Isabelle Hunt
The University of Manchester, Medicine, Department Member
Research Interests:
Background Community treatment orders (CTOs) enable patients to be treated in the community rather than under detention in hospital. Population-based studies of suicide among patients subject to a CTO are scarce. Aims To compare suicide... more
Background Community treatment orders (CTOs) enable patients to be treated in the community rather than under detention in hospital. Population-based studies of suicide among patients subject to a CTO are scarce. Aims To compare suicide rates among patients subject to a CTO with all discharged psychiatric patients and those detained for treatment but not subject to a CTO at discharge (‘CTO-eligible’ patients). Method From a national case series of patients who died by suicide within 12 months of contact with mental health services in England during 2009–2018, we estimated average annual suicide rates for all discharged patients, those on a CTO at the time of suicide, those ever treated under a CTO and CTO-eligible patients. Results Suicide rates for patients on a CTO at the time of suicide (191.3 per 100 000 patients) were lower than all discharged patients (482.3 per 100 000 discharges). Suicide rates were similar in those ever treated under a CTO (350.1 per 100 000 CTOs issued) an...
Objective: Family responses to patients with chronic fatigue syndrome (CFS) may influence the course of the disorder and family members themselves are likely to be adversely affected. However, the beliefs and responses of relatives of CFS... more
Objective: Family responses to patients with chronic fatigue syndrome (CFS) may influence the course of the disorder and family members themselves are likely to be adversely affected. However, the beliefs and responses of relatives of CFS patients have been under-researched. The aim of this study was to produce an easy-to-administer questionnaire to assess the responses of family members to people
Research Interests:
Objective: Family responses to patients with chronic fatigue syndrome (CFS) may influence the course of the disorder and family members themselves are likely to be adversely affected. However, the beliefs and responses of relatives of CFS... more
Objective: Family responses to patients with chronic fatigue syndrome (CFS) may influence the course of the disorder and family members themselves are likely to be adversely affected. However, the beliefs and responses of relatives of CFS patients have been under-researched. The aim of this study was to produce an easy-to-administer questionnaire to assess the responses of family members to people
Research Interests:
Recent years have seen a substantial increase in the use of crisis resolution home treatment (CRHT) teams as an alternative to psychiatric in-patient admission. We discuss the functions of these services and their effectiveness. Our... more
Recent years have seen a substantial increase in the use of crisis resolution home treatment (CRHT) teams as an alternative to psychiatric in-patient admission. We discuss the functions of these services and their effectiveness. Our research suggests high rates of suicide in patients under CRHT. Specific strategies need to be developed to improve patient safety in this setting.
Patients admitted to hospital at the weekend appear to be at increased risk of death compared with those admitted at other times. However, a 'weekend effect' has rarely been explored in mental health and there may also be other... more
Patients admitted to hospital at the weekend appear to be at increased risk of death compared with those admitted at other times. However, a 'weekend effect' has rarely been explored in mental health and there may also be other times of year when patients are vulnerable. To investigate the timing of suicide in high-risk mental health patients. We compared the incidence of suicide at the weekend v. during the week, and also in August (the month of junior doctor changeover) v. other months in in-patients, patients within 3 months of discharge and patients under the care of crisis resolution home treatment (CRHT) teams (2001-2013). The incidence of suicide was lower at the weekends for each group (incidence rate ratio (IRR) = 0.88 (95% CI 0.79-0.99) for in-patients, IRR = 0.85 (95% CI 0.78-0.92) for post-discharge patients, IRR = 0.87 (95% CI 0.78-0.97) for CRHT patients). Patients who died by suicide were also less likely to have been admitted at weekends than during the week ...
Research Interests: Epidemiology, Immunology, Adolescent, Prospective studies, Humans, and 15 moreChronic Disease, Female, Male, SHOULDER PAIN, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Prognosis, Long Term, Cross sectional Study, Cross Sectional Studies, Cohort Studies, and Disability Evaluation
OBJECTIVE: To determine whether psychological symptoms and mental disorder are an intrinsic part of the chronic widespread pain syndrome or whether they have been observed in clinic attenders primarily because of their influence on the... more
OBJECTIVE: To determine whether psychological symptoms and mental disorder are an intrinsic part of the chronic widespread pain syndrome or whether they have been observed in clinic attenders primarily because of their influence on the decision to seek a medical consultation.METHODS: A population survey of 1953 subjects was conducted in the Greater Manchester area of the United Kingdom. The survey included a postal questionnaire, and in a subgroup of respondents with high levels of distress, the presence of mental disorder was assessed by a semistructured standardized interview. Subjects with chronic widespread pain were classified according to whether they had sought a medical consultation for the reported pain ("consulters") or not ("nonconsulters").RESULTS: In all, 252 subjects (13%) satisfied American College of Rheumatology criteria for chronic widespread pain, and of these 72% reported having consulted a general practitioner about this pain. There was a clear difference in levels of psychological distress, measured by the General Health Questionnaire (GHQ), between consulters, nonconsulters, and those with no pain. Consulters did not differ from nonconsulters in terms of levels of fatigue, social dysfunction, or number of somatic symptoms reported. Although consulters (among whom one in 4 had a mental disorder) were more likely to have a mental disorder than subjects without pain [OR = 4.9, 95% CI (2.6, 9.5)] the increase in risk comparing consulters to nonconsulters [OR = 2.1, 95% CI (0.7, 5.9)] and nonconsulters to subjects without pain [OR = 1.4, 95% CI (0.7, 2.6)] was not significant.CONCLUSION: The results suggest that psychological distress is associated with chronic widespread pain in addition to any effect on whether consultation is sought for symptoms. The finding that one-quarter of consulters to primary care with chronic widespread pain have a mental disorder should alert primary care physicians and rheumatologists to screen for mental disorder in this group.
