Suicide and attempted suicide reported by general practitioners in Belgium, 1990–1991

In 1990–1991 the Belgian sentinel network of general practitioners recorded suicide and suicide attempts within their practices. The annual attempted suicide rate is estimated at 13.0 cases per 10,000 inhabitants. The highest incidence rates are found among women and young people. The annual suicide rate is estimated at 2.3 cases per 10,000 inhabitants, with the highest rates in men and in elderly people. The highest incidence rates of suicide attempts as well as of suicide are found among divorced people. About 30% of the attempters and committers made at least one earlier attempt. Drug overdose and hanging are the most frequently used methods, respectively when attempting and committing suicide. About 60% of both committers and attempters contacted their general practitioner within a period of 1 month preceding the attempt. Nearly half of the attempters and of the committers were treated for a mental disorder in the year preceding the attempt.     

Suicide and attempted suicide in a general hospital in western Ethiopia

ABSTRACT Suicidal behaviour in western Ethiopia as seen in a general hospital is reported on. The suicide rate is at least 3–11 per 100,000 inhabitants per year (mean 4.5) which is higher than is usually reported from Africa. As many women as men seem to commit suicide and the incidence is highest in the age group 19–24 years and lowest in the oldest group. The incidence seems to be higher in urban areas. Hanging is the most frequent method used by both sexes.     

Suicide and suicide attempts in general hospital psychiatry: Clinical and statistical study

Abstract Thirty-six psychiatric patients with completed suicide, 162 with attempted suicide and 154 patients referred for suicidal behavior, four of whom died, were investigated and classified according to the ICD-10. Thirty-six patients with completed suicide among 9085 new psychiatric patients (1969-92) gave a suicide rate of 82.6/100 000 per year. Schizoaffective and depressive disorder in psychiatric patients with completed suicide and schizophrenia, depressive disorder and adjustment disorders in patients with attempted suicide were significantly more frequent than in 312 controls. Intrafamilial conflicts, divorce or loss of love and death or severe disease of family member were the most common precipitants. Loneliness from living alone in males, losing a spouse and intrafamilial conflicts within a large family of three generations in females were supposed to be risk factors. A high referral rate of 48% in attempted suicide indicated the important role of consultation-liaison psychiatry in emergency medicine.     

Sex differences in risk factors for suicide after attempted suicide

Abstract.Aim: This study aims to investigate suicide risk factors after attempted suicide and whether and how these risk factors differ between the sexes.Method: A total of 1052 suicide attempters admitted to the Medical Emergency Inpatient Unit, Lund University Hospital, Sweden were followed up concerning suicide and death from other causes after a median period of 6 years and 5 months. In all, 50 persons committed suicide during follow-up. At the index suicide attempt, socio-demographic data and information about clinical characteristics were gathered in a standardised manner. Risk factors were identified among these data using survival analyses for the whole sample and for each sex separately.Result: Men had a higher frequency of suicide and a greater overall mortality than women. Cox regressions showed that suicide attempt(s) prior to the index attempt and the use of a violent method for the index attempt were risk factors for men only, whereas older age and a high suicidal intent (Beck SIS score) were female ones. Major depression was a risk factor for both sexes.Conclusion: More attention probably needs to be paid to the importance of gender in assessment of suicide risk and treatment of suicide attempters.     

Ulcer, attempted suicide and suicide.

Attempted suicide and suicide have been investigated among 2,619 patients suffering from duodenal ulcer, gastric ulcer and ulcer dyspepsia without ulcer demonstrable by x-ray. There was no difference in the percentage of attempted suicides and suicides among the three ulcer groups or between the sexes. Within well-defined periods, there was a statistically significant greater excess of attempted suicides among patients operated on than among unoperated patients. The distribution according to psychiatric diagnosis was very similar to the one observed among persons in general in Copenhagen attempting suicide. The number of patients committing suicide exceeded the expected number significantly, for men as well as for women, but there was no difference between patients operated on and unoperated patients. The psychiatric diagnoses of those committing suicide were predominantly neuroses and psychopathy.     

Age and attempted suicide

Clinical and demographic factors associated with suicide attempts admitted to the West Midlands Poisons Unit over a 2-year period were compared by age group. Risk factors for future suicide (living alone, physical illness, psychiatric illness and high suicidal intent in the attempt) were significantly more common among elderly patients (65 years and over) than middle-aged patients (35-64 years) and significantly less common among young patients (under 35 years) than middle-aged patients. Elderly patients that attempted suicide resemble elderly patients that completed suicide and should be considered at high risk of future suicide.     

Suicide attempts among Inuit youth: a community survey of prevalence and risk factors

The prevalence of and risk factors for attempted suicide and suicidal ideation were examined with a survey of 99 Inuit, aged 14–25 years, residing in a community in Northern Québec. A total of 34% of survey respondents reported a previous suicide attempt, and 20% had attempted suicide more than once. A suicide attempt had resulted in injury in about 11 % of those surveyed. The prevalence of suicidal ideation was also very high: 43% of subjects reported past thoughts of suicide, and 26% had had suicidal thoughts during the month before the survey. Risk factors for suicide attempts included male gender, having a friend who had attempted or committed suicide, a history of being physically abused, a history of solvent abuse, and having a parent with an alcohol or drug problem. Protective factors included a family history of having received treatment for a psychiatric problem, more frequent church attendance, and a high level of academic achievement. While individuals in the community who are at high risk for suicide can be targeted for preventive measures, the high prevalence and effect of family problems on likelihood of suicide attempts indicate the need for family- and community-based approaches.     

