The Balkan Piedmont: male suicide rates pre-war, wartime, and post-war in Serbia and Montenegro.

The epidemiology of suicide in Serbia and Montenegro from 1989 to 2003, a period of civil war, is presented. Following the break-up of former Yugoslavia, Serbia and Montenegro underwent a period of war from 1991-1994 and another in 1999. During the war years, the number of suicides increased, reaching its peak in 1993. Male suicides outnumbered female suicides by a ratio of 2:1. Male suicides decreased slightly after the war of 1991-1994 only to rise in 1997 and continue at this higher level throughout the nineties. In Serbia alone, male suicide reached its peak in 2002 (nearly 29/100,000). The methods of suicide changed significantly, with the use of firearms doubling during and after the war years. Speculations are offered about the findings, many consistent with Durkheim's classical hypothesis concerning suicide and unpopular wars.     

SUICIDE RATES AND METHODS IN DIFFERENT AGE GROUPS: AUSTRALIAN DATA AND PERCEPTIONS

Objectives. The two major aims of this study were (1) to assess senior medical students’ knowledge of the age pattern of suicides in Australia, and (2) to note changes in the pattern of suicide in recent years. Design. (1) Two groups of medical students were asked to graph the age distribution of Australian male and female suicides. (2) Suicide statistics (up to 1994) were provided by the Australian Bureau of Statistics. Results. (1) Only 40% of the 75 medical students were aware that suicide in Australia is much more frequent among males. Only two of the 75 drew graphs that were similar to the true pattern. (2) The male rate of suicide at age 20–40 years was almost 35 per 100 000 in 1989–94; above 80 years it was nearly 40 per 100 000. The female suicide rate of all age groups from 20 years to late old age was about 7 per 100 000. The most striking changes in method of suicide in Australia in recent years have been the doubling of male rates of suicide by hanging and car exhaust fumes, increases being greater in younger age groups. Elderly females are more likely than younger females to use hanging as a means of suicide. Conclusions. Male suicide rates peak in young adulthood and (higher) in late old age. Senior medical students were unaware of the true age and sex patterns of suicide in Australia. Treating depressions and preventing suicides of elderly people (as well as of young people) should be top priorities. © 1997 John Wiley & Sons, Ltd.     

Epidemiological study of suicide in the Republic of Croatia -- comparison of war and post-war periods and areas directly and indirectly affected by war.

We examined the differences in the suicide characteristics between areas directly and indirectly affected by war activities and in war and post-war periods according to the following variables: suicide rate, sex, age and method of suicide. Analysis was done on 5349 suicides committed in the period 1993-1998 (war and post-war years). The suicide rates in the Republic of Croatia oscillated in the pre-war, war and post-war periods (1985-2000) but without significant differences. In the areas directly affected by war, the suicide rate was significantly lower than in other areas during the study period 1993-1998 (chi-square = 10.3245; P = 0.0017). The number of suicides in both sexes declined in the areas directly affected by war-more in men than in women; the difference between sexes was statistically significant (chi-square = 3.6697; P = 0.055). Middle- and old-aged people were the population with high suicide risk in both areas (t = 1.76; P = 0.078). There were significant differences in the methods of suicides between war and non-war areas (chi-square = 108.8473; P = 0.001). Firearms or explosive devices were the methods used more significantly for suicides in the areas directly affected by war than in other areas, whereas hanging was more frequently used in the areas indirectly affected by war.     

Changes in male suicides in Scottish prisons: 10-year study

BACKGROUND: In 1999 I estimated the expected number of UK prison suicides, taking into account that opioid users' deaths from suicide were 10 times the number expected for their age and gender. Changes have since taken place in Scottish prisons. AIMS: To estimate the expected number of male suicides in Scottish prisons in 1994-2003, having taken age and opioid dependency into account; and to consider the extremes of prisoner age. METHOD: The effective number that prisons safeguard in terms of suicide risk was approximated as 10 times the number of opioid-dependent inmates plus other inmates. By applying age-appropriate suicide rates for Scottish males to these effective numbers, expectations for male suicides in Scottish prisons were calculated. RESULTS: In 1994-98, there were at least 57 male suicides, significantly exceeding the age- and opioid-adjusted expectation of 41. In 1999-2003, the 51 male suicides in prison were consistent with expectation (upper 95% limit: at least 54). During the decade 1994-2003, observed and expected suicides were mismatched at both extremes of age: 40 males aged 15-24 years died by suicide v. 24 expected, and 13 males aged 45+ v. 2 expected. Against 4.5 prison suicides expected for males aged 15-24 years during a 2-year period, actual suicides were 3 in 2002 + 2003 and 4 in 2004 + 2005. CONCLUSIONS: Scotland has redressed an excess of male suicides, especially by its youngest prisoners.     

