A Longitudinal Study of Predictors of Suicide Attempts Among Lesbian, Gay, Bisexual, and Transgender Youth

This short-term prospective study examined general and lesbian, gay, bisexual, and transgender (LGBT)-specific risk and protective factors for suicide attempts in an ethnically diverse sample of LGBT youth (N = 237, 47.7 % male). A structured psychiatric interview assessed clinical depression and conduct disorder symptoms, as well as past and prospective suicide attempts over a 1-year follow-up period (91 % retention). Participants completed questionnaires measuring general risk factors for suicide attempts, including hopelessness, impulsiveness, and perceived social support. They also completed measures of LGBT-specific suicide risk factors, including gender nonconformity, age of first same-sex attraction, and LGBT victimization. Correlation and multivariate regression analyses were conducted to examine the relations between predictors and suicide attempt, and to identify mediators. Of nine variables examined, seven were related to lifetime history of attempted suicide: hopelessness, depression symptoms, conduct disorder symptoms, impulsivity, victimization, age of first same-sex attraction, and low family support. Depressive symptoms and hopelessness mediated the relation between multiple risk and resilience factors and suicide attempts. Suicide attempt history was the strongest predictor of prospective suicide attempts. Participants who previously attempted suicide (31.6 % of the sample) had more than 10 times greater odds of making another attempt in the 1-year follow-up period than were those who had made no previous attempt. These results highlight the need for suicide prevention programs for LGBT youth and suggest the importance of addressing depression and hopelessness as proximal determinants and family support and victimization, which have more distal effects.     

Suicide among male veterans: a prospective population-based study

OBJECTIVES: To assess the risk of mortality from suicide among male veteran participants in a large population-based health survey. DESIGN AND SETTING: A prospective follow-up study in the US. Data were obtained from the US National Health Interview Surveys 1986-94 and linked to the Multiple Cause of Death file (1986-97) through the National Death Index. PARTICIPANTS: The sample comprised 320 890 men, aged >/=18 years at baseline. The participants were followed up with respect to mortality for 12 years. RESULTS: Cox proportional hazards analysis showed that veterans who were white, those with >/=12 years of education and those with activity limitations (after adjusting for medical and psychiatric morbidity) were at a greater risk for completing suicide. Veterans were twice as likely (adjusted hazard ratio 2.13, 95% CI 1.14 to 3.99) [corrected] to die of suicide compared with non-veterans in the general population. The risk of death from "natural" causes (diseases) and the risk of death from "external" causes did not differ between the veterans and the non-veterans. Interestingly, male veterans who were overweight had a significantly lower risk of completing suicide than those who were of normal weight. CONCLUSIONS: Veterans in the general US population, whether or not they are affiliated with the Department of Veterans Affairs (VA), are at an increased risk of suicide. With a projected rise in the incidence of functional impairment and psychiatric morbidity among veterans of the conflicts in Afghanistan and Iraq, clinical and community interventions that are directed towards patients in both VA and non-VA healthcare facilities are needed.     

广东省居民自杀未遂的流行特征及影响因素分析

目的 了解广东省居民自杀未遂的注行特征,探讨自杀未遂的影响因素.方法 通过分层随机抽样抽取广东省21个县区中街道/乡镇的家庭为调查样本户,对每个住户用KISH法确定1名15～69岁的家庭成员进行问卷调查,获得自杀未遂及相关的危险因素.采用SPSS 16.0软件对数据进行分析,筛选自杀未遂的危险凶素.结果 共调查6625人,过去一年内自杀未遂的发生率为0.8%,其中女性(1.1%)高于男性(0.5%),25～35岁女性自杀未遂率最高(1.6%),城市农村间差异无统计学意义.多因素分析显示,女性(OR=2.1)、经历负性事件(OR=15.5)、睡眠状况差(OR=1.6)、孤独感(OR=1.5)、焦虑感(OR=1.8)是自杀未遂的危险因素;而饮酒、吸烟、体力活动情况、文化程度、年龄、城乡、家庭农药存放情况与自杀未遂发生无显著相关.结论 广东省自杀未遂发生率高,影响因素复杂,应该采取综合的措施进行预防控制.     

Suicidality in a venue-based sample of young men who have sex with men.

