Suicide risk among recently released prisoners in New South Wales, Australia

OBJECTIVE: To determine the risk of suicide and drug overdose death among recently released prisoners. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study of 85 203 adult offenders who had spent some time in full-time custody in prisons in New South Wales between 1 January 1988 and 31 December 2002. MAIN OUTCOME MEASURES: Association between time after release and risk of suicide and overdose death. RESULTS: Of 844 suicides (795 men, 49 women), 724 (86%) occurred after release. Men had a higher rate of suicide than women both in prison (129 v 56 per 100,000 person-years) and after release (135 v 82 per 100,000 person-years). The suicide rate in men in the 2 weeks after release was 3.87 (95% CI, 2.26-6.65) times higher than the rate after 6 months. Male prisoners admitted to the prison psychiatric hospital had a threefold higher risk than non-admitted men both in prison and after release. No suicides among women were observed in the 2 weeks after release. No increased risk of suicide was observed among Aboriginal Australians in the first 2 weeks after release. Of 1674 deaths due to overdose, 1627 (97%) occurred after release. Drug-related mortality in men was 9.30 (95% CI, 7.80-11.10) times higher, and in women was 6.42 (95% CI, 3.88-10.62) times higher, in the 2 weeks after release than after 6 months. CONCLUSIONS: Prisoners are at a heightened risk of suicide and overdose death in the immediate post-release period. After 6 months post-release, the suicide rate approaches the rate observed in custody.     

Prevention of suicide.

We reviewed the epidemiologic features of suicide in Canada and evaluated suicide prevention programs. Three groups were found to be at increased risk for suicide: men aged 70 years or more, women aged 65 to 69 and men aged 20 to 24. The other groups, in decreasing order of risk, were the mentally ill, people who have attempted suicide, those with a life-threatening illness, native people, people with a family history of suicide and prisoners. Studies that evaluated suicide prevention programs showed that none significantly reduced the incidence of suicide; however, the studies were found to be methodologically inadequate or used noncomparable systems of data collection. On the basis of our findings we recommend that primary care physicians routinely evaluate suicide risk among patients in high-risk groups and that intervention include counselling, follow-up and, if necessary, referral to a psychiatrist. Close follow-up is recommended for newly discharged psychiatric patients and those who recently attempted suicide.     

Study of 100 patients injured by London underground trains 1981-6

One hundred patients who were injured by London underground trains during 1981-6 were studied; 43 of them died. Deliberate self harm was probable in roughly three quarters. Alcohol intoxication was thought to play an important part in a further tenth of cases. Thirteen were psychiatric inpatients at the time of the incident, and a further two had recently been discharged. Early warning of a potential suicide attempt was given during the 24 hours preceding the incident in 15 of the cases. Some of the deaths in the psychiatric patients may have been preventable.     

Maternal deaths from suicide in Singapore

INTRODUCTION: Maternal mortality in Singapore, as in other developed countries, has remained low in the past decade. In the United Kingdom and Australia, maternal deaths from suicide and psychiatric causes have been the leading cause of maternal mortality, and there have therefore been comprehensive healthcare programmes to address the mental health needs of mothers. METHODS: In this study, we looked at maternal deaths from 2000 to 2004, by linking coronial cases of female suicide in the reproductive age group 15-45 years, with the birth registration database, to identify both early and late maternal deaths. RESULTS: There was only one identified maternal death among 589 female suicides aged 15-45 years, occurring in a teenager within the first month postpartum. There was likely also another case that was unconfirmed and unreported. CONCLUSION: From this preliminary study, suicide and psychiatric causes are not significant causes of maternal mortality in Singapore. However, given that the epidemiology of postnatal depression statistics mirror that of the other countries, it is possible that maternal suicides have been underreported, and the load may well be higher. There is a need for a similar confidential enquiry into maternal deaths to be set up here, as is already in place in various countries, notably the United Kingdom and Australia, for the past decade.     

Psychiatric illness in the medical profession: incidence in relation to sex and field of practice.