Research Interests: Immunology, Pain, Adolescent, Fatigue, Anxiety, and 17 moreHumans, Chronic Disease, Female, Male, The, Mental Disorders, Health Status, Clinical Sciences, Prevalence, Middle Aged, Questionnaires, Adult, Public health systems and services research, Sex Factors, Age Factors, ANXIETY, and Pain Measurement
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Research Interests: Psychiatry, Mental Health, Treatment, Suicide, Public Health, and 17 moreSuicide prevention, Prevention, England, Mental Illness, Electroconvulsive therapy, Humans, Female, Male, Mental Disorders, Mental health services, Aged, Middle Aged, Adult, Health surveys, Chi Square Distribution, Affective Disorder, and Severity of Illness Index
Research into which aspects of service provision in mental health are most effective in preventing suicide is sparse. We examined the association between service changes, organisational factors, and suicide rates in a national sample. We... more
Research into which aspects of service provision in mental health are most effective in preventing suicide is sparse. We examined the association between service changes, organisational factors, and suicide rates in a national sample. We did a before-and-after analysis of service delivery data and an ecological analysis of organisational characteristics, in relation to suicide rates, in providers of mental health care in England. We also investigated whether the effect of service changes varied according to markers of organisational functioning. Overall, 19 248 individuals who died by suicide within 12 months of contact with mental health services were included (1997-2012). Various service changes related to ward safety, improved community services, staff training, and implementation of policy and guidance were associated with a lower suicide rate after the introduction of these changes (incidence rate ratios ranged from 0·71 to 0·79, p<0·0001). Some wider organisational factors, such as non-medical staff turnover (Spearman's r=0·34, p=0·01) and incident reporting (0·46, 0·0004), were also related to suicide rates but others, such as staff sickness (-0·12, 0·37) and patient satisfaction (-0·06, 0·64), were not. Service changes had more effect in organisations that had low rates of staff turnover but high rates of overall event reporting. Aspects of mental health service provision might have an effect on suicide rates in clinical populations but the wider organisational context in which service changes are made are likely to be important too. System-wide change implemented across the patient care pathway could be a key strategy for improving patient safety in mental health care. The Healthcare Quality Improvement Partnership commissions the Mental Health Clinical Outcome Review Programme, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, Social Services and Public Safety, and the States of Jersey and Guernsey.
Suicide risk after discharge from psychiatric inpatient care is high, particularly in the first few weeks. The aim of the study was to identify risk factors and protective factors (that is, factors associated with a reduced risk of... more
Suicide risk after discharge from psychiatric inpatient care is high, particularly in the first few weeks. The aim of the study was to identify risk factors and protective factors (that is, factors associated with a reduced risk of suicide), including variation in health care received, for suicide among patients in the two-week postdischarge period. This was a national population-based retrospective case-control study of 100 psychiatric patients in England (2004-2006), age 18-65, who died by suicide within two weeks of hospital discharge. These patients were matched on discharge date with 100 living control group patients. Fifty-five percent of suicides occurred within a week of discharge, 49% of whom died before their first follow-up appointment. Conditional logistic regression analyses indicated that recent adverse life events and a short (less than one week) final admission were independently associated with postdischarge suicide, as were older age and comorbid psychiatric disorders. Receiving enhanced aftercare (under the Care Programme Approach) was protective of suicide. Discharged patients viewed as being at high risk of suicide require immediate community follow-up. Mental health services should be mindful of discharging patients after a short admission. The potential role of detrimental life experiences indicates that mental health clinicians need to be aware of the circumstances into which patients are being discharged. Use of enhanced levels of care, such as that offered by the Care Programme Approach, may play a strong role in preventing suicide within two weeks of discharge.
