Northern excess in adolescent male firearm suicides: a register-based regional study from Finland, 1972–2009

There are more firearms in Northern Finland as compared to Southern Finland, and a positive association between suicide rates and the number of firearms in a given region has been demonstrated in previous literature. Accordingly, the authors compared firearm suicide rates of Finnish adolescent (under 18 years) males in the two geographic regions. Young adult (18–24 years) and adult (25–44 years) males were used as reference groups. National data on cases of suicide in Northern and Southern Finland between 1972 and 2009 were obtained from Statistics Finland. Firearm suicides (n = 5,423) were extracted according to ICD-classification (ICD-8/9: E955, ICD-10: X72-X75). The distribution of types of firearms (hunting gun, handgun, other) employed in suicides was also investigated. The adolescent male firearm suicide rate in Northern Finland was almost three times higher than that observed in Southern Finland, while there was no difference in rates of suicide by other methods. A northern excess in firearm suicide rates was also found among young adult and adult males. Hunting guns were the most common type of firearms employed in young male suicides, and their use was especially common in Northern Finland. Our results indicate that the use of firearms plays a major role in explaining the northern excess in young Finnish male suicide rates, and emphasize a need to advance suicide prevention according to specific regional characteristics.     

Suicidal behaviour in national and international adult adoptees

Background Previous studies have shown an elevated risk for suicidal behaviour in adolescent and young adult international adoptees. Comparisons between national and international adoptees in this respect have been inconclusive. Methods A total of 6,065 international adoptees were compared to 7,340 national adoptees and 1,274,312 non-adopted study subjects, all born between 1963 and 1973 and followed up until 2002 using the National Swedish Registers. Cox regression of person years was used in multivariate analyses to compare risks for suicide death and suicide attempt. Results International adoptees had clearly increased risks for suicide attempt (risk ratio 4.5 [95% confidence interval 3.7–5.5]) and suicide death (3.6 [2.6–5.2]) after adjustments for sex, age and socio-economic factors. National adoptees had lower risks than international adoptees, but had increased risks compared to non-adoptees (suicide attempt, 2.8 [2.2–3.5]; suicide death, 2.5 [1.8–3.3]). Biological parents' morbidity explained approximately one third of the increased risk for national adoptees. Female international adoptees' risk for suicide attempt was elevated to an even greater extent than in male international adoptees, when compared to the general population. Conclusions Clinicians should be aware that an increased risk for suicide and suicide attempts in international adoptees is a topic that is equally relevant to child and adult psychiatry.     

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.     

The association of suicide attempts and comorbid depression and substance abuse in psychiatric consultation patients

Substance abuse has been associated with attempted suicide and suicide. Few studies have examined the prevalence and associations of combined depression and substance abuse in suicide attempters. A chart review study of 1136 adult general hospital patients referred for psychiatric consultation between 1995 and 1998 was conducted to assess this further. Among 371 cases with self-harm, 311 (84%) attempted suicide. Suicide attempters were younger and diagnosed more often with comorbid substance abuse than patients without self-harm. Depressive disorders were found in 59% and substance abuse disorders in 46%. Comorbid depression and substance abuse was the most frequent category in suicide attempters, i.e., in 37%. Self-reported suicide intent was associated with increasing age, male gender, and comorbid depression and substance abuse. The suicide rate in suicide attempters was 322 per 100,000 patient-years, and 131 per 100,000 in consultation patients without self-harm. It is concluded that comorbid depression and substance abuse is associated with attempted suicide in psychiatric consultation patients. Suicide attempters should be thoroughly assessed for substance abuse. The increased suicide rate in psychiatric consultation patients with and without suicide attempts warrants further research.     

Young adult suicide and exposure to television

Summary Young adult suicide rates tripled following the introduction of television into the United States and Canada. To assess whether exposure to television is a risk factor for young adult suicide (ages 15–24), suicide trends were compared between the U. S., Canada, and South Africa, 1949–1985. Major increases in young adult suicide rates occurred in all three countries, even though there was no television broadcasting in South Africa prior to 1975. For the U. S., the timing of a census region's acquisition of television did not correlate with the timing of the subsequent regional increase in young adult suicide rates (r=–0.01). Nonspecific exposure to television is not a risk factor for young adult suicide. Television producers still need to be judicious in their portrayals, and discussions, of suicide on television, because of the risks of imitative suicides, particularly among the young.     

Excess suicide among formerly hospitalized child psychiatry patients

The authors report suicide risk among 1331 child psychiatry inpatients followed up for 4 to 15 years in a record-linkage study. Age- and sex-matched comparisons were made with the general population of Iowa (the state from which most of the subjects were selected). Suicide rates were higher than expected for both sexes, but the excess (9 suicides) was significant only for males. No suicides occurred earlier than age 17. The risk of suicide was 80 times that expected for schizophrenic patients and 25 times that expected for patients with organic mental disorders. Unlike follow-up studies of adult inpatients, a significant excess of suicide was not associated with affective disorder, substance abuse, neurosis, or anorexia nervosa. Clinical variables indicating more complicated psychiatric disturbance were associated with an even greater rate of suicide; these variables included multiple hospitalizations, a hospital stay of more than 15 days, and the presence of a medical diagnosis.     

