Dorothy Buglass

Thirty married agoraphobic women referred to out-patient clinics in Edinburgh were compared with 'normal' controls (selected from GP records and screened for the absence of psychiatric symptoms) matched on age, sex social class and marital status. The agoraphobics' husbands were similarly compared with the husbands of the controls. On most measures of attitudes, behaviour, domestic organization and marital interaction, the 2 groups were strikingly similar.

Between 1962 and 1970, the male parasuicide (attempted suicide) rate in Edinburgh has doubled, and the rate for women shows a 70 per cent increase (Kreitman, 1972). Of those who are admitted following a parasuicidal act a substantial proportion are readmitted—approximately 15 per cent within 12 months and 25 per cent within three years. Parasuicide is a sign of severe distress, and repetition indicates that the distress has not been adequately alleviated. A means of early identification of the potential repeaters would be valuable.

Parasuicide admissions to the Regional Poisoning Treatment Centre in Edinburgh are reviewed over the seven year period 1968-74. Special emphasis is given to trends in parasuicide rates for Edinburgh City, but social and clinical data are also described. Though the mean annual increase for admissions is 10-6 per cent, recent years have shown a fall in the rates for men and a levelling off for women. There have been increases in the rates for the young, for men in social classes 4 and 5 and for divorced women, and in poisonings with psychotropic drugs and alcohol consumption among women. At the same time it is important to note variables which have not changed: the relative risks by age and sex, repetition rates, the diagnostic picture, poisoning with non-prescribed drugs, and the rank order of municipal ward rates: and variables which have diminished: the rates for divorced men, overcrowding, domestic gas and barbiturate poisoning, and drug misuse. A comprehensive explanation of parasuicide in the contemporary scene would have to explain both the consistencies and the changing trends. The answer to the central question of why parasuicide is changing remains elusive.

For some years we have monitored a steady increase in the rates for parasuicide (attempted suicide) in Edinburgh (Aitken et al ., 1969; Kreitman, 1972). Some changes in the character of the group have been demonstrated; in particular, the proportion of young people admitted has increased. The proportion readmitted within 12 months has, however, remained constant at around 15 per cent. Identification of potential repeaters is dependent on the group possessing characteristics which remain consistent over time. In this paper the characteristics of both repeaters and non-repeaters are compared over a three-year period, and stable predictors of repetition are identified. An earlier study (Buglass and McCulloch, 1970) suggested that prediction of repetition was best considered separately for each sex. This question is reconsidered in the light of new data. Thirdly, the interaction between the type of disposal recommended after the parasuicidal episode and subsequent repetition is examined.

A study of 'attempted suicide' in Edinburgh was undertaken by Kessel and McCulloch from mid- 1962 to mid-1963 and, in part, reported in the Milroy Lectures to the Royal College of Physicians Special interest in attempted suicide has continued in Edinburgh since that time. At the ward in the Royal Infirmary for the treatment of such cases, the Regional Poisoning Treatment Centre, admissions are seen not only by physicians but for the most part also by a psychiatrist. The practice in the city for all hospital-referred cases of attempted suicide to be admitted there has remained unchanged over the last five years, and it is therefore possible to compare the current preva- lence of attempted suipide with that observed five years ago.