Australian suicide trends 1964-1997: youth and beyond?

OBJECTIVE: To examine Australian suicide rates across all ages, and compare Australian rates with those of other Western nations. DESIGN: Australian Bureau of Statistics data were used to examine Australian suicide trends, 1964-1997, by age and sex. For comparison, suicide rates of 22 other Western nations, 1990-1994, were obtained from the World Health Organization. RESULTS: Australian suicide rates for males 15-24 years and 25-34 years rose from 1964-1997. Comparable rates for females showed no significant change. Suicide rates for several of the older age and sex groups declined over this period. Comparison with suicide rates of other Western nations showed that, while Australian youth suicide rates are relatively high, this is not the case for older age groups. Australian suicide rates are higher than those in the European nations of origin of our major migrant groups, but similar to those of other Western nations also recently colonised by Europeans (Canada, the United States and New Zealand). CONCLUSIONS: Priorities for suicide prevention in Australia are correctly concentrated on youth, but the targeted age range should be extended to include men aged 25-34 years. A comprehensive policy should also not neglect the needs of other age groups. Further epidemiological study of national and international data may suggest new approaches to suicide prevention.     

Alcohol, firearms, and suicide among youth. Temporal trends in Allegheny County, Pennsylvania, 1960 to 1983

The death certificates and coroners' reports for all suicides, undetermined causes of death, and questionable accidents were obtained from the Pennsylvania Department of Vital Statistics for 10- to 19-year-old residents of Allegheny County, Pennsylvania, from 1960 to 1983. During the 24-year study period, 159 cases of definite suicide and 38 cases of likely suicide were noted. The suicide rate increased markedly among youth during the study period, particularly among white males aged 15 to 19 years, and was not due to changes in classification procedures over time. The suicide rate by firearms increased much faster than the suicide rate by other methods (2.5 vs 1.7-fold). The proportion of suicide victims who had detectable blood alcohol levels rose 3.6-fold from 12.9% in 1968 to 1972 to 46.0% in 1978 to 1983. Suicide victims who used firearms were 4.9 times more likely to have been drinking than were those who used other methods of suicide. The availability of firearms and the increased use of alcohol among youth may have made a significant contribution to the increase in the suicide rate among the young.     

Suicide management skills and the medical student

To determine the suicide management skills of medical students at different levels of training, 141 medical students were administered the Suicide Intervention Response Inventory (SIRI), a self-report instrument assessing skills in responding to the self-destructive patient. As predicted, third-year students having completed a course in medical interviewing scored higher on the SIRI than first-year students who had not. Additional improvement in suicide management skills was evidenced for third-year students who completed a six-week inpatient psychiatry rotation. Whether or not students believed that suicide was ethically acceptable in some circumstances had no impact on their ability to select an appropriate response to the self-destructive patient. Several additional findings are discussed, and the potential utility of the SIRI in evaluating medical student skills in this important area is highlighted.     

海南医学生自杀意念现况及影响因素研究

目的 了解海南医学生自杀意念的现状及其影响因素,为预防其自杀提供科学依据.方法 采用多阶段抽样方法,选取11个专业共696名海南医学院学生作为研究对象,采用一般情况调查表、简易应对方式问卷、青少年生活事件量表（ASLEC）、抑郁自评量表（SDS）、社会支持评定量表、自尊调查表和自杀意念调查表（SIOSS）进行调查.结果 ①海南医学院学生自杀意念发生率为15.4％,自杀意念率男性高于女性（=7.161,P=0.006）.②Logistic回归分析,结果显示户口所在地在农村和高抑郁是自杀意念产生的危险因素,而积极应对方式、较高的客观支持和高自尊是自杀意念的保护因素.结论 自杀意念在海南医学院学生中的发生率较高,且自杀意念的产生是多种因素共同作用的结果,应从学校、家庭、社会三方面共同采取措施,减少自杀意念的产生,防止自杀意念转变为自杀行为.     

What people close to death say about euthanasia and assisted suicide: a qualitative study

OBJECTIVE: To explore the experiences of people with a "terminal illness", focusing on the patients' perspective of euthanasia and assisted suicide. METHOD: A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a "terminal" illness, malignant or non-malignant. RESULTS: That UK law should be changed to allow assisted suicide or voluntary euthanasia was felt strongly by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse. CONCLUSION: Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death.     

Youth suicide in New South Wales: urban-rural trends.

