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OBJECTIVES: Doctors are at higher risk of suicide than many other occupational groups. This study was conducted to investigate factors associated with suicide in doctors. METHOD: Psychological autopsy study of 38 working doctors who died by suicide in England and Wales between January 1991 and December 1993. RESULTS: Psychiatric illness was present in 25 of the doctors. Depressive illness and drug or alcohol abuse were the most common diagnoses. Twenty-five doctors had significant problems related to work, 14 had relationship problems and 10 had financial problems. Multiple and interrelated problems were often present. The most common method of suicide was self-poisoning, often with drugs taken from work. CONCLUSION: Prevention of suicide in doctors requires a range of strategies, including improved management of psychiatric disorder, measures to reduce occupational stress and restriction of access to means of suicide when doctors are depressed.

BACKGROUND: Deliberate self-harm (DSH) is a major healthcare problem in adolescents. Identification of targets for prevention and treatment requires ongoing monitoring of trends and characteristics of those involved. METHOD: Using data from the Oxford Monitoring System for Attempted Suicide, we have examined trends and characteristics in adolescents aged 12-18 years presenting to a general hospital because of DSH between 1990 and 2000. RESULTS: The numbers of presentations by females increased during the study period. An association of DSH with school stress was suggested by there being fewer presentations during the school holiday periods, the largest number in term times occurring on Mondays, and study problems being common. Self-poisoning was involved in more than 90% of episodes. Paracetamol overdoses decreased following legislation on pack sizes of analgesics. Antidepressant overdoses increased during the study period, in keeping with the rise in prescriptions. Drug misuse increased markedly in the boys, as did a history of violence to others. Being a victim of violence increased in girls. Suicide intent was higher in males. Problems faced by the adolescents showed marked gender differences, and differed between age groups and between those carrying out their first DSH episode and repeaters. CONCLUSIONS: Clinical management of DSH in adolescents requires a range of responses, often involving multiservice and multidisciplinary input. Preventive initiatives in schools are also required.

Background: Self-harm is a major healthcare problem in the United Kingdom, but monitoring of hospital presentations has largely been done separately in single centres. Multicentre monitoring of self-harm has been established as a result of the National Suicide Prevention Strategy for England. Method: Data on self-harm presentations to general hospitals in Oxford (one hospital), Manchester (three hospitals) and Leeds (two hospitals), collected through monitoring systems in each centre, were analysed for the 18-month period March 2000 to August 2001. Results: The findings were based on 7344 persons who presented following 10,498 episodes of self-harm. Gender and age patterns were similar in the three centres, 57.0% of patients being female and two-thirds (62.9%) under 35 years of age. The largest numbers by age groups were 15-19 year-old females and 20-24 year-old males. The female to male ratio decreased with age. Rates of self-harm were higher in Manchester than Oxford or Leeds, in keeping with local suicide rates. The proportion of patients receiving a specialist psychosocial assessment varied between centres and was strongly associated with admission to the general hospital. Approximately 80% of self-harm involved self-poisoning. Overdoses of paracetamol, the most frequent method, were more common in younger age groups, antidepressants in middle age groups, and benzodiazepines and sedatives in older age groups. Alcohol was involved in more than half (54.9%) of assessed episodes. The most common time of presentation to hospital was between 10 pm and 2 am. Conclusions: Multicentre monitoring of self-harm in England has demonstrated similar overall patterns of self-harm in Oxford, Manchester and Leeds, with some differences reflecting local suicide rates. Diurnal variation in time of presentation to hospital and the need for assessment of non-admitted patients have implications for service provision. © Springer-Verlag 2007.