Controlling firearms use in Australia: has the 1996 gun law reform produced the decrease in rates of suicide with this method?

BACKGROUND: Observed reductions in firearm suicides in Australia have been linked to the 1997 national firearms agreement (NFA) introduced following the 1996 Port Arthur massacre. The NFA placed strong access restrictions on firearms. AIMS: To assess the impact of legislative restrictions on the incidence of firearm suicide in Queensland and explore alternative or contributory factors behind observed declines. METHOD: The Queensland suicide register (QSR) provided detailed information on all male suicides in Queensland (1990-2004), with additional data for Australia (1968-2004) accessed from other official sources. Trends in suicide rates pre/post NFA, and in method selection, were assessed using negative binomial regressions. Changing method selection patterns were examined using a cohort analysis of 5 years of age classes for Australian males. RESULTS: The observed reduction in firearms suicides was initiated prior to the 1997 introduction of the NFA in Queensland and Australia, with a clear decline observed in Australian figures from 1988. No significant difference was found in the rate pre/post the introduction of the NFA in Queensland; however, a significant difference was found for Australian data, the quality of which is noticeably less satisfactory. A marked age-difference in method choice was observed through a cohort analysis demonstrating both time and age influences. Within sequential birth cohorts, rates of firearms suicides decreased in younger males but increased in hanging suicides; this trend was far less marked in older males. CONCLUSIONS: The implemented restrictions may not be responsible for the observed reductions in firearms suicide. Data suggest that a change in social and cultural attitudes could have contributed to the shift in method preference.     

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.     

Correlates of Suicide in Building Industry Workers

Suicide within the construction industry in Queensland, Australia was reportedly high in a recent Royal Commission report. The current study examined the incidence and causes of suicide in this industry using psychological autopsy and focus group investigations. A total of 64 male suicides occurred over the seven-year period, representing a crude suicide rate of 40.3 per 100,000, significantly greater than the working age Australian male rate. Young employees were at excessive risk with separation/divorce, relationship problems, and untreated psychiatric conditions the major contributors. Focus groups emphasized the importance of work/home interface factors and industry-specific factors preceding suicide.     

Correlates of suicide in building industry workers.

Suicide within the construction industry in Queensland, Australia was reportedly high in a recent Royal Commission report. The current study examined the incidence and causes of suicide in this industry using psychological autopsy and focus group investigations. A total of 64 male suicides occurred over the seven-year period, representing a crude suicide rate of 40.3 per 100,000, significantly greater than the working age Australian male rate. Young employees were at excessive risk with separation/divorce, relationship problems, and untreated psychiatric conditions the major contributors. Focus groups emphasized the importance of work/home interface factors and industry-specific factors preceding suicide.     

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.     

Youth suicide and gender in Australia and New Zealand compared with countries of the Western world 1973-1987.

Based upon standardised mortality figures, between 1973-1987, Australian male suicide rose by 39%, and New Zealand male suicide by 53%. In both countries there were even greater increases in male youth suicides (15-24 years), 66% and 127% respectively. The female suicide statistics were more varied with a fall of -24% in Australia, but an increase of 26% in New Zealand. In both countries however, female youth suicide, relative to their general rates, increased. A comparison of youth suicide in the western world demonstrated that Australia and New Zealand were unique as they were the only countries in which male and female youth suicide levels were higher than their average rates.     

A comprehensive meta-analysis of the risk of suicide in eating disorders

Preti A, Rocchi MBL, Sisti D, Camboni MV, Miotto P. A comprehensive meta‐analysis of the risk of suicide in eating disorders. Objective: Past meta‐analyses on suicide in eating disorders included few available studies. Method: PubMed/Medline search for papers including sample n ≥ 40 and follow‐up ≥5 years: 40 studies on anorexia nervosa (AN), 16 studies on bulimia nervosa (BN), and three studies on binge eating disorder (BED) were included. Results: Of 16 342 patients with AN, 245 suicides occurred over a mean follow‐up of 11.1 years (suicide rate = 0.124 per 100 person‐years). Standardized mortality ratio (SMR) was 31.0 (Poisson 95% CI = 21.0–44.0); a clear decrease in suicide risk over time was observed in recent decades. Of 1768 patients with BN, four suicides occurred over a mean follow‐up of 7.5 years (suicide rate = 0.030 per 100 person‐years): SMR was 7.5 (1.6–11.6). No suicide occurred among 246 patients with BED (mean follow‐up = 5.3 years). Conclusion: AN and BN share many risk factors for suicide: the factors causing lower suicide rates per person‐year in BN compared to AN should be investigated.     

