Suicide without explicit precursors: a state of secret despair?

Although it is usually assumed that all those who commit suicide give some prior indication of their intention to take their own life, there is growing evidence that a small but significant proportion of suicides occur without clear, explicit indicators. It is proposed that these suicides emerge from similar pathways to other suicides but the despair is not expressed so clearly, often being kept secret. In order to identify such suicides and potential suicides it is helpful to have an indicator of the dominant sub-sets of constituents that are precursors to suicide. Support for three prototypical sub-sets; illness, life circumstances and depressive history, was provided from an MDS analysis of a scale of suicidal precursors applied to 128 cases of suicide that occurred between January 1997 and December 2000 in Stockport (South Manchester). These are offered as coherent themes in the life of potential suicides, which may be of assistance both in determining whether an equivocal death is suicide or not, and in alerting caring agencies to the potential for suicide even when the despair is kept secret.