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Clustering of suicides among people with mental illness

Camden and Islington Mental Health and Social Care Trust and Department of Psychiatry and Behavioural Sciences, Royal Free and University College London Medical Schools, London

SABINE LANDAU, PhD

Department of Biostatistics and Computing Institute of Psychiatry, London

NAVNEET KAPUR, MMedSc, MRCPsych, MD, JANET MEEHAN, MRCPsych, JO ROBINSON, MSc, HARRIET BICKLEY, BA, REBECCA PARSONS, BA and LOUIS APPLEBY, MD, FRCP, FRCPsych

National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, School of Psychiatry and Behavioural Sciences, University of Manchester, UK

Correspondence: Dr Nigel McKenzie, Highgate Mental Health Centre, Dartmouth Park Hill, London N19 5JG, UK. E-mail: n.mckenzie{at}ucl.ac.uk

Declaration of interest None.

Background Most previous investigations of imitative suicide have reported suicide clustering in the general population, either temporal clustering following media reporting of suicide or case studies of geographically localised clusters.

Aims To determine whether space – time and space–time–method clustering occur in a national case register of those who had recent contact with mental health services and had died by suicide and to estimate the suicide imitation rate in this population.

Method Knox tests were used for space–time and space–time–method clustering. Model simulations were used to estimate effect size.

Results Highly significant space–time and space–time–method clustering was found in a sample of 2741 people who died bysuicide over 4 yearswho hadhadrecent contact with one of 105 mental health trusts. Model simulations with an imitation rate of 10.1% (CI 4–17) reproduced the observed space–time–method clustering.

Conclusions This study provides indirect evidence that imitative suicide occurs among people with mental illnesses and may account for about 10% of suicides by current and recent patients.

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