Life events and psychosocial factors in elderly suicides--a case-control study.

BACKGROUND: Stressful life events, such as family conflicts, separation, bereavement, somatic illness and financial problems are common antecedents of suicide. Studies on suicide among younger persons dominate the literature, despite the fact that a large proportion of suicides occur among elderly persons. METHODS: The occurrence of stressful life events was investigated among elderly suicide cases and population controls. The study was conducted in the southwestern part of Sweden and included 85 persons (46 males and 39 females) 65 years and above who had committed suicide from January 1994 to May 1996. Population controls (84 males and 69 females) were randomly selected. Interviews were carried out with the controls and with informants for the suicide cases. Questions on sociodemographic background, mental and somatic health status, and life events (0-6, 7-12 and 13-24 months preceding suicide/interview) were included in the interviews. RESULTS: Somatic illness, family discord and financial trouble were significant risk factors during all three time periods. Other risk factors were mental disorder, lower education, feelings of loneliness and previous suicide in the family. Factors associated with a decreased risk included active participation in organizations and having a hobby. Variables that remained in the multivariate logistic regression model were mental disorder (men, odds ratio (OR) = 62.4, 95% CI 17.9-217.5; women, OR = 55.9, 95% CI 14.1-222.3) and family discord (men, OR = 10.0. 95% CI 1.7-59.8; women, OR = 9.2, 95% CI 1.9-44.8). CONCLUSIONS: Mental disorder and family discord were the two major risk factors for suicide among elderly men and women.     

Suicide at 50 years of age and older: perceived physical illness, family discord and financial strain

BACKGROUND: Mental disorders amplify suicide risk across the lifecourse, but most people with mental disorder do not take their own lives. Few controlled studies have examined the contribution of stressors to suicide risk. METHOD: A case-control design was used to compare 86 suicides and 86 controls aged 50 years and older, matched on age, gender, race and county of residence. Structured interviews were conducted with proxy respondents for suicides and controls. RESULTS: Perceived physical illness, family discord and employment change amplified suicide risk after controlling for sociodemographic covariates and mental disorders that developed > or = 1 year prior to death/interview. Only the effect of physical illness (OR 6.24, 95% CI 1.28-51.284) persisted after controlling for all active mental disorders. CONCLUSIONS: Interventions to decrease the likelihood of financial stress and to help families manage discord and severe physical illness may effectively reduce suicides among middle-aged and older adults.     

Psychomotor retardation in elderly depressed patients

BACKGROUND: Up to 70% of older people who commit suicide consult a general practitioner (GP) in the month prior to their death. The purpose of this study was to identify the clinical and demographic characteristics of older adults who are contemplating suicide and are in contact with a GP. METHODS: We utilised a cross-sectional study to investigate the association between suicidal ideation and clinical/demographic variables of 504 consecutive patients aged 60 years or over, attending 1 of 54 randomly selected Western Australian GPs. Prior to their medical consultation, patients completed a self-report questionnaire, which included questions about suicidal ideation (Depressive Symptom Inventory-Suicidality Subscale, DSI-SS), demographic factors, lifestyle factors, physical health and mental health, including depression (Center for Epidemiologic Studies-Depression Scale, CES-D). RESULTS: Within our sample of older patients, 6.3% acknowledged current suicidal ideation. Multivariate analyses indicated that current suicidal ideation was strongly associated with being depressed at least occasionally during the previous week (OR=7.3, 95% CI=2.3-23.0), CES-D scores of 16 points or greater (OR=3.6, 95% CI=1.0-12.1), and a prior history of attempted suicide (OR=15.5, 95% CI=4.0-60.6). Limitations: Our results and conclusions are limited to suicidal ideation, and may not apply to suicidal behaviour. CONCLUSIONS: Depressive symptomatology is strongly associated with suicidal ideation in later life. Strategies that enhance GPs' identification and treatment of affective illness in older patients should have the greatest impact on suicide rates within this age group.     