The overall incidence of psychiatric illness among the physicians of British Columbia during 1970-74 was 1.27% per year. The overall suicide rate was more than 36.5/100 000. Incidence was not dependent on sex or age. The two specialties with the highest incidence--ophthalmology and psychiatry--had previously been demonstrated to have significantly high rates of suicide. The highest incidence was among psychiatric residents; in other resident groups collectively the incidence was at the expected rate. Greater severity of illness and poorer prognosis was found in family physicians compared with specialists, although the incidence was the same in the two groups.     

20世纪末广西人口自杀死亡率的流行病学调查研究

目的:查明20世纪末广西人口自杀死亡的发生强度,研究自杀死亡的各种有关因素和预防自杀的策略措施.方法:以分层随机整群抽样的方法,确定调查样本.结果:自杀的粗死亡率为14.87/105;自杀死者的年龄为6～94岁,中位数为38.68岁;每位自杀死者平均减寿27.92岁;女性的自杀死亡危险性高于男性;男女两性在20～岁年龄组,自杀死亡率均呈突然陡升;在20岁以上的人群中,有配偶者的自杀死亡率低于其他各种婚姻状况者;受教育程度较高者,其自杀死亡率较低.以上差异,均有统计学显著性.结论:妇女在家庭与社会中的地位问题,青年人的升学、就业与婚姻问题,老年人对家庭与社会的特殊需求问题,等等,都是自杀的预防与控制的关键问题.     

Is suicidal behaviour increasing among Australian youth?

The rate of suicide of 15- to 19-year-old Australian boys appears to have doubled since 1965. Some of this rise might be due to a trend by coroners to reach a verdict of suicide more frequently than previously. One in seven deaths of teenage boys is now termed suicide. Hospital admissions of boys and girls in Western Australia for attempted suicide doubled in the past decade. These figures indicate that suicidal behaviour among the young constitutes a serious problem for health and welfare services.     

When is a maternal death a maternal death? A review of maternal deaths at the Mercy Maternity Hospital, Melbourne

The limiting of the reporting of maternal deaths to those that are included in the criteria of the World Health Organization excludes deaths which yield useful information for further improvements in clinical performance. In this series of 22 maternal deaths, six deaths would have been excluded from reporting: one "direct" obstetric death of pre-eclampsia; one "indirect" death as a result of renal and cardiac failure; two deaths as a result of postnatal depression which led to suicide three and four months postpartum, respectively; and two deaths of cancers, where diagnostic delay may have been a result of the coexistent pregnancy. The importance of primary pulmonary hypertension, cardiomyopathy and psychiatric illness is emphasized. We endorse the recent recommendation of the International Federation of Gynaecology and Obstetrics (FIGO) that all maternal deaths that occur more than 42 days after the end of a pregnancy should be assessed for possible relationships with childbirth, and suggest that a time limit of one year would include all deaths that are worthy of scrutiny.     

精神病人自杀行为的随访研究

目的探讨精神病人自杀行为的危险因素。方法对73例有自杀行为的精神病人出院后进行5年跟踪随访研究。结果出院后5年内有61.6%的病人再次出现自杀行为,其中15.1%的病人自杀身亡。再次出现自杀的因素有阳性家族史、社会支持状态较差等。结论有精神病和自杀家族史且有自杀行为者再次发生自杀的机率较大,病人出院后的心理康复治疗和建立良好的社会环境是防止自杀的重要措施。     

Indicators of psychiatric disorder among women admitted to prison

A random sample of 708 women prisoners recently admitted to Holloway Prison was screened for evidence of psychiatric disorder. Of the 708 women, 195 had a history of self harm, 44 of whom had a history of cutting themselves, 125 had a history of psychiatric illness, 99 were dependent on opiates, and 89 took psychotropic drugs regularly. These findings suggest that there is a need for psychiatric units in women's prisons such as Holloway Prison, and that initiatives to alter policies of admission to psychiatric hospitals should be pursued.     

