Long, Jean (2012) First report of National Suicide Support and Information System. Drugnet Ireland, Issue 43, Autumn 2012, pp. 20-21.

The first report of the national Suicide Support and Information System (SSIS) was published in July 2012 and presented the results of a pilot implementation of the system in Co Cork between September 2008 and March 2011.¹ 

The specific objectives of the SSIS are to: provide better support to the bereaved family members; identify and better understand the causes of suicide; identify and improve the response to clusters of suicide and extended suicide; describe the incidence of and explore patterns of suicide in Ireland; and identify individuals who present for medical treatment due to deliberate self-harm and who subsequently die by suicide.

 

The SSIS operates a two-step approach which involves:

1. Pro-active facilitation of support for family members bereaved by suicide, and;
2. Obtaining information from the different sources who had been in contact with the deceased in the year prior to death or at the time of death, including coroners’ records, family informants and medical professionals. 

The research team identified 178 cases of suicide and 12 deaths with open verdicts in Co Cork between September 2008 and March 2011. Initial contact with family members of the deceased was made by letter, explaining about the SSIS and offering support, with one or more follow-up phone calls from senior research psychologists on the team in 124 cases.

 

In relation to these 124 cases, two-fifths (40%) of close family members participated in bereavement support facilitated by the SSIS team. Just under half (48%) had obtained bereavement support prior to contact with the team. A small proportion (8%) welcomed further contact with a member of the team but did not want formal bereavement support. One in twenty (5%) family members did not wish to receive further contact following the initial invitation letter from the team.

 

In relation to the 190 fatalities, data on 189 cases were obtained from the checklists completed on the basis of the coroners’ records, further information was obtained from psychological autopsy interviews with family members for 70 (37%) cases and from questionnaires completed by medical professionals for 64 (34%) cases.

 

Suicide cases

The vast majority of those who had died with a verdict of suicide were men (81%). The average age was 38 years and men were significantly younger at the time of death (36 years) than women (45 years). The majority were Irish (92%), single (56%), and living in a house or flat (96%). Just under two-fifths (38%) were unemployed, one-fifth (21%) were living alone and 4% were living in a supervised hostel. In terms of occupation, one-third (33%) had been working in the construction sector.

 

The majority (71%) of the 178 suicide cases died by hanging, 11% by drowning and 10% (19) by intentional drug overdose. Legal drugs used in the overdose cases included both prescribed (17%) and non-prescribed (83%) medication. Illegal drugs used included cocaine and heroin. Eighteen per cent of the total number of cases had taken medication and/or drugs in combination with other methods, such as hanging and drowning Over one-third (36%) had consumed alcohol at the time of suicide. A minority had used other methods, including cutting or stabbing, carbon monoxide poisoning, firearms and self-immolation. Forty-six per cent of cases had left a note, in the form of a letter, e-mail or text message.

 

Three-fifths (61%) of the suicide cases had a family history of mental disorder and the same proportion had a personal or family history of substance abuse. Over 39% of cases had either a personal experience of significant physical, sexual or emotional abuse or a family history of such abuse. Ten per cent of fatalities had a parent or sibling who had a non-natural death, such as suicide, homicide or accident

 

At some time before their death, 45% of cases had engaged in at least one act of deliberate self-harm. Of these, 50% had engaged in one act, 21% in two acts and 29% in three or more acts. Just under half (48%) had engaged in deliberate self-harm in the 12 months prior to ending their lives, 24% less than a week before and 12% less than a day before.

 

Over two-thirds (68%) of the suicide cases were known to have experienced suicidal behaviour (fatal and/or non-fatal) by family members or friends at some point in their lives. Of these, 7% had experienced the event less than 12 months prior to their own death.

 

A psychiatric assessment was known to have taken place in 31% of the cases. In the majority (61%) of these cases, mood disorder (such as depression or bipolar) was the primary diagnosis, followed by anxiety disorder (13%), schizophrenia (9%) and alcohol dependence (9%).

