Methods of suicide used by children and adolescents

Although relatively rare, suicide is a leading cause of death in children and adolescents in the Western world. This study examined whether children and adolescents are drawn to other methods of suicide than adults. Swiss suicides from 1998 to 2007 were examined. The main methods of suicide were analysed with respect to age and gender. Of the 12,226 suicides which took place in this 10-year period, 333 were committed by children and adolescents (226 males, 107 females). The most prevalent methods of suicide in children and adolescents 0–19 years were hanging, jumping from heights and railway-suicides (both genders), intoxication (females) and firearms (males). Compared to adults, railway-suicides were over-represented in young males and females (both P < .001). Jumping from heights was over-represented in young males (P < .001). Thus, availability has an important effect on methods of suicide chosen by children and adolescents. Restricting access to most favoured methods of suicide might be an important strategy in suicide prevention.     

A longitudinal epidemiological comparison of suicide and other causes of death in Italian children and adolescents

The objective of the study is to evaluate temporal trends, gender effects and methods of completed suicide amongst children and adolescent (aged 10–17) when compared with temporal trends of deaths from other causes. Data were extracted from the Italian Mortality Database, which is collected by the Italian National Census Bureau (ISTAT) and processed by the Statistics Unit of National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS) at the National Institute of Health (Istituto Superiore di Sanità). A total of 1,871 children and adolescents, age 10–17 years, committed suicide in Italy from 1971 to 2003 and 109 died by suicide during the last 3-year period of observation (2006–2008). The average suicide rate over the entire period of observation was 0.91 per 100,000; the rate was 1.21 for males and 0.59 for females. During the study period, the general mortality of children and adolescents, age 10–17 years, decreased dramatically, the average annual percentage change decrease was of −3.3% (95% CI −4.4 to −1.9) for males and −2.9% (95% IC −4.4 to −2.5) for females. The decrease was observed, for both genders, for all causes of deaths except suicide. For males, the most frequent method was hanging (54.5%), followed by shooting/fire arms (19.6%), falls/jumping from high places (12.7%); for females, the most frequent method, jumping from high places/falls, accounted for 35.7% of suicides during the whole study period. In conclusion, this study highlights that over the course of several decades suicide is a far less preventable cause of death as compared to other causes of death amongst children and adolescents. Our study demonstrated that suicide rates in adolescents are not a stable phenomenon over the 40 years period of study. It suggested that rates for males and females differed and varied in different ways during specific time periods of this study. National suicide prevention actions should parallel prevention measures implemented to reduce other causes of death.     

Suicide among Italian adolescents: 1970–2002

The purpose of the present study was to analyze sex and regional differences in the suicide rate of adolescents and the methods they used for suicide in Italy during the period 1970–2002. Temporal trends and regional variations in suicide for Italian adolescents were retrieved from the Italian database on mortality for the period 1970–2002, collected by the Italian Census Bureau and processed by the Italian National Institute of Health-Statistics Unit. In the period 1970–2002, 3,069 adolescent suicides were monitored in Italy. Analyses of these suicides identified significant differences by region of residence and sex. Males were 2.1 times more likely than females to kill themselves. Male and female suicides had inverse trends in the years analyzed, so that the sex difference at the present time is the result of a continuous increase in male suicides and a decrease in female suicides since 1970. The dramatic peaks observed over the time period studied cannot be attributed to a single cause, indicating that further studies are needed to better understand the phenomenon.     

Update of suicide trends in Italy from 1986 to 1996

Background In some Western countries increasing suicide rates have been observed among males, especially young men, with a decline of female suicides. The present study analysed age-specific and age-standardised suicide rates in Italy. Method From 1986 to 1996 national statistics on numbers of suicides in each sex and age group were examined. Results Overall, suicides have remained substantially stable from 1986 to 1996. Among males over 45 years of age rates progressively decreased, and among subjects below 15 years rates remained stable. In the 15–24 and 25–44 age groups rates progressively rose: an overall increase of 2.76/100,000 and 1.60/100,000 was recorded, respectively. Among females over 45 years of age suicide rates progressively decreased, while rates in the other age groups remained fairly stable. Conclusion The present analysis documents a rise in suicides among young men, and highlights the need for age-specific suicide prevention programmes. Accepted: 11 January 2001     

a2-Adrenoreceptor antagonism and serotonin reuptake inhibition in patients with Parkinson disease and depression

The aim of this paper is to examine the classification of suicide in children and young adolescents. Although under-classification of suicide in the very young is a well-known problem, our hypothesis was that accidents might wrongly be classified as suicides, leading to over-classification. This may more easily occur in the very young. Method: Information about all registered young suicides under 20 years of age in Norway in 1990–92 was gathered from professional informants. The suicides were reclassified as certain, uncertain or improbable suicide. People under 15 years of age (n=14) were compared with late adolescent suicides (15–19 years) (n=115). Results: Uncertain or improbable suicides were significantly more common in the very young (50% vs. 5%, P<0.001). In contrast to the very young who completed suicide, the very young with uncertain suicide had few risk factors (mental disorders, broken families, known stressors or precipitants, suicide intent and farewell notes). Clinical vignettes are given. Conclusion: Some accidents in children may wrongly have been classified as suicide. Cases of death following experimenting or imitations of models from television or fiction should rather be classified as accidents or undetermined deaths. Misclassification of suicide may be an unnecessary burden to families and peers.     

