Gender differences in suicide methods

Introduction

Gender differences in suicide completion rates have been attributed to the differences in lethality of suicide methods chosen by men and women, but few empirical studies have investigated factors other than demographic characteristics that might explain this differential.

Methods

Data from the 621 suicides in Summit County, Ohio during 1997–2006 were disaggregated by gender to compare known correlates of suicide risk on three methods of suicide—firearm, hanging and drug poisoning.

Results

Compared to women, men who completed suicide with firearms were more likely to be married and committed the act at home. Unmarried men were likelier to hang themselves than married men, but unmarried women were less likely to hang themselves than married women. Men with a history of depression were more likely to suicide by hanging, but women with depression were half as likely to hang themselves compared to the women without a history of depression. Men with a history of substance abuse were more likely to suicide by poisoning than men without such history, but substance abuse history had no influence on women’s use of poisoning to suicide. For both sexes, the odds of suicide by poisoning were significantly higher for those on psychiatric medications.     

Suicide in the elderly in Kaniyambadi block, Tamil Nadu, South India

BACKGROUND: Inefficient civil registration systems, non-report of deaths, variable standards in certifying death and the legal and social consequences of suicide are major obstacles in investigating suicide in the developing world. Very high rates of suicide have been recorded in the region in the general population and among younger people. OBJECTIVE: This paper describes the suicide rate among the elderly in Kaniyambadi block, Tamil Nadu, South India for the years 1994-2002 using verbal autopsies. METHOD: The setting for the study was a comprehensive community health program in a development block in rural South India. The main outcome measure was death by suicide diagnosed by a detailed verbal autopsy and census, birth and death data to identify the population base. RESULTS: The average annual suicide rate was 189 per 100,000 for people over 55 years of age. The ratio of male to female suicides was 1: 0.66. The age-specific suicide rate for men and women increased with age. Hanging (52%) and poisoning with organo-phosphorus compounds (39%) were the commonest methods employed for committing suicide. Significantly more women chose drowning or burning than men who preferred poisoning or hanging (chi2 19.75; df 1; p < 0.001). CONCLUSIONS: The suicide rate documented in this study among the elderly is very high. The reasons for the high suicide rate observed in older people are not known. There is a need to develop innovative strategies to reduce deaths by suicide.     

Smoking and the risk of suicide

OBJECTIVE: To estimate the relationship between cigarette smoking and the risk of suicide. METHOD: The mortality of 36527 adult men and women was monitored for the mean 14.4 years. Information on deaths caused by suicide was obtained from the National Mortality Register. Suicides were subclassified by the level of violence used. Current smokers of 1-20 cigarettes per day were considered light/moderate smokers and heavy smokers were defined as those smoking > or =21 cigarettes per day. RESULTS: There were 134 suicides among 17798 men and 31 suicides among 18729 women. The most common suicide methods were hanging, firearms and drug overdose. According to the Cox model the adjusted relative risk of both violent and non-violent suicide was significantly and linearly increased among light/moderate and heavy smokers compared with non-smokers. CONCLUSION: Smoking was associated with an increased risk of suicide irrespective of the level of violence used.     

Child and adolescent suicides in Virginia: 1987 to 2003

OBJECTIVES: The aim of this study was to better understand suicides in children and adolescents using records from the Office of the Medical Examiner of Virginia from 1987 to 2003. MAIN FINDINGS, KEY DATA, AND STATISTICS: Suicide accounted for 16.8% of unnatural deaths. Suicide rates were highest for Caucasians. Guns were the most common method of death for suicides, followed by hanging and poisoning. Poisoning other than carbon monoxide accounted for 7.8% of suicides, with tricyclic antidepressants (TCAs) the most identifiable poison. Female youths were 10 times more likely to die from TCAs than male youths, after adjusting for race and age. CONCLUSIONS: Guns and hanging were the principal methods of suicide. Among the antidepressants, TCAs have been the most common poisons used in suicide. Increasing age was a powerful determinant of suicide. Some patients may have stockpiled their TCAs for a while before their TCA overdose. Other suicide victims may have used TCA supplies from family members. Hence, some of the suicide victims may not have taken TCAs on a regular basis before committing suicide. Further exploration of TCA-induced suicidal thoughts is needed. Conclusions cannot be made at the time about the precise role that TCAs played in TCA-induced suicide reported in our study.     