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Research Interests: General Practice, Epidemiology, Immunology, Pain, Public Health, and 33 moreAdolescent, Osteoarthritis, Pathophysiology, United Kingdom, Multivariate Analysis, Sports, Humans, Questionnaire, Female, Male, Exercise, Track and Field, Risk factors, Clinical Sciences, Aged, Prevalence, Middle Aged, Risk Factor, Questionnaires, Mechanical Stress, Adult, Public health systems and services research, Odds ratio, Risk Factors, Case Control Study, Occupational Diseases, *Physical Exertion, Confidence Interval, Long Distance, Leisure Activities, Case Control Studies, Cumulant, and Mechanical Loading
Suicide in pregnant and postnatal women is an important cause of maternal death, but evidence to guide suicide prevention in this group is scarce. We aimed to compare the trend, nature, and correlates of suicide in perinatal and... more
Suicide in pregnant and postnatal women is an important cause of maternal death, but evidence to guide suicide prevention in this group is scarce. We aimed to compare the trend, nature, and correlates of suicide in perinatal and non-perinatal women in contact with psychiatric services. We used 1997-2012 data from the UK National Confidential Inquiry into Suicides and Homicides by People with Mental Illness, which includes all suicides by people (age ≥10 years) who had been in contact with psychiatric services in the previous year. The study sample comprised all women who died by suicide in pregnancy or the first postnatal year (perinatal suicides), and all women in the same age range who died by suicide outside this period (non-perinatal suicides). We compared suicides among perinatal and non-perinatal women with logistic regression of multiply imputed data. The study sample included 4785 women aged 16-50 years who died by suicide, of whom 98 (2%) died in the perinatal period. Of the 1485 women aged 20-35 years, 74 (4%) women died in the perinatal period. Over the course of the study, we recorded a modest downward trend in the mean number of women dying by suicide in the non-perinatal period (-2·07 per year [SD 0·96]; p=0·026), but not the perinatal period (-0·07 per year [0·37]; p=0·58). Compared with non-perinatal women, women who died by suicide in the perinatal period were more likely to have a diagnosis of depression (adjusted odds ratio [OR] 2·19 [95% CI 1·43-3·34]; p<0·001) and less likely to be receiving any active treatment (0·46 [0·24-0·89]; p=0·022) at the time of death. Women who died by suicide within versus outside the perinatal period were also more likely to be younger (crude OR -6·39 [95% CI -8·15 to -4·62]; p<0·0001) and married (4·46 [2·93-6·80]; p<0·0001), with shorter illness duration (2·93 [1·88-4·56]; p<0·001) and no history of alcohol misuse (0·47 [0·24-0·92]; p=0·027). There were no differences in service contact or treatment adherence. In women in contact with UK psychiatric services, suicides in the perinatal period were more likely to occur in those with a depression diagnosis and no active treatment at the time of death. Assertive follow-up and treatment of perinatal women in contact with psychiatric services are needed to address suicide risk in this group. Healthcare Quality Improvement Partnership and National Institute for Health Research.
Absconding from inpatient care is associated with suicide risk in psychiatric populations. However, little is known about the real world context of suicide after absconding from a psychiatric ward or the experiences of clinical staff... more
Absconding from inpatient care is associated with suicide risk in psychiatric populations. However, little is known about the real world context of suicide after absconding from a psychiatric ward or the experiences of clinical staff caring for these patients. To identify the characteristics of inpatients who died by suicide after absconding and to explore these and further key issues related to suicide risk from the perspective of clinical staff. A mixed-methods study using quantitative data of all patient suicides in England between 1997 and 2011 and a thematic analysis of semi-structured interviews with 21 clinical staff. Four themes were identified as areas of concern for clinicians: problems with ward design, staffing problems, difficulties in assessing risk, and patient specific factors. Results suggest that inpatients who died by suicide after absconding may have more complex and severe illness along with difficult life events, such as homelessness. Closer monitoring of inpatients and access points, and improved risk assessments are important to reduce suicide in this patient group.
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Psychiatric in-patients are at high risk of suicide. Recent reductions in bed numbers in many countries may have affected this risk but few studies have specifically investigated temporal trends. We aimed to explore trends in psychiatric... more
Psychiatric in-patients are at high risk of suicide. Recent reductions in bed numbers in many countries may have affected this risk but few studies have specifically investigated temporal trends. We aimed to explore trends in psychiatric in-patient suicide over time. A prospective study of all patients admitted to National Health Service (NHS) in-patient psychiatric care in England (1997-2008). Suicide rates were determined using National Confidential Inquiry and Hospital Episode Statistics (HES) data. Over the study period there were 1942 psychiatric in-patient suicides. Between the first 2 years of the study (1997, 1998) and the last 2 years (2007, 2008) the rate of in-patient suicide fell by nearly one-third from 2.45 to 1.68 per 100,000 bed days. This fall in rate was observed for males and females, across ethnicities and diagnoses. It was most marked for patients aged 15-44 years. Rates also fell for the most common suicide methods, particularly suicide by hanging on the ward (a 59% reduction). Although the number of post-discharge suicides fell, the rate of post-discharge suicide may have increased by 19%. The number of suicide deaths in those under the care of crisis resolution/home treatment teams has increased in recent years to approximately 160 annually. The rate of suicide among psychiatric in-patients in England has fallen considerably. Possible explanations include falling general population rates, changes in the at-risk population or improved in-patient safety. However, a transfer of risk to the period after discharge or other clinical settings such as crisis resolution teams cannot be ruled out.
