Temperature-associated suicide mortality: contrasting roles of climatic warming and the suicide prevention program in Finland

Objectives

Suicide is a notable cause of death worldwide, and while suicidal behavior appears to be associated with variations in temperature, no estimations are available of climate change impacts on suicide rates. The study aims to evaluate the influence of temperature on suicide mortality, especially on multi-decadal and longer time scales, that is, at scales on which the ongoing warming distinctly operates and is correspondingly appropriate for the current policy responses to warming climate.

Methods

Our results are based on an extraordinarily long record of deaths from suicide in Finland from 1751 to 2008, and a similarly long climatic record of ambient temperatures correlative of environmental change in the study region.

Results

We show that temperature variability explains more than 60 % of the total suicide variance up until the initiation of a national suicide prevention program. Despite ongoing warming, suicide rates have declined since the initiation of the program.

Conclusion

By understanding the complexity of suicidal behavior as a response to ambient warming and the observed effects of interventions, our results underline the pressing need for a network of prevention programs to battle against temperature-mediated health hazards.     

Variation and seasonal patterns of suicide mortality in Finland and Sweden since the 1750s

Objectives

Suicide mortality varies in both the short and long term. Our study examines suicide mortality in Finland and Sweden from the 1750s until today. The aim of our study is to detect any seasonal peaks in suicide rates and examine their temporal evolution to suggest a mechanism that may explain such peaks.

Method

We acquired the study material from the Finnish and Swedish cause of death statistics (257,341 deaths by suicide) and the relevant population gender structure data. We then separately calculated the annual male and female suicide rates per 100,000 inhabitants. We analysed the suicide peaks, calculating factors of proportionality for the available data by dividing the suicide rates in the peak months (May and October) by the annual suicide rates.

Results

Suicide rates in Finland and Sweden peak twice a year. Both men and women in both countries most often commit suicide in May. There is another peak in October, with the exception of Finnish men. These suicide peaks coincide with a temperature increase in May and the biggest annual drop in temperature in October. We also observed a monotonic long-term change in the Swedish statistics, but not in the Finnish data. Our hypothesis is that seasonal variation in suicide rates may be caused by abrupt temperature changes twice a year that trigger the activity in brown adipose tissue and deepen depression.

Conclusion

While the overall suicide mortality rates varied considerably, the monthly proportions in May did not. This finding suggests a routine factor underlying the spring peak in suicide mortality.     

Evaluation of attempted suicide in emergency departments in Sanliurfa province, southeastern Turkey

Aim

Attempted suicide is one of the most important public health problems among preventable causes of mortality in the general population. Identifying risk factors for the prevention of suicide is a major public health goal. The aim of this study was to determine the annual rate of attempted suicide, related risk factors, and interventions, among referrals to emergency departments in the Sanliurfa province of southeastern Turkey.

Subjects and methods

Data were obtained from all emergency departments in the province based on the ‘Suicide Attempt Registry’ standardized records for the calendar year 2010. Socio-demographic characteristics, aetiology, psychiatric history, psychiatric consultations, and interventions were examined. The groups were analysed with the chi-square test; the significance level was set at p?<?0.05.

Results

The annual rate of suicide attempts was 55.39 in 100,000 for the calendar year 2010. The rate was 3.47 times higher among women than men, and in particular 4.15 times higher for the 15–24 year age group among women than in men with the highest incidence of suicide attempts. The majority of cases were referred in April and May. Medication or toxic agent ingestions comprised 90.3 % of cases. The main reason for attempts was family problems or domestic violence among women, and economic hardships among men, and rates of physical and mental problems were similar for both sexes. Only 8.8 % of cases were subsequently referred for psychiatric consultation. Among cases with a prior suicide attempt history, 44.6 % had a reported psychiatric disorder.

Conclusion

The results of this investigation show that strengthening of surveillance and emergency healthcare systems, enhancement of mental health literacy, and inter-sector collaboration for development of community empowerment programmes are of vital importance for prevention of attempted suicide. The low rate of psychiatric referrals for subsequent intervention represented a major gap in urgent mental health services in the region.     

Computer use,sleep duration and health symptoms: a cross-sectional study of 15-year olds in three countries

Objectives

This study investigated whether computer use is associated with health symptoms through sleep duration among 15-year olds in Finland, France and Denmark.

