Trends in Suicide Mortality in Canada by Sex and Age Group, 1981 to 2017: A Population-Based Time Series Analysis: Tendances de la mortalité par suicide au Canada selon le sexe et le groupe d’âge, 1981 – 2017 : Une analyse de séries chronologiques dans la population

Objectives:Suicide is a complex global public health issue. The objective of this study was to assess time trends in suicide mortality in Canada by sex and age group.Methods:We extracted data from the Canadian Vital Statistics Death Database for all suicide deaths among individuals aged 10 years and older based on International Statistical Classification of Diseases and Related Health Problems, Ninth Revision (E950-959; 1981 to 1999) and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (X60-X84, Y87·0; 2000 to 2017) for a 37-year period, from 1981 to 2017. We calculated annual age-standardized, sex-specific, and age group-specific suicide mortality rates, and used Joinpoint Regression for time trend analysis.Results:The age-standardized suicide mortality rate in Canada decreased by 24.0% from 1981 to 2017. From 1981 to 2007, there was a significant annual average decrease in the suicide rate by 1.1% (95% confidence interval, −1.3 to −0.9), followed by no significant change between 2007 and 2017. From 1981 to 2017 and from 1990 to 2017, females aged 10 to 24 and 45 to 64 years old, respectively, had a significant increase in suicide mortality rates. However, males had the highest suicide mortality rates in all years in the study; the average male-to-female ratio was 3.4:1.Conclusion:The 3-decade decline in suicide mortality rates in Canada paralleled the global trend in rate reductions. However, since 2008, the suicide rate in Canada was relatively unchanged. Although rates were consistently higher among males, we found significant rate increases among females in specific age groups. Suicide prevention efforts tailored for adult males and young and middle-aged females could help reduce the suicide mortality rate in Canada.     

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.     

Suicide and the continental divide

Cross-cultural research is one avenue for investigating suicide. with Canada and the United States being obvious units for comparison. Studies of rates and patterns. homicide and suicide, facts and myths, psychological aspects. psychopathology, attitudes towards suicide and domestic and economic variables are reported. It is concluded that Canada has a higher rate and different pattern of suicide than the United States. Although there may be numerous similarities (e.g., psychological aspects. psychopathology), differences were noted in the relation between homicide and suicide, the attitudes toward suicide (e.g., Canadian young people, Canada's highest at risk group, see suicide as more normal and as an acceptable solution to issues than their American counterparts), and domestic stress, i.e., marriage. A historical explanation is provided as an avenue to understand these cultural differences in suicide.     

Ageing towards 21 as a risk factor for Young Adult Suicide in the UK and Ireland: ‘Many young men of twenty said goodbye’ †

Aims.Youth and young adult suicide has increasingly appeared on international vital statistics as a rising trend of concern in age-specific mortality over the past 50 years. The reporting of suicide deaths in 5-year age bands, which has been the international convention to date, may mask a greater understanding of year-on-year factors that may accelerate or ameliorate the emergence of suicidal thoughts, acts and fatal consequences. The study objective was to identify any year-on-year period of increased risk for youth and young adult suicide in the UK and Ireland.Methods.Collation and examination of international epidemiological datasets on suicide (aged 18–35) for the UK and Ireland 2000–2006 (N = 11 964). Outcome measures included the age distribution of suicide mortality in international datasets from the UK and Ireland, 2000–2006.Results.An accelerated pattern of risk up to the age of 20 for the UK and Ireland which levels off moderately thereafter was uncovered, thus identifying a heretofore unreported age-related epidemiological transition for suicide.Conclusions.The current reporting of suicide in 5-year age bands may conceal age-related periods of risk for suicide. This may have implications for suicide prevention programmes for young adults under age 21.Key words: Ageing, epidemiological transition, survival analysis, youth suicide     

Celebrity suicide: Did the death of Kurt Cobain influence young suicides in Australia?

This study examined the total rate of suicide in Australia for young people (aged 15–19 and 20–24 years) for the 30 day period after the announcement of Kurt Cobain's suicide in 1994, comparing with the identical period for the previous five years and accounting for unequal variability in weekends, Mondays and public holidays. The 1994 rates for male suicides for both age groups were lower than for 1992 and 1993, and were more similar to the 1990 rates. Female rates showed a steady small decline over the five years, sustained in 1994. Rates overall showed a reduction in all of the first five, ten and fifteen day rates, compared with previous years. There was no evidence of any increase in deaths from gunshot, the method used by Cobain. The conclusion appears to be that this celebrity suicide had little impact on suicide in young persons in Australia. Possible reasons for this are discussed.     