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.     

Completed suicide after a suicide attempt: a 37-year follow-up study

OBJECTIVE: Attempted suicide is the strongest known predictor of completed suicide. However, suicide risk declines over time after an attempt, and it is unclear how long the risk persists. Risk estimates are almost exclusively based on studies of less than 10 years of follow-up. METHOD: The authors followed a cohort of 100 consecutive self-poisoned patients in Helsinki in 1963, for whom forensically classified causes of death during the following 37 years were investigated. RESULTS: They found that suicides continued to accumulate almost four decades after the index suicide attempt. CONCLUSIONS: A history of a suicide attempt by self-poisoning indicates suicide risk over the entire adult lifetime.     

Late adulthood suicide: A life-span analysis of suicid enotes

Older adults are the developmental age group across the lifespan at highest risk for suicide in many Western countries. Given the extent of the problem, the paucity of integrated and sound empirical research in this area is remarkable. Often the literature attributes the death to one or two variables (e.g., illness). However, a lifespan developmental approach calls for conceptualizing suicide in late adulthood from a multivariate perspective. This paper outlines two studies that were designed to investigate the suicide notes of the elderly in an adult lifespan perspective. The main conclusion is in support of a multivariate approach. There are more similarities than differences in suicide behaviour across the adult lifespan, although some differences were noted. The differences in the elderly appear to be issues of the inability to cope with the vicissitudes of aging (e.g., illness, isolation). It is concluded that future research is warranted.     

Adolescent/Adult Differences in Suicidal Behavior and Outcome

A comprehensive literature review compared the patterns of suicide and suicidal behavior for adolescents and adults to identify age-related similarities and differences. Particular attention was given to follow-up rates of suicide by psychiatrically treated persons in these age groups. The major findings were that (1) adults and adolescent suicide completers were similar with respect to their gender ratio, use of guns in the attempt, completion of the initial attempt, and serious psychopathology; (2) adolescents differed from adults in suicidal behavior in their greater attempt rate, higher attempt/completion ratio, and lower rates of short and intermediate completion following psychiatric treatment; (3) the suicide outcome following psychiatric hospitalization is eightfold greater in adults than in youths during the first 3.5 years post-discharge; and (4) the 5:1 male/female ratio is the same for both adolescent attempters who later suicide and for all U.S. 15–19-year-old suicide completers. The frequent practice of combining adult and adolescent suicide and suicide behavior findings can result in misleading conclusions.     

Familial aggregation of suicidal behavior: a family study of male suicide completers from the general population

OBJECTIVE: This study compared suicidality in families of adult male suicide completers and community comparison subjects. METHOD: Two hundred forty-seven relatives of 25 male suicide completers and 171 relatives of 25 matched comparison subjects were assessed for recurrent risk of suicidal and related behaviors. Analyses were performed on a subgroup of relatives of suicide completers with cluster B personality disorders. RESULTS: Relatives of suicide completers were over 10 times more likely than relatives of comparison subjects to attempt or complete suicide after the authors controlled for psychopathology. Relatives of suicide completers were not more likely to exhibit suicidal ideation but had more severe suicidal ideation than relatives of comparison subjects. These findings were stronger for the suicide completers diagnosed with cluster B personality disorders. CONCLUSIONS: Suicide has a familial component independent of psychopathology that may be mediated by a combination of factors, including more severe suicidal ideation and aggressive behavior.     

Exposure to antidepressant medications and suicide attempts in adult depressed inpatients

The effects of antidepressant medication on suicide risk remain unclear. This study explores any association between antidepressant medication and suicide attempts leading to hospitalization in adult depressed patients.The medical records of 103 patients admitted after a suicide attempt were examined and compared with those of a matched control group of depressed patients (n = 103) admitted without suicide attempts as well as a patient group with and without suicide attempts on separate hospitalizations (n = 25). No significant difference in antidepressant medication exposure before hospitalization was found between groups. Selective serotonin reuptake inhibitor exposure was higher in patients with suicide attempts, albeit nonsignificant, but was identical in patients admitted on two occasions with and without suicide attempts. The most common method for suicide attempt was drug overdose (52.4%). Patients in the group with suicide attempts had significantly more past suicide attempts. Study results do not confirm any relationship between antidepressants and suicide attempts. Close monitoring of depressed patients is advised especially in early treatment.     

