Predictors of suicide differ according to patient gender
The role of GPs in the prevention of suicide is controversial. Suicide in general practice is rare and most patients do not consult in the month before their death.1 Nevertheless, concerns have been raised regarding the frequent failure of GPs to record risk assessments for those patients who do make contact.2 A new study has suggested that one of the keys to improving risk assessment is to recognise that men and women should be assessed differently.
The study identified 184 women and 130 men with major depression and followed them up, using standard rating scales, over a two year period. Patients with current substance and alcohol misuse were excluded.
At recruitment, 80% of the study population were inpatients, suggesting that this group of patients had relatively severe depression.
During the study, four patients committed suicide and 48 attempted suicide, representing 16.6% of the study group. One difficulty with prospective studies of this size is the need to use serious suicide attempts (characterised by a high score on the suicide intent scale) as a surrogate for completed suicide.
When multivariate analysis was used to eliminate association with other variables, the most robust predictors of suicidal acts in men were cigarette smoking and family history of suicidal acts. In women the predictors were previous suicide attempts, suicidal ideation and smoking.
The exclusion of patients with current substance and alcohol misuse may be the reason why aggression and hostility were not identified as significant risk factors in men.
This study suggests that it is important to take an adequate family history of patients who are at risk of attempting suicide, particularly in men. This may be facilitated by construction of a simple genogram.
The significance of smoking may come as a surprise. Smokers are reported to have more aggressive or impulsive behaviours, and it is suggested that smoking may lead to impairment of serotonin regulation through inhibition of monoamine oxidase.
Oquendo MA, Bongiovi-Garcia ME, Galfalvy H et al. Sex differences in clinical predictors of suicidal acts after major depression: a prospective study. Am J Psychiatry 2007;164:134-41Reviewer
Dr Phillip Bland