Impact of employment status and work-related factors on risk of completed suicide. A case-control psychological autopsy study

The objective of this study was to determine the impact of work-related factors on risk for completed suicide. Psychiatric disorders and socio-demographic factors including work-related factors were assessed by a semi-structured interview using the psychological autopsy method in 163 completed suicide cases and by personal interview in 396 living population-based control persons. Unemployment (in particular, for more than six months), (early) retirement, or homemaker status were associated with highly significantly increased suicide risk, independently of categorized psychiatric diagnosis. In addition, adverse psychosocial working conditions, such as monotonous work, increased responsibility and pronounced mental strain due to contact with work clients, significantly increased suicide risk as well, again independently of categorized psychiatric diagnosis. These findings demonstrate that negative consequences of unemployment, homemaker status with no outside occupation, or (early) retirement, as well as adverse psychosocial working conditions, present relevant risk factors contributing to suicidal behavior, independently of diagnosed psychiatric disorders. Employment and a positive modification of working conditions, may possibly be preventive to important adverse mental health outcomes, including suicidality.     

Impact of clozapine on completed suicide

OBJECTIVE: Clozapine has been found to be superior to typical neuroleptics in ameliorating the symptoms of refractory schizophrenia. This study evaluated clozapine's effect on the rate of death due to suicide. METHOD: All patients over a 4-year period who initiated treatment with clozapine while hospitalized within the Department of Veterans Affairs (VA) system (N=1,415) were matched with a schizophrenic control group (N=2,830) by propensity scoring-a widely accepted statistical method that has been used relatively little in psychiatric research. Centralized VA databases and a national death registry were used to identify all deaths within the two groups, along with listed causes, for the 3 years after discharge. RESULTS: Veterans exposed to clozapine while inpatients were significantly less likely to die during the follow-up period than those in the control group, but this was entirely attributable to the much lower rate of death due to respiratory disorders in the clozapine group. There were no significant differences in rates of suicide or accidental death. CONCLUSIONS: These results fail to support the hypothesis that clozapine treatment is associated with significantly fewer deaths due to suicide.     

The dexamethasone suppression test and completed suicide

The present study was undertaken to further explore the relationship between the dexamethasone suppression test (DST) and suicide. Depressed inpatients who had undergone the DST at index admission and later committed suicide (n = 13) were matched for age, gender, diagnosis, and type of DST (1 mg, 2 mg) with depressed inpatients from the same hospital and study time period to form 2 groups: a suicide attempter group (n = 25) and a nonattempter group (n = 28). The suicide completers group had significantly higher 1600 postdexamethasone cortisol levels than the suicide attempters group and a significantly higher 1600 rate of DST nonsuppression compared with the suicide attempter + nonattempter combined group. Although the rate of DST nonsuppression did not differ between the suicide attempter and nonattempter groups, serious attempters had significantly higher 1600 cortisol levels and a statistically higher proportion of patients who completed suicide than nonserious attempters.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cigarette smoking and risk of completed suicide: A meta-analysis of prospective cohort studies

BackgroundEpidemiologic studies have reported conflicting results relating smoking to suicide risk. We conducted a meta-analysis of prospective cohort studies to evaluate the association of cigarette smoking with completed suicide.MethodsEligible prospective cohort studies were identified from PubMed and EMbase databases (from 1966 to May 2011) and the reference lists of retrieved articles. Two authors independently extracted data and assessed study quality using the Newcastle–Ottawa Scale. Study-specific risk estimates were pooled using random-effects model and generalized least squares trend estimation was used to assess dose–response relationship.ResultsFifteen prospective cohort studies involving 2395 cases among 1,369,807 participants were included in the meta-analysis. Our data suggested that cigarette smoking significantly increased the risk of completed suicide. Compared with never smokers, the pooled RR was 1.28 (95% CI: 1.001–1.641) for former smokers, and 1.81 (95% CI: 1.50–2.19) for current smokers, respectively. Subgroup analyses showed that the increased suicide risk among current smokers appeared to be consistent, although there was heterogeneity among studies of current smoking (p < 0.001). Significant dose–response relationship was found between smoking and suicide, and the risk of suicide was increased by 24% for each increment of 10 cigarettes smoked per day (RR, 1.24; 95% CI: 1.20–1.28).ConclusionsOur meta-analysis robustly demonstrates that cigarette smoking is associated with an increased risk of completed suicide, consistent with a dose–response relationship. This conclusion has an important public health message for countries with high smoking prevalence and high suicide rate such as China.     

The impact of parental death on college-age women

This is a small sample study of the impact of a parent's death on college-age women. These women report that the death matures them, often putting them out of step with their peers. How they cope is related to the surviving parent's ability to respond to their needs as children. Regardless of the age at the time of the death, they felt unsure about how safe the world was for them, and they needed reassurance that they could count on the surviving parent to take care of them. As they mature, they need to discover what kind of person their deceased parent was and to find a place for the deceased in their adult identity.     

The impact of suicide on therapists in training

This article explores the impact of a patient's suicide during the therapist's training. It is the author's opinion that this subject has received too little attention, and some possible reasons for this are discussed. The scope of the problem is reviewed, including data from a recent study by the author. Also, some general comments about training program responses are offered.     

Psychological autopsy of completed suicide in children and adolescents

A psychological autopsy of 20 children and adolescents aged 12-19 years who had committed suicide and a matched-pair control group revealed that 85% of the victims and 18% of the control subjects had expressed suicidal ideation. A statistically significant number of the victims had a history of suicide threats (55%), suicide attempts (40%), drug or alcohol abuse (70%), antisocial behavior (70%), or inhibited personality (65%). Suicidal behavior of parents, relatives, or friends and a parental history of emotional problems and absence or abusiveness were also significant factors for the victims.     