Suicide in the Canary Islands, 1977-1983.

We studied suicide in the Canary Islands between 1977 and 1983 and found 775 cases, twice the official number of 381. This indicates the lack of validity and reliability of official figures for suicide in Spain today. The figures reveal an upward trend in the Canary Islands, with the annual rate of 6.81 per 100,000 in 1977 having increased to 10.64 per 100,000 in 1983. There were no significant differences in the frequency of suicide according to season, month or day of the week.     

Suicide trends in Canada, 1956-1981

Using official suicide statistics, this study examined suicide rates in Canada over a 25-year span (1956 to 1981) as a function of age, gender, and geographical region. The analysis revealed that, for both sexes, the risk of suicide among the 15-24 year-olds increased at a faster rate than in any other age group. Male and female age-standardized suicide rates demonstrated an overall increase between 1956 and 1981. The trend for males was one of continuous increase, whereas female rates reached a maximum in 1976 and then decreased. Regional differences in suicide rates were also apparent. Although not strictly observed, a trend toward increasing risk of suicide in males as one proceeds westward across Canada was found. For females, a pattern of increasing suicide with more westerly location was also found, except that Ontario and the Prairie Provinces were in reverse order. Several possible explanations for these findings are presented.     

Familial clustering of suicidal behaviour and psychopathology in young suicide attempters

Introduction Familial clustering of suicidal behaviour and psychopathology has been reported in young suicide attempters. Most of these studies were predominantly carried out in clinical treatment settings and lacked statistical power to assess the independent and modifying influences of own and familial psychopathology and suicidal behaviour. Methods We carried out a population-based record-linkage study with a nested case control design. The 14,440 individuals hospitalised due to suicide attempt (cases) and 144,400 matched controls were born in Sweden between 1968 and 1980 and followed up till December 31, 1999. Results Among the strongest independent familial risk factors for youth suicide attempt were siblings’ (OR 3.4; 2.8–4.1), maternal (OR 2.7; 2.5–3.1) and paternal (OR 1.9; 1.7–2.1) suicide attempt. Other important risk factors were familial personality and substance abuse disorders, maternal schizophrenia, non-affective psychoses and organic disorders and parental neurotic, stress-related and somatoform disorders (1.9–3.2 fold increase), and paternal (OR 1.9; 1.6–2.3) and maternal (OR 1.8; 1.3–2.4) suicide completion. Mental illnesses in index subjects, particularly substance abuse, affective and personality disorders, were the dominant determinants of suicide attempt. Strong interactions were observed between psychopathology in index subjects and familial suicidality. Familial suicide completion had a stronger effect on suicide attempt of earlier onset and on boys. Nearly half (47%) of all suicide attempts could be attributed to familial psychopathology (13%), family suicide attempt (7%) and suicide completion (1%) and own psychopathology (25%). Conclusion Early recognition and adequate treatment of individual mental illness contribute to prevent youth suicide attempts. Children of parents with psychopathology and suicidal behaviour should receive early support and attention. Evaluation of familial suicidal behaviour seems to be vital for suicide risk assessment in young psychiatric inpatients. There appears to be an independent effect of familial suicidal behaviour as well as familial psychopathology on youth suicide attempt beyond the transmission of mental illness.     

Trends in suicide in Sweden 1749-1975.

Changes in the suicide rate in Sweden have been studied over the period 1749-1975. It has risen from about 2 per 100,000 inhabitants at the middle of the 18th century to about 20 per 100,000 during the period 1971-1975. Thus a more than tenfold increase is evident. From the non-standardized figures a real and substantial increase can be demonstrated which becomes even more apparent after standardization. This increase is independent of variations in the age composition of the population. The increase has occurred in the younger age groups: between the ages of 20 and 35 years, i. e.during the most active years of life, suicide is the leading cause of death today. An account of legislative measures for suicide prevention during this period is also presented. There is considerable support for the assumption that the low suicide rate registered in Sweden up to the beginning of the 19th century was an effect of the powerful influence of religion over the population.     

Suicide in southwestern Greece 1979-1984

Study of suicide in a province of southwestern Greece (population 295,000) from 1979 through 1984 demonstrated: mean suicide rate 0.48/10,000 population/year; significant increase of the suicide rate in men after the age of 65, but not in women; significantly higher suicide rate in men from rural than from urban areas; significantly higher suicide rate in men than in women from rural areas, no difference in urban areas; differences in suicide frequency or age at suicide were observed between subjects of different marital status; violent methods of suicide were most frequently used; and psychological disorders were the most frequent causes of suicide. Many of these findings are observed for the first time. Some may be related to the characteristics of the population studied, whereas others may also be present in other populations.     

