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Assessment of Suicide Risk

Published online by Cambridge University Press:  02 January 2018

K. Hawton
K. Hawton*
Affiliation:
Warneford Hospital and University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
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Extract

Among the many clinical skills that psychiatrists must acquire, the ability to assess the risk of patients killing themselves is probably the most important and demanding. It is often a crucial factor when making clinical decisions, such as in the choice of treatments, when deciding whether admission to a psychiatric hospital is necessary and when implementing the Mental Health Act. This review first explores the problems in assessing suicide risk. Subsequently, the risks of suicide for patients with major psychiatric disorders and for particular clinical populations, including hospitalised patients and suicide attempters, are examined together with the findings from research investigations which can assist psychiatrists when making decisions about the risk of suicide.

Type
Lecture
Information
The British Journal of Psychiatry , Volume 150 , Issue 2 , February 1987 , pp. 145 - 153
Copyright
Copyright © 1987 The Royal College of Psychiatrists 

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References

Asberg, M., Traskman, L. & Thoren, P. (1976) 5-HIAA in the cerebrospinal fluid: a biological suicide predictor? Archives of General Psychiatry, 33, 1193–1197.CrossRefGoogle ScholarPubMed
Barraclough, B. (1981) Suicide & epilepsy. In Epilepsy and Psychiatry (eds E. H. Reynolds & M. R. Trimble). Edinburgh: Churchill Livingstone.Google Scholar
Barraclough, B. & Pallis, D. J. (1975) Depression followed by suicide: a comparison of depressed suicides with living depressives. Psychological Medicine, 5, 55–61.Google Scholar
Barraclough, B., Bunch, J., Nelson, B. & Sainsbury, P. (1974) A hundred cases of suicide: clinical aspects. British Journal of Psychiatry, 125, 355–373.Google Scholar
Beck, A. T., Ward, C. H. & Mendelson, M. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.Google Scholar
Beck, A. T., Ward, C. H., Schuyler, D. & Herman, J. (1974a) Development of suicidal intent scales. In The Prediction of Suicide (eds A. T. Beck, H. L. P. Resruk & D. J. Lettieri). Maryland: Charles Press.Google Scholar
Beck, A. T., Ward, C. H., Weissman, A., Lester, D. & Trexler, L. (1974b) The measurement of pessimism: the Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42, 861–865.Google Scholar
Beck, A. T., Ward, C. H., Beck, R. & Kovacs, M. (1975a) Classification of suicidal behaviours: I. Quantifying intent and medical lethality. American Journal of Psychiatry, 132, 285–287.Google Scholar
Beck, A. T., Ward, C. H. & Mendelson, M., Kovacs, M. & Weissman, A. (1975b) Hopelessness and suicidal behaviour: an overview. Journal of the American Medical Association, 234, 1146–1149.CrossRefGoogle ScholarPubMed
Beck, A. T., Ward, C. H. & Kovacs, M., & Weissman, A. (1979) Assessment of suicidal intention: the scale for suicide ideation. Journal of Consulting and Clinical Psychology, 47, 343–352.CrossRefGoogle ScholarPubMed
Beck, A. T., Ward, C. H., Steer, R. A. Kovacs, M. & Garrison, B. (1985) Hopelessness and eventual suicide: a 10 year prospective study of patients hospitalised with suicidal ideation. American Journal of Psychiatry, 145, 559–563.Google Scholar
Brown, G. W. & Harris, T. (1978) Social Origins of Depression. London: Tavistock.Google ScholarPubMed
Buglass, D. & Horton, J. (1974) A scale for predicting subsequent suicidal behaviour. British Journal of Psychiatry, 124, 573–578.Google Scholar
Bunch, J. (1972) Recent bereavement in relation to suicide. Journal of Psychosomatic Research, 16, 361–366.Google Scholar
Cohen, S., Leonard, C., Farberow, N. & Schneidman, E. S. (1964) Tranquilizers and suicide in the schizophrenic patient. Archives of General Psychiatry, 11, 312–321.Google Scholar
Copas, J. B. & Robin, A. (1982) Suicide in psychiatric in-patients. British Journal of Psychiatry, 141, 503–511.CrossRefGoogle ScholarPubMed
Coryell, W. (1981) Obsessive-compulsive disorder and primary unipolar depression: comparisons of background, family history, course and mortality. Journal of Nervous and Mental Disease, 169, 220–224.Google Scholar
