Psychiatric disorder

Psychiatric disorder is present immediately before death in up to 90 per cent of cases, as indicated by the 'psychological autopsy' technique of interviewing those who knew the dead person. Depressive illness, often inadequately treated, is the commonest diagnosis, especially in older people. Alcohol and drug misuse are also common, especially in the young. Personality disorder often coexists. 'Rational' suicide, by people without evidence of mental disorder, presumably in hopeless situations, seems to be rare in Western societies.

Follow-up of psychiatric patient populations indicates that in 5-15 per cent of subjects with mental illness, personality disorder, and/or drug or alcohol problems, suicide will be the cause of death. Risk of suicide is raised in all mental disorders, not just depression.

Other causes

stressful circumstances, including life events such as bereavement, and long-term social difficulties such as unemployment

social isolation in those who live alone and/or lack confiding relationships.

• physical illness: raised suicide rates are found in association with certain physical conditions, including epilepsy, other neurological disorders, peptic ulcer, renal failure on dialysis, and AIDS.

• neurochemistry: deficiency of 5-HT has been linked to suicidal behaviour in some studies.

The French sociologist Emile Durkheim, whose influential book Le Suicide was published in 1894, distinguished three types of suicide. 'anomic' related to a disorganized society, 'egoistic' among people isolated from their social group, and 'altruistic' for the benefit of others.

More recent research suggests that the psychological state of hopelessness is a key precursor of suicide.

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