The partners' views on precipitant stressors in suicide.

All suicides (n = 1397) in Finland during 1 year were studied by thorough interviews with the surviving next of kin. We included 388 suicides after which a spouse's or a cohabiting partner's subjective views of precipitant stressors in suicide process during the last 3 months and earlier in life were determined. In 82% of the cases the partner considered life events as precipitant stressors for the suicide. Among men, the most common stressors considered as suicide precipitants were somatic illness (25%), interpersonal discord (22%) and separation (14%). Among women these were mental disorder (28%), interpersonal discord (18%) and death of a significant other (17%). Somatic illness and retirement were more commonly considered as precipitants among older men, whereas interpersonal discord, separation and financial trouble were more common among younger men. Among women, job problems were more commonly considered as precipitants for younger subjects. Among both sexes, childhood adversity was more commonly reported among the younger subjects.     

Gender differences in life stressors associated with child and adolescent suicides in Singapore from 1995 to 2003

AIMS: This study explored gender differences in life stressors of children and adolescents who died by suicide. Three main classes of life stressors have been identified by previous research to be significant risk factors for suicide in children and adolescents: interpersonal/relationship problems, family problems, and academic/school problems. METHODS: The sample consisted of 156 (89 males and 67 females) completed child and adolescent suicides in Singapore from 1995 to 2003. The age of these individuals ranged from 10 to 19 years with a mean age of 16.49 (SD = 2.59). RESULTS: Significantly more females were found to have had interpersonal/ relationship problems as recent life stressors compared with males. No gender differences were found for the other two life stressors, family problems and academic/school problems. In addition, among the three life stressors studied, only interpersonal/relationship problems emerged as a significant predictor of female child and adolescent suicide. CONCLUSIONS: Consistent with previous research literature, these findings contribute to a growing literature documenting the relatively larger impact of relational life stressors on child and adolescent female suicidality. Implications for suicide intervention and prevention, especially among young females, were discussed.     

Suicide after hospitalization in the elderly: a population based study of suicides in Northern Finland between 1988-2003

OBJECTIVE: Elderly people commit suicide more often than people under the age of 65. An elevated risk is also attached to depression and other axis I psychiatric disorders. However, little is known about the preferred suicide method, effect of primary psychiatric diagnosis, and length of time between discharge from psychiatric hospitalization and suicide. The lack of information is most apparent in the oldest old (individuals over 75 years). METHODS: On the basis of forensic examinations, data on suicide rates were separately examined for the 50-64, 65-74 and over 75 year-olds (Total n=564) with regard to suicide method, history of psychiatric hospitalization and primary diagnoses gathered from the Finnish Hospital Discharge Register. Study population consisted of all suicides committed between 1988 and 2003 in the province of Oulu in Northern Finland. RESULTS: Of the oldest old, females had more frequent hospitalizations than males in connection with psychiatric disorders (61% vs 23%), of which depression was the most common (39% vs 14%). In this age group, 42% committed suicide within 3 months after being discharged from hospital and 83% used a violent method. Both elderly males and females were less often under the influence of alcohol, but used more often violent methods than middle-aged persons. CONCLUSIONS: Suicide rates within the first 3 months following discharge from hospital in the 65-74 and the over 75 year olds were substantial and should influence post-hospitalization treatment strategies. To reduce the risk of suicides in elderly patients discharged from hospital, close post-hospitalization supervision combined with proper psychoactive medication and psychotherapy, are possible interventions.     

Suicide, stressors, and the life cycle

OBJECTIVE: Relationships between stressors and suicide might be expected to vary with stages of the life cycle. The purpose of this study was to examine this possibility. METHOD: The authors examined the first 204 consecutive cases from the San Diego Suicide Study, a federally funded investigation of 283 suicides, for possible relationships between suicide and age and the frequency of specific stressors. Information was gathered from family members, spouses, acquaintances, employers, other witnesses, physicians, and other professionals by trained interviewers using a structured format. Hospital, physician, therapist, school, and police records were also included when available. DSM-III diagnoses were made by consensus of two investigators. Life events information was also reviewed independently by the investigators to determine stressors (if any) for each case. RESULTS: Of the 202 subjects for whom data were available, 195 (97%) had one or more stressors; 137 male subjects had a total of 272 stressors, and 58 female subjects had a total of 115 stressors. The authors found predictable patterns of the three most common stressor groups--conflict-separation-rejection, economic problems, and medical illness. The majority of the stressors among subjects 80 years old or older were illnesses. The only significant difference between the sexes was that more men than women had economic problems as a stressor. CONCLUSIONS: The variations in the patterns of stressors found in this study of suicides coincide with adult development theory. The lack of population comparison subjects and stressor scoring validation, however, limits the predictive value of these data in assessing suicidal persons.     

