Psychopathology and suicide method in mental health care.

BACKGROUND Not all suicide methods are evenly distributed among different psychiatric disorders. METHODS In a nationwide sample of 505 suicides by persons in mental health care, the relationship between psychiatric diagnosis and suicide method was examined with chi(2) tests, logistic regression analyses and multinomial logistic regression analysis, including interactions with age, gender and treatment status. RESULTS Psychotic disorders were associated with jumping from heights, and substance-related disorders were associated with self-poisoning. Depressive disorders were not associated with any particular suicide method. Male patients preferred hanging, female patients self-poisoning. Inpatients preferred jumping before a train, outpatients self-poisoning. Bipolar patients preferred jumping before a train over hanging. LIMITATIONS Psychological mechanisms for selection of suicide methods are still unknown. CONCLUSIONS Possible means of suicide prevention suggested by this study include limiting access to tall buildings or structures to patients with psychotic disorders; careful prescription of medication to female patients and particularly to patients with substance-related disorders; and limiting easy access to railways near clinical settings to patients with bipolar and psychotic disorders. Limiting access to means of suicide may be less effective for suicidal patients with depressive disorders who may switch to other available methods.