Do antidepressants precipitate youth suicide?

The association between treatment with Selective serotonin reuptake inhibitors (SSRIs) and suicide in children and adolescents on the individual and ecological level were examined in a nationwide Danish pharmacoepidemiological register-linkage study including all persons aged 10–17 years treated with antidepressants during the period 1995–1999 (n=2,569) and a randomly selected control population (n=50,000). A tripartite approach was used. In Part 1, changes in youth suicide and use of antidepressants were examined. In Part 2, we made an assessment of youth suicide characteristics. In Part 3, we analysed the relative risk (RR) of suicide according to antidepressant treatment corrected for psychiatric hospital contact to minimize the problem of confounding by indication. The use of SSRIs among children and adolescents increased substantially during the study period, but the suicide rate remained stable (Part 1). Among 42 suicides nationally aged 10–17 years at death, none was treated with SSRIs within 2 weeks prior to suicide (Part 2). There was an increased rate of suicide associated with SSRIs (RR=4.47), however, not quite significant (95% CI: 0.95–20.96), when adjusted for severity of illness (Part 3). Conclusively, we were not able to identify an association between treatment with SSRIs and completed suicide among children and adolescents.     

Rural−urban differences in Austrian suicides

Objectives The answer to the question whether suicide rates are higher in urban than in rural areas may have changed over the years. This study analyzes the longitudinal trends of rural and urban suicides in Austria from 1970 to 2005. The most recent decade, 1995–2005 was also investigated cross-sectionally in terms of age groups, gender, suicide methods and family status. Methods Official suicide statistics were calculated in a Poisson regression model to determine trends in suicide rates according to gender in rural and urban regions as well as the ratios of rural- to urban-suicide rates. Population density levels were used as a measure of urbanization. Differences in suicide rates across the rural–urban categories were investigated in terms of genders, age groups, suicide methods and family status using Spearman correlations. Results The ratio of rural to urban suicide rates has continuously increased in both genders over the past 35 years, indicating a growing risk in rural areas. Suicide methods used in rural and urban areas vary significantly and suicide rates among men, but not women, were found to decrease with increasing urbanicity. Conclusion In line with recent findings from other western countries, we showed a growing gap between rural and urban suicide rates. This suggests a need for rural-specific suicide prevention efforts, especially aimed at the male rural population.     

Suicide in Greece 1980–1995: patterns and social factors

A nationwide study of suicide in Greece from 1980 through 1995 demonstrated: 1. A mean age-standardized suicide rate of 5.86/100,000 for males and 1.89/100,000 for females. 2. An increase in suicide rates with age, especially in males. 3. Significant rising trends of male suicides in the 45–54 age group. 4. Significant declining trends of female suicides in age groups 15–24, 75–84, and total. 5. The lowest suicide rates among married men and women. 6. Exceptionally high rates in young widowed men. 7. Rural suicide rates were twice as high as urban rates. 8. Suicide methods were mostly violent, especially in males. 9. Hanging was the most common method, employed in approximately 50% of all suicides. The low suicide rates and the trends observed can probably be attributed to a synthesis of social and cultural characteristics of the Greek people and ongoing changes in Greek lifestyle. Accepted: 10 February 1998     

The geographical distribution of suicides in farmers in England and Wales

Farmers in England and Wales have an elevated risk of suicide. The aim of this study was to investigate the geographical distribution of suicides in farmers. Rates of suicide (including suicide and open verdicts) of farmers in England and Wales between 1981 and 1993 were calculated on a county basis. Trends in rates and differences in rates between counties, regions and England and Wales were then analysed. There were 719 suicides (634 suicide verdicts and 85 open verdicts). There was evidence of a decline in annual rates of suicide in farmers during the study period in England but not Wales. There was no evidence of geographical heterogeneity of farming suicides according to counties, but a relatively high rate for Devon (N = 62 suicides). County farming suicide rates did not appear to be related to local general population suicide rates, density of farmers or type of farm holding. While identification of counties with relatively large numbers of farming suicides should assist targeting of local preventive programmes, it is clear that any significant prevention strategies should be implemented on a national basis. Accepted: 27 August 1998     