Recent life events and their role in suicide as seen by the spouses.

The occurrence of recent life events during the last 3 months and their significance in the suicide process as subjectively perceived by the surviving partners were studied among a subpopulation of suicide victims (n = 400) who had a spouse or a cohabitant as the informant. This subpopulation was drawn from a total suicide population (n = 1397) of 1 year in Finland. According to the partners' reports, life events during the last 3 months were reported in 85% of the suicides. Job problems (33%), family discord (32%) and somatic illness (29%) were most commonly reported. More male than female victims had experienced recent life events, and the mean number of events was higher among men than among women. There were differences between single life events in terms of how often the partners perceived them as precipitants of suicide. Separation was seen as the most critical event: in 68% of suicides with reported separation during the last 3 months the partner also rated it as a precipitant, followed by somatic illness in 57%, family discord in 44%, financial trouble in 44%, unemployment in 34%, death in 29%, job problems in 19% and illness in family in 14%.     

Suicide in adolescent psychiatric inpatients: incidence and predictive factors

Of 1969 previous adolescent psychiatric inpatients, 1792 (91%) were traced after a mean follow-up period of 15 years. Thirty-five patients, 1.7% of the females and 2.2% of the males, had committed suicide, corresponding to a yearly suicide rate of 145/100,000 for males and 110/100,000 for females. This represents a 6-fold increase for males and a 19-fold increase for females compared with the suicide rate for 15- to 29-year-old males and females in the general population. There was seasonality in violent but not in nonviolent suicides. The patients who had committed suicide were compared with matched patients from the same sample who stayed alive. The suicide group had more depressive symptoms, more learning difficulties, poorer self esteem, were more help-rejecting, and had more immature defense mechanisms. They lacked parental support and were more often verbally abused by their parents. They had more frequently experienced serious losses in early childhood and had a higher score on enduring stressors on Axis IV in DSM-III-R. They more often came from urban areas and received poorer follow-up after discharge from hospital. Eight of these discriminating factors were combined into a predictive model for the lifetime risk of suicide in adolescent psychiatric inpatients. The model had strong predictive power, classifying 84% of the population correctly.     

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.     

Psychosomatic tendency for suicide among the elderly in Mie Prefecture, Japan

Background: The aim of the present study is to show the causative factors of suicide among the elderly (over 65) in Mie Prefecture, Japan, and to discuss the prevention of the suicidal influences in elderly patients. Methods: We investigated all inquest records during the 14‐year period 1989–2002 in cooperation with the First Department of Criminal Investigation of Mie Prefectural Police Headquarters. From all cases classified as suicides, we extracted data on age, sex and background, and we focused on suicide in the elderly group. Results: During the test period, there were 5048 suicides (3276 male and 1772 female suicides) of which 1513 (691 male and 822 female) were in the elderly group. The rate of suicide in the elderly group was approximately 30% of the total in all age groups. The rate of female suicides in the elderly group was approximately 46.3%. The major causative factors of suicide among the elderly were ‘suffering from physical illness’, and ‘psychiatric disorders’. ‘Physical diseases’ were not negligible backgrounds in middle and elderly groups. Among physical diseases, the number of malignant neoplasm was clearly less than the other diseases. Notably, ‘cardiovascular disease’ and ‘orthopedic disorders’ were most frequent causative factors of suicide other than malignant neoplasm. Conclusion: It is consequently concluded that improvements in the system of home nursing and health care should be involved in the suicidal prevention of the elderly who ‘suffer from physical illness’. The patients who ‘suffer from physical illness’ should be given physical and mental support. In order to prevent suicide, not only psychiatrists but also general practitioners as well as medical staff and general public should be provided with education regarding depression among ‘psychiatric disorders’.     