Gun Control and Suicide: Possible Impact of Canadian Legislation to Ensure Safe Storage of Firearms

In 1992, the Canadian Firearms Act aimed at ensuring safe storage of firearms was promulgated. This study compares suicide methods 6 years prior to the enactment of the law and 5 years after its enactment. The study encompassed 426 suicide cases from Abitibi-Témiscamingue (Northern Quebec), the region with the highest suicide rate and the highest firearm suicide rate in Quebec. Suicide by firearms decreased in the male and female population. Suicide by hanging increased among youths of both sexes, and suicide by poisoning doubled in the female population. A decrease in firearm suicides was most noticeable in the under-25 age group, although it was in this same age group that the general suicide rate increased the most. The reduction of firearm suicides was not accompanied by a decrease in overall suicide rates.     

Ulcer, attempted suicide and suicide.

Attempted suicide and suicide have been investigated among 2,619 patients suffering from duodenal ulcer, gastric ulcer and ulcer dyspepsia without ulcer demonstrable by x-ray. There was no difference in the percentage of attempted suicides and suicides among the three ulcer groups or between the sexes. Within well-defined periods, there was a statistically significant greater excess of attempted suicides among patients operated on than among unoperated patients. The distribution according to psychiatric diagnosis was very similar to the one observed among persons in general in Copenhagen attempting suicide. The number of patients committing suicide exceeded the expected number significantly, for men as well as for women, but there was no difference between patients operated on and unoperated patients. The psychiatric diagnoses of those committing suicide were predominantly neuroses and psychopathy.     

Age, gender, and ethnicity differences in patterns of cocaine and ethanol use preceding suicide

OBJECTIVE: The goal of this study was to examine the relationship between suicide and substance use among completed suicides in Fulton County, Ga., from 1994 through 1998. METHOD: Extensive data on completed suicides were obtained from records of the Office of the Medical Examiner. Specific characteristics of the victims who had used cocaine, ethanol, or both before committing suicide were compared across demographic groups. RESULTS: There were important race, sex, and age differences among the victims who had used cocaine and ethanol before committing suicide. Almost all (94.6%) of the suicide victims in whom cocaine was detected were male, 51.4% of the cocaine-positive victims were African American men, and 43.2% were white men. Substance use by teenage victims differed dramatically across ethnic lines. The vast majority (86.7%) of African American teenagers did not use either substance before committing suicide, whereas 50.0% of the white teenage victims had used one or both substances, with 41.7% of the white teenagers having used ethanol. Overall, ethanol use was much more common among white victims of all age groups. CONCLUSIONS: Intoxicant use preceding suicide occurred in specific age-, ethnic-, and gender-based patterns.     

Season of birth associated with the age and method of suicide

A recent study reported season of birth variation in CSF levels of 5-HIAA and HVA, with low 5-HIAA for February to April and high HVA for October to January (Chotai & Åsberg, 1999). We therefore analysed data on all completed suicides during 1952--1993 in the county of Västerbotten in northern Sweden (1466 cases), regarding these birth seasons in relation to suicide method and sociodemographic variables. Those with suicide age under 45 years were more likely than older suicides to have been born during February to April, significantly so compared to October to January. This was more pronounced for the later birth-year cohort (born in 1931 or later). Those who preferred hanging rather than poisoning or petrol gases were significantly more likely born during February to April. Those who preferred poisoning rather than hanging were significantly more likely born during October to January, particularly for the later birth-year cohort. The results regarding suicide method were somewhat more pronounced for males. The results of the study are compatible with a hypothesis of season of birth variation in CSF monoamine metabolites.     

Completed versus attempted suicide in psychiatric patients: a psychological autopsy study

The aims of this study were to identify specific risk factors associated with completed suicide in a sample of suicide victims diagnosed with mental illness and to discriminate completed suicides from attempted suicide in individuals who did not kill themselves for at least the next 2 years after the index attempt. Ninety-four adults (34 women; 60 men; mean age = 50.81 [SD = 18.08]) admitted to the Division of Psychiatry of the Department of Neurosciences of the University of Parma who died by suicide between 1994-2004 were matched for sex and age (+/- 2 years) with 94 outpatients (mean age = 50.70 [SD = 18.08]) who made at least one suicide attempt during the years of the study. Data were gathered by proxy-based interviews with referring psychiatrists and general practitioners and from examination of medical records. Suicide victims were more likely to be not married, have poor social support (OR = 5.28), and have more voluntary and compulsory admissions to hospitals (1 admission: OR = 5.44; > 1 admissions: OR= 8.84) than suicide attempters. Suicide victims were also less likely to have had stressful life events during their childhood and adolescence (OR = 0.09) and to be divorced or widowed than were the attempters.     