Methods

We used data from the WHO cross-national Health Behaviour in School-aged Children study collected in Finland, France and Denmark in 2010, including data on 5,402 adolescents (mean age 15.61 (SD 0.37), girls 53 %). Symptoms assessed included feeling low, irritability/bad temper, nervousness, headache, stomachache, backache, and feeling dizzy. We used structural equation modeling to explore the mediating effect of sleep duration on the association between computer use and symptom load.

Results

Adolescents slept approximately 8 h a night and computer use was approximately 2 h a day. Computer use was associated with shorter sleep duration and higher symptom load. Sleep duration partly mediated the association between computer use and symptom load, but the indirect effects of sleep duration were quite modest in all countries.

Conclusions

Sleep duration may be a potential underlying mechanism behind the association between computer use and health symptoms.     

Trends in mortality by labour market position around retirement ages in three European countries with different welfare regimes

Objectives

In the face of economic downturn and increasing life expectancy, many industrial nations are adopting a policy of postponing the retirement age. However, questions still remain around the consequence of working longer into old age. We examine mortality by work status around retirement ages in countries with different welfare regimes; Finland (social democratic), Turin (Italy; conservative), and England and Wales (liberal).

Methods

Death rates and rate ratios (RRs) (reference rates = ‘in-work’), 1970 s–2000 s, were estimated for those aged 45–64 years using the England and Wales longitudinal study, Turin longitudinal study, and the Finnish linked register study.

Results

Mortality of the not-in-work was consistently higher than the in-work. Death rates for the not-in-work were lowest in Turin and highest in Finland. Rate ratios were smallest in Turin (RR men 1972–76 1.73; 2002–06 1.63; women 1.22; 1.68) and largest in Finland (RR men 1991–95 3.03; 2001–05 3.80; women 3.62; 4.11). Unlike RRs for men, RRs for women increased in every country (greatest in Finland).

Conclusions

These findings signal that overall, employment in later life is associated with lower mortality, regardless of welfare regime.     

Long-term dietary l-arginine supplementation increases endothelial nitric oxide synthase and vasoactive intestinal peptide immunoexpression in rat small intestine

Background and aims

Nitric oxide (NO) and vasoactive intestinal polypeptide (VIP) are important intestinal neurotransmitters that coexist in the gut enteric nervous system and play an important role in intestinal physiology (e.g., absorption, motility, fluid secretion and smooth muscle relaxation). It is also known that cold exposure alters several aspects of gastrointestinal physiology and induces hyperphagia to meet increased metabolic demands, but there are no data regarding NO and VIP involvement in intestinal response during acclimation to cold. The objective of this study was to determine the influence of long-term l-arginine supplementation on the expression of the three isoforms of nitric oxide synthase (NOS) and VIP in small intestine of rats acclimated to room temperature or cold.

Methods

Animals (six per group) acclimated to room temperature (22 ± 1 °C) and cold (4 ± 1 °C), respectively, were treated with 2.25 % l-arginine, a substrate for NOSs, or with 0.01 % N ^ω-nitro-l-arginine methyl ester, an inhibitor of NOSs, for 45 days. The topographical distribution of VIP and NOSs expression in small intestine was studied by immunohistochemistry, and ImageJ software was used for semiquantitative densitometric analysis of their immunoexpression.

Results

Long-term dietary l-arginine supplementation increases VIP and NOSs immunoexpression at room temperature while at cold increases the endothelial NOS, inducible NOS and VIP but decrease neuronal NOS in rat small intestine.

Conclusion

Our results demonstrate that long-term dietary l-arginine supplementation modulates NOSs and VIP immunoexpression in rat small intestine with respect to ambient temperature, pointing out the eNOS as a predominant NOS isoform with an immunoexpression pattern similar to VIP.     

Adolescents’ Self-reported Running Away from Home and Suicide Attempts During a Period of Economic Recession in Greece

Background

Running away from home and suicide attempts during adolescence are high-risk behaviors for safety and health, and a “way out” from negative life experiences.

Objective

To examine the self-reported prevalence of running away and suicide attempts among adolescents in Greece in the midst of a severe economic recession which is exerting pressure on families, and to identify associated psychosocial factors.