Suicide Acceptability and Sexual Orientation: Results from the General Social Survey 2008–2014

Lesbian, gay, and bisexual (LGB) individuals have higher prevalence of lifetime suicide ideation and attempt than their heterosexual peers, but less is known about differences in suicide acceptability (i.e., believing suicide is a viable answer to a problem). The purpose of this study was to examine if LGB adults had greater suicide acceptability than heterosexual adults. A total of 4 items in the General Social Surveys from 2008 to 2014 assessed whether a nationally representative sample of U.S. adult respondents (n?=?5,037) thought it acceptable for individuals to kill themselves if one: goes bankrupt, dishonors their family, is tired of living, or has an incurable disease. Multiple logistic regression analyses were used to assess the association of sexual orientation with suicide acceptability items after adjusting for confounding factors. Compared with heterosexuals, lesbians/gays had higher odds of reporting suicide acceptability if one goes bankrupt (OR?=?1.92; 95% CI: 1.06, 3.46), dishonors family (OR?=?1.83; 95% CI: 1.01, 3.28), or is tired of living (OR?=?2.25; 95% CI: 1.30, 3.90). Bisexual and heterosexual groups were largely similar across the 4 suicide acceptability items. No sexual orientation differences were observed for reporting acceptability of suicide in the instance of an incurable disease. Post hoc analyses revealed significant interactions between sex and sexual orientation, such that differences in suicide acceptability seemed to be driven by sexual minority women rather than by sexual minority men. Suicide acceptability differs by sexual orientation, and community-level interventions around changing norms about suicide may be a prevention strategy for sexual minority individuals.     

Suicide attempts in which alcohol is involved: a special group in general hospital emergency rooms

Sixty-two percent of 1018 parasuicide patients treated in the emergency room of Helsinki University Central Hospital in 1983 for 1207 suicide attempts had recently consumed alcohol in addition to medical drugs: 46% were women and 54% men. High body alcohol levels were associated with young age and male gender. Alcohol consumption shortly before, or at the time of, parasuicidal acts was more common among young or lonely men with previous suicide attempts. Their suicide risk was assessed as less severe and they were less often referred to a psychiatrist compared with those who had not consumed alcohol. They were also more often left without arranged after-care. By the end of a 5.5-year follow-up period, 3.3% of these alcohol consumers had committed suicide, an annual suicide mortality of 598/100,000. In the year following the initial attempt, suicide mortality was 1809/100,000, a 51-fold risk compared to that of the total population in Helsinki. Sixty-seven percent of alcohol consumers during the initial suicide attempt also took it before actually committing suicide, and 30% of these revealed clear evidence of chronic alcohol consumption. Those who initially consumed alcohol were identifiable as a risk group for suicide, and thus improvement in their recognition and treatment in the emergency rooms of general hospitals is recommended.     

Family functioning and suicidality in depressed adults

This study examined the association between suicidality, family factors, and clinical and diagnostic variables in depressed adult inpatients. The subjects were 121 depressed adult inpatients living with a family member or significant other. Demographic, clinical, and diagnostic information about the patient, and subjective and observer ratings of family functioning were obtained. Trained interviewers rated families of suicidal depressed patients as more dysfunctional than families of patients with no history of attempted suicide. In a logistic regression model, earlier age of depression onset, number of psychiatric hospitalizations, and objectively rated poorer family communication were associated with a history of a prior suicide attempt. Also, modest evidence suggested that patients with a prior suicide attempt perceived their families as more dysfunctional than did their respective family members. Variations in family functioning are associated with different degrees of suicidality. However, prospective longitudinal designs would elucidate the causal relation between family dysfunction and suicidal behavior. Copyright by W.B. Saunders Company     

Asian americans' family cohesion and suicide ideation: moderating and mediating effects

The purpose of this study was to examine the relationship between family cohesion and suicide ideation in a national, adult community sample of Asian Americans (N?=?2072). The data for this study were drawn from the National Latino and Asian American Study, the first national epidemiological study of Asian Americans' mental health. The results indicate that family cohesion was negatively related to suicide ideation. In addition, English language proficiency moderated the relationship between family cohesion and suicide ideation. Family cohesion was related to lower odds of suicide ideation among low English proficiency Asian Americans. In contrast, family cohesion was not significantly related to suicide ideation among high English proficiency Asian Americans. Further, the findings are consistent with a model in which the relationship between family cohesion and suicide ideation was partially mediated by psychological distress. Practical implications for addressing suicide ideation among Asian Americans are discussed.     

Suicidal ideation and suicide attempts: Comorbidity with depression,anxiety disorders,and substance abuse disorder

The effect of comorbidity on rates of suicidal ideation and suicide attempts from an adult general population of former West Germany is investigated. The assessment instrument is a modified German version of the Diagnostic Interview Schedule (DIS), a fully standardized interview for the assessment of selected DSM-III lifetime diagnoses as well as suicidal ideation and suicide attempts. Of the general population 4.1% (2.2% male and 4.1% female) made suicide attempts during their lifetime. Only 2 of 18 people who attempted suicide did not meet criteria for a DSM-III-R diagnosis. Cases with pure major depression did not have an odds ratio for suicide attempts significantly higher than subjects with no DSM-III diagnosis. However, cases with both a major depression and a lifetime-anxiety-disorder diagnosis showed significantly elevated odds ratios. Therefore, it is suggested that comorbidity of anxiety and depression, and not depression itself, seems to be a risk factor for suicide attempts.