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Research Interests: Immunology, Psychometrics, Pain, Job Satisfaction, Social Support, and 18 moreProspective studies, Humans, Female, Male, Follow-up studies, Musculoskeletal pain, Risk factors, ROC Curve, Clinical Sciences, Psychological distress, Adult, Public health systems and services research, Odds ratio, Risk Factors, Occupational Diseases, Pain Measurement, Prospective Study, and Confidence Interval
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Comorbid anxiety in depression increases the risk of suicidal ideation and behavior, although data on death by suicide are scarce. We compared characteristics of depressed elderly patients with and without anxiety disorders who died by... more
Comorbid anxiety in depression increases the risk of suicidal ideation and behavior, although data on death by suicide are scarce. We compared characteristics of depressed elderly patients with and without anxiety disorders who died by suicide. From a 16-year clinical survey of all suicides in the UK (n = 25,128), we identified 1909 cases aged ≥60 years with a primary diagnosis of depression and no comorbidity other than anxiety disorders. Clinical characteristics of cases with (n = 333, 17.4%) and without (n = 1576) comorbid anxiety disorders were compared by logistic regression adjusted for demographic differences. Compared with cases without comorbid anxiety disorders, cases with comorbid anxiety disorders were more likely to have a duration of illness over 1 year (OR1-5 years = 1.4 [95% CI: 1.0-1.9], p = 0.061; OR≥5 years = 1.4 [95% CI: 1.6-2.8], p < 0.001), were more frequently prescribed psychotropic drugs other than antidepressants, lithium, and antipsychotics (OR = 2.1 [95% CI: 1.6-2.7], p < 0.001) and were more distressed during their last contact with services (OR = 1.3 [95% CI: 1.0-1.7], p = 0.037). In contrast, clinicians estimated the immediate and long-term suicidal risks lower in those with comorbid anxiety disorders (OR = 0.6 [95% CI: 0.3-0.9], p = 0.011 and OR = 0.7 [95% CI: 0.6-1.0], p = 0.028, respectively). Among depressed suicide cases, a comorbid anxiety disorder was identified in one out of six cases and associated with a higher prevalence of several suicide risk factors. This is important, as the detection of anxiety disorders comorbid to depression seems rather low and even when recognized clinicians rated such individuals as at low suicide risk. Copyright © 2015 John Wiley & Sons, Ltd.
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Background: Anxiety disorders are assumed to increase suicide risk, although confounding by comorbid psychiatric disorders may be one explanation. This study describes the characteristics of older patients with an anxiety disorder who... more
Background: Anxiety disorders are assumed to increase suicide risk, although confounding by comorbid psychiatric disorders may be one explanation. This study describes the characteristics of older patients with an anxiety disorder who died by suicide in comparison to younger patients. Method: A 15-year national clinical survey of all suicides in the UK (n = 25,128). Among the 4,481 older patients who died by suicide (≥ 60 years), 209 (4.7%) suffered from a primary anxiety disorder, and 533 (11.9%) from a comorbid anxiety disorder. Characteristics of older (n = 209) and younger (n = 773) patients with a primary anxiety disorder were compared by logistic regression adjusted for sex and living arrangement. Results: Compared to younger patients, older patients with a primary anxiety disorder were more often males and more often lived alone. Although 60% of older patients had a history of psychiatric admissions and 50% of deliberate self-harm, a history of self-harm, violence, and substa...
