Trends in the methods used for suicide in Northern Ireland.

As domestic gas was made less toxic in Northern Ireland during the period 1960-1988, it was used less often for suicide. During the same period, as car ownership increased, the use of car exhaust for suicide increased in popularity without there being a corresponding decrease in the use of other methods. Part of the temporal variation in suicide rates in Northern Ireland may be accounted for by the relative availability of lethal methods for suicide.

Psychological consequences of the Enniskillen bombing.

Eleven people were killed and 60 injured in the Enniskillen bombing of November 1987. Survivors were psychologically appraised six months and one year later. At six months 50% had developed post-traumatic stress disorder (PTSD). This group comprised more females than males. However, all victims had high scores on the GHQ. We found no correlation between psychological injury (as measured by the GHQ) and physical injury (as measured by the ISS), calling into question previous assertions.

Post-traumatic stress disorder and civil violence in Northern Ireland.

The case records of 499 victims of civil and terrorist violence were examined, and the presence or absence of post-traumatic stress disorder (PTSD) and associated features recorded. The results support the face, and predictive, validities of PTSD. 'Acting as if the event were reoccurring' and 'survivor guilt' seemed not to be characteristic symptoms, and the homogeneity of the emotional state in PTSD was questionable. Only marital disharmony and suicidal behaviour were associated complications. PTSD seemed to be found in a wide range of stressors, but the danger in over-reliance on results from combat veterans is emphasised.

Psychiatric aspects of terrorist violence: Northern Ireland 1969-1987.

For 18 years, Northern Ireland has suffered a changing pattern of civil disorder. Early years were marked by widespread sectarian rioting, shootings, and bombings, which heightened community tension and caused much social and commercial disruption. However, in recent years, terrorist organisations have been more selective in their acts of violence. There are methodological difficulties in assessing the psychological impact of civil disorder and terrorism. But, as well as can be judged from community surveys, hospital admissions and referral data, psychotropic drug usage, suicide and attempted suicide rates, and from assessment of the actual victims of violence, society has not 'broken down' nor has the impact been judged considerable. Possible explanations are discussed.

Post-traumatic stress in Northern Ireland.

The sample studied was a group of 643 adults each seeking compensation for "Nervous Shock" and seen by a single Belfast psychiatrist for medico-legal assessment. Demographic information, risk factors, diagnosis, type of incident, symptoms and outcome were recorded for each patient. From the symptoms recorded, a subgroup of 23% were identified as suffering from Post-Traumatic Stress Disorder (PTSD) as defined in DSM III. This subgroup tended to be older, included more females, had more depressive symptoms and had more severe, prolonged disturbance. The findings document our experience of PTSD in the special context of Northern Ireland and suggest it may be a more useful term in describing psychological reaction to violence than the nebulous concept of "Nervous Shock" used at present by our courts.