Testing Durkheim's theory of suicide: additional results from Germany

In a recent study of 14 European countries, Lester (1993), using inference statistical techniques, confirmed Durkheim's (1897) observation that lower birth rates were associated with higher suicide rates in 1870 and 1980. Due to changes in national boundaries, Germany was excluded from these analyses. Among the federal states of Germany, Bavaria most suitably lends itself to a study of the relationship between suicide and familial integration over time. A long-term analysis of the years between 1865 and 1980 reveals a prominent reciprocal relationship (r=–0.87;P<0.001) between rates of suicide and birth in Bavaria. Marriage rates, on the other hand, correlate only minimally (r=–0.19 ns) with rates of suicide. Our results accord with Durkheim's view that unlike birth rates, higher marriage rates per se are only slightly associated with suicide rates.     

Attempted suicide among Swedish-born people and foreign-born migrants

The present study focuses on 938 suicide attempts by Swedes and foreign-born people living in the catchment area of Lund University Hospital between 1991 and 1994.Foreign-born women older than 74 years of age had the highest rates for attempted suicide. Foreign-born women and men aged 45–54 years had two and three times higher rates for suicide attempt respectively than Swedes in the same age group. When adjusted for age, foreign-born people had a higher Incidence Density Ratio (IDR) for attempted suicide than Swedish-born people (IDR = 1.72, CI = 1.45–2.03). People living alone had a much higher risk of suicide attempt than those who were married (IDR = 3.13, CI = 2.69–3.65). The conclusion of the present article is that, when adjusted for age, foreign-born migrants have a higher risk of attempted suicide than Swedish-born people.     

Suicide in Alaska Natives, 1979-1984

Alaska native suicide data were reviewed for every Alaska native suicide (N = 90) from death certificate data for the years 1979-1984 and compared to suicide statistics of age- and sex-matched groups of the entire U.S. population. The yearly suicide rate for Alaska natives was about twice that for the United States. Most of this difference was accounted for by dramatically and significantly greater rates for young, single, Alaska native men compared to white men in the U.S.; this was true for both the 15-24 and 25-34 age groups. With advancing age, suicide rates among Alaska natives decreased; the rates for the 35-44 and 45-54 male groups were still much greater, but not significantly so, than the rates for the comparable U.S. groups. After age 55, no suicides were reported for Alaska natives while U.S. white men had their highest suicide rates in the 55-64 and 65 and above groups. A number of social factors appear to have fueled the rise in suicide rates in young Alaska native men, including: economic growth, industrialization and changing lifestyles; prevalence of firearms; and a high rate of alcoholism.     

Suicide Methods and Presence of Intoxicating Abusable Substances: Some Clinical and Public Health Implications

Toxicological studies have reported the presence of alcohol in about a third of suicides. Some have suggested that the presence of alcohol might predispose suicidal people to use particular methods, e.g., guns, although, in general, this does not appear to be the case. More recently, comprehensive toxicological studies have provided data on the detection of all intoxicating abusable substances (IAS) among suicides. The purpose of this report is to examine the presence of two samples of suicides to see if any relationships between presence of IAS at post mortem toxicology and any specific suicide method. The samples included 179 suicides from San Diego, California (1981–1982), and 225 suicides from Mobile, Alabama (1990–1995) for which comprehensive toxicological examination had been conducted. Methods were grouped into more immediately fatal (MIF) and less immediately fatal (LIF) categories. The most common method in each category (guns and overdoses respectively) were examined separately as well. The same proportions of men (51%) and women (65%) were positive for any IAS in both locations. There were no significant differences in the proportions of suicides that were positive for IAS between the sample totals or by gender or age groups (under age 30 and age 30 and over) for any of the methods or categories examined. Significantly more of the Mobile suicides were by MIF methods than in San Diego for both genders, almost totally attributable to the use of guns. The use of guns for suicide in Mobile (and the state of Alabama) was also significantly higher than the rest of the U.S. in the early 1990's. Nonetheless, the suicide rates for men and women in Mobile (and Alabama) were no higher than for the overall U.S. rates. We conclude that potentially suicidal people should be advised to avoid intoxicating abusable substances of any kind. We also suggest that physicians should avoid prescribing such substances to depressed or suicidal patients.     

