Selected Peer-Reviewed Scientific Publications
(Contact Dr Blair-West to access the full-text papers if you do not have institutional online access)
In summary, his research found that the accepted risk of suicide of 15% for those suffering from major depression could not have been more wrong. Not only was the actual figure 3.4%, Dr Blair-West's team's subsequent research found that this was misleading, as the vast majority of those who suicided were male. The figure of 3.4% averaged two highly disparate figures of 7% for men and 1% for women. Dr Blair-West then argued that this suggested that men were not being adequately diagnosed because diagnostic criteria were more suited to the female presentation of clinical depression.
It was in recognition of his research, published in the first three papers below, that resulted in Dr Blair-West being invited to speak at the 18th International Association for Suicide Prevention Congress and being awarded Lifetime Membership to The New York Academy of Sciences.
It was in recognition of his research, published in the first three papers below, that resulted in Dr Blair-West being invited to speak at the 18th International Association for Suicide Prevention Congress and being awarded Lifetime Membership to The New York Academy of Sciences.
Abstract
For 25 years the medical profession has accepted that of every 100 individuals with major depressive disorder (MDD), 15 subjects will ultimately commit suicide. The present paper demonstrates that the lifetime suicide risk in this condition cannot be so high. Conservative age-specific calculations give a lifetime suicide risk in MDD of 3.5%. Selection of hospital-based, high suicide risk, study populations in the index research, when most sufferers are out-patients, is the primary contributor to the overestimation of suicide risk. Evolving classification systems are a further factor. In terms of suicide risk, MDD is not a homogenous diagnostic category. As has been reliably replicated, the small subgroup of patients who have experienced hospital admission do experience a much greater lifetime suicide risk.
For 25 years the medical profession has accepted that of every 100 individuals with major depressive disorder (MDD), 15 subjects will ultimately commit suicide. The present paper demonstrates that the lifetime suicide risk in this condition cannot be so high. Conservative age-specific calculations give a lifetime suicide risk in MDD of 3.5%. Selection of hospital-based, high suicide risk, study populations in the index research, when most sufferers are out-patients, is the primary contributor to the overestimation of suicide risk. Evolving classification systems are a further factor. In terms of suicide risk, MDD is not a homogenous diagnostic category. As has been reliably replicated, the small subgroup of patients who have experienced hospital admission do experience a much greater lifetime suicide risk.
Abstract
Background: Recent work has demonstrated that the lifetime suicide risk for patients with DSM IV Major Depression cannot mathematically approximate the accepted figure of 15%. Gender and age significantly affect both the prevalence of major depression and suicide risk. Methods: Gender and age stratified calculations were made on the entire population of the USA in 1994 using a mathematical algorithm. Sex specific corrections for under-reporting were incorporated into the design. Results: The lifetime suicide risks for men and women were 7% and 1%, respectively. The combined risk was 3.4%. The male:female ratio for suicide risk in major depression was 10:1 for youths under 25, and 5.6:1 for adults. Conclusions: Suicide in major depression is predominantly a male problem, although complacency towards female sufferers is to be avoided. Diagnosis of major depression is of limited help in predicting suicide risk compared to case specific factors. The male experience of depression that leads to suicide is often not identified as a legitimate medical complaint by either sufferers or professionals. Increasing help-accessing by males is a priority. Clinical implications: Patients with a history of hospitalisation; comorbidity, especially for substance abuse; and who are male, require greater vigilance for suicide risk. It may be that for males the threshold for diagnosing and treating major depression needs to be lowered.
Background: Recent work has demonstrated that the lifetime suicide risk for patients with DSM IV Major Depression cannot mathematically approximate the accepted figure of 15%. Gender and age significantly affect both the prevalence of major depression and suicide risk. Methods: Gender and age stratified calculations were made on the entire population of the USA in 1994 using a mathematical algorithm. Sex specific corrections for under-reporting were incorporated into the design. Results: The lifetime suicide risks for men and women were 7% and 1%, respectively. The combined risk was 3.4%. The male:female ratio for suicide risk in major depression was 10:1 for youths under 25, and 5.6:1 for adults. Conclusions: Suicide in major depression is predominantly a male problem, although complacency towards female sufferers is to be avoided. Diagnosis of major depression is of limited help in predicting suicide risk compared to case specific factors. The male experience of depression that leads to suicide is often not identified as a legitimate medical complaint by either sufferers or professionals. Increasing help-accessing by males is a priority. Clinical implications: Patients with a history of hospitalisation; comorbidity, especially for substance abuse; and who are male, require greater vigilance for suicide risk. It may be that for males the threshold for diagnosing and treating major depression needs to be lowered.
