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To the Editor: Various risk factors have been identified in an effort to reduce suicide rates. Such factors generally define chronic risk and are not imminent predictors of suicide. One such precipitant occurred within a two-month span in 2005 for three patients with serious and persistent mental illness who lived in the New York City area. The patients all killed themselves in the context of imminent eviction from their apartments.
The first patient was a dysphoric and anxious 55-year-old woman with recurrent major depression, obsessive-compulsive disorder, posttraumatic stress disorder, and borderline personality disorder. After months of nonpayment of rent, she was served with eviction papers. No municipal agency was able to avert the action. She expressed shame, and she refused assignment to the shelter system or to housing for persons with mental illness. Five days before her scheduled eviction she committed suicide.
The second patient was a 58-year-old white woman with bipolar disorder. Although she had attempted suicide several times in recent years, her level of functioning and treatment adherence had improved considerably in the months before her death. When it was apparent that she would be evicted, plans were made for her to move into the home of friends in upstate New York. Her case manager met with her the day before she was to relocate. Her sister spoke with her that evening and did not notice anything amiss. The next morning she was found dead of a self-inflicted stab wound.
The third patient was a 48-year-old married white man. Six weeks before his suicide, he was hospitalized with mixed mania with suicidal ideation and compulsive gambling. He was nearly $250,000 in debt and facing eviction. He had petitioned to block the eviction and was optimistic that the judge would rule in his favor. On the day before his death, the court ruled that the landlord was entitled to evict him. He went missing and was found the next day in a secluded part of the apartment building, having killed himself by drug overdose.
These patients all killed themselves within five days of eviction. Eviction must be considered a traumatic rejection, a denial of one's most basic human needs, and an exquisitely shameful experience. These patients were all of middle-class background, making them unusual in the economically disadvantaged population generally served by the clinics they attended. Could the socioeconomic status of these three patients have contributed to their psychological vulnerability?
Why has eviction not been previously noted as a significant precursor of suicide? What explains this cluster of cases within a matter of weeks? Real estate values in New York City have attained record levels quite rapidly, and the real estate market has been frenetic. It is conceivable that landlords are more aggressive in pursuing eviction at this particular time. None of our three patients was facing homelessness, which highlights the possibility that eviction—distinct from homelessness—is a specific and proximal risk factor for suicide, particularly for vulnerable patients. These cases suggest that policy should not only focus on providing alternative housing for people with mental illness who have been evicted but also aim at preventing eviction itself.
Dr. Serby, Dr. Brody, and Dr. Yanowitch are affiliated with the department of psychiatry at Beth Israel Medical Center in New York City and with the department of psychiatry at Albert Einstein College of Medicine in Bronx, New York. Mr. Amin is with St. George's University School of Medicine in Grenada.
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