Death by suicide in Grampian 1991-1999: comparison with a previous study.

OBJECTIVES: To review the changes in suicide and undetermined death rates in Grampian between 1991-1999 and to make comparisons with a previous study on the same population. DESIGN: All suicide and undetermined deaths in Grampian recorded by the General Register Office for Scotland were included and linked with the psychiatric case records from Grampian Health Board. RESULTS: The high suicide and undetermined death rates in Grampian are accounted for by the excess of deaths in males. In males there has been a change in the method used to commit suicide with hanging now being the commonest method used. Firearm deaths have reduced dramatically since legislation was introduced in 1997 (RR = 021,95% CI [0.05,0.91). For those with previous psychiatric contact, a greater proportion were drug users than in 1974-1990 (OR = 3.75,95%CI [2.7, 5.2]). A higher percentage of suicides have a history of more than one previous attempt at suicide than in 1974-990. In Grampian there is a lower percentage of inpatient suicide than the rest of Scotland. CONCLUSION: There have been changes in suicide trends in Grampian and these are similar to elsewhere in Scotland Strategies to address this are discussed.

Using simulated patients in education about alcohol misuse.

It is important to educate medical students about alcohol misuse, but this process is hampered by negative attitudes and the unavailability of typical patients. However, simulated patients can describe full longitudinal histories in a characteristically defensive style and can provide direct feedback to student interviewers.

Changes in the presenting features of females with anorexia nervosa in northeast Scotland, 1965-1991.

OBJECTIVE: Rates of anorexia nervosa among females presenting to specialist services in northeast Scotland had increased significantly between 1965 and 1991. We sought to elucidate possible causes of this change. METHOD: Hospital and primary care records were searched. Age, weight, and body mass index (BMI) were determined for 196 patients and duration of symptoms from onset to presentation was established in 190 cases. Changes in these parameters were investigated over the 27-year period of the study. RESULTS: There was no significant change in duration of illness or in age at presentation. BMIs increased significantly, but this arose because patients decreased in height, not because they increased in weight. There was no increase in seriously underweight patients with BMIs of < or =15. DISCUSSION: Anorexic females were not referred at an earlier stage of their illness, but primary care teams may be identifying and referring milder cases. Alternatively, the findings may reflect an increasing incidence of eating disorders coupled with changes in their presenting symptomatology.