The seriousness of suicide attempts was evaluated in 62 consecutive referrals in 2 general hospitals. As measured by the Suicide Intent Scale (SIS) the majority of cases had a low to moderate intention to die. Increasing age, psychosis and deliberate self-injury were associated with high suicidal intent. Hopelessness and a sense of isolation are significantly more frequent antecedent ideo-affective states in cases with high intent and anger and frustration are more prevalent in cases with low intent. Two other measures of seriousness, the medical condition on admission and lethality of the method used, correlate significantly with the degree of intent. The SIS can distinguish between relatively homogeneous subgroups of suicide attempters for depth studies of aetiology and management.

Background: Three quarters of UK suicides were not in contact with mental health services one year before dying. The characteristics of this group of suicides have not been adequately explored. Aim: Identify risk factors in no-contact suicides and explain non-referral to Mental Health Services (MHS). Method: Ongoing, observational, retrospective survey of all suicides in West Kent (population 988,027) over 5 years. No contact suicides are compared with MHS suicides through standard questionnaires completed by consultant psychiatrists, and general practitioners, and by examining coroners' records. Results: No contact suicides were significantly more likely to be male, employed, living with others and not diagnosed with a mental disorder. They have a significantly lesser frequency of previous selfharm. Their suicide risk is retrospectively estimated to be lower. 50.5% of all suicides were either not registered, had no general practitioner contact, or were last seen 13 weeks or more before suicide. These characteristics can explain non referral to specialist services. Conclusion: No-contact suicides take place to a considerable extent outside the current limitations of primary health and social care systems. Many have a different risk factor profile, and are similar to people who do not seek medical help in the first place. Declaration of interest: None.

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Cross-cultural variation in the frequencies and modes of expression of depressive symptoms may influence the validity of depression rating scales. The most widely used instrument for this purpose, namely Hamilton's Depression Rating Scale (HDRS), has not been systematically evaluated in Arab countries. This study evaluates the face validity of the HDRS-21 by studying symptom frequencies, factor structure and symptom clusters in 100 UAE depressed patients. Concurrent validity is tested by comparing total HDRS scores with global estimates of severity made by clinicians, admission status, impairment of social and occupational functioning, and the endogenicity score of the Newcastle (NC) Diagnostic Index. Total HDRS scores show highly significant agreement with three independent measures of severity of depression. Rank orders of the most and least frequent symptoms are consistent with studies of similar design. Marked differences lie in more retardation and somatization and fewer cognitive components in the present study. Principal-component analysis confirmed the heterogeneous structure of the scale, separating a group of core depressive symptoms, and endogenous, somatization, anxiety and psychotic symptom components. The internal consistency (reliability) of the whole scale is moderate, and improves in the core symptom factor. The main conclusion is that the HDRS is sensitive to severity of depression in the UAE culture. However, it measures heterogeneous aspects, and its internal consistency suffers as a result. High levels of retardation and somatization contribute significantly to the total score in socially developing communities.