Celebrity suicide: Did the death of Kurt Cobain influence young suicides in Australia?

This study examined the total rate of suicide in Australia for young people (aged 15–19 and 20–24 years) for the 30 day period after the announcement of Kurt Cobain's suicide in 1994, comparing with the identical period for the previous five years and accounting for unequal variability in weekends, Mondays and public holidays. The 1994 rates for male suicides for both age groups were lower than for 1992 and 1993, and were more similar to the 1990 rates. Female rates showed a steady small decline over the five years, sustained in 1994. Rates overall showed a reduction in all of the first five, ten and fifteen day rates, compared with previous years. There was no evidence of any increase in deaths from gunshot, the method used by Cobain. The conclusion appears to be that this celebrity suicide had little impact on suicide in young persons in Australia. Possible reasons for this are discussed.     

Celebrity suicide: Did the death of Kurt cobain influence young suicides in Australia?

Abstract

This study examined the total rate of suicide in Australia for young people (aged 15-19 and 20-24 years) for the 30 day period after the announcement of Kurt Cobain's suicide in 1994, comparing with the identical period for the previous five years and accounting for unequal variability in weekends, Mondays and public holidays. The 1994 rates for male suicides for both age groups were lower than for 1992 and 1993, and were more similar to the 1990 rates. Female rates showed a steady small decline over the five years, sustained in 1994. Rates overall showed a reduction in all of the first five, ten and fifteen day rates, compared with previous years. There was no evidence of any increase in deaths from gunshot, the method used by Cobain. The conclusion appears to be that this celebrity suicide had little impact on suicide in young persons in Australia. Possible reasons for this are discussed.     

Suicide among Italian adolescents: 1970–2002

The purpose of the present study was to analyze sex and regional differences in the suicide rate of adolescents and the methods they used for suicide in Italy during the period 1970–2002. Temporal trends and regional variations in suicide for Italian adolescents were retrieved from the Italian database on mortality for the period 1970–2002, collected by the Italian Census Bureau and processed by the Italian National Institute of Health-Statistics Unit. In the period 1970–2002, 3,069 adolescent suicides were monitored in Italy. Analyses of these suicides identified significant differences by region of residence and sex. Males were 2.1 times more likely than females to kill themselves. Male and female suicides had inverse trends in the years analyzed, so that the sex difference at the present time is the result of a continuous increase in male suicides and a decrease in female suicides since 1970. The dramatic peaks observed over the time period studied cannot be attributed to a single cause, indicating that further studies are needed to better understand the phenomenon.     

Suicide in Thailand during the period 1998-2003

The aim of this study was to examine the characteristic features of suicides in Thailand between 1998 and 2003. Collected data during 1998-2003 from the Bureau of Policy and Strategy, Ministry of Public Health were analyzed to reveal the mortality from suicide according to age, gender, rate and methods of suicides. Suicide rates were found to have increased to a peak of 8.6 per 100 000 (5290 suicides) in 1999 and then to have decreased to 7.1 per 100 000 in 2003. The average suicide rate during 1998-2003 was 7.9 per 100 000 with a male to female ratio of 3.4:1. Male suicide reached a peak for those aged 25-29 years (21.9 per 100 000) while female suicide showed less variation with age. Hanging was the most common method used, followed by ingestion of agricultural toxic substances. Suicide was most prevalent in upper northern region where HIV infection might be related to the high prevalence. Suicide prevention program should focus on males in early adulthood, and particular measures should be conducted to reduce risk factors related to HIV infection among people in northern Thailand.     

High Early Suicide Risk in Elderly Patients After Self-Poisoning

This article reports the findings of a follow-up study of suicide mortality in elderly patients after an index episode of self-poisoning. A total of 222 consecutive patients (143 female) aged 65 years or older (mean age 76.5 years; range 65–100) presenting at the emergency department of the Karolinska University Hospital after self-poisoning during 1994–2000, were followed up for the cause of death by January 1, 2006. Survival analysis was applied to study suicide and death risk. Of the 15 suicides, 13 (87%) occurred during the first year after the index episode of self-poisoning (cumulative suicide risk 6.2%). The risk of dying of all causes during the first year was increased fourfold. Self-poisoning in both elderly men and women is associated with high early suicide risk.     