Methods

Data were drawn from a nationally representative school survey (n = 23,279, 15–19 years old). Students answered in their classrooms an anonymous questionnaire under the supervision of trained researchers.

Results

Each behavior was reported by one in nine adolescents (11.3 % for lifetime suicide attempts and 11.6 % for lifetime running away). Among those who reported the one behavior, a quarter also reported the other. Logistic regression analyses indicated that these behaviors share several common psychosocial correlates: family related (quality of parental relationships, parental monitoring), school related (poor performance and dissatisfaction), substance use, and emotional, psychological and behavioral problems. Gender was a significant correlate but in opposite directions for running away (more common among boys) and suicide attempts (more common among girls). Socioeconomic status was not a significant correlate for either behavior, possibly because the impact of the economic crisis on parents had not yet filtered down to their children in 2011 (the survey year).

Conclusions

Findings suggest the need for timely interventions towards vulnerable youth and their families by identifying personal, familial and school factors associated with these two health- and life-compromising behaviors.     

Suicide and Ambient Temperature in East Asian Countries: A Time-Stratified Case-Crossover Analysis

Background

A limited number of studies suggest that ambient temperature contributes to suicide; these studies typically focus on a single nation and use temporally and spatially aggregated data.

Objective

We evaluated the association between ambient temperature and suicide in multiple cities in three East Asian countries.

Methods

A time-stratified case-crossover method was used to explore the relationship between temperature and suicide, adjusting for potential time-varying confounders and time-invariant individual characteristics. Sex- and age-specific associations of temperature with suicide were estimated, as were interactions between temperature and these variables. A random-effects meta-analysis was used to estimate country-specific pooled associations of temperature with suicide.

Results

An increase in temperature corresponding to half of the city-specific standard deviation was positively associated with suicide in most cities, although average suicide rates varied substantially. Pooled country-level effect estimates were 7.8% (95% CI: 5.0, 10.8%) for a 2.3°C increase in ambient temperature in Taiwan, 6.8% (95% CI: 5.4, 8.2%) for a 4.7°C increase in Korea, and 4.5% (95% CI: 3.3, 5.7%) for a 4.2°C increase in Japan. The association between temperature and suicide was significant even after adjusting for sunshine duration; the association between sunshine and suicide was not significant. The associations were greater among men than women in 12 of the 15 cities although not significantly so. There was little evidence of a consistent pattern of associations with age. In general, associations were strongest with temperature on the same day or the previous day, with little evidence of associations with temperature over longer lags (up to 5 days).

Conclusions

We estimated consistent positive associations between suicide and elevated ambient temperature in three East Asian countries, regardless of country, sex, and age.

Citation

Kim Y, Kim H, Honda Y, Guo YL, Chen BY, Woo JM, Ebi KL. 2016. Suicide and ambient temperature in East Asian countries: a time-stratified case-crossover analysis. Environ Health Perspect 124:75–80; http://dx.doi.org/10.1289/ehp.1409392     

Suicide: a concept analysis

Background

Suicide is a national and global phenomenon with its rate increasing every year inspite of clinicians, policy makers and researchers grappling with suicide prevention and investing heavily in risk assessment, prevention and reduction. There seems to be a gap in the understanding of suicide and its associated behaviours.

Aim

The aim of this review was to undertake a concept analysis of suicide and behaviour.

Method

The Walker and Avant eight-step method was adopted. Search engines including Academic Search Elite, CINAHL, Ovid Online embracing Embase and Ovid Medline were utilised to access articles published in the last 10 years, written in English, with abstracts and full text.

Results

The concept of suicide require understanding of implicity and explicity of suicidal intent and how these relate to suicide behaviour. Areas of risk assessment such as thwarted belongingness and perceived burdensomeness should be considered. Associated with suicide are internal and external hazards, which tend to create vulnerability leading to suicidal behaviour. Clinicians should differentiate between suicide in the presence of mental illness and when there is a predicament. Risk assessment tools should not be taken as absolute as they do not provide 100 % detection of intent.

Conclusion

Understanding the concept of suicide would help clinicians comprehend their patients and suicidal behaviour and improve intervention methods.