The grief experiences and needs of bereaved relatives and friends of older people dying through suicide: a descriptive and case-control study

BACKGROUND: Little is known about grief experiences of individuals bereaved through suicide of older people. Legal procedures may be one source of distress. Studies have suggested that guilt feelings, and a sense of rejection, shame or stigma, are probably more frequent in relatives bereaved through suicide than in those bereaved through other modes of death. METHODS: We examined (a) problems experienced during legal procedures after death and (b) grief experiences, in 85 relatives and friends bereaved through the suicide of person 60 years old or over. In a case-control study the bereavement reactions in a subgroup of 46 people were compared with those of a control group bereaved by the natural death of an older person. Interviews, carried out 6-21 months after the deaths, included a semi-structured assessment of problems following the death, the Grief Experience Questionnaire (GEQ) and the Montgomery and Asberg Depression Rating Scale (MADRS). RESULTS: Thirty-six (42.4%) of those bereaved through suicide reported problems in their dealings with the coroner's office, and 33 (38.8%) described distress caused by media reporting of the inquest. Depression scores were similar in the group of individuals bereaved through suicide and those bereaved through natural causes. The former scored higher on subscales of the GEQ measuring stigmatisation, shame, sense of rejection and "unique reactions" compared with those bereaved through natural death. LIMITATIONS: The participation rate of potential subjects was somewhat low, especially in the control group. Proportions of different kinships to the deceased differed in the study and control groups. CONCLUSIONS: Problems in the media reporting of coroners' inquests and in inquest procedures are a frequent source of distress for bereaved relatives. The common themes of stigma, shame, and sense of rejection in bereavement after suicide suggest that these areas should be specifically addressed in the counselling of relatives bereaved in this way.     

Risk factors for suicide in China's youth: a case-control study

BACKGROUND: Suicide is the most common cause of death among youth in China. METHOD: A case-control psychological autopsy study in 23 geographically representative disease surveillance points around China collected information from family members and close associates of 114 persons aged 15-24 years who died by suicide (cases) and 91 who died of other injuries (controls). RESULTS: Among the 114 suicides 61% were female, 88% lived in rural villages, 70% died by ingesting pesticides (most commonly stored in the home), 24% previously attempted suicide, and 45% met criteria of a mental illness at the time of death. Multivariate logistic regression identified several independent risk factors: severe life events within 2 days before death (OR 31.8, 95% CI 2.6-390.6), presence of any depressive symptoms within 2 weeks of death (OR 21.1, 95% CI 4.6-97.2), low quality of life in the month before death (OR 9.7, 95% CI 2.8-34.1), and acute stress at time of death (moderate: OR 3.1, 95% CI 0.8-11.9; high: OR 9.1, 95% CI 1.2-66.8). A significant interaction between mental illness at time of death and gender indicated that diagnosis was an important predictor of suicide in males (OR 14.0, 95% CI 2.6-76.5) but not in females (OR 0.3, 95% CI 0.0-3.6). Prior suicide attempt was related to suicide in the univariate analysis (OR 57.5) but could not be included in the multivariate model because no controls had made prior attempts. CONCLUSIONS: Suicide prevention efforts for youth in China must focus on restricting access to pesticides, early recognition and management of depressive symptoms and mental illnesses, improving resiliency, and enhancing quality of life.     

自杀与其它伤害死亡全国性对照研究

目的:了解国内的自杀现状及其特征.方法:用自制的意外死亡研究问卷按"心理解剖"的调查方法从全国20个农村和3个城市疾病监测点抽取895例自杀和701例其它伤害死亡案例.对每个案例的家属及周围知情者单独进行持续约3小时的调查.结果:自杀案例中67%为服毒自杀(大多数为存放在家中的物品);63%自杀当时有精神障碍(39.8%为抑郁症);27%有过自杀未遂;91%从未看过精神科医生;近一年最常见的负性生活事件为经济困难(40%)、患急重病(38%)或夫妻不和(35%);自杀前两天内25%有突出的人际关系冲突;自杀当时10%有他人在现场.与其它伤害死亡者比较自杀者女性多、年龄偏大、读书年限少、家庭收入低并出现慢性和急性负性生活事件多.结论:我国自杀为多因素相互作用的结果,相当一部分属于冲动行为,与其它国家比自杀当时患精神障碍的比例低.     

