Recession-related increases in suicide have previously been reported globally. New research has shown an equivalent rise in suicide by mental health patients, particularly men aged 45-54.

The study, published in the British Journal of Psychiatry, comes from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) based at The University of Manchester.

The researchers found that suicide rates in male mental health patients increased by about 30% between 2009 and 2011. They found that the rise was most apparent in men aged 45-54.

Those who died by suicide during that time were also more likely to be unemployed or have a diagnosis of substance dependence or misuse than those who died before the recession. But there were no significant recession-related trends in suicide for female mental health patients.

The team examined data from over 21,000 patients aged 16 and over who had died by suicide in England between 2000 and 2016. They were particularly interested in looking at the effect of the 2008 economic recession.

Dr Saied Ibrahim, Research Associate at NCISH, said: “Many studies have highlighted the impact of the economic pressures in the general population, but the suicide of mental health patients in relation to the recession has not been previously examined.

“On the one hand, people under mental health care may be protected from the effect of economic uncertainty because of their clinical contact. However, on the other hand they may be more at risk, particularly if mental health services are faced with increased resource pressures during a recession. This was the issue we wanted to explore in this study.”

The research showed suicide rates in male patients fell after 2011 despite an increase in the number of patients seen by mental health services in England. Dr Ibrahim added: “This may be due to an improvement in the economic outlook or access to better mental health care.”

Commenting on their findings, the team say that more support and targeted interventions for patients with financial difficulties are needed, especially when considering additional factors such as drug and alcohol misuse.

Professor Nav Kapur, senior author of the study said “This study is important because it shows, for the first time, the possible impact of economic difficulties on suicide rates in people who are experiencing mental health problems. The results suggest that men who were mental health patients were at least as severely affected by the recession as men in the general population, perhaps even more so. Mental health services should be aware of the potential impact of economic factors on their patients who may be among the most vulnerable groups in society. Increased support for patients experiencing economic hardship and measures to tackle alcohol and drug misuse may be helpful or even lifesaving.”

Professor Louis Appleby, director of the Confidential Inquiry said “The worldwide recession affected the lives of patients, adding to the adversity they faced. However, we did also find a fall in suicide among patients in recent years at a time when the number of people accessing mental health services has been rising. Patient safety and suicide prevention must remain NHS priorities. We also need to do more to reach men who don’t seek help from health services or social care.”

Children who experience physical, sexual, and emotional abuse or neglect are at least two to three times more likely to attempt suicide in later life, according to the largest research review carried out of the topic.

The analysis of 68 studies by psychologists at the University of Manchester and University of South Wales revealed that suicide attempts were:

• Three times more likely for people who experienced sexual abuse as a child
• Two and a half times more likely for people who experienced physical abuse as a child
• Two and a half times more likely for people who experienced emotional abuse or neglect as a child

Also from the research published in Psychological Medicine today, children who experienced multiple abuse are as much as five times higher to attempt suicide.

And as those people who experienced abuse as children get older, the risk of suicide attempts increases.

People not in contact with mental health clinicians were found to be at the highest level of risk.

The sixty-eight studies were carried out across the world, producing about 262 thousand adults aged 18 years or older, who were exposed to childhood abuse and neglect.

, from The University of Manchester, also based at the NIHR Greater 91Ö±²¥ patient safety translational research centre, led the research team.

She said: “Around one adult in every three has experienced abuse as a child”.

“This study conclusively gives us solid evidence that childhood abuse and neglect is associated with increased likelihood that they will be at risk of suicide as adults.

“And that has important implications on healthcare. Other studies have shown that in the US, for example, the economic burden of childhood maltreatment is estimated to be around $124 billion.”

“Current treatment for people with suicidal behaviour usually centres around Cognitive Behavioural Therapy.

“But that assumes people will seek help themselves. This research identifies that people who are not under the care of clinicians are at risk.

“So, we need a new approach to identify these people and to focus our efforts on effective community intervention.

Dr Ioannis Angelakis from the University of South Wales said: “These findings not only provided a clear picture of the connection between abuse or neglect in childhood and suicide attempts later on in life, but also recognised that efficient interventions should take a broader community-based approach.”

The paper Childhood maltreatment and adult suicidality: A comprehensive systematic review with meta-analysis is published in Psychological Medicine

Mental health patients are at much greater risk of dying from unnatural causes following their first discharge from inpatient care than the rest of the population, according to new research.

In the most comprehensive study of this topic ever carried out, The University of Manchester team say though danger to patients is still relatively low, community services and GPs must be aware of the critical period in the first few weeks of discharge - when they are most at risk.

Though the report drew on data derived the entire population of Denmark, its results are relevant to the UK, which has a similar population and health system, say authors Professor Roger Webb and PhD student Florian Walter.

According to the team, the most common threat to life among patients after discharge is fatal poisoning compared to accidents among the general population.

The research was funded by Medical Research Council, European Research Council in partnership with Centre for Integrated Register-based Research and National Centre for Register-based Research at Aarhus University. It is published in the Journal of Clinical Psychiatry today.

The analysis compared over 1.6 million Danes with a subset of 47,000 people who were discharged from their first inpatient stay between 1982 and 1996.

Utilising national administrative datasets, the research team were able to track the group of patients, who averaged age 25 when they were discharged until they died or 31 December 2011.

They looked at method of suicide, types of accidental death, types of fatal poisoning and death by homicide.

Though there is a strong association between hospital discharge and unnatural death, there is no evidence of a causal link between the two, say the researchers.

According to the research, suicide was 32 times more likely after discharge: 171.7 people in every 100,000 died after leaving hospital, compared to 5.3 in every 100,000 for the general population

Intentional self-poisoning was 41 times more likely: 57.1 people in every 100,000 died after hospital discharge, compared to 1.3 in every 100,000 for the general population

And death from fatal psychotropic drugs poisoning , irrespective of intent was over 90 times more likely: 25.6 people in every 100,000 after hospital discharge, compared to 0.2 in every 100,000 for the general population.

Professor Webb said: “When we look at detailed causes of death, each one is markedly raised whether that’s traffic accidents or poisoning.

“So it’s clear this group of people is more vulnerable to dying from a variety of different unnatural causes after discharge, although the risks for each of these causes are nonetheless relatively low in absolute terms.

”However, it’s important to point out hospital is not a cause of unnatural death as these patients are a young cohort already from high risk groups; therefore the risk of dying could be even higher without hospitalisation.”

Florian Walter said: “This is the first study to look at the full range unnatural causes of death among mental health patients after discharge from hospital ever carried out.

“The Danish system is ideal for this sort of research because Danes are given a unique identification number which provides data that are entered into several national registers.”

A previous study by Walter, published in JAMA Psychiatry in 2017, found that patients are most at risk in the first month after discharge.

He added: “The overarching message is that transition from hospital to community is riskier for these people, especially during the first few weeks after discharge.

“Therefore mental health services need to develop broad strategies that include enhanced post-discharge surveillance. These strategies must account for the fact that discharged patients have higher risks of dying unnaturally in lots of different ways.

“We also think better liaison between inpatient and community services is important so that services can be more vigilant about patients taking their medication correctly at the doses prescribed.”

The paper: a national cohort study is published in the Journal of Clinical Psychiatry.