精神病人自杀行为的随访研究

目的：探讨精神病人自杀行为的危险因素。方法：对73例有自杀行为的精神病人的出院后进行5年跟踪随访研究。结果：出院后5年内有61．6％的病人再次出现自杀行为,其中15．1％的病人自杀身亡,再次出现自杀的因素有阳性家庭史,社会支持状态较差异等。结论：有精神病和自杀家族史且有自杀行为者再次发生自杀的机率较大,病人出院后的心理康复治疗和建立良好的社会环境是防止自杀的重要措施。     

The pattern of completed suicides seen in Kuala Lumpur General Hospital 1999

A study was done on 76 suicide cases managed by the Forensic Pathology Department of Hospital Kuala Lumpur (HKL) from January till December 1999 to explore the pattern of suicide and psychiatric history. The Chinese contributed 52% (n=40) of cases followed by the Indians (29%, n=22) and the Malays (12%, n=9). After the age of sixty, 84.6% of the subjects were Chinese. The common methods of suicide were poisoning (39%), hanging (34%) and jumping from height (22%). Four out of 12 case-notes traced had documented psychiatric history i.e. schizophrenia. Conclusion: the suicide rate for Kuala Lumpur is estimated at 7.4 per 100,000. The Indians has the highest suicide rate of 21.1 per 100,000 in keeping with other local studies. The suicide rate for the Chinese is 8.6 per 100,000, but it increased to 23 per 100,000 among the elderly Chinese. The suicide rate for Malays is 2.6 per 100,000, higher than what was cited in previous local studies. The incidence of jumping from height as a suicide method had doubled over the last 2 decades.     

疑似精神病的服刑人员司法鉴定229例分析

目的探讨分析监狱里疑似精神病服刑犯人的精神状态和服刑能力司法精神病鉴定情况。方法选择某监狱系统内的所有监狱服刑犯人作为研究对象,先由监狱系统排查出需要鉴定的疑似精神病服刑犯人,然后按程序进行司法鉴定。结果共完成司法精神病鉴定的229例,全是男性,其中有精神障碍的129人,无精神病的100人; 有服刑能力的164人,服刑能力削弱的20人,暂无服刑能力的45人。结论监狱里服刑的疑似精神病犯人精神问题和服刑能力情况复杂,应予以高度重视。     

An epidemiologic study of risk factors in two teenage suicide clusters

Two clusters of teenage suicides occurred in Texas between February 1983 and October 1984. The eight suicides from the first cluster and the six from the second were investigated together in a case-control study using a closed-response questionnaire administered to parents. Three control teenagers were matched with each case subject on the basis of school district, grade, race, and sex. Questions concerned the direct and indirect exposures of subjects to previous suicides as well as their life circumstances and behaviors. Case subjects were not more likely than control subjects to have had direct exposure to suicide as measured by their acquaintance with a person who committed suicide. Similarly, indirect exposure to suicide through the media was not associated significantly with suicide. Case subjects were more likely to have attempted or threatened suicide previously, to have damaged themselves physically, and to have known someone closely who died violently. Case subjects were more likely to have broken up with their girlfriends or boyfriends recently. They also had moved more often than control subjects, attended more schools, and lived with more parent figures. Identification of high-risk youths through knowledge of relevant risk factors can help to direct preventive services to those young people most susceptible to suicide.     

2006—2016年15例相约自杀案件分析

 目的 分析15例相约自杀死亡案件的特点,为此类型自杀案件的法医现场勘验及死亡方式鉴定提供参考和借鉴。方法 收集2006—2016年上海市闵行区及虹口区发生的相约自杀死亡案件15例,对案件中相约自杀人员的性别、年龄、关系、相约方式、自杀动机、自杀方式及现场情况进行统计分析。结果 15例案件中,男性多于女性,主要为18～44岁青年,大部分有明确的自杀动机,网络相约自杀案例明显增多,采用烧炭方式自杀者居多,大部分选择宾(旅)馆作为实施自杀的处所,一般采取相同的自杀方式。结论 了解案件特点有助于法医在同类型案件中抓住现场勘验重点,对死亡方式和性质作出快速、准确的判断。     

The characteristics,management, and aftercare of patients with suicide attempts who attended the emergency department of a general hospital in northern Taiwan

