Important Messages for Clinical Care and Health Policy on Suicide

According to Statistics Canada, suicide was responsible for 109 128 potential years of life lost in Canada in 2011, meaning that 339 potential years of life are lost per 100 000 members of the population per year.1 According to the Global Burden of Disease Project, self-harm ranked 14th as a cause of mortality in Canada in 2010, but as young people are often the victims, the ranking was 4th as a cause of years of life lost.2 Using a different set of categories, Statistics Canada ranks suicide 9th as a cause of death. The current issue of The Canadian Journal of Psychiatry (The CJP) contains 4 articles that advance the cause of suicide prevention. Dr Johanne Renaud and colleagues3 report estimates from a Quebec-based case–control study that used psychological autopsy methods. They document very high frequencies of mental disorders in young suicide victims, yet find disturbingly low rates of contact with health services. Less than one-half of the suicide victims received any services at all in the year preceding their death, while only about 20% received specialized mental health services. The authors present a series of recommendations that, if adopted, may help to improve this situation. Using administrative data from the Manitoba Health Data repository, Mr Jason R Randall and colleagues4 identified 2100 suicides between 1995 and 2009, as well as nearly 9000 suicide attempts. These authors report a cause-specific mortality rate of 12 per 100 000, close to Statistics Canada’s national estimate of 10.8 per 100 000.5 Examining these events in relation to a propensity matched control cohort, they report a particularly elevated odds of suicide in the 90 days following a psychiatric diagnosis, as well as an elevated odds of suicide attempts soon after diagnoses of depressive and anxiety disorders. This report identifies windows of opportunity that resonate with the call from Dr Renaud and colleagues3 for a more proactive and more effectively coordinated health system response. Dr Cendrine Bursztein Lipsicas and colleagues6 examine the issue of repeated suicide attempts using data collected in 7 European countries. They find a lower frequency of repeated attempts in some immigrant groups, despite substantially elevated overall rates in those groups. This suggests that different determinants may be important in these groups, compared with Western European natives. Similar dynamics should be explored in the Canadian population, where about 1 in 5 are foreign born. They found that 9.4% of the suicide attempters repeated their attempt within 1 year and, paralleling the findings of Mr Randall and colleagues,4 that nearly one-third of these occurred rapidly, within 30 days of the initial attempt. While Dr Renaud and colleagues3 put forth many recommendations for action, they do not touch on the controversial issue of possible antidepressant-induced increases in suicidal thinking or behaviour in young people. Dr Anne E Rhodes and colleagues7 previously reported that emergency department presentations for suicide-related behaviours in Ontario stopped declining around 2005 or 2006 after renewed warnings and, later, the economic recession. In the current issue, Dr Rhodes and colleagues8 buttress these results by reporting similar trends in the seriousness of suicidal behaviours underlying emergency visits. Taken together, these papers3,4,6,8—convey important messages, not only for clinical care but also for health policy, spanning the entire spectrum from health services administration to pharmaceutical regulation. According to the Conference Board of Canada, the country currently gets a B grade for its handling of suicide.9 The evidence and recommendations reported in this month’s issue of The CJP can, it is hoped, help this country move closer to the top of the class.

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