Weather and suicide: the present state of knowledge on the association of meteorological factors with suicidal behaviour

OBJECTIVE: To review the available literature on the association between daily and longer-term weather data and the incidence of attempted and completed suicide. METHOD: A computerized search supplemented by a cross-check of the references sections of the thereby identified papers was performed. RESULTS: A total of 27 studies looking for a relationship between attempted or completed suicide and weather or climate data were found. Most of the papers reported a statistical association of suicidal acts with at least one weather factor. However, the results are not conclusive and in part contradictory. CONCLUSION: Possibly due to the high variance in methodological approaches of the studies it is not possible to identify a specific weather condition associated with a generally higher risk for suicide. Weather and seasonal effects may interact with each other. Environmental effects on brain function and weather-related interactions of people may be involved in the occurrence of suicidal behaviour.     

Seasons and meteorological factors in suicidal behaviour

This study is part of a joint venture project carried out by the Centre for Suicidological Research, Odense, and the Danish Meteorological Institute, Copenhagen. The overall purpose of that project is to examine the seasonality of suicidal behaviour and any covariations between suicidal behaviour and the weather in the Scandinavian countries. The project will comprise studies involving parameters such as suicide and attempted suicide, temporal variations including weekdays, holidays, lunar phases, etc., and a variety of meteorological factors. In this article, which presents results from a pilot study based on Danish data (county of Funen), focus is on temporal variations (month, week) and covariations between suicide and meteorological factors and the methodological problems involved. The material comprises all deaths registered as suicides in Funen (appr. 10% of Denmark) in the period 1970–1993, in all 2610 (age 15+). The meteorological data from the same period consists of daily information on precipitation, temperatures, wind velocities, hours of sunlight, etc. The results confirm findings of several previous studies, especially concerning the spring peak and a decreasing tendency throughout the week with significantly fewer suicides on weekends. Our findings indicate that climatological factors, e.g., changing weather, also to some extent might have an impact on suicidal behaviour. Weather may not be a major factor, but it needs, however, to be taken seriously and into account, when considering the etiology of suicide.     

History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk

BACKGROUND: Despite evidence indicating high morbidity associated with pediatric bipolar disorder (BP), little is known about the prevalence and clinical correlates of suicidal behavior among this population. OBJECTIVE: To investigate the prevalence of suicidal behavior among children and adolescents with BP, and to compare subjects with a history of suicide attempt to those without on demographic, clinical, and familial risk factors. METHODS: Subjects were 405 children and adolescents aged 7-17 years, who fulfilled DSM-IV criteria for BPI (n = 236) or BPII (n = 29), or operationalized criteria for BP not otherwise specified (BP NOS; n = 140) via the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. As part of a multi-site longitudinal study of pediatric BP (Course and Outcome of Bipolar Youth), demographic, clinical, and family history variables were measured at intake via clinical interview with the subject and a parent/guardian. RESULTS: Nearly one-third of BP patients had a lifetime history of suicide attempt. Attempters, compared with non-attempters, were older, and more likely to have a lifetime history of mixed episodes, psychotic features, and BPI. Attempters were more likely to have a lifetime history of comorbid substance use disorder, panic disorder, non-suicidal self-injurious behavior, family history of suicide attempt, history of hospitalization, and history of physical and/or sexual abuse. Multivariate analysis found that the following were the most robust set of predictors for suicide attempt: mixed episodes, psychosis, hospitalization, self-injurious behavior, panic disorder, and substance use disorder. CONCLUSIONS: These findings indicate that children and adolescents with BP exhibit high rates of suicidal behavior, with more severe features of BP illness and comorbidity increasing the risk for suicide attempt. Multiple clinical factors emerged distinguishing suicide attempters from non-attempters. These clinical factors should be considered in both assessment and treatment of pediatric BP.     

