Avoidable Mortality in Cumbria: A Case File Review of 78 Suicides — (Liverpool John Moores University)

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Liverpool John Moores University Centre for Public Health

November 2014

Rachel E Brown

1. Executive Summary

On average, one person dies each week as a result of suicide in Cumbria. Gathering intelligence about suicide enables the identification of high-risk groups, risk factors and risk escalators, which can inform the development and implementation of local suicide prevention efforts.

Following an overview of avoidable mortality in Cumbria based on deaths between 2008 and 2012, it was revealed that the rate of avoidable deaths due to injuries (which include suicide) was significantly higher compared than the England average in 2011. Cumbria’s Director of Public Health then requested that an in-depth review of suicide be undertaken. A total of 78 suicides were reviewed in detail for this report (58 registered in 2012 and 20 registered in 2013), using coroner information, primary care files, and secondary mental health care files (where applicable).

Coroner Related Information

Hanging was the most common method of male suicide, and drug related poisoning was the most common method of female suicide and this mirrors national findings. Male suicide by hanging has increased considerably over the last 9 years. There were 21 (27%) individuals who were known to have consumed alcohol at the time of death. The proportion of narrative verdicts delivered by Cumbria’s coroners has increased more than two-fold since 2006. These commonly make reference to a mental health illness. The increase in narrative verdicts mirrors an increase seen at a national level.


Page 47)  11.3.7 Prescribed Drugs in the last 12 months

A total of 47 individuals (60%) had been prescribed a psychotropic drug in the 12 months before suicide, this compared to 48% in the UK.  A total of 25 individuals (32%) had no psychotropic drug treatment, and in a further 6 cases (8%) information on prescriptions could not be obtained.
Females were more likely to have been prescribed antipsychotic drugs in the previous 12 months compared to males (89% and 62% respectively).
As illustrated in table 9, prescriptions for selective serotonin reuptake inhibitors (SSRI) antidepressants were most common with 35% of individuals having been prescribed an SSRI in the previous 12 months. Citalopram was the most prescribed SSRI (n=12), followed by Fluoxetine (n=8),  and then Sertraline (n=6). The proportion of SSRI prescriptions in the last 12 months in Cumbria is higher compared to the UK proportion of 25%.

Table 9: Percentage (%) of psychotropic drug prescriptions in the last 12 months, compared to the UK

Psychotropic drug group Cumbria % UK %
Typical antipsychotics 0 6
Atypical antipsychotics 8 9
Depot antipsychotics 1 0.5
Lithium and other mood stabilisers 3 4
SSRI antidepressants 35 25
Tricyclic antidepressants 10 12
Other anti-depressants 15 12
Benzodiazepines 5 19
Other anxiolytics and hypnotics 22 14
Opioid analgesics 6 11

11.3.8 Multiple Drug Prescriptions

A total of 25 people (or 32%) had been prescribed drugs from two or more psychotropic drug groups in the previous 12 months, this was similar to the UK proportion of 31%.44 The proportion of

individuals that were prescribed drugs from 3 or 4 psychotropic drug groups was 12%.

[In other words, out of the population where prescription status was known (72 people), 48.6% were on SSRIs only.  If all the victims on antidepressants (including tricyclics and other) were only on one antidepressant, this would mean that 83% of people whose prescription status was known were on some antidepressant.   If 1/3 of the people who took multiple prescriptions took more than onw antidepressant, then 72% of people whose prescription status was known were on antidepressants of some kind.   Of all the suicides, 65.2% had been prescribed one or more psychotropic drugs.   This ought to alarm somebody.]