An editorial in theBritish Medical Journalin 1962 drew attention to the fact that research workers have taken relatively little interest in the psychoses of the elderly. The editorial commented on the important paper by Kay and Roth (1961), which analysed the condition known as “late paraphrenia”. Since the publication of this editorial, no significant contribution has been added to the analysis of this illness.

SynopsisA post mortem enquiry has been made into the social family and clinical circumstances of 50 individuals who, according to a coroner's verdict, killed themselves in Brighton. A dimensional analysis of the 123 variables thus collected suggested the possibility of three distinct types of suicide: ‘depressive suicide’, ‘sociopathic suicide’ and ‘physical illness suicide’. The reliability of this typology has been checked by the analysis of 55 selected variables for a total of 193 cases considered by the same coroner. A cluster analysis has confirmed that the data contain at least three independent types of suicide. Some implications for the prevention of suicide are discussed.

SUMMARYData on serious psychiatric illness (900 cases), suicide (150 cases), indictable crime (1,300 cases), and child welfare problems (800 cases) in individuals living in Brighton have been collected. Rates of these behavioural pathologies have been calculated for 19 wards in the city, and correlated with data collected in the 1966 Census. Results show that the behavioural pathologies are strongly intercorrelated and are associated with in-migrant areas containing rooming houses of poor quality. These areas tend to be in the city centre. Rates of psychiatric illness, including diagnostic groups in different age and sex groups, have been calculated for 110 enumeration districts in the city, and these rates correlated with factor scores from the principal components analysis of 53 census variables. Complex patterning of the data has been demonstrated. The identification of small areas in the city with high rates of behavioural pathology in particular social settings is an important precursor of the establishment of special measures for prevention and treatment. An important area for future research is the establishment of causal patterns, and the investigation of the primary or secondary role of social conditions in the emergence of mental illness and other behavioural pathology.

The County Borough of Brighton is a seaside town with a population at the 1971 census of 166,081. This population has fluctuated only slightly. In 1951, the total population was 156,486; in 1961 it was 163,159; in 1966 it was 159,510. Brighton's population contains a large percentage of elderly people; in 1966 there were 25 · 7 per cent of the population over the age of 60, and 18 · 8 per cent were over 65 years old, compared with 18 per cent over 60, and 12 per cent over 65 for England and Wales.

SynopsisA study has been made of cases coming before the Brighton coroner in the period 1970–2. Fifty cases in which a suicide verdict was recorded were specially studied, and relatives and acquaintances of the deceased were interviewed. The information thus obtained was compared with information available to the coroner in considering his verdict in 83 further cases in which he made a verdict of ‘suicide’. The reliability of thewhich the coroner's decision is based was largely validated. A study was made of variables which differentiated ‘suicide’ from 25 ‘open’ and 33 ‘accident’ cases considered by the same coroner. The prevalence of depression did not differentiate ‘suicide’ and ‘open’ cases, and this finding contradicts suggestions that the association of depression and suicide might be an artefact of the method of arriving at a suicide verdict. A number of other demographic and clinical factors did however significantly vary between ‘suicide’, ‘open’ and ‘accident’ cases.

SynopsisThe hypothesis has been tested that three types of suicide (‘old and handicapped’, ‘sociopathic’ and ‘depressed’) will vary in prevalence across ecologically defined urban areas. The hypothesis is supported with respect to ‘old and handicapped’ suicide, which predominates in middleclass areas with established residents of middle-class status; and with respect to ‘sociopathic’ suicide, which predominates in central areas with high rates of social pathology of all kinds, and poor housing conditions.

The incidence of deliberate self-injury without fatal outcome (‘attempted suicide’), and with consequent referral to casualty departments and wards of general hospitals, is a constant and growing concern for the medical and social professions. The situation may be described as a steady, never-ending epidemic, with no ready remedy capable of halting it. Indeed, for many hospitals all over the country the epidemic seems likely to overwhelm existing facilities for the treatment of psychiatric, and even non-psychiatric conditions.

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