城市居民自杀流行学研究

目的：了解城市居民的自杀流行学情况。方法：调查长沙市南区１９８７－１９９７年人群自杀的流行学特征。结果：长沙市南区人群１１年间平均自杀率为５．５／１０万。在１９９０－１９９７年８年间，自杀率有上升趋势（ｙ＝４．４７８＋０．６６４ｘ，Ｐ〈０．００１）。从自杀率的年龄分布看，存在两个高峰，２５－３４岁青年组及６５岁以上老年组，６５岁以上老年人自杀率（１８．３／１０万）为平均自杀率的３－４倍，男女自杀率     

Association study of BDNF with completed suicide in the Japanese population

We explored the association between the brain-derived neurotrophic factor gene with suicide using 307 Japanese completed suicides, 380 healthy controls, and data from previously published samples. The meta-analyses of the valine with methionine in codon 66 (Val66Met) single nucleotide polymorphism (SNP) showed that the Met-allele tended to be associated with attempted suicide in Asian populations, but not with the completed suicide.     

The impact of the reunification of Germany on the suicide rate

Abstract

Eastern Europe and Russia comprise a group of nations which have experienced fundamental political, economic and social changes as a consequence of communism's downfall (e.g. Keep, 1995; Stokes, 1993). For example, East Germans have gained political rights including freedom of speech, the right to independent organizations and free democratic elections (Adler, 1996). Further, there is some evidence of greater religious freedom after the fall of communism (Gautier, 1997). However, economic problems have generally worsened after the demise of communism. For example, unemployment rates in East Germany have increased from near zero to 21% for women and 11% for men (Adler, 1996). It is generally assumed that these political and economic changes are associated with an increase in stress levels (Adler, 1996; Cockerham, 1997; Kohn, et al., 1997) and possibly suicide rates (Yang & Lester, 1995).     

The Clarke Institute experience with completed suicide: 1966 to 1997.

OBJECTIVES: To describe the caseload of completed suicides at a single psychiatric facility and to review the perceived deficiencies in the care of those patients. METHOD: Demographic and diagnostic data, clinical circumstances, and the deficiencies in care and documentation or both were extracted from medical records and post-suicide audit reports. RESULTS: There were 276 completed suicides over the period reviewed, yielding suicide rates of 206 per 100,000 registered patients and 123.5 per 100,000 inpatient discharges. The male to female ratio was 2:1, and patients with schizophrenia or depression accounted for 63.7% of the caseload. Only 18% of inpatients were involuntary, and only 10% were under individual observation at the time of suicide. Individual psychiatrists had up to 15 suicides in their caseloads. Deficiencies and recommendations pursuant to case audits are summarized. CONCLUSION: This is the first report of the entire cumulative experience with completed suicide, including audited deficiencies in the care and documentation of that caseload, at a single Canadian psychiatric facility.     

The impact of media reporting of the suicide of a singer on suicide rates in Taiwan

Purpose  

To examine if widespread media reporting of the suicide of a young female singer by charcoal burning increased suicide rates, and to examine whether the suicide induced a high risk of imitation suicide by this method among the young female group.     

Comparison of completed and attempted suicide in Akita, Japan

To determine the factors underlying suicide in Akita prefecture, a questionnaire survey was conducted among members of the Akita Prefectural Medical Association (APMA), regarding suicide cases they attended. During the investigation period (1 July 2001-30 June 2002), the total number of suicide cases was 243 (138 completed, 105 attempted). Significant differences were identified between completed and attempted suicide groups in terms of gender, age distribution, and suicidal methods. Specifically, in the completed suicide group, the number of male completers exceeded that of female completers, the number of middle-aged or elderly completers was high, and the majority of completed suicide cases involved hanging as the suicide method. Conversely, in the attempted suicide group, the number of female attempters exceeded that of male attempters, younger attempters were frequent, hanging was rare, and drug overdose or cutting was common. In addition, the number of cases involving a history of previous suicide attempts was significantly higher in the attempted suicide group than in the completed suicide group. The results of the present study support the concept that the completed and attempted suicide groups are essentially of a different nature. Furthermore, the number of cases involving a history of previous suicide attempts was found to be significantly lower in the completed suicide group than in the attempted suicide group. This result indicates the difficulty in decreasing the number of completed suicides by simply providing intervention and care for individuals who have attempted suicide.     

Coffee,caffeine, and risk of completed suicide: Results from three prospective cohorts of American adults

Objective.To evaluate the association between coffee and caffeine consumption and suicide risk in three large-scale cohorts of US men and women. Methods. We accessed data of 43,599 men enrolled in the Health Professionals Follow-up Study (HPFS, 1988–2008), 73,820 women in the Nurses’ Health Study (NHS, 1992–2008), and 91,005 women in the NHS II (1993–2007). Consumption of caffeine, coffee, and decaffeinated coffee, was assessed every 4 years by validated food-frequency questionnaires. Deaths from suicide were determined by physician review of death certificates. Multivariate adjusted relative risks (RRs) were estimated with Cox proportional hazard models. Cohort specific RRs were pooled using random-effect models. Results. We documented 277 deaths from suicide. Compared to those consuming ≤ 1 cup/week of caffeinated coffee (< 8 oz/237 ml), the pooled multivariate RR (95% confidence interval [CI]) of suicide was 0.55 (0.38–0.78) for those consuming 2–3 cups/day and 0.47 (0.27–0.81) for those consuming ≥ 4 cups/day (P trend < 0.001). The pooled multivariate RR (95% CI) for suicide was 0.75 (0.63–0.90) for each increment of 2 cups/day of caffeinated coffee and 0.77 (0.63–0.93) for each increment of 300 mg/day of caffeine. Conclusions. These results from three large cohorts support an association between caffeine consumption and lower risk of suicide.