运用深入访谈探究自杀未遂者及其亲友对自杀未遂发生原因的看法

目的:对自杀未遂者及其亲友开展深入访谈以了解他们对自杀未遂行为的看法,提高自杀预防健康教育项目的效果。方法:针对自杀原因及经过等对4所市县级综合医院诊治的318例自杀未遂者及其陪诊的知情亲友进行独立的深入访谈,然后采用以下两种指标对深入访谈资料进行量化分析:(1)比例法,即计算访谈中发现的7类原因在两种独立访谈中的出现率(出现率之和>100%);(2)权重法,即先将各类原因在每个访谈案例自杀未遂行为发生中的相对重要性进行排序,然后用特定的公式计算出各自的权重分,最后得出各类因素在两种独立访谈中的权重分均值(各类因素的权重分之和=100)。结果:深入访谈分析结果显示多数自杀未遂行为属于剧烈人际矛盾后诱发的冲动行为,农药等自杀工具的方便易得为其发生提供了必要条件。独立分析自杀未遂者本人与亲友访谈,用比例法和权重法计算出的7类原因的出现率和相对重要性分别如下:人际关系问题(比例法84.2%比82.4%,权重法57.8比60.4)、心理问题(30.9%比26.7%,15.5比14.2)、经济问题(14.8%比12.4%,5.1比5.1)、躯体问题(9.4%比9.1%,3.0比2.9)、自杀未遂者的其他问题(25.2%比20.2%,11.0比9.6)、他人的问题(21.8%比19.9%,7.3比7.2)和原因不明(0.3%比0.9%,0.0比0.0)等7类。结论:将深入访谈这一定性资料中获得的信息进行量化分析是可行的。自杀未遂者及其亲友对自杀未遂不同原因的相对重要性的看法非常一致。他们对心理问题的相对重要性认识不足,因此提高公众对心理卫生的认识水平,转变其态度使得更多的人愿意因心理问题寻求专业帮助,以及扩展社区心理卫生服务是非常必要的。     

Factors distinguishing suicide attempters from suicide ideators in a community sample: social issues and physical health problems

BACKGROUND: Few studies have focused on factors that uniquely distinguish suicide attempters from suicide ideators. This study assesses prevalence of suicide attempts among suicide ideators within a community sample; explores demographics, employment status, mental and physical health conditions, personality, life stresses and social environment as factors that may distinguish these groups; examines effects of age and gender upon suicide attempts and associated factors; and investigates the increase in suicide attempts when multiple factors related to this behaviour are present. METHOD: Data were drawn from the PATH Through Life Project, a community survey of 7485 people in Canberra, Australia. A subsample of 522 suicide ideators were used for this study. RESULTS: Logistic regression was used to identify factors associated with suicide attempts. Physical medical conditions (OR 1.95) and negative interactions with friends (OR 1.20) were associated with an increased likelihood of suicide attempts among suicide ideators. Age and gender interaction effects for suicide attempts were found involving physical medical condition and mastery among men (OR 3.78 and 0.83 respectively) and not being employed for those aged 40-44 years (OR 8.94). A cumulative effect was found when multiple factors associated with suicide attempts were present, and the probability of an attempt was significantly elevated. CONCLUSIONS: Factors distinguishing those who attempt suicide from suicide ideators involve being unemployed, physical ill health and relationship difficulties. Contrary to expectation, this study found that ideators and attempters experience comparable levels of depression and anxiety.     

Suicide in adolescents: using life charts to understand the suicidal process

BACKGROUND: A greater understanding of the pathways which lead young people to take their lives is important in ensuring that prevention strategies and health service delivery are as effective as possible. In this study we examined the duration, development and characteristics of the suicidal process in young people who ultimately died by suicide. METHODS: Life charts of psychological autopsy information from multiple informants were used to identify the suicidal process among 27 young people who died by suicide. RESULTS: Life charts were generated for 27 young people who died by suicide, of whom 93% (n=25) were male, with an average age at death of 20.9 years (SD=2.4). Three types of suicidal process were identified: Group I characterised by longstanding difficulties which spanned the developmental domains of home, school and peers. The suicidal process was longstanding, and included deliberate self-harm prior to their death and direct communication to friends and family about suicidal ideas and plans. The second group was characterised by evidence of an established psychiatric disorder. Two subgroups were identified, namely those individuals with a protracted suicidal process which lasted approximately 5-9 years, and those with a brief suicidal process lasting approximately one year. The third and smallest group was characterised by the emergence of the suicidal process as an acute response to life events among young people who appeared to have previously been functioning well, without apparent mental illness or known self-harm. However, two out of five in this group communicated specific suicidal intent in the weeks before their death. CONCLUSIONS: The suicidal process may emerge and disappear in the lives of young people. Repeated episodes of self-cutting by young men, against a backdrop of substance abuse, relationship difficulties, and mental health problems require further clinical attention.     

