Some clinical considerations in the prevention of suicide based on a study of 134 successful suicides.

SUGGESTIONS concerning the prevention of suicide have arisen chiefly from statistical studies of coroners' records,1 from studies of patients who have been hospitalized and who commit suicide in the hospital or shortly after discharge,2-4 from the reports of psychiatrists based on their experiences with their own patients,5-7 and from studies of attempted suicide.8-10 These suggestions have, in general, been of value in helping to define more clearly the problem of preventing suicide. In none of these studies, however, have all of the suicides committed within a given geographical area in a specified time period been studied carefully with regard to both the clinical and ecological aspects of suicide. As a result, there are no reported data which can answer the following questions about an unselected (consecutive) group of suicides: (a) What proportion of persons who commit suicide are clinically ill prior to death? (b) What is the nature and frequency of the illnesses from which these persons suffer? (c) Are there other illnesses that, although common, are rarely or never associated with successful suicide? (d) What are some of the factors other than diagnosis that may be helpful in assessing the probability of suicide? (e) In urban United States to what degree is suicide currently a clinical problem, as measured by the proportion of suicides who had been seen by a physician or psychiatrist during their last episode of illness? Since answers to these questions should be useful in helping to prevent at least some suicides, the present investigation was designed to attempt to gain such information. All suicides occurring in metropolitan St. Louis in a one-year period were studied by means of interviews with relatives, friends, job associates, physicians, and others shortly after each successful suicide.