Mortality and rate of suicide of first admission psychiatric patients. A 5-year follow-up of a prospective longitudinal study

Patients who commit suicide in a psychiatric hospital are, in general, patients who have had previous admission or who have already made at least one suicide attempt. The following study focuses upon an earlier time within the course of a psychiatric illness, that is the time of first admission, and examines the rate of suicide of 258 patients after 5 years. Two control groups were selected: first admitted psychiatric patients who did not commit suicide, and patients who died a 'natural death'. We analyzed how the suicides were integrated into the vocational, social and medical areas of life before they were admitted to the hospital. Further it was possible to identify predictors of future suicide.     

General hospital suicides--a psychological autopsy study in Finland

Although both severe medical disorders and mental disorders are established risk factors for suicide, it is not known if patients who commit suicide in general hospitals differ from others. This study investigated current mental disorders and other clinical characteristics among general hospital suicide victims and compared them with other suicide victims in an unselected nationwide population. Drawing on data from a psychological autopsy study of all suicides (N = 1397) in Finland during one year, all suicides committed by patients in a general hospital setting were identified. Retrospective DSM-III-R consensus diagnoses were assigned and general hospital suicide victims were compared with other suicide completers in terms of clinical characteristics. Twenty-six general hospital suicide victims, 1.9% of all suicides, were identified. Subjects who completed suicide during general hospital treatment were older and used more violent suicide methods than other suicide victims. One or more diagnoses of psychiatric (Axis I) disorders were assigned for 88% of the general hospital suicide victims. Overall, the most prevalent disorder was major depression, which was more common among the general hospital suicide victims, even when age was controlled for. The findings of this study suggest that most people who commit suicide during a spell of general hospital treatment suffer from current mental disorder, as do suicide victims in general. The recognition and treatment of major depression in particular should be improved in order to prevent suicide in general hospitals.     

Suicide in Hong Kong

Coroners' statistics indicated there were 684 suicides for the whole of Hong Kong in 1981. This gave a crude suicide rate of 18.1 per 100,000 population aged 15 years and over and constituted 2.7% of all deaths reported in that year. Only a few data were recorded in all coroners' files but additional data were obtained from police records on 168 of these suicides. The age and sex distribution among the suicides as well as the effect of marital and employment status on suicide rates were found to be similar to western countries. Jumping from a height was the most common method of suicide (47.2%) followed by hanging (30.8%). Psychiatric illness and chronic physical disability were two most important precipitating causes of suicide (39.8% and 35.7% respectively). Twenty per cent had a history of previous attempts with one-third occurring within six months of their completed suicide. Over 40% had communicated their suicide intention to others, while 19% left a note. 'Psychiatric' cases as a group had special features: there were more in the younger age groups, more with records of previous suicide attempts and more chose readily available methods.     

Seasonal variation in suicide occurrence in Finland

The aim of this study was to investigate the age-, gender- and suicide method-related seasonality of suicide occurrence by using the largest database examined so far (n=21 279). The Chi-square test for multinomials was used as the overall measure of deviation. The monthly observed and expected numbers of suicides were calculated and classified by year, month, gender, age groups and suicide methods. To identify the statistically significant peak and trough months, the ratio of observed numbers of suicides to expected numbers with 95% confidence intervals was calculated. For males, there was a suicide peak from April to July, while for females the distribution was bimodal (with peaks in May and October). In elderly people there was a significant excess in the number of suicides in autumn, and the troughs were deeper in winter. For violent suicides there was a unimodal spring peak, but for non-violent suicides the distribution was bimodal. The results indicate that suicides among elderly subjects, as well as non-violent suicides, occur significantly more often during autumn than would be expected.     