厦门市18岁及以上人群自杀未遂流行病学调查

目的:了解厦门市自杀未遂的流行病学特征及相关因素。方法:采用2010年5月至2010年11月厦门市精神卫生流行病学调查样本,调查18岁及以上厦门市常住人口的自杀未遂发生情况。共调查12051人,回收有效应答问卷10758份。采用扩展的一般健康问卷(GHQ-12)量表作为筛查量表,修订的DSM-IV-TR轴I障碍定式临床检查(SCID-I/P)病人版作为诊断工具。结果:本样本的自杀未遂发生率为0.55%;农村发生率高于城市(0.82%vs.0.47%,P0.05)。多因素logistic回归分析显示:经常性参与赌博(OR=3.18)、精神障碍(OR=2.64)、因精神或心理问题住过院(OR=5.13)是自杀未遂的危险因素。自杀的最主要方式为"采用工具"(42.4%),工具来源主要为"放在家里"(61.1%),自杀最主要的原因为"家庭纠纷"(45.8%),自杀最主要的目的是"为了解脱痛苦"(64.4%)。结论:本研究显示农村自杀未遂的发生率高于城市,经常性参与赌博、精神障碍和因精神或心理问题住过院是自杀未遂主要的危险因素。     

Personality disorders and health problems distinguish suicide attempters from completers in a direct comparison

Background

Whether suicide attempters and completers represent the same population evaluated at different points along a progression towards suicide death, overlapping populations, or completely different populations is a problem still unresolved.

Methods

446 Adult suicide attempters and knowledgeable collateral informants for 190 adult suicide probands were interviewed. Sociodemographic and clinical data was collected for both groups using semi-structured interviews and structured assessments. Univariate analyses and logistic regression models were conducted to explore the similarities and differences between suicide attempters and completers.

Results

Univariate analyses yielded significant differences in sociodemographics, recent life events, impulsivity, suicide intent, and distribution of Axis I and II disorders. A logistic regression model aimed at distinguishing suicide completers from attempters properly classified 90% of subjects. The most significant variables that distinguished suicide from attempted suicide were the presence of narcissistic personality disorder (OR=21.4; 95% CI=6.8–67.7), health problems (OR=20.6; 95% CI=5.6–75.9), male sex (OR=9.6; 95% CI=4.42–20.9), and alcohol abuse (OR=5.5; 95% CI=2.3–14.2).

Limitations

Our study shares the limitations of studies comparing suicide attempters and completers, namely that information from attempters can be obtained from the subject himself, whereas the assessment of completers depends on information from close family or friends. Furthermore, different semi-structured instruments assessed Axis I and Axis II disorders in suicide attempters and completers. Finally, we have no data on inter-rater reliability data.

Conclusions

Suicide completers are more likely to be male and suffer from alcohol abuse, health problems (e.g. somatic illness), and narcissistic personality disorder. The findings emphasize the importance of implementing suicide prevention programs tailored to suicide attempters and completers.     

Treatment of bereavement-related depression and traumatic grief

In the bereaved, approximately 40% meet criteria for major depression within a month of the death. At a year, approximately 15% of the bereaved are depressed and at 2 years, the figure is approximately 7%. Open-label trials of medication for bereavement-related depression have shown promising results for desipramine, nortriptyline, and bupropion SR. One double-blind controlled trial supports the use of nortriptyline, but interpersonal psychotherapy did no better than placebo. In all these trials, depressive symptoms improve more than bereavement symptoms. Effective open-label treatments for traumatic grief include paroxetine, nortriptyline, and a form of psychotherapy called traumatic grief treatment.     

Suicide and undetermined death in south east Scotland. A case-control study using the psychological autopsy method

BACKGROUND: Mental disorders are major risk factors for suicide. Not all those who suffer from mental disorders kill themselves. Additional information is required to differentiate higher and lesser risk patients. METHODS: Retrospective case-control comparison was made of cases of suicide/undetermined death with living controls using psychological autopsy in South East Scotland. Cases and controls were matched for age, sex and mental disorder. Informants were those closest to cases and controls. The subjects were 45 cases of suicide/undetermined death and 40 living controls. RESULTS: Cases and controls did not differ significantly in severity of mental disorder. The main factors independently associated with undetermined death or suicide were: a history of deliberate self-harm (adjusted OR 4 1); physical ill health (adjusted OR 7.8); and engagement by mental health services (adjusted OR 0.01). Other antecedents associated with increased risk (criminal record, police involvement, financial problems and failure to vote) and those associated with decreased risk (contact with a doctor and in-patient care) did not exert effects after controlling for confounding. CONCLUSIONS: Controls were receiving more care of whatever kind. Treatment of mental disorder comorbid with physical illness and a history of deliberate self-harm may be especially important. Factors that separate those with mental disorder at high risk from those at lesser risk relate to care levels provided, which may be a function of engagement by and with health services. The role of mental health professionals is beneficial in suicide prevention. The focusing of that role towards engaging alienated or 'difficult' patients should be addressed.     

