Illness behaviour and help seeking prior to suicide

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Illness behaviour and help seeking prior to
suicide ?

• Dr Christabel Owens
• Peninsula Medical School, Universities of Exeter
  Plymouth
• Dr Helen Lambert Professor Jenny Donovan
• Department of Social Medicine, University of
  Bristol
• Professor Keith Lloyd
• Clinical School, University of Wales Swansea

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Background 1

• Suicide a major public health problem
• 5,000 suicides per year in England
• Commonest cause of death in males under 35
• National Suicide Prevention Strategy for England
  launched in 2002

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Background 2

• Most suffering from mental illness
• Many suicides preventable through medical
  intervention
• GPs play a key role
• But half or fewer of those who commit suicide
  consult doctor in final month
• Why?

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Methods

• Data from completed psychological autopsy study
• Semi-structured interviews with close relatives
  or friends
• 66 interviews transcribed verbatim (45 male, 21
  female)
• Qualitative analysis using data-derived
  categories and constant comparison methods
• Analysis focused on help-seeking behaviours and
  knowledge and beliefs that lay behind them

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Help seeking prior to suicide
Normalising responses
Individual
Self-referral
Lay referral
Others
No self-referral
No lay referral
Consultation in month prior to suicide (33)
Doctor
No consultation in month prior to suicide (33)
System
Individual
Suicide
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Routes to consultation

• Self-referral
• Father The headaches were very severe. He
  went to the doctor on his own and got medication
  for it. (077, male aged 18)
• Lay referral
• Mother I found him in the pub with his mate
  and he was a mess, he just didnt know whether
  he was coming or going and I said to him,
  Matt, Im really, really worried about you.
  Will you please go to the doctor? And I
  persuaded him to go to the doctor (080, male aged
  25)

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Help seeking prior to suicide
Normalising responses
Individual
Self-referral
Lay referral
Others
No self-referral
No lay referral
Consultation in month prior to suicide (33)
Doctor
No consultation in month prior to suicide (33)
System
Individual
Suicide
8
Barriers to consultation individual

• help-resistant by nature
• Wife He was always a man that did. He would
  put things right If the roof fell in he would
  be the first to strike, Ill sort it out, you
  know, very self-reliant, very independent, very
  practical Not the sort to go running off to get
  help. (083, male aged 56)
• ii) concealed distress from others
• Daughter I tried to get things out of him but
  he just couldnt discuss it. (072, male aged 65)
• Wife He gave me brilliant acting How he did it
  I just dont know. Everything was just brushed
  off in a very calm and convincing answer He
  fooled us completely. (087, male aged 47)
•  

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Barriers to consultation others

• too busy or preoccupied with other problems
• Wife I was away quite a bit I was very busy
  working from August to December so I wasnt
  around that much. (083, male aged 56)
• Mother I was worried about the other daughter.
  (095, female aged 25)
• ii) too trusting
• Wife There was no reason for me to doubt him I
  suppose if I was one of these people that delved
  into everything that came through the letter-box,
  um, I might have picked up on a few things but
  wed always been so open with each other. Wed
  been together for so long. (087, male aged 47)
•  

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Barriers to consultation normalising responses

• Habituation to disturbed behaviour
• Mother We sort of learned to live with it
  really. There was no way we were going to tie
  him down. He wasnt conventional like other
  people we got so used to him that we didnt
  really expect anything else. (026, male aged 24)
• ii) Normal response to adverse circumstances
• Daughter I didnt really take it seriously
  because under the circumstances considering the
  pain and the discomfort and everything else, it
  was within normal boundaries it seemed, you
  know, just healthy moaning. (045, male aged 77)
• iii) Just a passing phase
• Wife I knew he had problems but I thought it
  was the male menopause just an awkward phase
  he's going through. (062, male aged 46)

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Lay interventions and coping strategies

• Practical problem-solving measures
• consulted banks, financial advisors
• solicitors
• relationship counsellors
• employment agencies
• arranged home help, got him a dog for company
• bought lottery tickets
• Talking solutions counselling by family and
  friends
• Distractions
• holidays, outings
• new hobbies

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Conclusions

• No opportunity for medical intervention unless
  suicidal individuals consult
• Significant others play a key role in determining
  whether or not medical help is sought
• Lay people find it very difficult to judge the
  seriousness of another persons distress and to
  know whether it is medically significant
• Greater attention needs to be given to the role
  of lay networks in preventing suicide

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• Owens C, Lambert H, Donovan J, Lloyd KR (2005).
• A qualitative study of help seeking and primary
  care consultation prior to suicide.
• British Journal of General Practice, in press
  (due April)