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Community care provided by crisis resolution home treatment teams is used increasingly as an alternative to admission to psychiatric wards. No systematic analysis has been done of the safety of these teams in terms of rates of suicide. We... more
Community care provided by crisis resolution home treatment teams is used increasingly as an alternative to admission to psychiatric wards. No systematic analysis has been done of the safety of these teams in terms of rates of suicide. We aimed to compare the rate and number of suicides among patients under the care of crisis resolution home treatment teams with those of psychiatric inpatients. We also assessed the clinical features of individuals who died by suicide in both home and hospital settings. We did a retrospective longitudinal analysis between 2003 and 2011 of all adults (aged 18 years or older) treated by the National Health Service in England who died by suicide while under the care of crisis resolution home treatment services or as a psychiatric inpatient. We obtained data from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness and from the Mental Health Minimum Dataset. 1256 deaths by suicide (12% of all patient suicides) were recorded among patients cared for under crisis resolution home treatment teams, an average of 140 deaths per year. Different denominators meant that direct comparison between groups was difficult, but the average rate of suicide under crisis resolution home treatment services (14·6 per 10 000 episodes under crisis care) seemed higher than the average rate of suicide among psychiatric inpatients (8·8 per 10 000 admissions). The number of suicides in patients under the care of crisis resolution home treatment teams increased from an average of 80 per year (in 2003 and 2004) to 163 per year (in 2010 and 2011) and were twice as frequent as inpatient suicides in the last few years of the study. However, because of the growing number of patients under the care of crisis resolution home treatment teams, the average rate of suicide fell by 18% between the first and last 2 years of the study. 548 (44%) patients who died by suicide under the care of crisis resolution home treatment teams lived alone and 594 (49%) had had a recent adverse life event. In a third of patients (n=428) under the care of crisis resolution home treatment teams, suicide happened within 3 months of discharge from psychiatric inpatient care. Although the number of suicides under the care of crisis resolution home treatment teams has risen since 2003, the rate has fallen. However, suicide rates remain high compared with the inpatient setting, and safety of individuals cared for by crisis resolution home treatment teams should be a priority for mental health services. For some vulnerable people who live alone or have adverse life circumstances, crisis resolution home treatment might not be the most appropriate care setting. Use of crisis resolution home treatment teams to facilitate early discharge could present a risk to some patients, which should be investigated further. Healthcare Quality Improvement Partnership.
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Women visit their doctors more than men, but comparatively few studies have explored gender differences in consultation in detail. To identify the factors that predicted the number of primary care consultations in men and women over a... more
Women visit their doctors more than men, but comparatively few studies have explored gender differences in consultation in detail. To identify the factors that predicted the number of primary care consultations in men and women over a 5-year period. Prospective cohort study with three waves of data collection by postal questionnaire. A single suburban general practice in Greater Manchester, UK. Consultation data were sought from primary care records on a random sample of 800 adults. The main outcome measure was the number of consultations over the 5 years of the study. Questionnaire measures included the 12-item version of the General Health Questionnaire, the Illness Attitude Scales, a somatic symptom scale, a fatigue scale, and a functional assessment of disability. Consultation data were obtained on 738 patients (445 women, 293 men, 92% of selected subjects). Longitudinal models of consultation over 5 years showed that changes in psychological distress were more strongly associat...
Research Interests:
To determine the aetiology of forearm pain. In particular to determine the relative contribution of (a) psychological factors, features of somatisation, and health anxiety and behaviour, (b) work related mechanical factors, and (c) work... more
To determine the aetiology of forearm pain. In particular to determine the relative contribution of (a) psychological factors, features of somatisation, and health anxiety and behaviour, (b) work related mechanical factors, and (c) work related psychosocial factors in the onset of forearm pain. 2 year prospective population based cohort study, with retrospective assessment of exposures at work. Altrincham, Greater Manchester. 1953 individuals aged 18-65 years. Forearm pain of new onset. At follow up, 105 (8.3%) participants reported forearm pain of new onset lasting at least one day in the past month. Among these, 67% also reported shoulder pain, 65% back pain, and 45% chronic widespread pain. Increased risks of onset were associated with high levels of psychological distress (relative risk 2.4, 95% confidence interval 1.5 to 3.8), reporting at least two other somatic symptoms (1.7, 0.95 to 3.0), and high scores on the illness behaviour subscale of the illness attitude scales. The t...
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based on a 4-year sample of suicides in based on a 4-year sample of suicides in England and Wales.Detailed data were England and Wales.Detailed data were collected on those who had been in collected on those who had been in contact with... more
based on a 4-year sample of suicides in based on a 4-year sample of suicides in England and Wales.Detailed data were England and Wales.Detailed data were collected on those who had been in collected on those who had been in contact with mental health services in the contact with mental health services in the year before death. year before death.
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Few controlled studies have investigated factors associated with suicide in current in-patients. We aimed to identify psychosocial, behavioural and clinical risk factors, including variations in care, for in-patient suicide. We conducted... more
Few controlled studies have investigated factors associated with suicide in current in-patients. We aimed to identify psychosocial, behavioural and clinical risk factors, including variations in care, for in-patient suicide. We conducted a national population-based case-control study of people who died by suicide between 1 April 1999 and 31 December 2000 while in psychiatric in-patient care in England. Cases were 222 adult mental health in-patients who died by suicide matched on date of death with 222 living controls. Nearly a quarter of suicides took place within the first week of admission; most of these died on the ward or after absconding. After the first week, however, most suicides occurred away from the ward, the majority of patients having left the ward with staff agreement. Previous deliberate self-harm, recent adverse life events, symptoms of mental illness at last contact with staff and a co-morbid psychiatric disorder were associated with increased risk for suicide. Bein...
