This week in the BMJ
Volume 330, Number 7484, Issue of 22 Jan 2005Suicide: age and deprivation matter in Scotland
Suicide: age and deprivation matter in Scotland
Rates of suicide between 1981 and 2001 in Scotland have risen considerably among people aged 15-45 but are decreasing in those aged over 45. Examining changes in suicide rates in this 20 year period, Boyle and colleagues (p 175) found that suicide rates among older adults declined from 23 per 100 000 to 17 per 100 000 but rose from 15 per 100 000 to 24 per 100 000 among young adults. They particularly emphasise the relative rise in suicide among young people in poor areas.
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Suicide: intelligence matters in Sweden
Swedish men who score lower in intelligence tests at age 18 are more likely to commit suicide later in life than those with higher scores. Following a cohort of 987 308 men for five to 26 years, Gunnel and colleagues (p 167) found that the risk of suicide decreased by 12% (95% confidence interval 10% to 14%) for each additional unit scored in the test. Parents' socioeconomic status influenced the results only slightly, and poorly performing offspring of well educated parents were at greatest risk.
Suicide: nationality matters in Estonia
Since Estonian independence in 1991, Estonian Russians are committing significantly more suicides than Estonians in Estonia and Russians in Russia, although during the Soviet period suicide rates among Estonian Russians were the lowest of these three groups. Värnik and colleagues (p 176) analysed the data provided by the World Health Organization and found that suicide rates increased for all three groups during the transition: by 39% for Estonian Russians, 26% for Russians in Russia, and 17% for native Estonians. They argue that the phenomenon may be the consequence of the Russians becoming a non-privileged minority in Estonia.
Patients with direct access fix fewer outpatient appointments
Patients with rheumatoid arthritis like having direct access to specialist care when they need it, and make 38% fewer appointments than patients whose doctors arrange routine appointments. Hewlett and colleagues (p 171) randomised 209 patients to direct access or regular routine appointments and, after six years, patients with direct access were clinically and psychologically at least as well as those without such access.
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Preventive effect of child safety equipment is debatable
Fitting safety equipment in households with children under 5 does not reduce medically attended injuries in these children, but general practices' efforts to encourage such fittings do improve parents' safety practices. Watson and colleagues (p 178) randomised 3428 families with at least one child under 5 to a standardised safety consultation and provision of free or low cost safety equipment, or to usual care. Parents who received the intervention took their children to primary care for injuries significantly more often, but this was not followed by higher rates of attendance in secondary care or higher rates of medically attended injuries.
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When in trouble, doctors flee to medicine-land
Doctors faced with discussing difficult treatment options with severely ill patients focus on technical medical issues and avoid discussing patient's values, wishes, and fears, as well as offering advice, even if the patient specifically asks for it. Corke and colleagues (p 182) put 30 junior doctors in a staged "no-win" scenario and scored (from 3 = good to 0 = not discussed) the adequacy of their conversations with the patient (played by an actor). They found a median score of 2.7 for technical medical issues and between 0 and 0.5 for the rest of the topics, and argue that doctors' communication skills need to improve so they are better prepared to help patients make difficult decisions.
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