A 12-year National Study of Suicide by Jumping From Bridges in Norway

Studies from several countries suggest that erecting fences on bridges more commonly used for suicide by jumping may be an effective way of reducing the risk of suicide by jumping from these bridges. Distribution of suicides by jumping off bridges has not yet been studied on a national level in any country. This study included all suicides by jumping from high places registered in the Norwegian Cause of Death Registry (COD) in the period 1999–2010 (n = 319). Combining data from the COD registry and information from police records, 71 cases of suicide by jumping off a bridge were identified involving 36 bridges. This form of suicide constituted approximately 1% of all suicides in Norway in the period 1999–2010. Almost half of these suicides were registered at only 6 bridges. Three Norwegian bridges were secured during the observation period of this study. Two bridges had barriers installed on the full length of the bridge with 11 suicides registered before barriers were installed, and none after. On the 1 bridge that was only partially secured, no change in numbers of suicides was observed after barriers were installed. One-third of jumps from bridges occurred over land. We found that although suicide by jumping off bridges was a relatively rare event, there is a potential for saving lives by installing physical barriers on bridges that are more commonly used for suicide by jumping.     

Mortality in severe depression

ABSTRACT: Twelve hundred and six psychiatric in-patients, 506 men and 700 women, with severe depression/melancholia were rated at discharge with a multidimensional diagnostic schedule during 1956–1969. The sample was followed up until December 31, 1983. A total of 476 deaths were recorded including 103 suicides. Suicides and to a small proportion diseases of the nervous system constituted the total excess mortality in unipolar disorders. In bipolar disorders there was also an increased mortality from physical disorders, while the suicide frequency was lower (9% versus 4%). Male suicides had higher initial ratings for the items brittle, sensitive, maritial problems, acute onset and lower ratings for psychomotor retardation than other men. Female suicides had a higher frequency of attempted suicides than other women. Acute onset and attempted suicide were associated with suicides early in the course contrary to the other differentiating items. The suicide frequency was similar in admissions during 1956–1962 compared with those during 1963–1969.     

Completed suicides and traffic accidents: longitudinal analysis in France

In order to assess the relationship between suicidal behavior and traffic accidents, we analyzed the seasonal patterns of completed suicides and deaths related to traffic accidents in France over a period of 8 years. We found a clear seasonal rhythm of completed suicides with a peak in May, and an additional peak in September. The traffic accident rate also underwent seasonal variations with maximum values occurring in the fall. No positive covariation between the seasonal patterns of suicide and traffic accidents was detected. The lack of temporal relationship between suicide and traffic accident is consistent with recent epidemiological studies, and suggests that fatal traffic accidents and suicidal behavior may not be related.     

Suicide in epilepsy: psychopathology,pathogenesis, and prevention

OBJECTIVE: Death by suicide among patients with epilepsy has found scant psychiatric attention, yet it may occur at the rate reported among patients with manic-depressive illness. We aim to clarify the psychopathology and pathogenesis of suicide in epilepsy and to document an effective method of prevention.METHOD: A total of 10,739 patients with epilepsy were seen at the Epi-Care Center in Memphis from 1987 to 1999. The patients with significant psychiatric complications were evaluated systematically and treated with an increasingly effective psychopharmacologic approach.RESULTS: Five suicides were registered during the 12-year period. All occurred in patients with longstanding complex partial seizures and dysphoric disorder a short time after full control of the seizures was achieved. During the last 8years of the 12-year period, more effective pharmacotherapy of the psychiatric complications of epilepsy was used (augmented antidepressant medication), and the two suicides that still occurred had eluded this treatment. Review of earlier series confirms that suicide tends to occur particularly among patients with chronic epilepsy who have obtained good control of their seizures; suicide may occur during interictal dysphoric episodes with or without psychotic features or in a state of postictal depression.CONCLUSIONS: Suppression of seizures in longstanding epilepsy may be associated with suicidal risk. The psychotoxic effect of predominant inhibitory mechanisms appears to be the crucial pathogenetic factor in all suicides. The number of suicides in our series is a fraction of that expected based on previous reports and indicates that prevention by psychopharmacologic treatment is available.     

Autumn peak in shooting suicides of children and adolescents from northern Finland

Suicide is one of the leading causes of death among adolescents worldwide. Studies on the seasonal pattern of youth suicides are rare and the results are very contradictory and heterogeneous. Generally, suicide methods affect the pattern of suicide seasonality. Shooting is the most common suicide method among Finnish adolescents. We investigated whether shooting suicides of victims aged less than 18 years are correlated with a specific period of the year. Also, the seasonal pattern of shooting suicides in adolescents was compared with that of adult victims. Our data comprised 42 adolescent suicide victims and, for comparison, 1,926 adult suicide victims over the years 1988 to 2004 from Northern Finland. Of these, 59.5% (n = 25) of the adolescents and 28.8% (n = 554) of the adults had committed suicide by shooting.We observed that shooting suicides among the under-aged showed a significant peak in autumn (ratio 2.70, 95% CI: 1.97-3.42), while those of adult victims peaked in spring (ratio 1.19, 95% CI: 1.05-1.35). The monthly pattern of suicides correlated significantly with the mean duration of daily sunshine hours (trailing by 3 months) in the under-aged (r = 0.67, p = 0.016), but not in the adults (r = 0.06, p = 0.854). The role of firearm availability, psychosocial factors such as start of the school year, and some biological factors are discussed.     