Suicide patterns and characteristics in Akita, Japan

Akita Prefecture currently has the highest rate of suicide in Japan. Given this alarming statistic, investigation of the underlying causes of suicide and identification of strategies for suicide prevention are imperative. Members of the Akita Prefectural Medical Association (APMA) see most of the individuals who commit suicides in Akita Prefecture, so data from the APMA would prove advantageous in any investigation of suicides. In this study, members of the APMA who had attended to individuals who had committed suicide were asked to complete a questionnaire about the case to determine the factors underlying suicide in Akita Prefecture. From 1 July 2001 to 30 June 2002, a total of 138 cases (102 males, 36 females) of suicide were reported. Most suicide cases were of 50-69 year olds. Many cases involved relatively lethal methods (such as hanging). Most suicides were performed at home and at a time when the rest of the family was asleep or absent. The most common complaint appeared to be economic-related problems. Depressive disorder was the most common psychiatric disorder, and many cases displayed high depressive trait scores. The present results do not exclude the possibility that economic-related problems are playing a major role in recent increases in suicide numbers. However, strategies for dealing with depression as well as economic-related problems are considered important.     

Who Leaves Suicide Notes? An Exploration of Victim Characteristics and Suicide Method of Completed Suicides in Queensland

The objective of this study is to address the question: are those who leave suicide notes representative of the larger population of those who commit suicide? The method involves an analysis of a full population of suicides by residents of Queensland, Australia for the full year of 2004, with the information drawn from Coronial files. Our overall results suggest that, and in support of previous research, the population who leaves suicide notes are remarkably similar to those who do not. Differences are identified in four areas: first, and in contrast to prior research, females are less likely to leave a suicide note; second, and in support of previous research, Aboriginal Australians are less likely to leave suicide notes; third, and in support of some previous research, those who use gas as a method of suicide are more likely to leave notes, while those who use a vehicle or a train are less likely to leave notes; finally, our findings lend support to research which finds that those with a diagnosed mental illness are less likely to leave notes. The discussion addresses some of the reasons these disparities may have occurred, and continues the debate over the degree to which suicide notes give insight into the larger suicide population.     

A report on attempted suicide cases involving patients accepted by public health care institutions

We investigated attempted suicide cases, both successful and failed involving patients, accepted by public health care institutions in Shiga Prefecture, whose population is about 1. 4 million, from the 12th January 2010 to 14th February 2010. Prefectural emergency hospitals, fire stations, and pathologists cooperated in the investigation, and the cases were reported with the age and sex as well as the means and results of the attempts. How these institutions cooperated in the cases was also reported. A total number of 104 people attempted suicide, in which 40 people (38.5%) succeeded, 54 people (51.9%) failed, and the outcome was unknown in 10 people (9.6%). Forty-one people (39.4%) were in their 30s, being the most common age group. Successful suicides were most prominent among elderly males, and failed attempts were most prominent among young females. Hanging and poisonous gassing were the common means of suicide among the successful cases, and overdose, drinking, and wrist -cutting were the common means among the failed attempts. Sixty-four people (61.5%) were admitted to public emergency hospitals, 51 people (49.0%) were rescued by fire workers, and 34 people (32.7%) were sent for autopsy following police reports on fatal cases as suicide. Successful suicides and males were mostly sent for pathological examination without any coordinated care from different medical institutions, whereas, failed cases and females were often taken care of by several institutions. Five people (4.8%) were referred for psychiatric help. Suicide intervention needs to take account of differences in the sex, age, means, and other characteristics of those who attempt suicide. Each institution plays an important role, and they need to cooperate in order to establish an effective intervention.     

Ethnic differences in patterns of suicide across the life cycle

OBJECTIVE: The authors analyzed suicide across the life cycle of different ethnic groups in an urban population equally divided between blacks (44.6%) and whites (48.1%). METHOD: Two data sets were used: 1) all suicides in Fulton County, Ga., from January 1994 through December 2002 and 2) all U.S. suicides reported by the National Center for Injury Prevention in 1999 and 2000. RESULTS: The population rates for suicide in Fulton County were 1.22 per 100,000 black females, 10.74 per 100,000 black males, 9.89 per 100,000 white females, and 21.04 per 100,000 white males. In Fulton County, age at completed suicide was more than a decade lower in blacks than in whites. The median age of black victims was 32 years, with an interquartile range (IQR) of 23-45, and the median for whites was 44 years (IQR=31-58); the difference was significant. The mean ages of victims who were black (mean=36.1 years, SD=17.0) and of "other" race (mean=35.7, SD=14.3) were significantly lower than the mean for whites (mean=46.2, SD=18.5). The national data were similar, but minorities accounted for an even smaller percentage of suicides. Median age at completed suicide for African Americans nationally was 34 years (IQR=24-45) compared to 44 years (IQR=32-58) for Caucasians. CONCLUSIONS: African Americans commit suicide at rates much lower than those for whites, but they do so when much younger and they have a narrow, age-defined window of vulnerability. Age-specific psychopathological processes and protective factors may define suicide risk for each demographic group.     