     

Socioeconomic inequalities in alcohol use of adolescents: the differences between China and Finland

Objectives

Findings from previous studies on socioeconomic inequalities in alcohol use among adolescents are not consistent. This study examined and compared the relationship between socioeconomic status and alcohol use of adolescents in China and Finland.

Methods

The sample included 2,005 Chinese and 1,685 Finnish 15-year-old school children. The associations between Family Affluence Scale (FAS) and alcohol use were examined separately in two countries through binary logistic regression.

Results

Chinese adolescents from the high FAS group were more likely to report experiencing monthly alcohol use (OR = 2.13) and early onset of alcohol use (OR = 1.55) (girls), and early onset of drunkenness (OR = 1.81) (boys). However, no statistically significant difference was found in three FAS groups for all four measures of alcohol use among Finnish adolescents.

Conclusions

This study indicated clear differences of socioeconomic inequalities in alcohol use between Chinese and Finnish adolescents. It suggested that interventions on adolescent alcohol use in China should be targeted on those who are from the high affluent family whereas in Finland efforts should be made to curb adolescents drinking across the socioeconomic spectrum.     

Crisis,suicide and labour productivity losses in Spain

Objectives

Suicide became the first cause of death between the ages of 15 and 44 in Spain in the year 2013. Moreover, the suicide rate in Spain went up by more than 9 % with respect to the previous year. This increase could be related to the serious economic recession that Spain has been experiencing in recent years. In this sense, there is a lack of evidence to help assess to what extent these suicides have a social cost in terms of losses in human capital. Firstly, this article examines the relationship between the variables related to the economic cycle and the suicide rates in the 17 Spanish regions. Secondly, an estimate is made of the losses in labour productivity owing to these suicides.

Methodology

In this article, panel data models are used to consider different variables related to the economic cycle. Demographic variables and the suicide rates for regions across Spain from 2002 to 2013 also come into play. The present and future production costs owing to premature death from suicide are calculated using a human capital model. These costs are valued from the gross salary that an individual no longer receives in the future at the very moment he or she leaves the labour market.

Results

The results provide a strong indication that a decrease in economic growth and an increase in unemployment negatively affect suicide rates. Due to suicide, 38,038 potential years of working life were lost in 2013. This has an estimated cost of over 565 million euros.

Conclusions

The economic crisis endured by Spain in recent years has played a role in the higher suicide rates one can observe from the data in official statistics. From a social perspective, suicide is a public health problem with far-reaching consequences.

     

Economic crisis and suicides in Spain. Socio-demographic and regional variability

Background

Evidence from previous recessions suggests that at times of economic deterioration, suicides increase. Spain has been one of the European countries hardest hit by the financial crisis that started in 2008. The aim of this paper is to examine the impact of the double-dip recession in Spain on the most recent trends in suicide.

Methods

Suicide data from the years 2002–2012 were obtained from the ‘Death Statistic according to Cause of Death’ of the National Statistics Institute (NSI). Population figures were obtained from the population estimates of the NSI.

Results

While the suicide rate decreased between 2002 and 2012, the downward trend has reversed twice, in 2008–2009, and in 2012. This rise was particularly pronounced in males, with the rate ratio of 1.12 (95 % CI 1.05–1.20) in 2008 and 1.10 (95 % CI 1.03–1.18) in 2009. Following a decrease in 2010 and 2011, suicides among males have increased again in 2012—with RR of 1.10 (95 % CI 1.03–1.18) compared to 2007, however the difference between 2011 amounted to 14 % rise—the biggest interannual change in a decade. There was a similar but less pronounced pattern in females. Regional data showed variable results.

Conclusions

These results suggest that the Spanish economic crisis has been associated with suicide rates in 2008, 2009, and 2012. These findings are consistent with the double-dip recession that Spain experienced.

     

Lower air temperature is associated with ambulance transports and death in Takamatsu area,Japan

Objective

The aim of this study was to investigate the linkage among ambulance transports, the number of death and air temperature in Takamatsu area, Japan.

Methods

Monthly data of ambulance transports (total and acute disease) and the number of death from 2004 to 2012 were obtained from Fire Department Service in Takamatsu and Takamatsu city official website, Japan. Climate parameters for required period were also obtained from Japan Meteorological Agency. Population data in Takamatsu area were also used to adjust ambulance transports and the number of death. The linkage among ambulance transports, the number of death and climate parameters was evaluated by ecological analysis.