Coryell, W., Noyes, R. & Clancy, J. (1982) Excess mortality in panic disorder: a comparison with primary unipolar depression. Archives of General Psychiatry, 39, 701–703.Google Scholar
Dorpat, T. L. & Ripley, H. S. (1960) A study of suicide in the Seattle area. Comprehensive Psychiatry, 1, 349–359.CrossRefGoogle ScholarPubMed
Dorpat, T. L., Jackson, J. K. & Ripley, H. S. (1965) Broken homes and attempted and completed suicide. Archives of General Psychiatry, 12, 213–216.CrossRefGoogle ScholarPubMed
Drake, R. E. & Ehrlich, J. (1985) Suicide attempts associated with akathisia. American Journal of Psychiatry, 142, 499–501.Google ScholarPubMed
Drake, R. E., Gates, C., Cotton, P. G. & Whitaker, A. (1984) Suicide among schizophrenics: who is at risk? Journal of Nervous and Mental Disease, 172, 613–617.Google Scholar
Dyer, J. A. T. & Kreitman, N. (1984) Hopelessness, depression and suicidal intent in parasuicide. British Journal of Psychiatry, 144, 127–133.Google Scholar
Fernando, S. & Storm, V. (1984) Suicide among psychiatric patients of a district general hospital. Psychological Medicine, 14, 661–672.Google Scholar
Fox, K. & Weissman, M. (1975) Suicide attempts and drugs: contradiction between method and intent. Social Psychiatry, 10, 31–38.Google Scholar
Gale, S., Mesnikoff, A., Fine, J. & Talbott, J. A. (1980) A study of suicide in state mental hospitals in New York City. Psychiatric Quarterly, 52, 201–213.Google Scholar
Guze, S. B. & Robins, E. (1970) Suicide among primary affective disorders. British Journal of Psychiatry, 117, 437–438.Google Scholar
Hawton, K. (1978) Deliberate self-poisoning and self-injury in the psychiatric hospital. British Journal of Medical Psychology, 51, 253–259.Google Scholar
Hawton, K. & Fagg, J. Suicide and other causes of death following attempted suicide (in preparation).Google Scholar
Herold, R. C., Beck, A. T., Berchick, R. J., Brown, G. & Steer, R. A. Hopelessness as a predictor of long-term suicide in psychiatric outpatients (in preparation).Google Scholar
James, I. P. (1967) Suicide and mortality amongst heroin addicts in Britain. British Journal of Addiction, 62, 391–398.Google Scholar
Kessel, N. & McCulloch, W. (1966) Repeated acts of self-poisoning and self-injury. Proceedings of the Royal Society of Medicine, 59, 89–92.CrossRefGoogle ScholarPubMed
Kreitman, N. (1982) How useful is the prediction of suicide following parasuicide? In New Trends in Suicide Prevention (eds J. Wilmotte & J. Mendlewicz). Basel: Karger.Google Scholar
Langley, G. E. & Bayatti, N. N. (1984) Suicides in Exe Vale Hospital, 1972–1981. British Journal of Psychiatry, 145, 463–467.Google Scholar
McClure, G. M. G. (1984) Trends in suicide rate for England and Wales 1975–80. British Journal of Psychiatry, 144, 119–126.Google Scholar
McMahon, B. & Pugh, T. F. (1965) Suicide in the widowed. American Journal of Epidemiology, 81, 23–31.Google Scholar
Miles, C. P. (1977) Conditions predisposing to suicide: a review. Journal of Nervous and Mental Disease, 164, 231–246.CrossRefGoogle ScholarPubMed
Minkoff, K., Bergmann, E., Beck, A. T. & Beck, R. (1973) Hopelessness, depression and attempted suicide. American Journal of Psychiatry, 130, 455–459.Google Scholar
Morgan, H. G. & Priest, P. (1984) Assessment of suicide risk in psychiatric in-patients. British Journal of Psychiatry, 145, 467–469.Google Scholar
Motto, J. A. (1980) Suicide risk factors in alcohol abuse. Suicide and Life Threatening Behavior, 10, 230–238.Google Scholar
Murphy, G. E. & Robins, E. (1967) Social factors in suicide. Journal of the American Medical Association, 199, 303–308.CrossRefGoogle ScholarPubMed
Murphy, G. E., Armstrong, J. W., Hermele, S. L., Fischer, J. R. & Clenendin, W. W. (1979) Suicide and alcoholism: interpersonal loss confirmed as a predictor. Archives of General Psychiatry, 36, 65–69.Google Scholar
Ovenstone, I. M. K. & Kreitman, N. (1974) Two syndromes of suicide. British Journal of Psychiatry, 124, 336–345.Google Scholar
Pallis, D. J. & Sainsbury, P. (1976) The value of assessing intent in attempted suicides. Psychological Medicine, 6, 487–492.Google Scholar
Pallis, D. J. & Barraclough, B. M. (1977) Seriousness of suicide attempt and future risk of suicide: A comment on Card's paper. Omega, 8, 141–149.CrossRefGoogle Scholar