Political Beliefs,Region of Residence,and Openness to Firearm Means Safety Measures to Prevent Suicide

Firearms account for approximately half of all suicides in the United States and are highly lethal, widely available, and popular; thus, are an ideal candidate for targeted means safety interventions. However, despite their value as a suicide prevention tool, firearm means safety strategies are not widely utilized, possibly due to factors which impede openness to their use. This study examines the relationship between region, political beliefs, and openness to firearm means safety in a sample of 300 American firearm owners. Overall, firearm owners were more willing to engage in means safety for others than for themselves and to store firearms safely than temporarily remove them from the home. Social policy views and region were significantly associated with openness to firearm means safety measures, however, economic policy views were not. This study provides further context for the development and implementation of efficacious means safety measures capable of overcoming potential barriers to their use.     

Hanging, firearm, and non-domestic gas suicides among males: a comparative study

OBJECTIVE: To identify characteristics that could distinguish males who completed suicide by hanging from males who completed suicide by firearms and non-domestic gas, and to suggest suicide prevention strategies targeted at hanging. METHOD: Using the psychological autopsy design, males who used hanging, firearms and non-domestic gas were compared on a range of variables covering social, psychological, and health related factors and aspects of the suicide incident. The sample consisted of 950 males who completed suicide in Queensland, Australia, between 1994 and 1996. RESULTS: Compared with males who used firearms and non-domestic gas, males who used hanging were significantly younger, less likely to have left a suicide note, and more likely to have been diagnosed with a psychotic disorder. Compared with males who used firearms, males who used hanging were significantly more likely to have made prior suicide attempts and have had no physical illness. Compared with males who used non-domestic gas, males who used hanging were significantly more likely to have lived with others, have had prior legal trouble, and have completed suicide at their residence. CONCLUSIONS: The results are discussed in terms of the availability and socio-cultural acceptability of methods. The authors suggest a possible relationship between impulsive traits and method choice. This proposition requires further investigation using alternative methodologies. Some suicide prevention measures targeting hanging suicides are discussed in light of the results.     

Season of birth associated with the age and method of suicide

Abstract

A recent study reported season of birth variation in CSF levels of 5-HIAA and HVA, with low 5-m for February to April and high HVA for October to January (Chotai & Asberg, 1999). We therefore analysed data on all completed suicides during 1952–1993 in the county of Västerbotten in northern Sweden (1466 cases), regarding these birth seasons in relation to suicide method and sociodemographic variables. Those with suicide age under 45 years were more likely than older suicides to have been born during February to April, significantly so compared to October to January. This was more pronounced for the later birth-year cohort (born in 1931 or later). Those who preferred hanging rather than poisoning or petrol gases were significantly more likely born during February to April. Those who preferred poisoning rather than hanging were significantly more likely born during October to January, particularly for the later birth-year cohort. The results regarding suicide method were somewhat more pronounced for males. The results of the study are compatible with a hypothesis of season of birth variation in CSF monoamine metabolites.     

Some differences between men and women who commit suicide

Men have persistently had a several-fold higher suicide rate than women. In this study of 204 consecutive suicides, the authors examined three areas in which the men differed from the women. Men used more violent, immediately lethal methods of suicide, were almost three times more likely to be substance abusers, and were more likely to have economic problems as stressors. The authors conclude that while the difference in suicide rate between men and women is complexly determined, the weight of the evidence suggests that more men than women intend to commit suicide.     

Factors associated with suicide method among psychiatric patients in a general hospital in Korea

This study aims to highlight the factors associated with suicide method among psychiatric patients in a general hospital in Korea. In a sample of 467 suicides by patients who had received mental health care in a general hospital in Korea, the relationship between suicide method and time of death as well as clinical characteristics, including psychiatric adiagnosis, was examined using multinomial logistic regression analysis. Compared with the general population, psychiatric patients, regardless of disorder, committed suicide by jumping from heights more often than by hanging (OR=2.35–8.64). In particular, patients with psychotic disorders and female patients were more likely to use jumping from a height than hanging to kill themselves (OR=2.98 and 1.83, respectively). Patients were more likely to use suicide methods other than hanging (e.g., OR=6.7 for jumping, 5.3 for drowning, and 2.7 for self-poisoning) between midnight and dawn. Possible suicide-prevention strategies suggested by this study include limiting access to or fencing off tall structures in close proximity to psychiatric institutions and residential care homes. At night, limiting access to or instituting heightened supervision of tall structures is specifically indicated.     

