‘One size fits all’ suicide prevention does not account for ethnic differences

Suicide prevention efforts may need to account for ethnicity because of variation across underrepresented groups, according to results of an observational cohort study published in Lancet Psychiatry.

“Over the past 2 decades, we have seen the introduction of the national suicide prevention strategy and major policy initiatives to improve mental health care provision,” Isabelle M Hunt, PhD, of the Centre for Mental Health and Safety at the University of Manchester in the U.K., and colleagues wrote. “However, regarding mental health care for minority ethnic patients, we still do not know whether services are fit for purpose, yet knowledge of the relative risks of suicide and the characteristics of minority ethnic patients who have died by suicide could inform preventative efforts.”

The investigators sought to assess suicide rates among psychiatric patients from underrepresented ethnic groups and outline their social and clinical characteristics. They analyzed data of those who died by suicide within 12 months of mental health service contact between 2007 and 2018, with data collection occurring for the National Confidential Inquiry into Suicide and Safety in Mental Health. They compared suicide rates and standardized mortality ratios (SMRs) of 698 South Asian, Black African, Black Caribbean and Chinese patients (69% men; mean age, 41 years) with those of 13,567 white patients (66.6% men; mean age, 48 years).

Results showed lower suicide rates and SMRs among patients from underrepresented ethnic groups compared with white patients per 100,000 population. Between ethnic groups, Black Caribbean patients (1.89 deaths per 100,000 population) had higher suicide rates, and South Asian patients (1.49 deaths per 100,000 population) had lower suicide rates. White patients had an increase in rates between 2007 and 2012, followed by a decrease, but other ethnic groups had no change. Black African patients (54%) and Black Caribbean patients (44%) had higher rates of schizophrenia, whereas South Asian patients (41%) had higher rates of affective disorder. Patients from underrepresented ethnic groups overall exhibited markers of social adversity and received higher intensity care; however, clinicians viewed them as lower risk than white patients.

“The important social and clinical differences we found between minority ethnic groups highlights that the one size fits all approach by mental health services might not be fit for purpose,” Hunt and colleagues wrote. “Care needs to be better tailored to meet the needs of individual minority ethnic patients, and approaches to prevention should not treat minority ethnic patients as homogenous groups.”

In a related editorial, Phoebe Barnett, of the research department of clinical, educational and health psychology at the University College London, outlined a possible goal for mental health services related to bias reduction.

“Mental health services should work towards establishing a means of assessing the need for care that limits potentially implicit biases and ensures that adequate care is readily accessible and provided promptly and in the least restrictive means possible,” Barnett wrote.