 

In the year prior to death, 52% of the cases had abused alcohol and/or other drugs. Of these cases, 44% had abused alcohol only, 34% had abused both alcohol and other drugs and 16% had abused other drugs only.

 

Two-thirds (65%) of the fatalities were reported to have experienced significant loss in the month prior to death (such as relationships, family members/friends, prestige and finances), 47% experienced a significant disruption to a primary relationship, 34% experienced significant life changes, 24% had legal trouble or difficulties with the Gardaí (24.2%), 23% experienced an event that was perceived as traumatic, and 19% experienced the anniversary of a death or other important loss.

 

In the year prior to suicide, more than half of the cases had had serious relationship problems for more than a year (53%). Loneliness over a long period of time in the year prior to suicide was reported for 47%. Other commonly reported negative events in the year prior to suicide were serious financial problems (44%), problems with eating (33%), unemployment (31%), problems bringing up children (28%), mental maltreatment by a partner (28%) and failure in achieving an important goal (20%).

 

The most commonly reported negative events that occurred earlier in the lives of people who died by suicide were serious relationship problems lasting for more than a year (66%), problems in bringing up children (44%), addiction to alcohol, other drugs or medication (41%), serious financial problems (40%), the experience of loneliness over a long period of time (38%) and a sudden and unexpected emergency (37%).

 

The majority (81%) of the deceased had been in contact with their GP or a mental health service in the year prior to death. Fourteen per cent had received inpatient psychiatric treatment in that year. Forty-one per cent had been offered outpatient appointments with the mental health services. However, nearly half (48%) had difficulties attending these appointments and in 65% of cases the relatives reported no apparent benefits from attending the recommended outpatient mental health services.

 

Fifty-seven per cent of cases had used prescription medication for a mental disorder in the year prior to death. However, a high proportion of these (46.4%) did not comply with the instructions on the medication.

 

Suicide patterns

During the pilot phase, the SSIS identified a cluster of 19 suicides in two small areas in Cork comprising 40,125 inhabitants (males: 19,997, females: 20,128). The cluster involved adolescent and young adult males aged 14–36 years who died by hanging between September 2008 and December 2010. In addition, the system identified another small area in Co Cork with an emerging suicide cluster. In this area six men, aged between 34 and 67 years, took their lives over a period of 13 months. The multiple sources of information contributing to the SSIS allowed the researchers to identify a number of direct and indirect relationships among the suicide cluster cases. 

 

A matched comparison between cluster and non-cluster suicide cases in terms of mental health and social risk factors was undertaken. All except three of the young males involved in the larger cluster had used multiple drugs (prescription and street drugs), often combined with alcohol, while this was less common among the non-cluster cases. Compared to the non-cluster cases, the suicide cluster cases were less likely to communicate their suicidal intentions and they were more likely to have lost a friend by suicide.

 

Open verdict cases

An open verdict was returned in the case of 12 deaths. Two-thirds (67%) were men and the average age was 60 years. One-quarter were single. Only 8% were unemployed, and 42% were retired. With regard to cause of death, 42% died by drowning, 25% died by hanging and 33% had used other methods. A significant minority (46%) had consumed alcohol at the time of death. Seventeen per cent had left a suicide note, e-mail or text message prior to death. Two-fifths (42%) had a history of deliberate self-harm. A relatively high proportion (67%) had a confirmed psychiatric diagnosis. The vast majority (88%) had a mood disorder. One-quarter had a history of alcohol abuse. In the year prior to death, 58% had used psychotropic medication.

 

The open verdict cases, when compared with the suicide cases, were more likely to be male, older, retired and have a history of depression or alcohol dependence. They were less likely to be single and unemployed. They were also more likely to die by drowning and less likely to die by hanging. The number of open verdict cases is small and comparisons need to be interpreted with caution.

 

1. Arensman E, McAuliffe C, Corcoran P, Williamson E, O’Shea E and Perry IJ (2012) First report of the Suicide Support and Information System. Cork: National Suicide Research Foundation. https://www.drugsandalcohol.ie/18081

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