PURPOSE: To examine the incidence, prevalence, and characteristics of suicide attempts in a unique, venue-based sample of young men who have sex with men (YMSM). Eligible participants were 15-25-year-old men who were living in a major metropolitan area (Minneapolis/St. Paul, Minnesota) and had sex with men within 12 months of the interview. A total of 255 subjects were randomly sampled from popular venues for a structured, 20-min interview (1999) that included four items regarding suicide intentions and attempts. Data were analyzed using bivariate and multivariate tests of statistical significance. Eighty-six percent of eligible individuals completed the survey. One-third of all respondents reported at least one suicide attempt, and 4.7% attempted suicide in the past year. Although suicide attempts were more prevalent among African-Americans and urban residents; only school enrollment was significantly associated with attempts in the multivariate analysis (odds ratio = .55, 95% confidence interval = .31,.97). This study corroborates the findings of prior studies of high rates of suicide attempts among YMSM. In addition, it demonstrates that attempts are more prevalent among out-of-school youths.     

Suicide and attempted suicide in eating disorders, obesity and weight-image concern

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Meta-analyses have shown that individuals suffering from anorexia nervosa and bulimia nervosa commit suicide more often than their counterparts in the general population; also a few studies have suggested that suicide is the major cause of death among patients with anorexia nervosa, refuting the assumption that inanition generally threatens the life of these patients. Data concerning suicide in bulimia nervosa, on the other hand, are still scarce but suicide attempts are easily found among cohorts of patients with bulimia nervosa, which constitutes a risk factor for completed suicide. Suicidality in obesity and individuals with disturbed weight status has been reported. Both in the case of bulimia nervosa and obesity more long-term follow-up studies need to be completed before the risk of suicide for such disorders may be compared with that for anorexia nervosa.     

Evaluation of attempted suicide in emergency departments in Sanliurfa province, southeastern Turkey

Aim

Attempted suicide is one of the most important public health problems among preventable causes of mortality in the general population. Identifying risk factors for the prevention of suicide is a major public health goal. The aim of this study was to determine the annual rate of attempted suicide, related risk factors, and interventions, among referrals to emergency departments in the Sanliurfa province of southeastern Turkey.

Subjects and methods

Data were obtained from all emergency departments in the province based on the ‘Suicide Attempt Registry’ standardized records for the calendar year 2010. Socio-demographic characteristics, aetiology, psychiatric history, psychiatric consultations, and interventions were examined. The groups were analysed with the chi-square test; the significance level was set at p?<?0.05.

Results

The annual rate of suicide attempts was 55.39 in 100,000 for the calendar year 2010. The rate was 3.47 times higher among women than men, and in particular 4.15 times higher for the 15–24 year age group among women than in men with the highest incidence of suicide attempts. The majority of cases were referred in April and May. Medication or toxic agent ingestions comprised 90.3 % of cases. The main reason for attempts was family problems or domestic violence among women, and economic hardships among men, and rates of physical and mental problems were similar for both sexes. Only 8.8 % of cases were subsequently referred for psychiatric consultation. Among cases with a prior suicide attempt history, 44.6 % had a reported psychiatric disorder.

Conclusion

The results of this investigation show that strengthening of surveillance and emergency healthcare systems, enhancement of mental health literacy, and inter-sector collaboration for development of community empowerment programmes are of vital importance for prevention of attempted suicide. The low rate of psychiatric referrals for subsequent intervention represented a major gap in urgent mental health services in the region.     

Gun availability, psychopathology, and risk of death from suicide attempt by gun

PURPOSE: Suicide is the third leading cause of death among adolescents and the 8th leading cause of death overall. Guns figure prominently in this problem. Guns are the most lethal means of suicide, and in the United States about 60% of all suicides are committed by guns. We examined hospital admissions for suicide attempts (para-suicide) in the city of Chicago between 1990-1997. Our aim was to 1) quantify the risk of death from para-suicide by gun versus other methods, 2) determine whether individual with psychopathology are more likely than others to attempt suicide by gun, 3) determine proportion of variation in para-suicide by gun explained by community-level gun availability independent of individual-level determinants of para-suicide by gun.METHODS: Hospital admissions from city of Chicago during 1990-1997 were examined for cases of attempted or completed suicide. 11,584 individuals were identified with a diagnosis of para-suicide (E950-E959, classifiable to ICD-9CM). These individuals were then classified into suicide type (e.g., gun, crash, cut, poison) and were also identified as having a mental disorder or not (mental diagnoses classifiable to ICD-9CM).RESULTS: 1) Those attempting suicide by gun are about 70 times more likely to die from their injuries than those attempting suicide by other means. 2) Depressed and psychotic individuals compared with individuals with no-mental disorders are significantly more likely to attempt suicide with a gun (p < 0.001). 3) Inclusion of community-level gun availability in a hierarchical model reduced the variation in the model by 16%.CONCLUSIONS: Guns are the most lethal suicide method. Community-level availability, independent of individual-level factors, is an important determinant of suicide attempt by gun.     