Personal violence (suicide and homicide) in South Africa

An examination of recent suicide and homicide rates in the United States and South Africa showed quite similar patterns, with whites having higher rates of suicide and nonwhites having higher rates of homicide. In recent years, suicide rates for white males have risen in South Africa while remaining stable in the United States. In contrast, homicide rates have risen for nonwhites in South Africa.     

An epidemiologic investigation of potential risk factors for suicide attempts

Summary This is a report of new research on suicide attempts, based on an analysis of data from the Epidemiologic Catchment Area surveys in the United States. Risk of making a suicide attempt during a 1–2 year observation interval in the early 1980s was estimated in relation to selected personal and behavioral atributes of 13,673 study participants who completed baseline and follow-up interviews for these surveys. Being an active case of Major Depression was associated with increased risk of suicide attempt (estimated relative odds, RO=41; 95% CL=6.46–262), as was active alcoholism (RO=18; 95% CL=2.75–118) and being separated or divorced (RO=11; 95% CL=1.64–77). Being a user of cocaine was associated with increased risk of making a suicide attempt (RO=62; 95% CL=2.51–1528), but illicit use of marijuana, sedative-hypnotics, or sympathomimetic stimulants was not (P>0.30). Educational achievement was inversely associated with risk of suicide attempt at a marginal level of statistical significance (P=0.068). These multivariable conditional logistic regression results were obtained by applying a conventional epidemiologic strategy with poststratification of subjects into homogeneous risk sets. Limitations of the study data and the analytic strategy are discussed in relation to directions for future epidemiologic field surveys.     

Suicide,psychiatric reform,and the provision of psychiatric services in Italy

Summary An ecological approach has been adopted to study the effect on suicide of the 1978 psychiatric reform in Italy. Using regional data, the trend in suicide during the pre-reform quinquennium (1973–1977) is compared with that during the postreform quinquennium (1979–1983). The results show that the suicide rate in Italy as a whole has increased consistently over the past 10–15 years and that the increase is largely confined to the north-central parts of the country. No clear time trend emerged with respect to the proportion of suicides classified as being due to mental illness. The difference between the two 5-year trends (1973–1977 and 1979–1983) was positive (i.e., an increase in the suicide rate) for 10 of the 19 regions in Italy. This difference correlated negatively with the provision of general hospital psychiatric beds, a finding which persisted when controlled for the pre-reform trend in suicide. The post-reform regional provision of mental hospital beds (which have declined considerably in recent years) was not related to changes in the suicide rate. The usefulness of comparing trends in rates, rather than averaged rates, in the investigation of the effect of a new service on suicide is stressed.     

Antenatal Ultrasound and Risk of Autism Spectrum Disorders

We evaluated antenatal ultrasound (U/S) exposure as a risk factor for autism spectrum disorders (ASD), comparing affected singleton children and control children born 1995–1999 and enrolled in the Kaiser Permanente health care system. Among children with ASD (n = 362) and controls (n = 393), 13% had no antenatal exposure to U/S examinations; case–control differences in number of exposures during the entire gestation or by trimester were small and not statistically significant. In analyses adjusted for covariates, cases were generally similar to controls with regard to the number of U/S scans throughout gestation and during each trimester. This study indicates that antenatal U/S is unlikely to increase the risk of ASD, although studies examining ASD subgroups remain to be conducted.     

Self-Reported Suicide Attempts by Adolescents

A thorough medical literature review of adolescent self-reported suicide attempts focused on comparing the following: (1) the prevalence of attempts in anonymous vs. face-to-face surveys; (2) the prevalence rates in the United States and Canada vs. those reported elsewhere; and (3) the prevalence of attempt findings vs. self-harm behavior in anonymous surveys. The major findings were: (1) 29 anonymous self-report questionnaire studies from nine countries revealed that a median of 7–10% of adolescent students acknowledged having made one or more suicide attempts; (2) seven structured interview studies revealed a 3–4% lifetime prevalence of attempted suicide by adolescents; (3) self-report questionnaire responses failed to reveal any overlap between deliberate self-harm behavior and suicide attempts; (4) nonanonymous studies had an unusually high rate of refusal. Thus, self-reported suicide attempts are surprisingly frequent in adolescence and are reported two to three times more often under conditions of anonymity. Furthermore, youths report self-harm behavior as distinct from suicide attempts.     

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.     