BackgroundSuicide is a serious public health problem worldwide. The emergency department (ED) is often the first place of contact with medical and mental health care for suicidal patients. This study aimed to determine the characteristics, management, and aftercare of patients who attempted suicide and then were taken to the ED of a general hospital in Taipei, Taiwan.MethodsOur study was a cross-sectional retrospective study that consecutively recruited patients with suicide attempts attended to the ED of a general hospital from June 2004 to May 2005. The patients' medical information and records pertaining to their emergency visit were subsequently reviewed.ResultsOverall, 481 persons were recruited into our study. The male:female ratio of total surviving attempters was approximately 1:4 and the average age was 33.6 [standard deviation (SD) 12.3] years. The most frequently observed general characteristics from which participants suffered were mental illness (73.1%) and interpersonal problems (76.1%). Nearly all patients (91.7%) received ED on-site psychosocial assessments from social workers (SWs) and psychiatrists in 84.2% and 53.4% of cases, respectively. Less than half of patients (45.1%) were referred to psychiatric outpatient aftercare, and only 26.1% contacted the psychiatric outpatient clinics after discharge from the ED. The stated reasons for psychiatric outpatient referral were associated with interpersonal problems, current psychiatric illness, the ED on-site psychiatrist consultation, and admission to medical, surgical, or psychiatric wards. However, individuals with interpersonal problems, previous psychiatric intervention, and ED on-site psychiatrist consultation were significantly more likely to attend outpatient psychiatric aftercare.ConclusionIndividuals who harmed themselves had a high rate of psychiatric morbidity and interpersonal problems. However, their adherence to psychiatric outpatient aftercare was low. Improved identification of the needs of patients with suicidal tendencies who did not attend outpatient services will have implications for future services provided to this patient population, and will better enable medical personnel to most effectively assist in suicide attempt interventions.     

精神病专科医院门诊病人自杀意念调查与预防研究

目的对精神病专科医院门诊病人自杀意念进行调查研究。方法对2009年3月至2010年3月期间,在我精神病专科医院门诊部就诊的患者进行调查。结果在145例有效问卷中,有60例（41.38%）表示自己在过去的1周内有过自杀念头,有85人（58.62%）表示自己在过去的1周内没有过自杀念头。结论开展有关自杀心理的调查,积极采取措施进行预防,对于减少自杀发生有重要作用。     

The presence and accessibility of firearms in the homes of adolescent suicides. A case-control study.

OBJECTIVE--The presence of guns in the home, the type of gun, and the method of storage were all hypothesized to be associated with risk for adolescent suicide. DESIGN--Case-control study. SUBJECTS--The case group consisted of 47 adolescent suicide victims. The two psychiatric inpatient control groups were 47 suicide attempters and 47 never-suicidal psychiatric controls, frequency-matched to the suicide victims on age, gender, and county of origin. SETTING--The cases were a consecutive community sample, whereas the inpatients were drawn from a university psychiatric hospital. MAIN OUTCOME MEASURE--Odds of the presence of guns in the home of suicide victims (cases) relative to controls. RESULTS--Guns were twice as likely to be found in the homes of suicide victims as in the homes of attempters (adjusted odds ratio, 2.1; 95% confidence interval, 1.2 to 3.7) or psychiatric controls (adjusted odds ratio, 2.2; 95% confidence interval, 1.4 to 3.5). Handguns were not associated with suicide to any statistically significantly greater extent than long guns. There was no difference in the methods of storage of firearms among the three groups, so that even guns stored locked, or separate from ammunition, were associated with suicide by firearms. CONCLUSIONS--The availability of guns in the home, independent of firearms type or method of storage, appears to increase the risk for suicide among adolescents. Physicians should make a clear and firm recommendation that firearms be removed from the homes of adolescents judged to be at suicidal risk.     

自杀未遂者的一般特征与自杀行为特征

目的：了解急诊科自杀未遂人群的人口学特征和行为特征。方法：对某省会城市3年综合医院100例自杀未遂连续样本及其家属进行面对面晤谈。结果：自杀未遂者男女性别比为3．8：1，27％有各种精神科的诊断，24％既往有自杀未遂史，22％有各种躯体疾病；自然未遂的方式以服毒辣为主，服毒药物以苯二氮类药物为主；44％在自杀未遂前1月内明确向旁人表面自杀意念。50％在自杀当日与人发生争吵,48％在自杀之后给别人以明确自杀信息。结论：自然未遂者在自杀行为发生前后均有一定的征兆和线索，加强对苯二氮类和农药的管理，有利于减少自杀行为的发生。