Economic slump and suicide method: preliminary study in Kobe

During the recent half decade, Japan's suicide rate at approximately 25 deaths per 100 000 people has been one of the highest rates in the world. From the perspective of suicide prevention by restricting access to suicidal means, the aim of the present study was to examine what kind of suicidal method increased during prolonged economic slump. During 21 years (1981-2001), for all suicide victims (5161 cases) the gender, age, and suicide methods were investigated. The yearly full unemployment rate was also used as a representative socioeconomic factor during the same periods in Japan using government statistics, and the relationship between methods of suicide and full unemployment rate was investigated. Pearson's correlation suggested that there was a significant correlation only for hanging rate (r = 0.736, P < 0.001), but not for the percentages of other methods of suicide. This finding that unemployed persons may have a susceptibility towards certain suicide methods could help in the prevention of suicides. Mental health in Japan should be given more attention, especially for the working population, and social programs offering help should be considered widely.     

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。     

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.     

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.     

Completed suicide among psychiatric in‐patients with depression in an Australian mental hospital

Up to 45% of completed psychiatric in‐patient suicides have a diagnosis of depression. Twenty‐two completed psychiatric in‐patient suicides with depression, over a 21‐year period, in a large psychiatric hospital in Melbourne, Australia, were examined. The characteristics, including demographic and clinical data, for the completed suicides with depression were compared with a comparison group of ‘alive’ in‐patients with depression. Completed suicide among psychiatric in‐patients with depression was associated with male sex, suicidal thoughts during admission, and fluctuating suicidal ideation or continuous absence of suicidal ideation. Over 40% of completed suicides occurred whilst on approved leave and over 20% after absconding from the hospital. Violent methods (including jumping in front of trains, trams and road traffic, jumping of buildings, hanging and drowning) were used in over 65% of completed suicides. Psychiatric units should be developed away from readily available methods of suicide. In‐patients with suicidal thoughts during the admission and unstable suicidal ideation should be carefully observed to avoid absconding and suicide, and should be carefully assessed prior to granting of leave. Copyright © 2000 Whurr Publishers Ltd.     

Suicides among 523 persons in a Swedish county with and without contact with psychiatric care

Among 523 (350 males, 173 females) suicides in 1977-1984, subjects who had had contact with psychiatric care (PC) (63%) were compared with those who had never had such contact (NPC) (37%). The male:female ratios in the PC and NPC groups were 1.6 and 3.0, respectively. Intoxication with drugs and or alcohol was the main method of suicide among the PC subjects, and hanging and intoxication with carbon monoxide predominated among subjects of the NPC group. High percentages of divorces and widows/widowers were characteristic of both groups. Among men and women of the PC group the age groups in which the highest mean suicide rates per 100,000 were found were 45-54 and 55-64 years respectively. The corresponding age groups in the NPC group were greater than or equal to 75 and greater than or equal to 70 years. In the PC group the number of admissions to psychiatric hospitals was more than three in 55% of the subjects and more than eight in 25%. Seventy-three percent had had psychiatric contact within 6 months before the suicide. About 40% in each group had had depressive syndromes. Somatic disease of relevance to the suicides was found among 10% of the PC subjects and 20% of the NPC. About 1/4 of the subjects in both groups had expressed serious suicidal intent shortly before the suicide. The importance of information and education about suicide problems among personnel and relatives is underlined.     

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.     

Cohort trends in youth suicide in Australia 1964-1997

OBJECTIVE: This paper examines trends in the rate of suicide among young Australians aged 15-24 years from 1964 to 1997 and presents an age-period-cohort analysis of these trends. METHOD: Study design consisted of an age-period-cohort analysis of suicide mortality in Australian youth aged between 15 and 24 for the years 1964-1997 inclusive. Data sources were Australian Bureau of Statistics data on: numbers of deaths due to suicide by gender and age at death; and population at risk in each of eight birth cohorts (1940-1944, 1945-1949, 1950-1954, 1955-1959, 1960-1964, 1965-1969, 1970-1974, and 1975-1979). Main outcome measures were population rates of deaths among males and females in each birth cohort attributed to suicide in each year 1964-1997. RESULTS: The rate of suicide deaths among Australian males aged 15-24 years increased from 8.7 per 100,000 in 1964 to 30.9 per 100,000 in 1997, with the rate among females changing little over the period, from 5.2 per 100,000 in 1964 to 7.1 per 100,000 in 1997. While the rate of deaths attributed to suicide increased over the birth cohorts, analyses revealed that these increases were largely due to period effects, with suicide twice as likely among those aged 15-24 years in 1985-1997 than between 1964 and 1969. CONCLUSIONS: The rate of youth suicide in Australia has increased since 1964, particularly among males. This increase can largely be attributed to period effects rather than to a cohort effect and has been paralleled by an increased rate of youth suicides internationally and by an increase in other psychosocial problems including psychiatric illness, criminal offending and substance use disorders.     