Suicide after bereavement: an overlooked problem

BACKGROUND: To examine the effect of time on suicide after bereavement among widowed persons. METHOD: The data were extracted from Swiss mortality statistics for the period 1987-2005. The time between bereavement and subsequent death, specifically by suicide, was determined by linkage of individual records of married persons. The suicide rates and the standardized mortality ratios in the first week/month/year of widowhood were calculated based on person-year calculations. RESULTS: The annualized suicide rates in widowed persons were highest in the first week after bereavement: 941 males and 207 females per 100,000. The corresponding standardized mortality ratios were approximately 34 and 19 respectively. In the first month(s) after bereavement, the rates and the ratios decreased, first rapidly, then gradually. Except in older widows, they did not reach the baseline levels during the first year after bereavement. CONCLUSIONS: The suicide risk of widowed persons is increased in the days, weeks and months after bereavement. Widowed persons are a clear-cut risk group under the aegis of undertakers, priests and general practitioners.     

Suicidal ideation and attempts in adults seeking outpatient psychodynamic psychotherapy

Suicide is an important cause of death in patients with mental health disorders, but little is known about the occurrence of suicidal ideation and attempts in outpatient psychotherapy patients. The aim of this study was to identify the proportion of patients with and correlates of suicidal ideation and attempts in community-based psychotherapy practices. Using 983 applications for reimbursement of psychotherapy from individual patients, reports about suicidal thoughts and suicide attempts were extracted along with demographic, biographic and clinical data. Multivariate logistic regression analysis was used to identify correlates of suicidal ideation and attempts by calculating odds ratios (ORs). Among the patients, 19% presented with suicidal thoughts (11% currently and 8% in the past) and 6% with suicide attempts. Important correlates of suicidal thoughts were male gender (OR 1.7), lower education (OR 1.8), early retirement (OR 2.9), death of a parent when younger than 5 years old (OR 3.3), violence experienced from various people (OR 2.1), self-harm behaviour (OR 7.9) and alcohol misuse (OR 1.7). Suicide attempts were associated with male gender (OR 5.6), lower education (OR 4.2), violence experienced from partner (OR 2.5) or from various people (OR 9.5) and self-harm behaviour (OR 15.0). These results show that the proportion of suicidal patients seeking outpatient psychotherapy is high. It should therefore be a central topic in clinical training. Biographic data such as the loss of a parent at an early age or experiencing violence are associated with who is at increased risk and should be explored in detail.     

Suicides and serious suicide attempts: two populations or one?

BACKGROUND: Few studies have examined the extent to which populations of suicides and attempted suicides are similar, or different. This paper compares suicides and serious suicide attempts in terms of known risk factors for suicidal behaviour. METHODS: Using case-control methodology, risk factors for suicidal behaviour were examined in 202 individuals who died by suicide, 275 individuals who made medically serious suicide attempts and 984 randomly selected control subjects. Based on data from significant others, measures used spanned sociodemographic factors, childhood experiences, psychiatric morbidity and psychiatric history, exposure to recent stressful life events and social interaction. RESULTS: Multiple logistic regression identified the following risk factors that were common to suicide and serious suicide attempts: current mood disorder; previous suicide attempts; prior outpatient psychiatric treatment; admission to psychiatric hospital within the previous year; low income; a lack of formal educational qualifications; exposure to recent stressful interpersonal, legal and work-related life events. Suicides and suicide attempts were distinguished in the following ways: suicides were more likely to be male (OR = 1.9, 95% CI 1.1, 3.2); older (OR = 1.03, 95% CI 1.02, 1.04); and to have a current diagnosis of non-affective psychosis (OR = 8.5, 95% CI 2.0, 35.9). Suicide attempts were more likely than suicides to have a current diagnosis of anxiety disorder (OR = 3.5, 95% CI 1.6, 7.8) and to be socially isolated (OR = 2.0, 95% CI 1.2, 3.5). These findings were confirmed by discriminant function analysis, which identified two functions that described the three subject groups: the first function discriminated the two suicide groups from control subjects on a dimension corresponding to risk factors for suicide; the second function discriminated suicide from suicide attempt subjects on a series of factors including gender, non-affective psychosis and anxiety disorder. CONCLUSIONS: Suicides and medically serious suicide attempts are two overlapping populations that share common psychiatric diagnostic and history features, but are distinguished by gender and patterning of psychiatric disorder.     

