Australia's national suicide prevention strategy: the next chapter - Commentary

Australia's National Suicide Prevention Strategy (NSPS) is about to move into a new funding phase. In this context this paper considers the emphasis of the NSPS since its inception in 1999. Certain high-risk groups (particularly people with mental illness and people who have self-harmed) have been relatively neglected, and some promising approaches (particularly selective and indicated interventions) have been under-emphasised. This balance should be re-dressed and the opportunity should be taken to build the evidence-base regarding suicide prevention. Such steps have the potential to maximise the impact of suicide prevention activities in Australia.

Lifetime suicide risk in major depression: sex and age determinants

Background: Recent work has demonstrated that the lifetime suicide risk for patients with DSM IV Major Depression cannot mathematically approximate the accepted figure of 15%. Gender and age significantly affect both the prevalence of major depression and suicide risk, Methods: Gender and age stratified calculations were made on the entire population of the USA in 1994 using a mathematical algorithm. Sex specific corrections for under-reporting were incorporated into the design. Results: The lifetime suicide risks for men and women were 7% and 1%, respectively. The combined risk was 3.4%. The male:female ratio for suicide risk in major depression was 10:1 for youths under 25, and 5.6:1 for adults. Conclusions: Suicide in major depression is predominantly a male problem, although complacency towards female sufferers is to be avoided. Diagnosis of major depression is of limited help in predicting suicide risk compared to case specific factors. The male experience of depression that leads to suicide is often not identified as a legitimate medical complaint by either sufferers or professionals. Increasing help-accessing by males is a priority. Clinical implications: Patients with a history of hospitalisation; comorbidity, especially for substance abuse; and who are male, require greater vigilance for suicide risk. It may be that for males che threshold for diagnosing and treating major depression needs to be lowered. Limitations: This research is based on a mathematical algorithm to approximate a life-long longitudinal study that identifies community cases of depression. Our findings therefore rely on the validity of the statistics used. Extrapolation is limited to populations with an actual suicide rate of 17/100,000 or less and a lifetime prevalence of major depression of 17% or more. (C) 1999 Elsevier Science B.V. All rights reserved.

Impact of specialised first-episode psychosis treatment on suicide following initial presentation to mental health services: Retrospective cohort study

Background: Suicide risk in psychosis peaks early in the course, however little is known about the effect on rates of suicide of specialised first-episode psychosis (FEP) programs.