Changing patterns of suicide in Hong Kong

This paper aims to examine the changes in frequency, distribution and methods of suicide in the past 30 years in Hong Kong, and to explore the sociocultural factors behind such changes. Official data on suicides, undetermined deaths and seven social variables were used to estimate the age-, sex- and method-specific suicide rates and monthly occurrence of suicides, and to measure social changes. A low anomie status has been maintained for the past 30 years in Hong Kong. After accounting for undetermined deaths, suicide rates in adult males and young females (aged 15–24 years) decreased, while the rates in adult females remained stable. The phenomenon may be due to a protective effect of employment in males and by the changing status of women in Hong Kong. Suicide by jumping from heights became increasingly common, but appears to have substituted other means of suicide rather than increasing the overall suicide rate. Winter months had lower suicide rates, and the same circannual rhythm across diverse cultures speaks for a shared socio-biological process underlying suicide.     

Suicide in peacekeepers

Abstract. Objective: Several studies have investigated post-traumatic stress reactions and other psychosocial problems in former peacekeepers. The question has also been raised as to whether such veterans might be at increased risk of suicide. This study investigated the suicide mortality in Norwegian former peacekeepers. Methods: Cause-specific mortality was identified in the population of Norwegian peacekeepers having participated in army missions in the years 1978–95. General population data were used for comparison. Standardized Mortality Ratios (SMRs) were calculated for different suicide methods and certain peacekeeping-related variables. Marital status was available for each year and controlled for by using separate suicide rates for unmarried, married and divorced. Results: A moderately, but significantly, increased SMR of 1.4 for suicide was found among the former peacekeepers (95% confidence interval = 1.1–1.8). After adjusting for marital status, the SMR was reduced to insignificance (SMR = 1.1, 95% confidence interval = 0.9–1.4). There was a significant increase in suicide by means of firearms and carbon monoxide poisoning. Conclusions: The increased risk of suicide in former peacekeepers was related to the peace-keepers lower marriage rate compared to the general population. This finding may indicate that the personnel were characterized by certain vulnerability factors before entering peacekeeping service, resulting in a reduced ability to enter into and remain in stable love relations. However, it cannot be excluded that stress reactions following peacekeeping may have contributed to possible strains on interpersonal relationships. Preventative work should, thus, include improved personnel selection routines and preferably also psychosocial support for veterans and their families. The increased number of suicides by use of firearms indicates that gun control might be an important prevention measure in this group.     

Risk factors for suicide and attempted suicide among young people

OBJECTIVE: Suicide rates in young people have increased during the past three decades, particularly among young males, and there is increasing public and policy concern about the issue of youth suicide in Australia and New Zealand. This paper summarises current knowledge about risk factors for suicide and suicide attempts in young people. METHOD: Evidence about risk factors for suicidal behaviour in young people was gathered by review of relevant English language articles and other papers, published since the mid-1980s. RESULTS: The international literature yields a generally consistent account of the risk factors and life processes that lead to youth suicide and suicide attempts. Risk factor domains which may contribute to suicidal behaviour include: social and educational disadvantage; childhood and family adversity; psychopathology; individual and personal vulnerabilities; exposure to stressful life events and circumstances; and social, cultural and contextual factors. Frequently, suicidal behaviours in young people appear to be a consequence of adverse life sequences in which multiple risk factors from these domains combine to increase risk of suicidal behaviour. CONCLUSIONS: Current research evidence suggests that the strongest risk factors for youth suicide are mental disorders (in particular, affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology, indicating that priorities for intervening to reduce youth suicidal behaviours lie with interventions focused upon the improved recognition, treatment and management of young people with mental disorders.     

Suicide,unemployment and gender variations in the Western world 1964–1986

Summary The gender related suicide and unemployment rates for 1964–1986 from twenty-three Western countries were reviewed. A statistically significant correlation was found for both genders for the 1974–1986 period, which saw major rises in both suicide and unemployment in many Western nations. This was in contrast to a non-significant correlation for 1964–1973. As unemployment reached a critical level the statistical link with suicide became stronger. This suggests that unemployment is a contributing factor in increased suicide. Major gender changes occured, in particular rises in female suicide rates, though these were not uniform. Whilst the expected greater male/female ratio for suicide was confirmed, there were significant variations between countries, with the ratio widening particularly amongst anglophone nations. This indicated differential gender changes in patterns of suicide. The possibility of some protective mechanism against suicide for women in anglo phone countries is discussed.