Title:
Intimation of intent in elderly fatal self-harm: do the elderly who leave suicide notes differ from those who do not?

Abstract:
Suicide notes may provide valuable information about suicide victims' final thoughts, and thus may be considered as markers of the severity of the suicide attempt. However, very few studies have described the characteristics of elderly suicide note-writers and their final thoughts.
To explore whether there is a difference between those who do and do not leave a note among the elderly victims of Fatal Self Harm (FSH). Also to examine the content of suicide notes and their clinical significance.
We carried out a retrospective review of suicide notes obtained from coroners' records of FSH in all over 60 years of age in Cheshire over a period of 13 years (1989-2001). The term 'Fatal Self Harm' was applied to all those who were subjects of coroner's inquests and attracted verdicts of suicide, misadventure and open verdicts.
In 71 cases (33%) (43 males, 28 females) (61% M, 39% F) suicide notes were reported in the coroner's records. The variables that appeared to differ significantly between the note-leavers and non-note-leavers were: a suicide verdict, not known to psychiatric services, and method of FSH ( P < 0.05). Gender, marital status, history of DSH, social isolation, mental or physical morbidity did not appear to differ between the two groups. More of those who took an overdose, used plastic bags, electrocuted themselves or used car exhaust fumes left suicide notes. Those who died by hanging, jumping from a height, immolation or wounding appeared equally likely to leave or not to leave a suicide note. Significantly fewer cases who died by drowning left suicide notes ( P < 0.01). No statistically significant difference in the content of suicide notes was observed in relation to gender or age.
The failure to identify consistent parameters that could differentiate between note-leavers and non-note-leavers only leads to the conclusion that a minority of suicide victims leave suicide notes. Suicide note-writers may not be typical of the average suicide case and information elicited from the study of suicide notes may only apply to note-writers and not to suicide in general. However, the absence of a suicide note must not be considered an indicator of a less serious attempt. (Int J Psych Clin in Pract 2002; 6: 155-161).