Correlates of suicide attempts in an open cohort of young men who have sex with men

OBJECTIVE: To investigate baseline correlates of attempted suicide in a large cohort of young gay and bisexual men. METHODS: Participants completed annual questionnaires asking demographic information, sexual behaviours, history of forced and paid sex, comfort with sexual orientation, use of illicit drugs, and validated measures of depression, social support, alcohol dependency, self-esteem and suicide ideation and attempts. Contingency table analysis and step-wise logistic regression were used to identify potential predictors of self-reported suicide attempts. RESULTS: Of 345 gay and bisexual men eligible for this cross-sectional analysis, 150 (43.5%) reported that they had ever considered suicide and 67 (19.4%) that they had attempted suicide at least once. After adjustment for multiple explanatory variables, the use of nitrite inhalants (poppers) (AOR = 2.37; 95% CI 1.30, 4.33), social support scores below the 75th percentile of all scores (AOR = 2.19; 95% CI 1.18, 4.09) and low or moderate self-esteem (AOR = 3.73; 95% CI 2.03, 6.86) were independently associated with elevated risk of attempted suicide. CONCLUSION: Our data indicate that men in this analysis who ideate or attempt suicide earlier in life are more likely to report lower social support and self-esteem, and high popper use.     

The Relation Between Sexual Orientation and Suicide Attempts in Austria

Previous studies indicate that homosexual or bisexual individuals are at a higher risk of attempting suicide compared to heterosexuals. To overcome biases in these studies, more rigorous definitions of “suicide attempts” and the assessment of multiple dimensions of sexual orientation are needed. In addition, studies from the German speaking region are sparse, especially those not recruiting participants from the gay or lesbian communities. We solicited self-reported suicide attempts among 1,382 Austrian adults recruited through structured snowball sampling from students’ social networks. Suicide attempts were more frequently reported by those participants with homosexual or bisexual fantasies, partner preference, behavior, and self-identification, compared to their heterosexually classified counterparts. This was true for any dimension of sexual orientation and for suicide attempts with intent to die or suicide attempts that required medical treatment. Our Austrian study confirmed existing evidence that homosexual and bisexual individuals are at an increased risk for attempting suicide. This should be considered in suicide preventive efforts.     

Theoretical perspectives on suicide in gay men with AIDS

Suicide among gay men with AIDS constitutes a significant theoretical and practical problem. In order to understand this problem it is necessary to consider the specific circumstances that surround these individuals. Whilst there are many theories of suicide with which to address the problem, few are able to capture the special context within which gay men with AIDS live. This article explores three broad concepts from the theoretical literature on suicide that have explanatory potential in this unique context. The three concepts are: the search for meaning in the midst of suffering, Shneidman's [Shneidman, E., 1985. Definition of Suicide. John Wiley, New York] notion of unendurable psychological pain, and hopelessness. This article attempts to demonstrate how these three concepts can incorporate the experiences of gay men with AIDS and contribute to understanding the problem of suicide in this population.     

Factors associated with suicidal behaviors in a large French sample of inpatients with eating disorders

OBJECTIVE: The objective of the present study was to identify factors associated with suicidal behaviors among patients with eating disorders. METHOD: A large database including sociodemographic and clinical characteristics of 1,009 consecutive patients hospitalized for an eating disorder in Paris, France, was examined. Data gathered upon admission to hospital were analyzed to identify factors associated with a history of suicide attempt or current suicidal ideation, among the whole sample as well as among each subtype of eating disorder. RESULTS: Among the whole sample, the factor most strongly associated with suicide attempt or suicidal ideation was the diagnostic category, with the highest odds ratio for bulimia nervosa followed by anorexia nervosa of the binging/purging subtype. Among diagnostic subgroups, the strongest factors were drug use, alcohol use, and tobacco use. CONCLUSION: Suicide risk should be monitored carefully among patients with eating disorders, paying particular attention to combinations of risk factors.     

