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Correspondence |
Peasley Cross Hospital, St Helens, 5 Boroughs Partnership Trust, Hollins Park, Winwick, Warrington WA2 8WA, UK. E-mail: esalib{at}hotmail.com
We read the short report by Bennewith et al (2005) with interest. The authors attempted to address one of the objectives of the National Suicide Prevention Strategy for England, restricting access to means of suicide (Department of Health, 2002).
The authors found 10 cases (6%) of ‘potentially preventable’ suicide by hanging in controlled environments such as hospitals and prisons, among 162 cases of a randomly selected sample of suicide by hanging from a wide geographical area in England.
We would like to make the following comments. The report made no reference to the proportion of older victims in the randomly selected sample. The mean age given in the report (41 years) is almost the same as that for all people over the age of 16 years in England and Wales who hanged themselves in the same year as the study (2001) and over the past 23 years. These cases include, on average, 16% over the age of 64 years. This means that the study sample of 162 contained at least 25 victims over the age of 64, a sizeable older element that was not referred to in the report.
This is important and ought to have been clarified particularly in relation to the deaths that occurred in hospital when the victims were found seated (4.7%), kneeling (7.4%), lying (8.7%) or partially suspended (3.4%) and to individuals who were found alive (4.3%). However, this does not apply to hanging in prison where victims had an estimated mean age of 28 years (Shaw et al, 2004).
We calculate the expected annual rate of ‘potentially preventable suicides by hanging’ within institutions (controlled environment) in England and Wales to be about 110 cases of a total of 1300 expected annual suicides by hanging: 86 in prison (Shaw et al, 2004) and 24 (about a third of 71 hanging incidents by psychiatric in-patients) in hospital (Department of Health, 1999). ‘Potentially preventable suicide by hanging’ in controlled environments involving prisoners represents 5% of all suicide by hanging in England and Wales and 2% in the case of psychiatric in-patients. This is remarkably similar to the 6% in the report of Bennewith et al.
It would be of real interest, and certainly of practical value, if future studies specifically investigated suicide by hanging within controlled environments such as hospitals and prisons using an appropriately selected sample over a period of time (e.g. 220 incidents expected over 2 years in England and Wales, based on current figures). This would provide a study with acceptable power and some inferential value compared with the modest 10 cases reported by Bennewith et al.
EDITED BY KIRIAKOS XENITIDIS and KHALIDA ISMAIL
REFERENCES
Bennewith, O., Gunnell, D., Kapur, N., et al
(2005) Suicide by hanging: multicentre study based on
coroners' records in England. British Journal of
Psychiatry, 186, 260
-261.
Department of Health (1999) National Confidential Inquiry Into Suicide and Homicide by People with Mental Health Problems, pp. 38-39. London: Department of Health.
Department of Health (2002) National Suicide Prevention Strategy for England. London: Department of Health.
Shaw, J., Baker, D., Hunt, I. M., et al
(2004) Suicide by prisoners: national clinical survey.
British Journal of Psychiatry,
184, 263
-267.
Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK
Department of Psychiatry and Behavioural Sciences, Manchester Royal Infirmary, Manchester
Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford
EDITED BY KIRIAKOS XENITIDIS and KHALIDA ISMAIL
The aim of our research was to undertake a detailed assessment of a sample of all (community and institutional) suicides by hanging in a defined geographical area over a 6-month period, focusing on potentially preventable aspects of these deaths. The context for the research was the rise in suicides by hanging in England and Wales (Gunnell et al, 2005) and the National Suicide Prevention Strategy for England (Department of Health, 2002). Of note, rates of suicide by hanging have not increased among men or women aged 65 years and over (Gunnell et al, 2005). Although generally Office for National Statistics figures for England and Wales from the 1970s onwards show that rates per 100 000 for deaths by hanging were higher in those aged 65 and over compared with rates in other age groups, this is not the case from 2000 onward when rates for death by hanging increased in the 15- to 44-year age group and decreased among those aged 65 and over (Gunnell et al, 2005).
The Editor decided that our paper should be resubmitted as a short report. The limited space did not enable us to give a full breakdown of the distribution of age, gender, race, social class, etc. of all of our sample. In response to the concern of Drs Salib and Theophanous we can confirm that 13 (8.0%) of the 162 cases in our study were aged over 65 years. Furthermore, 19 (11.7%) were aged under 25 years and 139 (85.8%) were male.
For those interested in a more detailed account of suicides in psychiatric hospitals and prisons we suggest the following sources: Dooley (1990), Shaw et al (2003), Shaw et al (2004) and Gunnell et al (2005).
REFERENCES
Department of Health (2002) National Suicide Prevention Strategy for England. London: Department of Health.
Dooley, E. (1990) Prison suicide in England and
Wales 1972-87. British Journal of Psychiatry,
156, 40-45.
Gunnell, D., Bennewith, O., Hawton, K., et al
(2005) The epidemiology and management of suicide by hanging:
a review. International Journal of Epidemiology,
34, 433
-442.
Shaw, J., Appleby, L. & Baker, D. (2003) Safer Prisons: A National Study of Prison Suicides 1999-2000 by the National Confidential Inquiry into Suicides and Homicides by People with Mental Illness. London: Department of Health.
Shaw, J., Baker, D., Hunt, I. M., et al
(2004) Suicide by prisoners: National clinical survey.
British Journal of Psychiatry,
184, 263
-267.
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