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John D. Loeser, MD, Department Editor
Reviewed by Mark Sullivan, MD PhD
E. Stenager, & E. Stenager, Haworth Medical Press, Binghampton, NY, 1998, 128 pages, $14.95 (softcover), ISBN 0-7890-0295This little book assembles information useful for current debates concerning the relationship between chronic physical disease and associated pain and disability, and suicidal thoughts and behavior. It reviews studies that address the magnitude of increased suicide risk posed by various chronic diseases, with special emphasis on neurological disorders such as multiple sclerosis, stroke, and epilepsy. The authors, a public health physician and a neurologist from Denmark, have been studying this issue for years and are well qualified.
The book is written in a simple, straightforward style with the occasional odd expression typical of some nonnative English speakers. It carefully delineates the different types of studies on which conclusions about suicide risk in various disorders are based. For example, the authors stress the importance of looking for age and sex standardization in patients who are at risk for suicide. Without such standardization, one is liable to have a distorted picture of suicide risk in disorders that preferentially afflict patients of a particular age or gender. The authors themselves have done some of the best studies of suicide risk in patients with neurological disorders. It is notable that while they cite their own studies through 1996, citations of other studies stop at around 1992.
The book is generally weaker regarding clinical guidance than in identifying the shortcomings of research methods. General orientation to suicide and mental disorders will be useful to those who are not psychiatrists or psychologists. Orientation to the phases of adaptation to chronic disease will be useful to mental health practitioners who do not routinely treat patients with chronic illnesses. One of the strengths of the book is that it distinguishes the strengths and weaknesses of autopsy studies, follow-up studies, and register studies of suicide risk. Useful tables of the studies, organized by medical disorder, are provided. The chapters on neurological disorders and cancer are the best, probably because the best data are available for these diseases. The authors correctly note that, due to diagnostic heterogeneity, no studies have examined suicide risk in patients with chronic pain. The authors' concluding remarks about clinical care and policy are weaker than the review of the literature. This little book succeeds in bringing together useful information in an area where all too often, there is much heat and little light.
Mark Sullivan is assistant professor of psychiatry and behavioral sciences and is a member of the Multidisciplinary Pain Center at the University of Washington in Seattle.
