Background. Female nurses appear to have an increased risk of suicide but the reasons are unknown.
Method. We have concluded a study of nurse suicides (N = 106) in England and Wales, including a psychological autopsy study (N = 42) and case–control comparison with living nurses (N = 84).
Results. Nearly three-quarters of the nurse suicides had previous contact with psychiatric services and almost half had been psychiatric in-patients in the past. There were particularly marked differences between the cases and controls for current psychiatric disorder (90·5% v. 7·1%, OR = 68·5), personality disorder (38·1% v. 1·2%, OR = 32), and history of deliberate self-harm (71·4% v. 2· 4%, OR = 58·5). Family background and social factors (especially concerning interpersonal relationships) also distinguished the two groups. Smoking and serious alcohol abuse were much more frequent in the suicides. There was some indication that while many of the suicides were in contact with psychiatric services, care may not have been optimal in some cases.
Conclusions. The most important strategies for suicide prevention in nurses are in prevention, detection and management of psychiatric disorders. In assessing suicide risk a history of DSH and the presence of comorbid psychiatric and personality disorders are particularly important.