Risk factors for suicide attempts among African American women

The aim of this study was to examine psychological and interpersonal risk factors for suicidal behavior in low income, African American women; 285 African American women who reported being in a relationship with a partner in the past year were studied, 148 presented to the hospital following a suicide attempt, and 137 presented for general medical care. Cases were compared to controls with respect to psychological symptoms, alcohol and drug abuse, family violence (intimate partner abuse, childhood trauma), relationship discord, and social support. Psychological risk factors for suicide attempts at the univariate level included psychological distress [Crude Odds Ratio (COR) = 6.5], post traumatic stress disorder (PTSD) symptoms (COR = 3.8), hopelessness (COR = 7.7), and drug abuse (COR = 4.2). Interpersonal risk factors at the univariate level included relationship discord (COR = 4.0), physical partner abuse (COR = 2.5), nonphysical partner abuse (COR = 2.8), childhood maltreatment (COR = 3.2), and low levels of social support (COR = 2.6). A multivariate logistic regression model identified four variables that were strongly and independently associated with an increased risk for suicide attempts: psychological distress, hopelessness, drug abuse, and relationship discord. The model predicted suicide attempt status correctly 77% of the time. The results reveal that African American women who report high levels of psychological distress, hopelessness, drug use, and relationship discord should be assessed carefully for suicidal ideation and referred for appropriate mental health care.     

Synchronized annual rhythms in violent suicide rate,ambient temperature and the light-dark span

To investigate whether violent and nonviolent suicide and homicide are related to atmospheric or geomagnetic activity, we investigated the relationships between weekly number of suicides or homicides for all Belgium for the period 1979–1987, and ambient temperature, relative humidity, air pressure, hours of sunlight and precipitation per day, wind speed and geomagnetic index. The occurrence of violent suicide was significantly and positively related to ambient temperature, sunlight duration, an increase in temperature over the few past weeks, and negatively to relative humidity. Higher ambient temperature and an increase in air temperature over the few past weeks were the most significant climatic predictors of violent suicide rate. A highly significant common annual rhythm with a common acrophase of 190° was detected in violent suicide rate, ambient temperature and sunlight duration. No significant time-relationships between nonviolent suicide or homicide and any of the weather variables were found. It is concluded that i) violent suicide may be related to short-term fluctuations in the weather and in particular to temperature; and ii) the annual rhythm in violent suicide may be synchronized by the annual rhythms in ambient temperature and light-dark span.     

Prospective predictors of suicide and suicide attempts in 1,556 patients with bipolar disorders followed for up to 2 years

Objectives:  Bipolar disorders are associated with high rates of suicide attempts (SAs) and completions. Several factors have been reported to be associated with suicide in persons with bipolar disorder, but most studies to date have been retrospective and have not utilized multivariate statistics to account for the redundant prediction among variables submitted for analysis.
Methods:  This study examined the association between baseline clinical and demographic variables and subsequent SAs and completions through 2 years of follow-up of participants in the Systematic Treatment Enhancement Program for Bipolar Disorder using a pattern-mixture model.
Results:  Of the sample with complete data (n = 1,556), 57 patients (3.66%) experienced an SA or completion (CS). Several variables predicted suicidality (SA + CS) in this data set when considered alone, but after controlling for redundant prediction from other baseline characteristics, only history of suicide [odds ratio (OR) = 4.52, p < 0.0001] and percent days depressed in the past year (OR = 1.16, p = 0.036) were significantly associated with SAs and completions. A secondary analysis included a greater number of variables but a smaller sample size (n = 1,014). In the secondary analyses, only prior SAs predicted prospective suicidality (OR = 3.87, p = 0.0029).
Conclusions:  These results indicate that patients with bipolar disorder who present with a history of SAs are over four times as likely to have a subsequent SA or completion. Further studies are needed to evaluate and prevent future attempts in this high-risk cohort.     

