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Aim: The present study was conducted to examine differences in psychosocial and psychiatric characteristics between suicide completers with and without a history of psychiatric treatment within the year before death, using a psychological autopsy method.
Methods: A semi-structured interview was administered by a psychiatrist and other mental health professionals for the closest bereaved of 76 suicide completers.
Results: Suicide completers with a history of psychiatric treatment (n = 38) were significantly younger than those without (n = 38) (P < 0.01), and a significantly higher proportion of cases in the treatment group were estimated to be suffering from schizophrenia. Further, in 57.9% of the treatment group, the fatal suicidal behavior involved overdose with prescribed psychotropic drugs. In addition, female suicide completers in the treatment group were more likely to have a history of self-harm or non-fatal suicidal behavior.
Conclusion: Many suicide completers who received psychiatric treatment were young adults. It was common for suicide completers to overdose on prescribed drugs as a supplementary means of suicide, and many experienced self-harming behavior before death. In addition, a higher proportion of the treatment cases suffered from schizophrenia.
IN JAPAN, THE number of suicides has rapidly increased over the last several decades, to over 30 000 in 1998, and remains high today. Although multiple factors are known to influence suicide, the presence of a mental disorder is one of the most important risk factors.1,2 Over the last 2 decades, the correlation between suicide and mental disorders has been the focus of several studies.3,4 Previous reports have indicated that, despite more than 90% of suicide completers exhibiting some kind of mental disorder immediately prior to suicide, most did not receive psychiatric treatment.5,6 These findings appear to support the appropriateness of Japanese countermeasures for suicide, which seek to increase high-risk individuals' access to psychiatric treatment.
However, some suicide completers do receive psychiatric treatment before death. Several studies have reported that suicide among psychiatric patients is particularly strongly associated with acute episodes of disease, recent hospital discharge, social factors, and some self-harming behaviors.7,8 These findings indicate that currently available psychiatric treatment may be insufficient to prevent suicide of patients susceptible to these risk factors, suggesting that the improvement of psychiatric services is required, as well as increasing patients' access to psychiatric treatment. However, no studies in Japan have examined the detailed profiles of suicide completers under psychiatric treatment, and accordingly, it is unclear how psychiatric services should be improved.
The present study sought to clarify the psychosocial characteristics of suicide completers that received psychiatric treatment, compared with suicide completers that did not have access to psychiatric treatment.
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We wish to thank the bereaved families for participating in our study, and investigators from local government agencies for their cooperation and valuable data collection.
This study has been supported by the Health Labour Sciences Research Grant by the Ministry of Health and Welfare, Comprehensive Research on Disability Health and Welfare, ‘A study on the causes and processes of suicide using a data base collected by a psychological autopsy method’ (Principal investigator, Kaga M). We declare no conflicts of interest that may be inherent in this study.