Differences in Firearm Suicides by Residential Location in Texas, 2006–2015

This study used Texas state vital statistics records, 2006–2015, to examine firearm use rates among 28,010 suicide decedents by residential location (urbanized vs. all others). Firearms were responsible for 44% of all teenage suicides and 76–90% and 50–60% of suicides of men and women aged 60?+?years, respectively, and firearm use rates remained steady for both genders during the study period. Logistic regression analysis showed a significantly higher firearm use rate (AOR =?1.35, 95% CI =?1.28–1.42) among decedents who resided in nonurbanized areas. Differences in firearm use rates by residential location likely reflect higher firearm ownership in smaller communities and rural than urban areas. The findings underscore the importance of community- and individual-level suicide prevention strategies.     

Trends in suicide rates of the elderly in Austria, 1970-2004: an analysis of changes in terms of age groups, suicide methods and gender

BACKGROUND: Suicides of the elderly (persons aged 65 and older) make up a large proportion of total suicides. Since suicide rates of the elderly are highest in western populations, addressing them as a risk group in prevention plans has been recommended. In order to assess possible approaches to prevention strategies, this study examines high-risk groups of the elderly. METHODS: We examined official statistics on suicides that occurred in Austria between 1970-2004 (18,101 Suicides of the elderly). We analyzed time trends and differences in suicide methods as well as in age groups and both genders of the elderly. RESULTS: Three major high-risk groups were identified: elderly male suicides by firearms; elderly female suicides by poisoning, which occur more often with increasing age; and suicides of both genders by jumping from heights. CONCLUSION: Besides conducting treatment of psychiatric disorders of the elderly, restricting the means to commit suicide may help to prevent it among the elderly. Such specific prevention strategies should be implemented in national suicide prevention plans for the high-risk groups identified in this study.     

Suicide by Firearm,a Unique Pattern from Iran

Throughout the one-year period from March 21, 2002 to March 21, 2003, the Legal Medicine Organization of Iran in Tehran investigated 27 firearms suicides. The crude mortality rate from firearms suicides was about 0.21 per 100,000 (the rate of suicide in Tehran is around 9.8 per 100,000).

All of the victims were young males. Military rifles were responsible for the majority of the suicides. The most common sites of entrance wounds were the submentum (37%) and chest (25.9%). In 84.6% of the cases gunshots were fired from contact or near contact range. With the exception of 1 of the suicides, all were committed at either garrisons or police stations. The unique pattern of suicides found in this series is discussed in the context of availability of method.     

Are suicide rates in Sweden associated with changes in the prescribing of medicines?

A key issue in the debate on suicide prevention is the extent to which suicide rates are affected by the availability of means of committing suicide. The aim of this study was to analyse the changes in rates of suicides committed by poisoning in Sweden between 1969 and 1992, and to determine to what extent these were associated with changes in the prescribing of medicines. We compared suicide rates from 1969 to 1992 with trends in the sales of antidepressants, barbiturates, neuroleptics and analgesics during the same period. The incidence of suicide by poisoning decreased during the 1970s, especially in younger and middle-aged men. This was mainly due to a decrease in suicides by barbiturate poisoning, which closely followed a decrease in sales of barbiturates. Sales of analgesics and antidepressants increased during the study period, and so did the rates of suicide using these drugs. We conclude that the availability of medicines is an important factor influencing suicide rates, and that changes in the prescribing of medicines may influence suicide rates.     

Association of IQ scores and school achievement with suicide in a 40-year follow-up of a Swedish cohort

Objective: Few studies have investigated the association of childhood IQ and school achievement with suicide. The aim of this study was to investigate the association of childhood IQ with suicide in a cohort of Swedish women and men. Method: 21 809 subjects born in 1948 and 1953 who completed IQ and school tests at age 13 years have been followed until 2003. Information on paternal education and in‐patient care for psychosis was linked using the Swedish personal identification number. Results: There were 180 suicides amongst subjects with measured IQ. High IQ was associated with reduced suicide risk among men (OR per unit increase in age‐adjusted model 0.90, 95% CI 0.83–0.99), while there was no statistical evidence of an association in women (OR 1.04, 95% CI 0.90–1.20). Among men with a history of psychosis, high IQ was associated with an increased risk of suicide. Conclusion: Low childhood IQ at age 13 years is associated with an increased risk of suicide in men but not in women; however, amongst those with psychosis, low IQ appears to be protective.