Abstract
Objective: This paper will summarize the authors' research that disproved the accepted lifetime suicide risk in major depression. It will then explore the pivotal issue of gender in understanding suicide risk in depression and raise questions as to whether this is adequately reflected in the current diagnostic construct of this condition.
Method: The methods of two recent papers published by the authors are briefly recounted. In the first of these papers, an age-specific algorithm was developed to reflect the necessary mathematical relationship between the prevalence of major depression, total population suicide rates and suicide risk in depression. It allowed for deaths in each age group from other causes, corrected for official underreporting, and was calculated on the entire population of the USA. In the second paper this methodology was further refined and applied to gender and age data. Results: The suicide risk in major depression as it is currently defined diagnostically is of the order of 3.4% rather than the previously accepted figure of 15%. However, a single figure is misleading as it averages two highly disparate figures of almost 7% for men and only 1% for women. In youths (< age 25) the male : female ratio is even higher (10:1). Conclusions: Among sufferers of major depression, men and those who have been hospitalized have a much greater risk of suicide. These findings are sensitive to diagnostic inclusivity (the algorithm's denominator) which raises the question as to whether women with a depressive illness are more likely to be correctly identified than male sufferers? An argument is made for a gender-based nosological revision of the diagnostic criteria. In the interim, given the treatable morbidity of depression and the availability of safe, welltolerated antidepressants, there is a prima facie case for lowering our threshold of treatment in men and youths presenting with a history of anger dyscontrol, or substance abuse, who have decompensated from previous levels of functioning and who show features of either typical or atypical depression.
Objective: This paper will summarize the authors' research that disproved the accepted lifetime suicide risk in major depression. It will then explore the pivotal issue of gender in understanding suicide risk in depression and raise questions as to whether this is adequately reflected in the current diagnostic construct of this condition.
Method: The methods of two recent papers published by the authors are briefly recounted. In the first of these papers, an age-specific algorithm was developed to reflect the necessary mathematical relationship between the prevalence of major depression, total population suicide rates and suicide risk in depression. It allowed for deaths in each age group from other causes, corrected for official underreporting, and was calculated on the entire population of the USA. In the second paper this methodology was further refined and applied to gender and age data. Results: The suicide risk in major depression as it is currently defined diagnostically is of the order of 3.4% rather than the previously accepted figure of 15%. However, a single figure is misleading as it averages two highly disparate figures of almost 7% for men and only 1% for women. In youths (< age 25) the male : female ratio is even higher (10:1). Conclusions: Among sufferers of major depression, men and those who have been hospitalized have a much greater risk of suicide. These findings are sensitive to diagnostic inclusivity (the algorithm's denominator) which raises the question as to whether women with a depressive illness are more likely to be correctly identified than male sufferers? An argument is made for a gender-based nosological revision of the diagnostic criteria. In the interim, given the treatable morbidity of depression and the availability of safe, welltolerated antidepressants, there is a prima facie case for lowering our threshold of treatment in men and youths presenting with a history of anger dyscontrol, or substance abuse, who have decompensated from previous levels of functioning and who show features of either typical or atypical depression.
Abstract
This paper argues that clinicians face the unique artistic challenge of taking concrete pieces of data and abstracting them into effective therapeutic interventions. Moreover, this abstraction has to be modified for different personality types. The process of therapeutic change and how it can be impeded by the traditional medical model are briefly explored. The doctor-patient dyadic treatment relationship, while appropriate and necessary for many medical interventions, can disavow the source of change when it comes to lifestyle conditions such as obesity. Restraint theory and its origins in Greek mythology are briefly reviewed and integrated with Bowlby's attachment theory as precepts in developing a psychologically based dietary approach. By retaining in people's diets foods they have a deep emotional attachment to, the "low sacrifice diet" attempts to encourage caloric restriction in a way that does not trigger rebound overeating.
This paper argues that clinicians face the unique artistic challenge of taking concrete pieces of data and abstracting them into effective therapeutic interventions. Moreover, this abstraction has to be modified for different personality types. The process of therapeutic change and how it can be impeded by the traditional medical model are briefly explored. The doctor-patient dyadic treatment relationship, while appropriate and necessary for many medical interventions, can disavow the source of change when it comes to lifestyle conditions such as obesity. Restraint theory and its origins in Greek mythology are briefly reviewed and integrated with Bowlby's attachment theory as precepts in developing a psychologically based dietary approach. By retaining in people's diets foods they have a deep emotional attachment to, the "low sacrifice diet" attempts to encourage caloric restriction in a way that does not trigger rebound overeating.