Research Interests: Psychology, Suicide, Adolescent, Psychological Medicine, Humans, and 14 morePsychological, Hospitalization, Female, Male, Mental Disorders, Length of Stay, Aged, Great Britain, Middle Aged, Adult, Public health systems and services research, Case Control Study, Neurosciences, and Case Control Studies
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Research Interests: Rheumatology, Immunology, Pain, Community-Based Mental Health Services, Adolescent, and 16 moreMultivariate Analysis, Prospective studies, Humans, Chronic Disease, Female, Male, Follow-up studies, Risk factors, Clinical Sciences, Aged, Prevalence, Middle Aged, Adult, Public health systems and services research, Somatoform disorders, and Risk Factors
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Little is known about the numbers and characteristics of people who travel away from home before dying by suicide. Therefore, this studied attempts to identify the sociodemographic characteristics, location, and method of suicide in... more
Little is known about the numbers and characteristics of people who travel away from home before dying by suicide. Therefore, this studied attempts to identify the sociodemographic characteristics, location, and method of suicide in people who died distant from home, in a national sample. Data were collected on all English suicides and a patient population; nonresident suicides resided in one Health Authority but died in a different one. Twelve percent of suicides were nonresident and features of these included: young age, social adversity, and severe mental illness. In conclusion, both individual- and area-based factors are likely to contribute to suicide away from home.
Research Interests: Psychology, Suicide, England, Humans, Female, and 6 moreMale, Mental Disorders, Adult, Time Factors, Age Factors, and Socioeconomic Factors
Comparisons of psychiatric patients who die by suicide using different methods are scarce. We aimed to establish the methods of suicide used by those who are currently or have recently been in contact with mental health services in... more
Comparisons of psychiatric patients who die by suicide using different methods are scarce. We aimed to establish the methods of suicide used by those who are currently or have recently been in contact with mental health services in England and Wales (N = 6,203), and describe the social and clinical characteristics of suicides by different methods. We found that hanging, self-poisoning, and jumping (from a height or in front of a moving vehicle) were the most common methods of suicide, accounting for 79% of all deaths. The implications of these and other findings are discussed.
Research Interests: Psychology, Mental Health, Sex, Suicide, Public Health, and 22 moreAdolescent, Comparative Study, England, Mental Illness, Humans, Child, Age, Wales, Female, Male, Young Adult, Comparative Analysis, Mental Disorders, Social Environment, Socioeconomic Status, Aged, Middle Aged, Questionnaires, Adult, Sex Factors, Age Factors, and Socioeconomic Factors
Suicide prevention is a health service priority. Homeless mental health patients present a challenge to services because of their complex health and social needs. To establish the numbers of homeless patients in contact with services who... more
Suicide prevention is a health service priority. Homeless mental health patients present a challenge to services because of their complex health and social needs. To establish the numbers of homeless patients in contact with services who die by suicide; to describe their suicide methods and their social and clinical characteristics including aspects of clinical care. A national clinical survey based on a 4-year (1996-2000) sample of people in England and Wales who died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death. A total of 131 individuals who died by suicide were reported to have been homeless at the time of death--3% of all suicides by psychiatric patients, over 30 per year. Hanging was the most common cause of death. The most frequent diagnosis was schizophrenia. Around half were in-patients at the time of death. Social and clinical risk factors for suicide were common, including drug and alcohol misuse, and recent suicidal ideas and behaviour. Despite this, their clinical care was characterised by disengagement from services as a result of missed contacts, self-discharge, lack of follow-up and lack of key worker. In order to reduce the number of deaths by suicide in those who are homeless and mentally ill, improvements in in-patient safety and engagement in the community are needed. This may be achieved through assertive community treatment, dual diagnosis services, and dedicated community mental health teams.