OBJECTIVE: The study tested the hypotheses that (i) the rate of suicide by firearms among youth (aged 10-19 years) is increasing at a greater rate than rates of suicide by other methods; (ii) the rate of youth suicide in rural New South Wales is significantly higher than those in urban areas; and (iii) the increase in youth suicide by means of firearms is occurring at a greater rate in rural males aged 15-19 years than in other groups. DESIGN: Data were obtained from the NSW Office of the Australian Bureau of Statistics concerning 735 youth suicides in NSW between 1964 and 1988. These were reviewed for information concerning residential area and method of death. Five five-year periods were used, and rates were calculated with population figures obtained in the census years for the same age and sex group. RESULTS: From 1964 to 1988, suicide by firearms has risen most substantially, from 3.4 to 5.6 per 100,000 per year in 15-19-year-old males. There has also been a substantial increase in 15-19-year-old male suicides by hanging (0.7 to 3.4 per 100,000 per year). Poisoning suicides have declined among females and males in the past 15 years. Suicide rates in Sydney, Newcastle and Wollongong have remained stable. In rural cities, they have increased from 1.5 to 4.7 per 100,000 per year (F = 4.9, P less than 0.02) while in rural municipalities and shires they have increased from 1.3 to 6.4 (F = 14.6, P less than 0.0001). The suicide rate of 15-19-year-old males has shown a modest increase in Sydney and no change in Newcastle or Wollongong, but the rate for 15-19-year-old males in rural cities has more than doubled, from 5.1 to 12.5 (F = 7.7, P less than 0.003), while in rural municipalities and shires, the rate has increased more than fivefold, from 3.9 to 20.7 (F = 9.3, P less than 0.001). There has been no significant change in the suicide rates of 15-19-year-old females, or in 10-14-year-olds. The rate of suicide by firearms among 15-19-year-old males has not risen significantly in rural cities, but in rural municipalities and shires the rates have risen fivefold from 2.8 to 14.8 (F = 5.6, P less than 0.01). CONCLUSIONS: Each hypothesis was confirmed. An increase of this magnitude is not an artefact of coroners' verdicts. The findings are believed to be due to ready access to firearms, the use of alcohol and drugs (particularly in firearms suicides) and increasing socioeconomic, health, and identity problems for rural youth, especially males.     

抑郁症自杀相关基因的研究进展

自杀是全球重大的公共卫生问题,在全球范围内都是主要的死亡原因之一,给人类造成巨大的社会经济损失和心理伤害。抑郁症是自杀死亡的首要原因,探究抑郁症自杀的病理生理机制对于预防和减少自杀具有重要意义。抑郁症自杀与遗传、环境、社会、心理以及生物学因素关系密切。随着基因组学技术的发展,越来越多的研究者对抑郁症自杀相关基因进行探究。对近年来抑郁症自杀相关基因的研究进行综述,以期为其病理机制研究提供思路。     

广东省大学生死亡、自杀态度及死亡教育需求调查

目的:了解大学生对死亡、自杀的态度及死亡教育的需求,为学校死亡教育的开展提供理论基础,引导大学生建立正确积极的生命观。方法:采用整群随机抽样方法,应用死亡态度和自杀态度问卷调查广东省4所高校在校大学生,对研究因素进行t检验统计分析。结果:80.8%的大学生认为死亡是生命的必然结局,但面对死亡时仍有54.6%的人会产生悲伤、恐惧等消极态度,说明大学生对生命的本质及意义的认识不够深刻;81.8%的大学生愿意接受死亡教育,说明大学生有死亡教育需求,但仅有20.8%的人接受过死亡教育,反映高校死亡教育缺失,从大学生自杀态度总体情况看,大学生对自杀持中立或矛盾的态度。结论:在高校开展死亡教育,有利于提高大学生对死亡的认识和思考,引导大学生建立健康积极的生命观,降低大学生的自杀率。     

老年上消化道出血的病因与影响预后的因素

目的:探讨老年上消化道出血(UGB)的病因、合并症及其严重程度对预后及治疗费用等的影响。方法:对同期因UGB住院的347例老年患者及545例中青年患者的临床资料进行统计分析。结果:UGB患者中老年女性的发病比率高于中青年组女性,老年组的住院费用、合并症患者及病死率显著高于中青年组;老年组的球溃、复合溃疡发病率、HP感染率低于中青年组;老年组糜烂性胃炎、胃溃疡、胃癌、胰腺癌、各类肿瘤浸润转移致UGB及不明原因的出血高于中青年组;老年组食道癌、肝癌及肝硬化的发病率与中青年组相似;老年死亡组与非死亡组在年龄、性别上无显著差异,老年死亡组住院费用、合并症高于非死亡组;合并休克及严重糖尿病、心、肺、肾疾病的病死率显著增高。结论:老年上消化道出血中胃溃疡、胃癌、其他肿瘤浸润转移以及不明原因出血者、合并症、病死率高于中青年组,老年组占用了更多的医疗资源并以老年死亡组为最;老年死亡组有更多以及更严重的合并症。     

Epidemiology of suicides in Northern Ireland 1984–1989

Suicide in the UK is the 2nd commonest cause of death among the under 45 year age group accounting for 10% of all Potential Years of Life Lost (PYLL). An epidemiological analysis has been carried out on selected factors based on 558 consecutive cases (1985-89) of self-inflicted death. The study reveals a dramatic increase in suicide among young men and especially security force personnel. There has also been a change in the methods used and the age/sex profile.     

