Fifty-eight consecutive suicides committed between 1984 and 1987 by adolescents and young adults (ages 15 to 29 years) in an urban community were the subject of retrospective investigation through interviews with survivors and analyses of medical records. Classification in accordance with DSM-III-R showed a large proportion of axis II disorders. Borderline personality disorder (BPD) was found in 19 subjects (33%). When compared with subjects with other disorders, BPD subjects showed more antisocial traits and substance use disorders. Early parental absence, substance abuse in the homes, employment and financial problems, lack of a permanent residence, and sentence by court were also more frequent in BPD subjects.
Suicidal behaviour is a public health problem closely related to other problems such as mental illness, abuse, violence and accidents. This approach is illustrated by the prevention of railway suicides. A theoretical framework is sketched, which allows for the use of principles from injury prevention in the prevention of suicide. ICD-9 encoded death certificates from 1974, 1980, 1986 and 1987 which concerned suicides and undetermined deaths on roads and railways were analysed (N = 294). Additional data were collected from autopsy, police and hospital protocols and from interviews with engine-drivers. Railroad victims dominated the sample (78% of cases). The mean age was 42 yr. Alcohol was detected in 27% of cases, drugs in 36% and severe illness (mostly psychiatric) in 57%. The relationship between types of collision and nature of injury is discussed. Environmental changes, such as changing the locomotive front design, are suggested as strategies for reducing accidents and suicides on railways.
Survival groups and suicide clusters constitute new challenges for suicide prevention. Emergency ward and intensive care personnel and psychologists working in close co-operation with general practitioners are strategically important in such preventive endeavours. Scientists and health care personnel need to develop joint strategies for the purpose. Politicians and administrators are important target groups for information on suicide prevention. The foregoing are important findings in the first year's experience of the West Swedish Network for Suicide Prevention.
BACKGROUND: Qualitative aspects of childhood experiences are believed to have an impact on course in affective disorder. Does perception of parental rearing correlate to persistence of affective illness? METHODS: In retrospective life charts were recorded every previous illness episode for 38 consecutive patients with treatment-refractory affective disorder. A semi-structured interview was used for collecting information about perception of parental rearing. RESULTS: Ten patients perceived themselves as "unwanted" during childhood, and 28 as "wanted". These former were found to have a more malignant illness course, as measured by total days in illness, percent of life in illness, and illness days per episode. LIMITATIONS: The patient sample was small and the findings require replication. CONCLUSIONS: Perception of not having been wanted by parents during upbringing might be an important vulnerability factor in the persistence of depressive symptomatology into adult life.