control groups) and a