重复自杀行为众多影响因素分析

目的探讨重复自杀行为者的特点及其自杀的危险因素。方法采用WHO健康量表、Beck抑郁自评量表、自杀强度量表等对115例住院的自杀未遂者实施调查,并追踪随访6年,对整个病程中仅有单次自杀行为和重复自杀行为两类人群住院时人文特点及评估资料进行比较。结果115例自杀未遂者中重复自杀行为24例,占20.9%。24例重复自杀行为者就诊治疗时年龄42.6±13.2岁,WHO健康量表得分7.04±5.64,Beck抑郁自评得分26.25±17.36,自杀强度得分10.04±4.94,16例(66.7%)患有精神疾病;91例单次自杀行为者年龄32.6±13.9岁,WHO健康量表得分15.91±5.61,Beck抑郁自评得分6.82±10.51,自杀强度得分7.76±3.97,20例(22.0%)患有精神疾病。重复与单次自杀行为者比较,两组在年龄、WHO健康量表、Beck抑郁自评得分、自杀强度得分、有无精神疾病以及自杀方式、是否真的想死、是否存在困扰1年以上躯体病或残疾、未来没有希望、身体健康状况自评方面存在明显差异(均P<0.05)。回归分析显示,自杀强度得分与是否真的想死得分相加代表的自杀致死倾向(P=0.036,OR=2.85,β=1.047),WHO健康量表与身体健康自评得分相加所代表的健康心理状态(P=0.026,OR=0.320,β=-1.141)进入回归方程。结论重复自杀行为者多患有精神疾病,抑郁心境、无望、自杀强度高等。有效评估这些因素对了解或防范未遂者再次出现自杀风险有重要意义。     

Elderly suicide in primary care

BACKGROUND: Primary care is probably the most suitable setting to start a strategy for suicide prevention for the elderly especially as more people are seen before committing suicide in primary care than in secondary care. AIM: This study examines the nature of complaints and timing of presentation to general practitioners by suicide victims in their last GP consultation, comparing persons aged 65 and over with those aged between 18 and 64. METHODS: Details of all cases of suicide verdict and open verdict, which were returned in inquests, held at the Coroner's Court of Birmingham and Solihull, between January 1995 and December 1999 were reviewed. The study provided a comparison between older people (65+) and younger adults. RESULTS: Older people had more physical illness, and were more likely to have seen their GP in the 6 months before suicide. Younger adults presented with more psychiatric symptoms, while older adults presented with more physical symptoms. Complaints to the GP in the last consultation were significantly different between the two age groups. Older people are more commonly present with physical pain and depression. CONCLUSIONS: The study found that elderly suicide victims had different characteristics and attributes from those of younger adults presenting to primary care. This difference may have implications for suicide research, training of primary care staff and suicide prevention programmes.     

Survival analysis of suicide risk after attempted suicide

Survival analysis of suicide risk by sex and age after attempted suicide was studied in a cohort of 1573 suicide attempters referred to the psychiatric emergency room at the Karolinska Hospital from 1981 to 1988. The time course of suicide risk and the overall prognosis after attempted suicide and, in particular, the possible usefulness of sex and age as risk factors for the prediction of suicide risk after attempted suicide was analyzed. Nearly two thirds of the sample were women and most of the suicide attempters were young (in their twenties and thirties), and the median age was 35 years. The overall mortality after a 5-year mean observation period after attempted suicide was 11%, and the suicide mortality was 6 %. The suicide risk after attempted suicide among men (8.3%) was nearly twice the female suicide risk (4.3%). Age as a possible suicide risk factor was analyzed for each sex separately by median split subgrouping. It was concluded that both older and younger male suicide attempters are at high risk of suicide (7% and 10% respectively), and older women are at higher risk than younger (6%, vs 2%). The suicide risk is particularly high during the first year after the suicide attempt. The high suicide risk group of young adult male suicide attempters is one of the main feasible targets of psychiatric intervention research programs on suicidal behavior. Suicide among young men is a major cause of years of life lost.     