Research Interests: Psychology, Cognitive Science, Mental Health, Community-Based Mental Health Services, Patient Safety, and 24 moreSuicide, Dual Diagnosis, Suicide prevention, Adolescent, Mental Illness, Humans, England and Wales, Health Services, Assertive Community Treatment, Female, Male, Social Psychiatry, Mental health services, Risk factors, Clinical Sciences, Aged, Great Britain, Middle Aged, Questionnaires, Adult, Time Factors, Health surveys, Risk Factors, and Homeless Persons
Despite extensive research, the reasons why patients consult their doctors are unclear. The aim of the current study was to identify the psychosocial and illness related factors that independently predicted primary care consultation over... more
Despite extensive research, the reasons why patients consult their doctors are unclear. The aim of the current study was to identify the psychosocial and illness related factors that independently predicted primary care consultation over a 5-year period. We carried out a prospective, population-based cohort study with three waves of data collection by postal questionnaire in one general practice in Greater Manchester (UK). Consultation data were sought from primary care records on a random subsample of 800 adult patients. The main outcome measure was the number of consultations (including surgery and home visits) over the 5 years of the study as determined by raters blind to questionnaire responses. Questionnaire measures included the 12-item version of the General Health Questionnaire, the Illness Attitude Scales, a somatic symptom scale, a fatigue scale, a functional assessment of disability. Consultation data were obtained on 738 patients (92% of selected subjects), who accounted for 12182 consultations. Negative illness attitudes, the presence of physical and psychiatric disorder, health anxiety, changes in psychological distress, reported physical symptoms and demographic factors such as age and sex were independently associated with consultation over a 5-year period. These variables together accounted for a difference of ten consultations per year between groups. Consultation in primary care is a complex behaviour with a complex aetiology. Terms such as 'frequent attenders' may be less helpful than recognizing a number of dimensions that operate across the whole spectrum of consultation frequency. Future research should consider the wider context of consultation.
Research Interests: Psychology, Algorithms, Primary Care, Primary Health Care, Forecasting, and 18 moreAdolescent, England, Psychological Medicine, Prospective studies, Humans, Female, Male, Cohort Study, Health Status, Aged, Middle Aged, Questionnaires, Adult, Public health systems and services research, Sick Role, Neurosciences, Cohort Studies, and Socioeconomic Factors
Psychiatric in-patients are at particularly high risk of suicide but few studies have investigated trends in in-patient suicide over time. We conducted a prospective study of all patients admitted to National Health Service (NHS)... more
Psychiatric in-patients are at particularly high risk of suicide but few studies have investigated trends in in-patient suicide over time. We conducted a prospective study of all patients admitted to National Health Service (NHS) in-patient psychiatric care in England (1997-2003). The study was carried out as part of the National Confidential Inquiry into Suicide. The main outcome measure was death by suicide. Suicide rates were determined using Hospital Episode Statistics (HES) as the denominator. Between the first 2 years of the study (1997 and 1998) and the last 2 years of the study (2002 and 2003) the annual number of in-patient deaths from suicide fell from 187 to 156 (a 17% reduction). The rate of in-patient suicide fell by between 9% and 28% depending on which denominator was used. This fall was observed for both males and females, and was most marked for those aged 15-44 years. Reductions were also observed for the three most common methods of death (hanging, jumping, poisoning), but the trend for hanging did not reach statistical significance. Although the number of post-discharge suicides fell, the risk of post-discharge suicide (using admissions as a denominator) may have increased by as much as 10% during the study period. The rate of suicide among psychiatric in-patients appears to have fallen. The fall may reflect falling general population rates, changes in in-patient case mix, service improvements, or a transfer of risk to the post-discharge period. Services need to be aware of the importance of providing high quality aftercare following discharge from hospital.
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Research Interests: Psychology, Mental Health, Suicide, Public Health, Risk assessment, and 25 moreAdolescent, Psychological Medicine, Humans, Hospitalization, Female, Male, Follow-up studies, Mental Disorders, Social Environment, Risk factors, Mood Disorders, Aged, Middle Aged, Risk Factor, Questionnaires, Adult, Aftercare, Public health systems and services research, Time Factors, Risk Factors, Risk Assessment, Case Control Study, Case Control, Neurosciences, and Case Control Studies
Research Interests: Psychiatry, Community-Based Mental Health Services, Survey Sampling, Suicide, England, and 22 moreMental Illness, Humans, England and Wales, Wales, Female, Male, Family Environment, Depressive Disorder, Mental Disorders, Mental health services, Risk factors, Aged, Middle Aged, Questionnaires, Adult, Health surveys, Risk Factors, Community Based Mental Health Services, Carbon Monoxide Poisoning, Affective Disorder, Life Change Events, and LIFE EVENT
Research Interests: Psychiatry, Mental Health, Treatment, Suicide, Public Health, and 17 moreSuicide prevention, Prevention, England, Mental Illness, Electroconvulsive therapy, Humans, Female, Male, Mental Disorders, Mental health services, Aged, Middle Aged, Adult, Health surveys, Chi Square Distribution, Affective Disorder, and Severity of Illness Index
Suicide risk after discharge from psychiatric inpatient care is high, particularly in the first few weeks. The aim of the study was to identify risk factors and protective factors (that is, factors associated with a reduced risk of... more
Suicide risk after discharge from psychiatric inpatient care is high, particularly in the first few weeks. The aim of the study was to identify risk factors and protective factors (that is, factors associated with a reduced risk of suicide), including variation in health care received, for suicide among patients in the two-week postdischarge period. This was a national population-based retrospective case-control study of 100 psychiatric patients in England (2004-2006), age 18-65, who died by suicide within two weeks of hospital discharge. These patients were matched on discharge date with 100 living control group patients. Fifty-five percent of suicides occurred within a week of discharge, 49% of whom died before their first follow-up appointment. Conditional logistic regression analyses indicated that recent adverse life events and a short (less than one week) final admission were independently associated with postdischarge suicide, as were older age and comorbid psychiatric disorders. Receiving enhanced aftercare (under the Care Programme Approach) was protective of suicide. Discharged patients viewed as being at high risk of suicide require immediate community follow-up. Mental health services should be mindful of discharging patients after a short admission. The potential role of detrimental life experiences indicates that mental health clinicians need to be aware of the circumstances into which patients are being discharged. Use of enhanced levels of care, such as that offered by the Care Programme Approach, may play a strong role in preventing suicide within two weeks of discharge.