Communication practices in the social construction of health in an AIDS kesidence

Physical illness and well-being, while grounded in bodily and psychological experiences, are also constructed socially through communication practices. Significant symbols, rituals and myths, among other forms, converge to create shared meanings that help define the health/illness experience. This article first provides a conceptual framework for understanding how communication intertwines physical, psychological and collective worlds. This perspective is then contextualized by illustrating some communication practices within a residential facility for people with AIDS that help residents cope with the 'depression bind' created by the need to 'grieve efficiently' over the loss of fellow residents. In- depth interviews with residents uncover metaphors that describe this bind, the military and journey myths embedded in the language of 'fighting AIDS' and 'passing', and the remembering and 're membering' rituals of bereavement. These communication practices help residents grasp elusive meanings, discharge deep and contradictory feelings and manage the tensions of everyday life.     

武警官兵自杀问题与危机干预的研究

目的研究武警官兵自杀问题与危机干预。方法对某部队自1983年至2007年自杀的21例官兵进行了自杀原因、自杀方式、结果、发生年份、职务、年龄及其他情况分析。结果①官兵自杀有一定预兆;②恋爱、考学、疾病、人际关系、退伍、经济和社会压力是自杀的主要原因。结论健全部队危机干预体系,实施自杀预防策略,可以减少自杀问题对部队及官兵家庭造成的危害。     

Impaired decision-making in suicide attempters may increase the risk of problems in affective relationships

BACKGROUND: Decision-making has been found to be altered in suicide attempters and may represent a neuropsychological trait of vulnerability to suicidal behaviour. Environmental stressors such as adverse life events and interpersonal problems have been demonstrated to precipitate suicidal acts in vulnerable people. However, the link between vulnerability and stressors is complex and may even be circular. In the present study, we hypothesized that impaired decision-making may be associated with an increased risk of negative life events in suicide attempters. METHODS: Forty-eight patients with a history of attempted suicide were assessed with the Iowa Gambling Task and interviewed regarding life events experienced over the past 12 months. RESULTS: Decision-making performance was negatively correlated with interpersonal difficulties in the affective--namely marital and family--domain (rs=-0.39, p=0.006) but not with interpersonal difficulties in other social contexts, stressful life events or somatic health problems. LIMITATIONS: The relatively small sample size and the use of non-parametric methods may lead to a risk of type II errors. Furthermore, data on life events were retrospectively collected. CONCLUSIONS: Altered decision-making may increase the risk of problematic affective relationships. These results underline the complex and possibly reciprocal link between environmental stress factors and cognitive vulnerability traits. This could be useful for the design of intervention strategies for suicidal behaviour.     

Potential for suicide prevention in primary care? An analysis of factors associated with suicide.

BACKGROUND: General practitioners (GPs) need to be aware of the risk factors for suicide. GP records may provide clues to identifying the relative importance of such risk factors. AIMS: To identify, in suicide cases and matched controls, the patterns of consultation, diagnosis, and treatment of mental illness, and recording of risk factors for suicide. To examine the usefulness of data routinely collected by GPs in computerized databases to investigate treatment of patients in general practice prior to suicide. METHOD: Case control study using GP records from the General Practice Research Database (GPRD). Three controls selected for each case, matched for age, sex, and duration of registration with practice. Information extracted of the prevalence of major disease; diagnosis of, and treatment, or referral for, mental illness; frequency of recording of recent life events; and consultations with the GP in the 12 months prior to death. RESULT: Of the 339 suicide cases recorded, 80% were male, which is similar to the national percentage for this age group. Females were more likely than males to have a history of mental illness and to have been diagnosed and treated for mental illness in the 12 months before death (59% versus 35%), and women were more likely to have previously attempted suicide (47% versus 27%). There was no significant difference between males and females in period of time since last contact with GP practice, but females consulted more frequently. Twenty-nine per cent of cases had not consulted their GP in the six months prior to death. In multivariate analysis, the following were identified as independent risk factors: history of attempted suicide; untreated serious mental illness (odds ratio > 20); recent (past 12 months) marital life event; alcohol abuse; frequent consultations with GP; and previous mental illness. Recording of life events by GPs was poor. CONCLUSIONS: Females at risk of suicide are more likely than males to have been diagnosed and treated for mental illness. It is likely that GPs are under-diagnosed and under-treating males at risk. Data from the GPRD give comparable results to those from other studies. The GPRD is a potentially useful tool for research into relatively uncommon events in general practice.