A Systematic Literature Review of Technologies for Suicidal Behavior Prevention

Suicide is the second cause of death in young people. The use of technologies as tools facilitates the detection of individuals at risk of suicide thus allowing early intervention and efficacy. Suicide can be prevented in many cases. Technology can help people at risk of suicide and their families. It could prevent situations of risk of suicide with the technological evolution that is increasing. This work is a systematic review of research papers published in the last ten years on technology for suicide prevention. In September 2017, the consultation was carried out in the scientific databases PubMed, ScienceDirect, PsycINFO, The Cochrane Library and Google Scholar. A general search was conducted with the terms “prevention” AND “suicide” AND "technology. More specific searches included technologies such as "Web”, “mobile”, “social networks”, and others terms related to technologies. The number of articles found following the methodology proposed was 90, but only 30 are focused on the objective of this work. Most of them were Web technologies (51.61%), mobile solutions (22.58%), social networks (12.90%), machine learning (3.23%) and other technologies (9.68%). According to the results obtained, although there are technological solutions that help the prevention of suicide, much remains to be done in this field. Collaboration among technologists, psychiatrists, patients, and family members is key to advancing the development of new technology-based solutions that can help save lives.     

四所综合医院自杀未遂者自杀意念特征

目的了解自杀未遂者有无自杀意念特点,为自杀未遂心理危机干预策略提供参考。方法使用贝克自杀意念量表（BSS）和美国精神障碍诊断与统计手册第4版病人版（DSM-Ⅳ）轴I障碍临床定式检查为调查和诊断工具,对同一时段内在沈阳市4所三级综合医院急诊室诊治的自杀未遂者进行调查。结果①有无自杀意念两组在性别、年龄、受教育年限等方面无显著性差异（P〉0．05）,但两组在这次最早出现伤害自己的想法到自伤所间隔时间、自伤最主要的目的、自杀当时想死程度、对这次自杀态度等方面存在显著差异（P〈0．01）。结论有无自杀意念自杀未遂者的特征有明显不同。     

Deaths in children with a diagnosis of acute appendicitis in England and Wales 1980-4

Thirty five children died of acute appendicitis in England and Wales in 1980-4 compared with 204 in 1963-7. Thirteen of the 35 deaths in 1980-4 took place at home or on the day of admission to hospital before operation and a further 18 on the day of operation or the first day after it. Thirty one of the children had peritonitis. A third of the deaths were in children aged 0-4 years, and the hospital fatality rate in this age group was one death in 320 cases compared with one death in 4760 cases in children aged 5-14 years. The fall in the number of deaths between the 1960s and the 1980s was due to improvements in medical care, a reduction in the incidence of appendicitis, and changes in the age structure of the child population. Difficulty and delay in diagnosis and inadequate intravenous therapy are now the main factors contributing to death.     

医学生自杀态度与自我和谐的相关性研究

目的：了解医学生自杀态度和自我和谐水平,并分析两者的相关性。方法：采用自杀态度问卷（SAQ）和自我和谐量表（SCCS）对554名医学生进行问卷调查。‘结果：多数医学生对自杀行为、自杀者、安乐死持矛盾或中立的态度;医学生自我和谐总分大多处于中（77．08％）、高分组（12．45％）水平;医学生的自杀态度及自我和谐程度在人口学上存在差异（P〈0．05）。相关与多元回归分析发现,自我与经验的不和谐、自我的灵活性及自我的刻板性均对自杀态度有影响作用（P〈0．05）。结论：医学生对自杀的态度以中立为主,其自我和谐程度不高,自我和谐程度是影响自杀态度的重要因素。     

抑郁症住院患者的自杀行为及防范措施

抑郁症患者主要表现情绪低落,抑郁悲观,终日忧心忡忡,对工作、学习、家庭、前途丧失信心,常有自责自罪观念;认为自己丧失工作能力,成为废人,或对微不足道的小事加以夸大,并罗列种种罪名,出现消极观念--自杀行为.据资料统计,抑郁症患者自杀率为4%～10.6%,其中单相抑郁症患者自杀率高达26.4%.自杀企图和行为是住院抑郁症患者最危险的而且是最常见的症状,因此预防防范自杀行为的发生是临床护理工作的重要任务之一.应对抑郁症住院患者加强相应的护理干预措施,减少甚至杜绝自杀行为的发生率.     