Research Interests:
A reduction in suicide among individuals with mental illness is an international public-health priority. Approximately 10% of patients with schizophrenia will die by suicide. The goal of this study was to describe social and clinical... more
A reduction in suicide among individuals with mental illness is an international public-health priority. Approximately 10% of patients with schizophrenia will die by suicide. The goal of this study was to describe social and clinical characteristics of people with schizophrenia who completed suicide, including aspects of the clinical care they received. A national clinical survey was conducted based on a 4-year (1996-2000) sample of people in England and Wales who had died by suicide and had been in contact with mental health services in the previous 12 months. Of 20,927 individuals who committed suicide, 5,099 (24%) were known to have been in contact with mental health services in the year prior to death. Completed questionnaires were returned on 4,859 cases of suicide. Of these, 960 (20%) were diagnosed with schizophrenia. These suicides were characterized by more violent modes of death, with over a quarter (27%) jumping from a height or in front of a moving vehicle compared to 10% of the remaining sample. They were more likely than the other individuals in the sample to be young, male, unmarried, and from an ethnic minority with high rates of unemployment. Rates of previous violence and drug abuse were high and they were proportionally more likely to be inpatients at the time of death and to have been noncompliant with medication. Patients with schizophrenia and comorbid substance abuse showed particularly complex social and clinical morbidity. Measures that may prevent suicide among patients with schizophrenia include improved ward safety, closer supervision in both inpatient and community settings, particularly for those with poor medication compliance, and effective treatment of substance abuse.
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... Isabelle M. Hunt*, Ashim B. Nicola Swinson, Sandra Flynn, Adrian J. Hayes, Alison Roscoe, Cathryn Rodway, Tim Amos, Nav Kapur, Louis ... Case series have described the elderly committing 'mercy... more
... Isabelle M. Hunt*, Ashim B. Nicola Swinson, Sandra Flynn, Adrian J. Hayes, Alison Roscoe, Cathryn Rodway, Tim Amos, Nav Kapur, Louis ... Case series have described the elderly committing 'mercy killings', that is, 'an intentional killing which is prima facie murder but which is ...
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Suicide is a leading cause of death among youths. Comparatively few studies have studied recent trends over time, or examined rates and characteristics of service contact in well-defined national samples. Data on general population... more
Suicide is a leading cause of death among youths. Comparatively few studies have studied recent trends over time, or examined rates and characteristics of service contact in well-defined national samples. Data on general population suicides and mid-year population estimates were used to calculate suicide rates (per 100,000/year) among youths aged 10-19 years in the United Kingdom. We then determined the proportion of youths who had been in mental health service contact in the year prior to death. Social and clinical data were collected via questionnaires sent to clinicians who had provided care. The general population rate of suicide was higher in males than females, and was higher in 15-19-year-olds compared to 10-14-year-olds. Suicide rates for 10-19-year-olds declined by 28% between 1 January 1997 and 31 December 2003 (compared with an 8% reduction in those aged >19 years); the fall was particularly marked for males. Mental health service contact was low at 14% (compared with 26% for adults), especially for males (12%). Youths in mental health contact were characterised by: diagnosis of affective disorder, mental illness history, residential instability, self-harm, and substance misuse. Over half of youths were living with parents and one-fifth were in full-time education. The suicide rate for 10-19-year-olds in the UK appeared to fall between 1997 and 2003. Further monitoring of suicide rates is needed to determine whether this trend has continued for the most recent years (e.g., 2004-7). The fall in rates may have been related to socio-economic or clinical factors. The rate of contact with services was low compared to adults, particularly in males. This is concerning because young males have the highest suicide rate in the UK. Suicide prevention in young people is likely to require a multi-agency approach.