Youth suicide in Australasia
1
Emergency Medicine (2002) 14 , 8 Blackwell Science, Ltd Commentary Youth suicide in Australasia Tom Hamilton Emeritus Consultant, Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Suicide has been ever-present and relatively constant in Australia and New Zealand over the last century, with some variation during global warfare and economic depression. Current concerns are predicated upon a demographic shift in the last three decades or so with an increase in the proportion of young people exhibiting this behaviour and a corresponding decrease among the elderly. The obvious and pertinent question is why, from within these stable and affluent, developed societies, should young persons, particularly males, be induced to take their own lives — as many as die from motor vehicle accidents? Interest in the topic worldwide has generated thousands of articles, dozens, perhaps hundreds, of doctoral theses, several specialist journals and what might be regarded as a subspecialty of ‘suicidology’ including within its embrace psychiatrists, general and emergency physicians, mental health professionals, social workers, psychologists, epidemiologists, socio- logists, toxicologists, administrators, political activists and suicide survivors. The spectrum of interest groups and individuals is testimony to the complexity of the problem. There is no simple, reliable diagnostic test for suicidal intent or risk. The plethora of algorithms and risk assessment scales fail the test of universal applicability. What is becoming clear is that acknowledged aetiological features are expressed to varying degree within national, regional and even local boundaries. Evaluation of individual medical, psychiatric, psychological, economic, social, gender and cultural influences remains the touchstone of clinical practice. When face-to-face with a patient it behoves practitioners to extrapolate from group statistics to individual probability. Attainment of this goal in the current context is prejudiced by the difficulties in achieving the collaboration and coordination of interdisciplinary and intersectoral resources and personnel necessary for continuity of care. This is a systemic issue for which, by training and inclination, emergency physicians are well accustomed and suited. They have a pivotal role in this regard and must be prepared to bear the yoke of responsibility. A significant step towards facilitating clinical assessment and collaboration between disciplines was the joint endeavour by The Australasian College for Emergency Medicine and The Royal Australian and New Zealand College of Psychiatrists in formulating ‘Guidelines for the Management of Deliberate Self Harm in Young People’ in July, 2000. The results from this initiative are awaited with interest. In the current series, four leading investigators from Australia and New Zealand discuss a wide range of features of suicide and deliberate self-harm which are of particular interest to emergency physicians and psychiatrists at the forefront of the management of those who present to hospital with manifestations of self-harming behaviour. From a global perspective it is clear that while there are identifiable common features in behaviour patterns there is also significant variation in their expression between and within national and regional bound- aries. These differences gain particular relevance with respect to indigenous populations who are surely deserving of a better deal in health care. The differ- ences between males and females with respect to their respective expression of successful suicide vis-à-vis deliberate self-harm, require careful evaluation to avoid the facile generalizations of conventional wisdom. These articles add significantly to the knowledge and understanding of suicidal behaviour for all engaged in managing this complex and perplexing problem in our region. Dr Tom Hamilton, AM, FACEM, Emeritus Consultant.
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Transcript of Youth suicide in Australasia
Emergency Medicine
(2002)
14
, 8
Blackwell Science, Ltd
Commentary
Youth suicide in Australasia
Tom
HamiltonEmeritus Consultant, Department of Emergency Medicine, Sir Charles Gairdner Hospital,
Perth, Western Australia, Australia
Suicide has been ever-present and relatively constantin Australia and New Zealand over the last century,with some variation during global warfare andeconomic depression. Current concerns are predicatedupon a demographic shift in the last three decadesor so with an increase in the proportion of youngpeople exhibiting this behaviour and a correspondingdecrease among the elderly. The obvious and pertinentquestion is why, from within these stable and affluent,developed societies, should young persons, particularlymales, be induced to take their own lives — as manyas die from motor vehicle accidents?
Interest in the topic worldwide has generatedthousands of articles, dozens, perhaps hundreds, ofdoctoral theses, several specialist journals and whatmight be regarded as a subspecialty of ‘suicidology’including within its embrace psychiatrists, generaland emergency physicians, mental health professionals,social workers, psychologists, epidemiologists, socio-logists, toxicologists, administrators, political activistsand suicide survivors.
The spectrum of interest groups and individuals istestimony to the complexity of the problem. There isno simple, reliable diagnostic test for suicidal intent orrisk. The plethora of algorithms and risk assessmentscales fail the test of universal applicability. Whatis becoming clear is that acknowledged aetiologicalfeatures are expressed to varying degree within national,regional and even local boundaries. Evaluation ofindividual medical, psychiatric, psychological, economic,social, gender and cultural influences remains thetouchstone of clinical practice. When face-to-facewith a patient it behoves practitioners to extrapolatefrom group statistics to individual probability.
Attainment of this goal in the current context isprejudiced by the difficulties in achieving the collaboration
and coordination of interdisciplinary and intersectoralresources and personnel necessary for continuity of care.This is a systemic issue for which, by training andinclination, emergency physicians are well accustomedand suited. They have a pivotal role in this regard andmust be prepared to bear the yoke of responsibility.
A significant step towards facilitating clinicalassessment and collaboration between disciplines wasthe joint endeavour by The Australasian College forEmergency Medicine and The Royal Australian andNew Zealand College of Psychiatrists in formulating‘Guidelines for the Management of Deliberate SelfHarm in Young People’ in July, 2000. The results fromthis initiative are awaited with interest.
In the current series, four leading investigatorsfrom Australia and New Zealand discuss a wide rangeof features of suicide and deliberate self-harm whichare of particular interest to emergency physiciansand psychiatrists at the forefront of the managementof those who present to hospital with manifestationsof self-harming behaviour.
From a global perspective it is clear that while thereare identifiable common features in behaviour patternsthere is also significant variation in their expressionbetween and within national and regional bound-aries. These differences gain particular relevance withrespect to indigenous populations who are surelydeserving of a better deal in health care. The differ-ences between males and females with respect to theirrespective expression of successful suicide vis-à-visdeliberate self-harm, require careful evaluation to avoidthe facile generalizations of conventional wisdom.
These articles add significantly to the knowledgeand understanding of suicidal behaviour for allengaged in managing this complex and perplexingproblem in our region.
Dr Tom Hamilton, AM, FACEM, Emeritus Consultant.
EMM278.fm Page 8 Wednesday, February 6, 2002 9:10 PM
