Mental disorders are major risk factors for suicide. Not all those who
suffer from them kill themselves. Additional information is required to
differentiate higher from lesser risk patients.
Cases and controls did not differ in any significant way with respect to
severity of mental disorder. The main factors independently associated
with undetermined death or suicide were:- a history of deliberate self
harm (adjusted OR 4.1) physical ill health ( adjusted OR 7.8) treatment of
whatever kind by mental health services (adjusted OR 0.01). Other
antecedents associated with increased risk (criminal record, involvement
with police, financial problems and failure to vote) and those associated
with decreased risk (contact with a doctor and in- patient care) did not
exert effects after controlling for confounding.
Controls were receiving more care of whatever kind. Treatment of mental
disorder comorbid with physical illness and a a history of deliberate self
harm may be especially important. Factors which separate those with
mental disorder at high risk from those at lesser risk relate to care levels
provided, which may be a function of engagement by and with health
services. The role of mental health professionals is beneficial in suicide
prevention. The focusing of that role toward engaging alienated or
"difficult" patients should be addressed.