Suicide and depression

Suicide is considered to be a symptom or sequel of depression. Depressive patients (15-20%) die after committing suicide. Aetiology of suicide comprises social factors, psychological factors and biological factors. Suicide, ideational or operational must receive immediate therapeutic attention. Pharmacotherapy, electroconvulsive therapy constitute the management of suicide--Preventive strategies include primary, secondary or tertiary preventions.     

昆明医科大学医学生自杀企图和自杀态度状况调查分析

目的研究医学生的自杀企图、自杀态度状况及特点,为心理健康教育与咨询工作提供针对性建议．方法采用自编的自杀企图调查题目和自杀态度问卷（QSA）对昆明医科大学567名本科生和130名研究生进行测查,对不同群体进行比较．结果14．46％的医学生有自杀意念,4．23％的医学生有过自杀行为的尝试,男、女生无显著差异（P〉0．05）;医学生总体自杀态度为矛盾、中立态度,自杀态度在性别、学历、年级、家庭所在地、经济状况变量上存在显著差异（P〈0．05）．结论医学生虽然对采取自杀这一行为本身并不认可,但仍在一定程度上体现出对人的关怀及对生命质量和生命价值的尊重和追求;人口统计学变量对医学生自杀态度具有显著影响．     

Estimates of the number of motherless youth orphaned by AIDS in the United States.

OBJECTIVE--To estimate the number of youth in the United States who have been or will be left motherless by the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic, in order to project the need for family supports, age-appropriate foster and congregate care, and mental health and social services. DESIGN--Orphans are defined as youth whose mothers (the usual caregiving parent) die of HIV/AIDS-related causes. A mathematical model was constructed to estimate the number of such motherless youth. Cumulative fertility rates were applied to the number of reported AIDS deaths (1981 through 1990) and projected deaths (1991 through 1995) of adult women less than 50 years old. The results were adjusted for underreporting of HIV/AIDS-related mortality, pediatric AIDS deaths, infant mortality, ethnic and racial variation in fertility, and decreased fertility associated with late-stage HIV disease. Estimates were made for the number who were children (less than 13 years of age), adolescents (13 to 17 years of age), or young adults (18 years of age or older) at the time of their mothers' death. RESULTS--By the end of 1995, maternal deaths caused by the HIV/AIDS epidemic will have orphaned an estimated 24,600 children and 21,000 adolescents in the United States; unless the course of the epidemic changes dramatically, by the year 2000, the overall number of motherless children and adolescents will exceed 80,000. In 1991, an estimated 13% of US children and 9% of adolescents whose mothers died of all causes were children of women who died of HIV/AIDS-related diseases. These proportions will surpass 17% and 12%, respectively, by 1995. The vast majority of these motherless youth will come from poor communities of color. CONCLUSIONS--A large and rapidly growing number of American youth are being orphaned by the HIV/AIDS epidemic. Unless increased attention and resources are devoted to this vulnerable population, a social catastrophe is unavoidable.     

精神病专科医院门诊病人自杀意念调查与预防研究

目的对精神病专科医院门诊病人自杀意念进行调查研究。方法对2009年3月至2010年3月期间,在我精神病专科医院门诊部就诊的患者进行调查。结果在145例有效问卷中,有60例（41.38%）表示自己在过去的1周内有过自杀念头,有85人（58.62%）表示自己在过去的1周内没有过自杀念头。结论开展有关自杀心理的调查,积极采取措施进行预防,对于减少自杀发生有重要作用。     

2006—2016年15例相约自杀案件分析

 目的 分析15例相约自杀死亡案件的特点,为此类型自杀案件的法医现场勘验及死亡方式鉴定提供参考和借鉴。方法 收集2006—2016年上海市闵行区及虹口区发生的相约自杀死亡案件15例,对案件中相约自杀人员的性别、年龄、关系、相约方式、自杀动机、自杀方式及现场情况进行统计分析。结果 15例案件中,男性多于女性,主要为18～44岁青年,大部分有明确的自杀动机,网络相约自杀案例明显增多,采用烧炭方式自杀者居多,大部分选择宾(旅)馆作为实施自杀的处所,一般采取相同的自杀方式。结论 了解案件特点有助于法医在同类型案件中抓住现场勘验重点,对死亡方式和性质作出快速、准确的判断。