Gender differences in risk factors for attempted suicide among young adults: findings from the Third National Health and Nutrition Examination Survey

PURPOSE: To identify the significant factors associated with attempted suicide among men and women, and determine whether socioeconomic status (SES) and social support indictors, health risk factors, and lifetime history of medical and psychiatric illnesses can explain gender differences in attempted suicide. METHODS: We used data from 3357 men and 4004 women aged 17 to 39 years, who completed a mental disorder diagnostic interview as a part of the Third National Health and Nutrition Examination Survey, 1988-1994. Adjusted odds ratios (ORs) were calculated for the association between risk factors and attempted suicide. RESULTS: The prevalence of lifetime attempted suicides was 7.58% (SE, 0.66) in women and 3.69% (SE, 0.49) in men. In men, low income and smoking were associated with attempted suicide, while attempted suicide in women was associated with poor self-evaluated health, low educational attainment, and drug use. A history of medical and psychiatric illnesses was associated with attempted suicide in both genders, for cancer/pulmonary disease, OR=2.89 (95% CI, 1.25-6.67) in men and 1.94 (1.09-3.45) in women; for major depressive disorder, OR=9.86 (5.08-19.14) in men and 5.00 (3.19-7.83) in women. The significant gender difference of attempted suicide prevalence remained after being adjusted for risk factors selected. CONCLUSION: There were significant gender differences in the risk factors for attempted suicide among young adults, and the gender difference in the prevalence of lifetime attempted suicides could not be explained by differential exposure to risk factors selected.     

Suicides among older United States residents: epidemiologic characteristics and trends.

Suicide rates for elderly US residents decreased between 1950 and 1980, but have increased recently. We analyzed suicide mortality trends using national mortality data for the period 1980 through 1986. Suicide rates during this period increased for each 5-year age group over age 65. Elderly White males have the highest suicide rates and experienced a rate increase of 23%. The rate for Black males rose by 42%. Divorced males have the highest age-adjusted sex- and martial status-specific rates, and experienced a rate increase of 38% over the 7-year period. Suicide rates among older US residents vary by region of the country and are highest in the West. Rates increased in all regions except the Northeast. Fire-arms are the most common method of suicide in the elderly, and firearm use increased during this period from 60% to 66% of all suicides. Given the recent increase in suicide rates for the elderly and the magnitude of the problem in this age group, it is again important to direct our attention to the problem of suicide in the elderly and recognize the need for effective prevention strategies.     

Suicide Rates in Colorado from 1980 to 1989: Metropolitan, Nonmetropolitan, and Farm Comparisons

Suicide rates among farm populations have been reported to be higher than among other populations. Overall economic stressors and exposure to hazardous work conditions have been reported to be associated with the increased rates of suicide. The purpose of this paper is to examine the pattern of suicide among white men in Colorado, contrasting the rates of on-farm suicides with those of other nonmetropolitan and metropolitan residents. The analysis indicated a high suicide rate in Colorado compared to white males in the United States; however, the farm suicide rate was similar to the U.S. rate. On-farm suicide rates in Colorado were lower than suicide rates for the metropolitan and nonmetropolitan males. Prior to targeting all farm populations as at high risk for suicide, more work needs to be done assessing actual risk and considering potential differences in agricultural populations across the country.     

Suicide rates in psychiatric in-patients: an application of record linkage to mental health research

OBJECTIVE: To study trends in the rate of suicide in psychiatric patients in Western Australia. To examine the associations of suicide with demographic and clinical factors. METHODS: A population-based cohort of 52,010 individuals whose first psychiatric admission occurred in 1980-95 was identified from the Health Services Research Linked Database. There were 471 deaths by suicide by 31 December 1995. Age standardised suicide rates per 1,000 person-years at risk were calculated. Suicide rates in the first year after a patient's first admission were also examined and a proportional hazards regression analysis was performed to examine risk factors for suicide. RESULTS: Male psychiatric patients were 3.4 times more likely to commit suicide than female patients (95% CI 2.76-4.24). Younger patients were at higher risk than older patients, and patients with extended periods of in-patient treatment were at more than double the risk of short-stay patients. Over the 16-year period, the rate of suicide in the first year after first psychiatric admission was found to increase by 3.4% a year (95% CI -0.7-7.6%). CONCLUSIONS: The findings confirm that psychiatric patients are at high risk of suicide. Patient outcomes in terms of risk of suicide after hospital discharge have deteriorated. IMPLICATIONS: Improvements are needed in the provision of community support to high risk psychiatric patients. Further work should be done to identify patients at highest risk of suicide.     