Suicide attempters in a general hospital unit in India: their socio-demographic and clinical profile — emphasis on cross-cultural aspects

The number of suicide attempts in developing countries has been increasing progressively, as in the West. It is important to note that much of the data on suicidal behaviour is based on information obtained from developed Western societies. All such data need to be evaluated within their specific cultural context as well as cross-culturally. The present study explored the various socio-demographic, clinical characteristics of suicide attempters in a general hospital unit in India. There were certain findings that contrasted markedly with those observed in the West. Male suicides tended to predominate here, as in many Indian studies. None of them were living alone, separated or deserted by their partner. Some suicide attempters continued to live with their extended family. There was virtually no alcohol consumption by female suicide attempters. The commonest agents used were organophosphates and other household poisons. Several cross-cultural variations in the suicidal act emerged compared to the West. The 'suicide potential’ in the Indian culture is discussed.     

Adolescent suicide attempts 1973-1982 in the Helsinki area

Four hundred and twenty-two adolescent suicide attempts were examined. The intent to die was weaker than in adult persons. Within lethality no difference was found. Adolescents came mostly from the lowest social classes and their educational status was low. Their mental health was often unsatisfactory. The psychiatric treatment, which was arranged after the suicide attempt, was not more intensive than that arranged for adult suicide attempters.     

CSF 5-HIAA, suicide intent and hopelessness in the prediction of early suicide in male high-risk suicide attempters

OBJECTIVE: To study the predictive value of the Beck Suicide Intent Scale (SIS), the Beck Hopelessness Scale (BHS) and of 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid for future early suicide in a group of high-risk male suicide attempters. METHOD: Fifteen consecutive male suicide attempters admitted to a psychiatric ward at the Karolinska Hospital, who were not receiving any treatment with antidepressants were diagnosed according to DSM-III, assessed with SIS and BHS and submitted to lumbar puncture. All patients were followed up for cause of death. RESULTS: Five early suicides (within 2 years) were identified. Mean cerebrospinal fluid (CSF) 5-HIAA differed between suicides and survivors. Low CSF 5-HIAA was identified in those who committed early suicide. Neither the Suicide Intent Score nor the Hopelessness Score distinguished suicides from survivors. CONCLUSION: In high suicide risk hospitalized male psychiatric patients CSF 5-HIAA may be a better predictor of early suicide after attempted suicide than SIS or BHS.     

Suicide and attempted suicide in Greenland

Suicidal behaviour in Eskimo populations has changed in pattern and quantity over the last decades. Rates have more than quadrupled and performers now are mainly young persons with obscure motivation. In a study from Greenland's major township all cases of attempted or completed suicide among Greenlanders are analysed for social, emotional, somatic, and environmental predisposing factors in comparison with a non-psychiatric, never-suicidal, matching group. Almost two per thousand of the adult population committed suicide yearly while attempts at suicide were five times as frequent. A quarrelsome, drinking, childhood home background was often found, at least as regards the attempters, who themselves frequently suffered from emotional conflicts with close contacts, alcohol affliction, criminality, and instability at work. Neither bereavement, cross-cultural exposure, broken homes, nor meteorological factors seemed to exert a significant influence. The results are discussed in relation to the social and cultural evolution of the Greenlandic society.     

Repetition of Attempted Suicide Among Immigrants in Europe

Objectives

To compare frequencies of suicide attempt repetition in immigrants and local European populations, and the timing of repetition in these groups.

Method:

Data from 7 European countries, comprising 10 574 local and 3032 immigrant subjects, were taken from the World Health Organization European Multicentre Study on Suicidal Behaviour and the ensuing Monitoring Suicidal Behaviour in Europe (commonly referred to as MONSUE) project. The relation between immigrant status and repetition of suicide attempt within 12-months following first registered attempt was analyzed with binary logistic regression, controlling for sex, age, and method of attempt. Timing of repetition was controlled for sex, age, and the recommended type of aftercare.

Results:

Lower odds of repeating a suicide attempt were found in Eastern European (OR 0.50; 95% CI 0.41 to 0.61, P < 0.001) and non-European immigrants (OR 0.68; 95% CI 0.51 to 0.90, P < 0.05), compared with the locals. Similar patterns were identified in the sex-specific analysis. Eastern European immigrants tended to repeat their attempt much later than locals (OR 0.58; 95% CI 0.35 to 0.93, P < 0.05). In general, 32% of all repetition occurred within 30 days. Repetition tended to decrease with age and was more likely in females using harder methods in their index attempt (OR 1.29; 95% CI 1.08 to 1.54, P < 0.01). Large variations in the general repetition frequency were identified between the collecting centres, thus influencing the results.

Conclusions:

The lower repetition frequencies in non-Western immigrants, compared with locals, in Europe stands in contrast to their markedly higher tendency to attempt suicide in general, possibly pointing to situational stress factors related to their suicidal crisis that are less persistent over time. Our findings also raise the possibility that suicide attempters and repeaters constitute only partially overlapping populations.     

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.