Pallis, D. J., Barraclough, B. M., Levey, A. B., Jenkins, J. S. & Sainsbury, P. (1982) Estimating suicide risk among attempted suicides: I. The development of new clinical scales. British Journal of Psychiatry, 141, 37–44.Google Scholar
Pallis, D. J., Gibbons, J. S. & Pierce, D. W. (1984) Estimating suicide risk among attempted suicides: II. Efficiency of predictive scales after the attempt. British Journal of Psychiatry, 144, 139–148.Google Scholar
Pierce, D. W. (1981) The predictive validation of a suicidal intent scale: a five year follow-up. British Journal of Psychiatry, 139, 391–396.Google Scholar
Pierce, D. W. (1984) Suicidal intent and repeated self-harm. Psychological Medicine, 14, 655–659.Google Scholar
Pitts, F. N. & Winokur, G. (1966) Affective disorder - VII: alcoholism and affective disorder. Journal of Psychiatric Research, 4, 37–50.Google Scholar
Platt, S. (1984) Unemployment and suicidal behaviour: a review of the literature. Social Science and Medicine, 19, 93–115.Google Scholar
Pokorny, A. D. (1964) Suicide rates in various psychiatric disorders. Journal of Nervous and Mental Disease, 139, 499–506.Google Scholar
Robins, E., Gassner, S., Kayes, J., Wilkinson, R. H. & Murphy, G. E. (1959a) The communication of suicidal intent: a study of 134 consecutive cases of successful (completed) suicide. American Journal of Psychiatry, 115, 724–733.Google Scholar
Robins, E., Murphy, G. E., Wilkinson, R. H., Gassner, S. & Kayes, J. (1959b) Some clinical considerations in the prevention of suicide based on a study of 134 successful suicides. American Journal of Public Health, 49, 888–899.Google Scholar
Roose, S. P., Glassman, A. H., Walsh, B. T., Woodring, S. & Vital-Herne, J. (1983) Depression, delusions and suicide. American Journal of Psychiatry, 140, 1159–1162.Google ScholarPubMed
Rosen, D. H. (1970) The serious suicidal attempt: epidemiological and follow-up study of 886 patients. American Journal of Psychiatry, 127, 764–770.Google Scholar
Roy, A. (1982a) Suicide in chronic schizophrenia. British Journal of Psychiatry, 141, 171–177.CrossRefGoogle ScholarPubMed
Roy, A. (1982b) Risk factors for suicide in psychiatric patients. Archives of General Psychiatry, 39, 1089–1095.Google Scholar
Roy, A. (1983) Suicide in depressives. Comprehensive Psychiatry, 24, 487–491.Google Scholar
Sainsbury, P. (1955) Suicide in London. Maudsley Monograph No. 1. London: Chapman & Hall.Google Scholar
Salmons, P. H. (1984) Suicide in high buildings. British Journal of Psychiatry, 145, 469–472.Google Scholar
Shepherd, D. M. & Barraclough, B. M. (1980) Work and suicide: an empirical investigation. British Journal of Psychiatry, 136, 469–478.CrossRefGoogle ScholarPubMed
Sims, A. (1984) Neurosis and mortality: investigating an association. Journal of Psychosomatic Research, 28, 353–362.Google Scholar
Sims, A. & Prior, F. (1978) The pattern of mortality in severe neuroses. British Journal of Psychiatry, 133, 299–305.CrossRefGoogle ScholarPubMed
Sletten, I. W., Brown, M. L., Evenson, R. C. & Altman, H. (1972) Suicide in mental hospital patients. Diseases of the Nervous System, 33, 328–334.Google Scholar
Smith, R. (1985) Occupationless health. ‘I couldn't stand it any more’: suicide and unemployment. British Medical Journal, 291, 1563–1566.Google Scholar
Stanley, M. & Mann, J. J. (1983) Increased serotonin-2 binding sites in frontal cortex of suicide victims. Lancet, 2, 214–216.Google Scholar
Stanley, M., Virgilio, J. & Gershon, S. (1982) Science, 216, 1337–1338.Google Scholar
Traskman, L., Asberg, M., Bertilsson, L. & Sjostrand, L. (1981) Monoamine metabolites in CSF and suicidal behavior. Archives of General Psychiatry, 38, 631–663.Google Scholar
Tuckman, J. & Youngman, W. F. (1963) Identifying suicide risk groups among attempted suicides. Public Health Reports, 78, 763–766.Google Scholar
Tuckman, J. & Youngman, W. F. (1968) A scale for assessing suicide risk of attempted suicides. Journal of Clinical Psychology, 24, 17–19.Google Scholar
van Pragg, H. M. (1983) CSF 5-HIAA and suicide in non-depressed schizophrenics. Lancet, 2, 977–978.Google Scholar
Wetzel, R. D. (1976) Hopelessness, depression and suicide intent. Archives of General Psychiatry, 33, 1069–1073.Google Scholar
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