Methods of youth suicide in New Zealand: trends and implications for prevention

OBJECTIVE: One commonly suggested approach to reducing suicide is to restrict access to potentially lethal means of suicide. This paper summarises recent trends in methods of suicide among young people in New Zealand and examines the feasibility of suicide prevention through restricting access to methods of suicide. METHOD: Data derived from official mortality statistics were used to examine trends, from 1977 to 1996, in methods of suicide among young people aged 15-24 years. RESULTS: During the last two decades, male youth suicide rates in New Zealand doubled, from 20.3 per 100,000 in 1977 to 39.5 per 100,000 in 1996. This increase was accounted for, almost entirely, by increased use of hanging (71% of total increase) and vehicle exhaust gas (26% of total increase). Suicide rates among young females also increased, from 4 per 100,000 in 1977 to 14.3 per 100,000 in 1996. As for males, the increased female suicide rate was largely accounted for by increased rates of hanging and vehicle exhaust gas. CONCLUSIONS: The marked increases in rates of youth suicide in New Zealand during the past two decades are accounted for, almost wholly, by increases in rates of suicide by hanging and, to a lesser extent, vehicle exhaust gas. In 1996 the majority (79.7%) of youth suicides were accounted for by these two methods: hanging (61.5%) and vehicle exhaust gas (18.2%). Both methods are widely available and difficult to restrict, implying that limiting access to means of suicide is a strategy which is unlikely to play a major role in reducing suicidal behaviour among young people in New Zealand.     

Causative factors as cues for addressing the rapid increase in suicide in Mie Prefecture, Japan: comparison of trends between 1996-2002 and 1989-1995

The number of suicides in Japan has increased from approximately 22 000 per year from 1988 to 1997 to >30 000 per year since 1998. Likewise, the number of suicides has been increasing in Mie Prefecture. The purpose of the present study was to examine the incidence of and circumstances surrounding all suicide cases during 1996-2002 in Mie Prefecture and to compare the data with those from 1989 to 1995. In Mie Prefecture, the age-specific suicide rate during the second 7-year period included marked increases among men aged 50-59 and 60-69 years. Among women, the age-specific suicide rate increased with age during both 7-year periods. During the second period, psychiatric disorders as causative factors increased in all generations. They were especially important for women of the younger generation, whereas economic problems were the most common causative factor among men aged 40-64. Physical illness as a causative factor in suicide was high among the elderly, but among the other age groups this factor trailed behind economic difficulties for men and psychiatric disorders for women. To prevent suicide, social cooperation as well as a plenitude of visiting nurses and psychiatric care is required, and early detection and treatment are also important.     

Celebrity Suicides and Their Differential Influence on Suicides in the General Population: A National Population-Based Study in Korea

ObjectiveAlthough evidence suggests that there is an increase in suicide rates in the general population following celebrity suicide, the rates are heterogeneous across celebrities and countries. It is unclear which is the more vulnerable population according to the effect sizes of celebrity suicides to general population.MethodsAll suicide victims in the general population verified by the Korea National Statistical Office and suicides of celebrity in South Korea were included for 7 years from 2005 to 2011. Effect sizes were estimated by comparing rates of suicide in the population one month before and after each celebrity suicide. The associations between suicide victims and celebrities were examined.ResultsAmong 94,845 suicide victims, 17,209 completed suicide within one month after 13 celebrity suicides. Multivariate logistic regression analyses revealed that suicide victims who died after celebrity suicide were significantly likely to be of age 20-39, female, and to die by hanging. These qualities were more strongly associated among those who followed celebrity suicide with intermediate and high effect sizes than lower. Younger suicide victims were significantly associated with higher effect size, female gender, white collar employment, unmarried status, higher education, death by hanging, and night-time death. Characteristics of celebrities were significantly associated with those of general population in hanging method and gender.ConclusionIndividuals who commit suicide after a celebrity suicide are likely to be younger, female, and prefer hanging as method of suicide, which are more strongly associated in higher effect sizes of celebrity suicide.     

Characteristics of completed suicides after Greek financial crisis onset: A comparative time-series analysis study

Severe financial crises could influence a country’s suicide trends and characteristics. We aimed to highlight differences among suicide completers before and after the onset of Greece’s serious debt crisis of 2010 based exclusively on forensic data. The sample’s size permitted a further elaboration by means of a time series analysis too. Data were collected from the Piraeus Department of Forensic Medicine for the period 1992–2016. We extracted information on sociodemographic parameters, psychiatric medication and alcohol intake, suicide method, place and month of suicide. The “after crisis onset” group (2011–2016) was significantly older (p = 0.039)—primarily due to differences in the 55–64 age group—, had more frequently used psychiatric medications (p < 0.001), less often alcohol (p = 0.001) and died more frequently by immolation (p = 0.001). These differences were—almost exclusively—due to changes regarding male suicidal behavior. Time series analysis indicates that no strong increasing trend in total (male + female) suicide count can be observed, despite a local increase in 2009–2010. Antidepressant-positive suicides show an increase after 2010, whereas alcohol-positive suicides show a decrease. Future predicted forecasts for antidepressant-positive suicides indicate a decrease (from 5.6 per year in 2018 to 4.3 per year in 2025) whereas an increase is predicted in alcohol-positive suicides (7.7 per year in 2017, 9.36 per year in 2025). Middle-aged men, compared to middle-aged women, presumably found it harder to adjust to economic hardship after the crisis onset. Finally, comparatively more men than women who died by suicide appear to have started and/or complied with psychiatric treatment after 2010.