SUICIDE, HOMICIDE AND MENTAL ILLNESS
Two papers in the Journal this month investigate suicide rates among two groups in recent contact with mental health services – one group having been in contact with services in the previous 12 months (Hunt et al, pp. 135–142) and the other group a sample of in-patients and those within 3 months of hospital discharge (Meehan et al, pp. 129–134). Data for both studies derive from a national clinical survey and were carried out as part of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Hunt et al assert that young people might benefit more from suicide prevention strategies targeting schizophrenia, dual diagnosis and loss of contact with services, whereas strategies targeting depression, isolation and physical ill health might reduce risk of suicide in older adults. Over the 4-year survey period (ending March 2000), Meehan et al found that 16% of those in recent contact with services who died by suicide were in-patients at the time of death, with hanging being a common method used by this group. Among those discharged from in-patient care within the previous 3 months, risk of suicide was highest in the first 2 weeks after leaving hospital. In a study of homicide offenders carried out as part of the same national inquiry, Shaw et al (pp. 143–147) report that although an association is suggested between schizophrenia and homicide conviction, most offenders with a lifetime history of mental disorder were neither acutely ill at the time of the offence, nor were they in contact with mental health services.
ADVERSE EXPOSURES IN CHILDHOOD
Interest in the impact of cannabis use on mental health continues
to rise. Results from a large Dutch cross-sectional survey
reveal that cannabis use in adolescence is associated with
delinquency and aggressive behaviour but not with internalising
problems (Monshouwer
et al,
pp. 148–153). The strength
of the associations were found to increase with the frequency
of cannabis use and remained even after adjustment for strong
confounding factors such as cigarette smoking and alcohol use.
In a study of much younger children in the Gaza Strip, Thabet
et al (
pp. 154–158) found that traumatic exposures,
both direct and indirect, were associated with behavioural
and emotional problems.
MORTALITY IN SCHIZOPHRENIA AND MORBIDITYAMONG PRISONERS
In a previous study, Joukamaa and colleagues found schizophrenia
to be associated with excess mortality by both suicide and
natural causes. In this month’s
Journal (
pp. 122–127)
the authors further report that the number of neuroleptics
used at baseline predicted mortality after 17 years of follow-up,
even after adjustment for age, gender, somatic diseases and
other risk factors for premature death. The implications of
this finding are taken up in an invited commentary by David
Healy (
p. 128). In an Iranian sample, Assadi
et al (
pp. 159–164)
have replicated the finding often reported in Western settings
that psychiatric morbidity is high among prisoners. Over half
the sample were found to have a current Axis I disorder, with
rates of depression and substance use disorders higher than
those previously found in many Western countries.
FATHERS OF THE STILLBORN AND CARERS OF THOSE WITH PSYCHOSIS
In a cohort of expectant couples, fathers who had previously
experienced a stillbirth were found to have significant levels
of anxiety and post-traumatic stress disorder antenatally but
their symptom levels were lower than those of the mother throughout
and did remit postnatally (Turton
et al,
pp. 165–172).
In a cross-sectional study of patients experiencing psychotic
relapse and their carers, Kuipers
et al (
pp. 173–179)
report that high expressed emotion in carers was associated
with higher patient levels of anxiety and depression but not
psychotic symptoms or low self-esteem. Critical comments by
carers was the component of high expressed emotion found to
predict patient anxiety and, in carers, was associated with
low self-esteem and poor coping.
WHITE-MAT TER HYPERINTENSITIES IN DEPRESSION
Iosifescu
et al (
pp. 180–185) found no difference in
the prevalence of white-matter hyperintensities on magnetic
resonance imaging between those with major depression and a
control group of healthy volunteers. They also found no relationship
between global hyperintensity measures and clinical outcome,
considered either in terms of response to treatment or remission.
They did, however, find that left-hemispheric subcortical hyperintensities
were associated with poor outcome on anti-depressant treatment,
and that hyperintensities in the group with depression were
associated with the presence of cardiovascular risk factors.
Source: The British Journal of Psyquiatry
Site: http://bjp.rcpsych.org/cgi/content/full/188/2/105-a5