Childhood Bullying Behaviors as a Risk for Suicide Attempts and Completed Suicides: A Population-Based Birth Cohort Study

ObjectiveThere are no previous studies about the association of childhood bullying behavior with later suicide attempts and completed suicides among both sexes. The aim was to study associations between childhood bullying behaviors at age 8 years and suicide attempts and completed suicides up to age 25 years in a large representative population-based birth cohort.MethodThe sample includes 5,302 Finnish children born in 1981. Information about bullying was gathered at age 8 years from self-report, as well as parent and teacher reports. Information about suicide attempts requiring hospital admission and completed suicides was gathered from three different Finnish registries until the study participants were 25 years old. Regression analyses were conducted to determine whether children who experience childhood bullying behaviors are at risk for later suicide attempts and completed suicides after controlling for baseline conduct and depression symptoms.ResultsThe association between bullying behavior at age 8 years and later suicide attempts and completed suicides varies by sex. Among boys, frequent bullying and victimization are associated with later suicide attempts and completed suicides but not after controlling for conduct and depression symptoms; frequent victimization among girls is associated with later suicide attempts and completed suicides, even after controlling for conduct and depression symptoms.ConclusionsWhen examining childhood bullying behavior as a risk factor for later suicide attempts and completed suicides, each sex has a different risk profile.     

Suicide and mental disorders

Abstract In Japan, there has not yet been a complete psychological autopsy study. The author conducted a retrospective study of failed suicides (quasi-completed suicides) admitted to an emergency critical care center. According to the lethality of suicide methods, 133 out of 265 subjects over 6 years (1986–1991) were classified as the absolutely dangerous (AD; the failed suicides) group. As a principal diagnosis, psychoses, endogenous depression, substance abuse were present in 75% of the AD group. The diagnostic distribution largely differed with depressive disorders being mainly in the older group (50+ years), and psychoses predominating in the younger group (<30 years). This study suggested that the majority of suicide victims in Japan also had mental disorders, and suicide prevention should be confronted with this clinical fact.     

The relationship of restrictions on state hospitalization and suicides among emergency psychiatric patients

OBJECTIVE: This study explored the relationship between mandated decreases in transfers to a state hospital from a large urban psychiatric emergency facility and the occurrence of suicide in the catchment area served. METHODS: During 1996, new admission criteria that emphasized psychiatric diagnosis and potential benefit from hospitalization and that restricted the admission of recidivistic patients and of those with a primary diagnosis of a substance use disorder were phased in. Data on the number of patients seen in a psychiatric emergency service and the number transferred to the state hospital were obtained for the period 1994-1998. Data on all completed suicides in the county served by the hospital were also obtained. RESULTS: During 1994 and 1995, a total of 9,308 patients were transferred to the state hospital. In 1997 and 1998, a total of 4,072 patients were transferred. The number of patients seen in the emergency service remained constant throughout the study period. No change was noted in the absolute number or the rate of suicide in the county after the new admission criteria were implemented. A total of 164 suicides were recorded in 1994-1995 (12 per 100,000 population per year), compared with 152 in 1997-1998 (ten per 100,000 population per year). CONCLUSIONS: Transfers to the state hospital were reduced by 56 percent, with no change in the suicide rate. This finding suggests that the availability of inpatient psychiatric hospitalization may not have a direct effect on the suicide rate.     

Time trends in suicide mortality in Lithuania.

OBJECTIVE: The aim of this study was to analyse the time trends of suicides during the period 1970-1995 in Lithuania, and to assess the importance of the effects of age, period and birth cohort as risk factors. METHOD: Trends in suicides and average annual changes were based on logarithmic regression analysis. For assessment of the effects of age, period and birth cohort on suicide mortality, a log-linear regression model with parameters representing age, period and cohort effects was fitted. RESULTS: Between 1970 and 1995 age-standardized suicide rates almost doubled. There was an increase in suicides in birth cohorts of males from 1910 to 1950, and in cohorts born after 1965. In females, an increase was observed in all successive birth years from 1905 to 1925 and after 1970. The period effect in males and the cohort effect in females were dominant. CONCLUSION: It is unlikely that suicide rates will decrease in the near future.