Results

Total ambulance transports (/a hundred thousand people/day) and ambulance transports due to acute disease (/a hundred thousand people/day) were 12.3 ± 0.9 and 6.8 ± 0.7, respectively. The number of death (/a hundred thousand people/day) was 2.5 ± 0.4. By quadratic curve, ambulance transports due to acute disease and the number of death were significantly correlated with the parameters of air temperature. However, the number of death was the highest in January and the lowest in August.

Conclusion

Although higher air temperature was only associated with higher ambulance transports, lower air temperature was associated with both higher ambulance transports and the number death in Takamatsu area, Japan.     

Socio-economic differences in the use of dairy fat in Russian and Finnish Karelia, 1994–2004

Objectives

To determine socio-economic differences from 1994 to 2004 in the use of butter and milk in Pitkäranta in the Republic of Karelia, Russia and North Karelia, Finland.

Methods

Health behaviour surveys in Pitkäranta (n = 3,599) and North Karelia (n = 3,652) in 1994, 1996, 1998, 2000 and 2004.

Results

A clear overall decrease occurred in the use of butter in cooking in Pitkäranta from 1994 to 2004. In both areas, subjects with lower education used butter in cooking and drank fat-containing milk more often. Regarding butter on bread, the educational patterns in the two areas were opposite: in Pitkäranta, subjects with lower education used butter less often but in North Karelia, they used butter on bread more often. Practically, no changes in socio-economic differences from 1994 to 2004 were observed in either area.

Conclusions

The socio-economic differences in the use of dairy fat were stable in both areas but larger in North Karelia than in Pitkäranta. Our results support earlier assumptions of a weaker role of education as a determinant of health in Russia than in the western societies.     

The effects of heat stress and its effect modifiers on stroke hospitalizations in Allegheny County,Pennsylvania

Purpose

Heat has been known to increase the risk of many health endpoints. However, few studies have examined its effects on stroke. The objective of this case-crossover study is to investigate the effects of high heat and its effect modifiers on the risk of stroke hospitalization in Allegheny County, Pennsylvania.

Methods

We obtained data on first stroke hospitalizations among adults ages 65 and older and daily meteorological information during warm seasons (May–September) from 1994 to 2000 in Allegheny County, Pennsylvania. Using conditional multiple logistic regressions, the effects of heat days (any day with a temperature greater than the 95th percentile) and heat wave days (at least two continuous heat days) on the risk of stroke hospitalization were investigated. The potential interactions between high heat and age, type of stroke, and gender were also examined.

Results

Heat day and heat wave at lag-2 day were significantly associated with an increased risk for stroke hospitalization (OR 1.121, 95 % CI 1.013–1.242; OR 1.173, 95 % CI 1.047–1.315, respectively) after adjusting for important covariates. In addition, having two or more heat wave days within the 4 day window prior to the event was also significantly associated with an increased risk (OR 1.119, 95 % CI 1.004, 1.246) compared to having no heat wave days during the period. The effect of high heat on stroke was more significant for ischemic stroke, men, and subjects ages 80 years or older.

Conclusions

Our study suggests that high heat may have adverse effects on stroke and that some subgroups may be particularly susceptible to heat.     

The effect of antioxidant vitamins E and C on cognitive performance of the elderly with mild cognitive impairment in Isfahan,Iran: a double-blind,randomized, placebo-controlled trial

Purpose

This study was carried out to investigate the effect of vitamins E and C on cognitive performance among the elderly in Iran.

Methods

About 256 elderly with mild cognitive impairment, aged 60–75 years, received 300 mg of vitamin E plus 400 mg of vitamin C or placebo daily just for 1 year.

Background

Demographic characteristics, anthropometric variables food consumption, cognitive function by Mini-Mental State Examination (MMSE), and some of the oxidative stress biomarkers were examined.

Results

Antioxidant supplementation reduced malondialdehyde level (P < 0.001) and raised total antioxidant capacity (P < 0.001) and glutathione (P < 0.01). The serum 8-hydroxydeoxyguanosine remained unchanged (P < 0.4). After adjusting for the covariates effects, MMSE scores following 6- (25.88 ± 0.17) and 12-month antioxidant supplementation (26.8 ± 0.17) did not differ from control group (25.86 ± 0.18 and 26.59 ± 0.18, respectively).