Suicide mortality: gender and socioeconomic differences

OBJECTIVE: To describe suicide mortality trend and sociodemographic patterns identifying gender and socioeconomic differences. METHODS: The trend of crude rates of suicide mortality by sex in the city of Campinas, Brazil, for the period 1976-2001 was assessed. Data from the Mortality Registry were used for sociodemographic analyses in the period 1996-2001. An ecological approach was used to examine socioeconomic differences and the 42 city areas of health care units were classified into 4 homogeneous strata. Rates were age-adjusted using direct method. RESULTS: The city has a low suicide rate (less than 5/100,000) in comparison with other countries. Male excess mortality was over 2.7 male suicides for each female suicide. While in 1980-1985 the older group (55 years and older) had the highest suicide rates, in 1997-2001 the middle-aged adult group (35-54 years old) showed the highest ones. As for suicide methods, men used hanging (36.4%) and firearms (31.8%), while women used poisoning (24.2%) and firearms and hanging (21.2% each). Hangings led to death at home, while firearms or poisoning deaths took place more often in hospitals. Suicide is different from homicide in that there is no rate increase with lower socioeconomic level. CONCLUSIONS: Suicide rates are low with successive increments and decrements without consistent growing or lowering trends. The risk of dying by suicide is higher among men and does not increase with lower socioeconomic condition.     

An outcome evaluation of the SOS Suicide Prevention Program

OBJECTIVES: We examined the effectiveness of the Signs of Suicide (SOS) prevention program in reducing suicidal behavior. METHODS: Twenty-one hundred students in 5 high schools in Columbus, Ga, and Hartford, Conn, were randomly assigned to intervention and control groups. Self-administered questionnaires were completed by students in both groups approximately 3 months after program implementation. RESULTS: Significantly lower rates of suicide attempts and greater knowledge and more adaptive attitudes about depression and suicide were observed among students in the intervention group. The modest changes in knowledge and attitudes partially explained the beneficial effects of the program. CONCLUSIONS: SOS is the first school-based suicide prevention program to demonstrate significant reductions in self-reported suicide attempts.     

Risk factors for suicide attempts among Navajo adolescents.

BACKGROUND: Rates of adolescent suicide in the United States are highest among Native Americans but little is known about risk factors for suicide attempts in this population. METHODS: To identify risk factors for self-reported suicide attempts by Navajo adolescents, we analyzed the 1988 Indian Health Service Adolescent Health Survey that was administered to 7,254 students in grades 6 through 12 on the Navajo reservation. The responses of students reporting a past suicide attempt were compared to others. RESULTS: Nearly 15 percent (N = 971) reported a previous suicide attempt; over half of those admitted to more than one attempt. Controlling for age, a logistic regression model revealed the following associations with suicide attempts: a history of mental health problems (OR = 3.2); alienation from family and community (OR = 3.2); having a friend who attempted suicide (OR = 2.8); weekly consumption of hard liquor (OR = 2.7); a family history of a suicide or attempt (OR = 2.3); poor self-perception of health (OR = 2.2); a history of physical abuse (OR = 1.9); female gender (OR = 1.7); and sexual abuse (OR = 1.5). CONCLUSIONS: Efforts to prevent adolescent suicide attempts in this population should target individuals with those risk factors of the highest risk and prevalence of exposure.     

Cluster and regional influences on suicide in a Southwestern American Indian tribe

Suicide is the second leading cause of death among American Indian youth. Elevated rates of suicide in Indian communities have been attributed both to outbreaks and to regional trends. We assessed the contribution of these two factors for a single tribe, and attempted to define a profile of individuals at risk. Data came from the tribe's registry of suicide attempts and completions for 1990-1993 and analysis of death certificates for the period 1985-1996. Using combined tribal and death certificate data, the average annual (age-adjusted) rate of completed suicide among tribal members was 44.7/100,000 for 1990-1993. Within the 45 suicide deaths and serious attempts in this time period, we identified one grouping of seven cases taking place in a 40-day period. All seven involved hanging and youth (13-28 years old). Using death certificate data alone, the average annual rate of suicide death for non-natives in the surrounding county in the period 1985-1996 was 22.7/100,000. Age-adjusted to the county population, the tribal rate for the same period was not significantly different (24.6/100,000). Tribal and county suicide patterns differed by age distribution and method but not by gender. We concluded that both regional trends and clustering contribute to suicide in this community. Further prevention efforts may need to focus on both unique tribal characteristics and shared factors among non-native neighbors.