High social class and suicide in persons at risk for schizophrenia

Objective: The relationship between suicide and social class has been equivocal. While some authors have reported that higher social class is related to higher rates of suicide, most other studies report that lower social class is associated with higher rates of suicide. Our study attempted to resolve these inconsistencies by using a High Risk for schizophrenia method. Method: Children of women with severe schizophrenia were assessed in 1962. In 2005, when subjects were a mean age of 58 years, we identified those who had committed suicide. Results: A higher rate of suicide was associated with risk for schizophrenia in the High‐Risk sample. Higher social class origin was associated with suicide in persons at risk for mental illness. Conclusion: Higher social class origin was associated with suicide in subjects at genetic risk for schizophrenia (but not those without risk).     

Social environment factors associated with suicide attempt among low-income African Americans: The protective role of family relationships and social support

Abstract Background Suicide and suicide attempts are important public health concerns, and recent decades have witnessed a rising rate of suicide among African Americans. A history of prior attempts is a leading risk factor for completed suicide. Further research is needed into the social environment risk factors for suicide attempt among African Americans. This study focused on two important dimensions of the social environment, family relationships and social support, as well as an important person-level risk factor—depressive symptoms. Method Data were obtained from a case-control study of 200 African American men and women aged 18–64 years, who sought services at a large, urban, public hospital. Odds ratios adjusted for significant sociodemographic differences between groups (aORs) were calculated for environment risk factors for suicide attempt among the cases and controls. The role of depressive symptoms was also studied. Results Lower levels of family adaptability and family cohesion increased the relative rate of suicide attempt in the sample. The aOR associated with the lowest quartile of family adaptability was 3.90, and the aORs associated with the first and second quartiles of family cohesion were 8.91 and 5.51, respectively. Lower levels of social embeddedness and social support increased the relative rate of suicide attempt in our sample. The aOR associated with the first and second quartiles of social embeddedness were 5.67 and 4.93, respectively, and the aOR associated with the lowest quartile of social support was 6.29. A mediating role of depression was discovered when depressive symptoms were entered into the logistic regression models. Conclusions Our findings indicate that social environment factors including deficits in family functioning and social support are associated strongly with suicide attempts among low-income African American men and women seeking treatment in a large, urban hospital. Thus, better family functioning and social supports can be considered protective factors in this population. The presence of depressive symptoms, a well-known risk factor for suicide attempts and suicide, appears to mediate the association between social environment factors and suicide attempt.     

Risk factors of attempted suicide in the elderly: The role of cognitive impairment

The authors’ aim was to assess the prevalence and importance of dementia and cognitive impairment in relation to suicidal behaviour in elderly psychiatric inpatients. The level of cognitive functioning (according to the Mini Mental State Examination – MMSE) of the elderly suicidal inpatients (N=62) were compared to the general elderly inpatients (N=152). There were significant differences in cognitive functioning between the two groups, in the non-suicidal group the level of cognitive function was significantly lower. However, mild cognitive deficit or mild dementia were registered in 60% of the suicide attempters. The results indicate that not only mood disorders, but other risk factors (especially mild cognitive impairment), have a key role in developing suicidal behaviour in the elderly. Thus, in the treatment and prevention of suicidal behaviour in the elderly, it is important to apply the complex bio-psycho-social model, in which (besides adequate pharmacotherapy) psychotherapeutic approaches and procedures to enhance cognitive functioning are of outstanding significance.     

Systematic review and meta-analysis of the clinical factors associated with the suicide of psychiatric in-patients

Large M, Smith G, Sharma S, Nielssen O, Singh SP. Systematic review and meta‐analysis of the clinical factors associated with the suicide of psychiatric in‐patients. Objective: To estimate the strength of the associations between the suicide of psychiatric in‐patients and demographic, historical, symptomatic, diagnostic and treatment factors. Method: A systematic review and meta‐analysis of controlled studies of the suicide of psychiatric in‐patients including suicides while on approved or unapproved leave. Results: Factors that were significantly associated with in‐patient suicide included a history of deliberate self‐harm, hopelessness, feelings of guilt or inadequacy, depressed mood, suicidal ideas and a family history of suicide. Patients suffering from both schizophrenia and depressed mood appeared to be at particular risk. The association between suicidal ideas and in‐patient suicide was weak and did not reach statistical significance after a quantitative correction for publication bias. A high‐risk categorization as defined by a combination of retrospectively determined individual risk factors was strongly statistically associated with in‐patient suicide (OR = 10.9), with a sensitivity of 64% and a specificity of 85%. Conclusion: Despite the apparently strong association between high‐risk categorization and subsequent suicide, the low base rate of in‐patient suicide means that predictive value of a high‐risk categorization is below 2%. The development of safer hospital environments and improved systems of care are more likely to reduce the suicide of psychiatric in‐patients than risk assessment.     