Conclusion

Despite significant improvement in most of the oxidative stress biomarkers, antioxidants’ supplementation was not observed to enhance cognitive performance. A large number of kinetic and/or dynamic factors could be suspected.     

Postprandial glucose, insulin and gastrointestinal hormones in healthy and diabetic subjects fed a fructose-free and resistant starch type IV-enriched enteral formula

Background

Reducing the dietary glycaemic response has been proposed as a means of reducing the risk of diabetes.

Aim

To evaluate the effects of a new diabetes-specific formula (DSF) enriched with resistant starch type IV and fructose-free on postprandial glycaemia, insulinaemia and gastrointestinal hormones in healthy volunteers and in outpatient type 2 diabetics.

Methods

(1) Twenty-four healthy volunteers were divided into two groups: Group 1 ( n = 10) was provided 50 g of the carbohydrate (CHO) constituent of the new product and 50 g of glucose separated by 1 week; Group 2 ( n = 14) was provided 400 ml of the new DSF (T-Diet Plus^® Diabet NP) and 400 ml of a control product separated by 1 week. (2) Ten type 2 diabetic patients received 400 ml of the new DSF and two other commercially available DSF (Glucerna^® SR and Novasource^® Diabet) on three occasions separated by 1 week. Venous blood samples were drawn at time 0 and at different times until 120 min. Glucose, insulin and gastrointestinal hormones were determined. Glycaemic and insulinaemic indices and glycaemic load were calculated.

Results

The CHO constituent and the new DSF showed low glycaemic index and glycaemic load. In healthy subjects, insulin and C-peptide release were lower after administration of the CHO constituent as well as after the new DSF (P < 0.001). Ghrelin, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) production were lower after intake of the CHO constituent (P ranging from <0.001 to 0.019) compared with glucose, and GIP was lower after ingestion of the new DSF (P = 0.002) than after the control product. In type 2 diabetic patients, glucose AUC was lower after the administration of the new DSF (P = 0.037) compared with the others.

Conclusions

Our results indicate that this new product could be beneficial for diabetic patients.     

Occupational respiratory and skin diseases among Finnish machinists: findings of a large clinical study

Purpose

Machinists are exposed to many sensitizing and irritant substances, but no previous study has assessed the occurrence of clinically verified occupational diseases in an unselected large workforce of machinists. Our aim was to study the occurrence of clinically verified occupational respiratory and skin diseases cross-sectionally in a large sample of machinists in southern Finland.

Methods

A computer-assisted telephone interview on occupational exposures and health was carried out in a sample of 961 machining workers from 64 metalworking companies. Of these, 757 (79 %) answered the interview. A total of 245 subjects reported work-related respiratory or skin symptoms and were invited to clinical examinations; 138 of these underwent a clinical interview and examination by an occupational health physician. On the basis of this examination, 32 subjects were further examined at the Finnish Institute of Occupational Health (FIOH) for occupational skin or respiratory diseases.

Results

One case of occupational asthma (OA) and seven cases of occupational dermatoses (OD) were diagnosed, giving a prevalence of 0.13 % (95 % CI 0–0.39) for OA, and 0.92 % (95 % CI 0.24–1.16) for OD. The OA was induced by the patient’s own MWF. Additional five cases of newly diagnosed non-occupational asthma (0.79 %, 95 % CI = 0.16–1.42) were detected. No cases of occupational rhinitis or COPD were diagnosed. The dermatoses diagnoses consisted of four cases of allergic contact dermatitis and three cases of irritant contact dermatitis. The most common causes of the ODs were MWFs.

Conclusion

This large clinical study of machinists representing metalworking in South Finland showed a prevalence of 0.13 % of OA and 0.92 % of OD. This relatively low occurrence of occupational diseases may reflect the strict Finnish criteria for the diagnosis of these occupational diseases and the relatively good level of occupational hygiene in machining workshops in Finland. Reported respiratory and skin symptoms were common, and these milder conditions may be linked to irritant rather than sensitizing exposures.