Suicide in Hungarian Huntington's disease patients

We studied 96 families with Huntington's disease (HD). There were 396 deaths reported in 195 males and 201 females. Family history and clinical information about the deceased were collected and 40 suicides were found. Suicide occurred most frequently in the early or late stages of the disease; age at onset was slightly lower among those who committed suicide. Of the 40 subjects who committed suicide, 34 were male and 6 were female; this was not significantly different to the expected ratio based on suicide in the general population. Those who committed suicide had a smaller number of children than other HD patients. No significant relationship was shown between the sex of the affected parent and suicide. Four suicides occurred in hospital. Suicide among patients with HD is more common than in the general population. Knowledge about the high suicide risk in this disease is important for genetic counseling.     

有严重躯体疾病老年自杀死亡者的特征及其有无精神障碍者间的比较

目的了解有严重躯体疾病的老年自杀死亡者的特征并比较有无精神障碍者特征的异同。方法由精神科医师运用心理解剖方法对全国23个疾病监测点上报的≥55岁的304例自杀案例的家属和周围知情人进行调查,分析其中178例(58.6%)报告自杀死亡前1年内有严重躯体疾病者的自杀特征。结果178例自杀死亡者中,女性占41.6%;79.2%居住在乡村;58.4%从未上过学;38.8%丧偶;25.8%有自杀未遂既往史;10.7%一级血缘亲属有自杀行为;43.3%服农药或鼠药自杀,32.6%上吊;68.0%自杀当时有精神障碍,主要是重性抑郁障碍;仅5.1%自杀当时有人在场。有、无精神障碍者在社会人口经济学特征、有无自杀未遂史和自杀行为家族史、负性生活事件导致的慢性心理压力和急性应激强度以及自杀前一个月的生命质量等方面的差异无统计学意义(P均大于0.05)。结论有严重躯体疾病老年人自杀死亡最常见的两种方式是服毒和上吊,2/3有精神障碍,但有无精神障碍者的自杀相关特征无明显不同。     

Characterizing Suicide in Toronto: An Observational Study and Cluster Analysis

Objective:

To determine whether people who have died from suicide in a large epidemiologic sample form clusters based on demographic, clinical, and psychosocial factors.

Method:

We conducted a coroner’s chart review for 2886 people who died in Toronto, Ontario, from 1998 to 2010, and whose death was ruled as suicide by the Office of the Chief Coroner of Ontario. A cluster analysis using known suicide risk factors was performed to determine whether suicide deaths separate into distinct groups. Clusters were compared according to person- and suicide-specific factors.

Results:

Five clusters emerged. Cluster 1 had the highest proportion of females and nonviolent methods, and all had depression and a past suicide attempt. Cluster 2 had the highest proportion of people with a recent stressor and violent suicide methods, and all were married. Cluster 3 had mostly males between the ages of 20 and 64, and all had either experienced recent stressors, suffered from mental illness, or had a history of substance abuse. Cluster 4 had the youngest people and the highest proportion of deaths by jumping from height, few were married, and nearly one-half had bipolar disorder or schizophrenia. Cluster 5 had all unmarried people with no prior suicide attempts, and were the least likely to have an identified mental illness and most likely to leave a suicide note.

Conclusions:

People who die from suicide assort into different patterns of demographic, clinical, and death-specific characteristics. Identifying and studying subgroups of suicides may advance our understanding of the heterogeneous nature of suicide and help to inform development of more targeted suicide prevention strategies.