Risk factors associated with suicide attempt in young French people

Demographic data, personal and familial characteristics, as well as DSM-III-R-based psychiatric diagnoses were collected in 369 adolescents and young adults aged between 15 and 29 years, referred to an Emergency Department for psychological problems. In total, 60% of them were suicide attempters. Separations before the age of 12 years and depression in the family emerged as the main features distinguishing the suicidal group from the psychiatric control group. Fifty per cent of suicide attempters were repeaters. Fostering during childhood, suicide attempts and depression in the family were found to be risk factors for repeated self-attempts. These results support the view that significant levels of dysfunction, together with increased psychiatric morbidity, especially suicidal behaviour, characterize the families of young self-attempters.     

Characteristics of HIV patients who attempt suicide

OBJECTIVE: To examine the risk factors for suicidal behaviour in human immunodeficiency virus (HIV) positive patients. METHOD: HIV substance dependent positive patients who had attempted suicide were compared with HIV substance dependent positive patients who had never attempted suicide for suicide risk factors. RESULTS: Among the 149 HIV positive patients examined almost half had attempted suicide. Significantly more HIV positive patients who had attempted suicide were female. Attempters were significantly younger than non-attempters. Significantly more of the attempters had a family history of suicidal behaviour. Attempters also reported significantly more childhood trauma, scored significantly higher for neuroticism, had experienced significantly more comorbidity with depression, and more of them had received antidepressant medication. CONCLUSION: These data suggest that both distal and proximal risk factors are involved in suicidal behaviour in HIV positive substance dependent patients.     

Outcome of attempted suicide and psychiatric consultation: risk factors and suicide mortality during a five-year follow-up.

A total of 1018 self-poisoned patients were treated during the year 1983 in the emergency room of Helsinki University Central Hospital. By the end of a 5-year follow-up period, 3.2% of these had committed suicide, making annual suicide mortality 589 per 100,000. During the first year after the index attempt, suicide mortality was 1768 per 100,000, a 50-fold risk compared with that of the total population in Helsinki. Risk factors were being male of advancing age, having mental disorders, previous suicide attempts, a nonimpulsive index suicide attempt, moderate to very serious lethality and severe intention to die during the index suicide attempt. When the lethality was assessed as being very serious or intention to die as certain, 21% later committed suicide. The relative risk for those left without psychiatric consultation was 0.6 when the lethality was mild and 1.6 when it was severe. Results indirectly indicate that psychiatric consultation seemed to have a positive effect on the outcome of these attempted suicides.     

Coping styles and suicide risk

A total of 30 psychiatric in-patients admitted because of suicidal behaviour were compared with 30 non-suicidal psychiatric in-patients and 32 healthy controls on measures of suicide risk and coping styles. The three groups were similar with regard to demographic variables, but the suicidal group scored higher on the suicide risk scale. Suicidal patients were significantly less likely to use the coping styles of minimization and mapping. They were unable to de-emphasize the importance of a perceived problem or source of stress. They also lacked the ability to obtain new information required to resolve stressful life events. Four coping styles correlated negatively with the suicide risk (minimization, replacement, mapping and reversal), while another three (suppression, blame and substitution) correlated positively. These findings may have important implications for therapists and primary prevention workers, and might pave the way towards recognition of the role played by coping styles in predicting suicide and its use for cognitive intervention in these high-risk patients.