Accidents and Suicide

Question 1

Deaths of England and Wales in one year - accidents.

Answer 1

10,000

Question 2

Deaths of England and Wales in one year - suicide.

Answer 2

5000

Question 3

Deaths of England and Wales in one year - homicide.

Answer 3

300

Question 4

Accidents, suicide and homicide - % of all deaths in men? In women?

Answer 4

4% of all deaths in men, 2% in women

Question 5

Accidents, suicide and homicide - % of all deaths in 15-34 year olds?

Answer 5

58% of all deaths in men, 33% in women

Question 6

How many adults report suicidal thoughts in UK in one year?

How many report symptoms of depression?

Answer 6

1 million+ adults

6 million

Question 7

How can suicide be prevented?

Answer 7

By removing the means - suicide is impulsive and the impulse may only last a minute

Question 8

Explain how the “means” of suicide by carbon monoxide poisoning were removed?

Answer 8

E.g. putting head in gas oven. They reduced the % of CO in domestic gas gradually, until 0% in 1975. When gas ovens were no longer a means of suicide, the rate of suicide fell accordingly. People did not simply find another way because suicide is impulsive.

Question 9

Drugs most commonly used in fatal overdose (1998)?

Answer 9

Paracetamol (11%)
Dothiepin (10%)
Coproxamol (10%)
Amitryptilline (6%)
Other antidepressants (5%)
Aspirin (1%)
All others (57%)

Question 10

What analgesic legislation was brought in in 1998 to prevent overdoses?

Answer 10

Limit size of the pack
Blister pack format
3 years after –> reduction in overdoses in total and especially paracetamol and aspirin

Question 11

What is co-proxamol?

Answer 11

Paracetamol plus dextropropoxyphene

Question 12

Why is death following overdose 10x more common with co-proxamol than with comparable analgesics?

Answer 12

As dextropropoxyphene –> ventricular arrhythmias &

respiratory depression

Question 13

When was co-proxamol withdrawn from the market? What effect did this have on overdoses?

Answer 13

2005
Obviously cut down overdoses using co-proxamol to almost 0, and it didn’t increase fatal overdoses using other analgesics. People still took overdoses but far fewer were fatal.

Question 14

The approach is not to attempt to stop people racing to their bathroom cabinet, but to make the contents of the bathroom cabinet less lethal.
Use sedatives and anti-depressants as examples.

Answer 14

Sedatives: benzodiazepines instead of barbiturates

Anti-depressants: SSRIs instead of tricyclics

Question 15

How can suicide by train by prevented?

Answer 15

1. Pits under the track in London Underground
   stations. 32% reduction in death rates in those who jump in front of the train in stations with a pit.
2. Doors barring access to the track in tube/metro stations.

Question 16

How can suicide by jumping from a height be prevented?

Answer 16

Patrolling cliffs etc. regularly

Suicide barriers on bridges

Question 17

How do methods of suicide differ between the sexes?

Answer 17

Men - hanging by far the most common (60%)

Women - hanging + drug overdoses about equal

Question 18

Most common types of fatal accidents?

Answer 18

Falls
Drugs
Road traffic accidents

Question 19

The annual number of deaths from RTAs has more than halved in the last 40 years. What interventions have taken place to reduce fatalities?

Answer 19

Seat belts
Breathalysers and police vigilance
Social disapproval of drink driving
More dual carriageways
Speed cameras and road humps
Safer cars (air bags, better brakes)
Ban on mobile phone use while driving
Cycle helmets
More pedestrian crossings

Question 20

Road traffic accident deaths - what population are they more common in?

Answer 20

Men (3:1 ratio) in the age group 15-44 (51%)

Question 21

How many % of fatal RTAs was the driver over the alcohol limit?

Answer 21

12%

Question 22

What % of drivers killed in accidents tested positive for recreational drugs?

Answer 22

33%

Question 23

How do accidents commonly occur on A roads?

Answer 23

Speed, or alcohol, with:
Failure to take a bend
Dangerous right turn
Head on collision

Question 24

Deaths from falls most commonly affect which age group?

Answer 24

65+ (85%)

Question 25

Average lifetime risk of hip fracture in women compared to men?

Answer 25

Women 1 in 7 (same as stroke)

Men 1 in 28

Question 26

Incidence of hip fracture in women over the age of 90?

Answer 26

26%

Question 27

Why are hip fractures more common in women?

Answer 27

Rapid bone loss for ten years after the menopause, reducing bone density by about a third. This combined with a lower bone density than men to begin with, puts women at a higher risk of all long bone fractures.

Question 28

Status one year after fractured hip - how many % are dead? How many % walk unaided? How many % walk with a frame or stick?

Answer 28

34%
15%
47%

Question 29

Consequences of hip fracture? (4)

Answer 29

• precipitation of confusional states, dementia
• pressure sores, pneumonia
• a third die in first year after
• half have impaired mobility after

Question 30

How can hip fracture be prevented?

Answer 30

Regular exercise (halves risk)
Avoid immobility (doubles risk if >3 weeks)
Stopping smoking (smoking doubles risk)
HRT (if taken continuously for 30 years or more)
Thiazides (almost halves risk)

Question 31

What increases the risk of falling?

Answer 31

Mental impairment
Gait/balance disorder
Impaired mobility
Neuro diseases
Visual impairment

Question 32

How can falls be prevented by modifying living accommodation?

Answer 32

• Carpeted floors
• No slippery mats
• No electricity cords crossing floors where people walk
• No steps
• Handrails in bathroom and toilet

Question 33

Homicide according to relationship to culprit - how does this differ for males and females?

Answer 33

Almost 50% of female homicides are by the woman’s spouse/partner, and another 20% by other family members.
In males, “known, not family” and “stranger” makes up almost 70%.