Child and young adolescent suicide in New Zealand

OBJECTIVE: To describe the epidemiology and characteristics of all suicide deaths among under 15-year-olds in New Zealand over a 10-year period. METHOD: In a 10-year retrospective study the features of all 61 children and young adolescents aged less than 15 years who died by suicide in New Zealand from 1989 to 1998 were examined by review of coronial files. RESULTS: Suicide among under 15-year-olds is very rare but increasing. Suicide risk increases with age: the majority of those who die are aged 14 years (57.4% of the total) or 13 years (26.2%). Boys (72.1%) and Maori (57.4%) predominate. Most suicides occurred in children not living in intact biological families (67.2%). Hanging was the predominant method (78.7%). One in three children left suicide notes. One in four had a history of contact with social welfare authorities. There was a family history of suicide in 10% of cases. A minority had a documented history of prior suicide attempts (13.1%) or mental health problems (23%). One in four (23%) was reported to have made threats of suicide within the year prior to their death. A majority of deaths appeared to have been precipitated by relatively minor family arguments or disciplinary events, which, however, occurred in the context of actual or anticipated disruptions or transitions in family living arrangements or school circumstances, or severe family problems. CONCLUSIONS: In general, the impression of young adolescent suicide was of a disadvantaged, vulnerable and distressed group of adolescents growing up in extremely difficult circumstances. Maori children predominate in this group. There is clearly a need to verify these impressions with an in-depth investigation of the familial and social circumstances of children who die by suicide. Such investigations might best be conducted by annual mortality review and monitoring of all young adolescent suicides.     

Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14,857 suicides

OBJECTIVE: To test the hypothesis that selective serotonin reuptake inhibitor (SSRI) antidepressants may have a suicide emergent effect, particularly in children and adolescents. METHOD: Detections of different antidepressants in the forensic toxicological screening of 14 857 suicides were compared with those in 26,422 cases of deaths by accident or natural causes in Sweden 1992-2000. RESULTS: There were 3411 detections of antidepressants in the suicides and 1538 in the controls. SSRIs had lower odds ratios than the other antidepressants. In the 52 suicides under 15 years, no SSRIs were detected. In 15-19-year age group, SSRIs had lower relative risk in suicides compared with non-SSRIs. CONCLUSION: The hypothesis that treatment of depressed individuals with SSRIs leads to an increased risk of suicide was not supported by this analysis of the total suicidal outcome of the nationwide use of SSRIs in Sweden over a period of 9 years, either in adults or in children or adolescents.     

Gun Control and Suicide: Possible Impact of Canadian Legislation to Ensure Safe Storage of Firearms

In 1992, the Canadian Firearms Act aimed at ensuring safe storage of firearms was promulgated. This study compares suicide methods 6 years prior to the enactment of the law and 5 years after its enactment. The study encompassed 426 suicide cases from Abitibi-Témiscamingue (Northern Quebec), the region with the highest suicide rate and the highest firearm suicide rate in Quebec. Suicide by firearms decreased in the male and female population. Suicide by hanging increased among youths of both sexes, and suicide by poisoning doubled in the female population. A decrease in firearm suicides was most noticeable in the under-25 age group, although it was in this same age group that the general suicide rate increased the most. The reduction of firearm suicides was not accompanied by a decrease in overall suicide rates.     

Gun control and suicide: possible impact of Canadian legislation to ensure safe storage of firearms.

In 1992, the Canadian Firearms Act aimed at ensuring safe storage of firearms was promulgated. This study compares suicide methods 6 years prior to the enactment of the law and 5 years after its enactment. The study encompassed 426 suicide cases from Abitibi-Témiscamingue (Northern Quebec), the region with the highest suicide rate and the highest firearm suicide rate in Quebec. Suicide by firearms decreased in the male and female population. Suicide by hanging increased among youths of both sexes, and suicide by poisoning doubled in the female population. A decrease in firearm suicides was most noticeable in the under-25 age group, although it was in this same age group that the general suicide rate increased the most. The reduction of firearm suicides was not accompanied by a decrease in overall suicide rates.     

Divergent trends in suicide by socio-economic status in Australia

Objectives This study investigated secular trends in socio-economic status (SES) differentials in Australian suicide (1979–2003), which includes overall declines in male suicide from 1998. Method Suicide rates were stratified by approximate equal-population quintiles of area-based SES for the period 1979–2003 and examined across five quinquennia, centred on each Australian Census from 1981 to 2001, to determine if (1) SES differentials in suicide have persisted over time, and (2) if SES differentials have widened or narrowed. Suicide rates (per 100,000) were adjusted for confounding by sex, age, country-of-birth, and urban–rural residence using Poisson regression models, and secular changes in SES differentials were assessed using trend tests on suicide rate ratios (low to high SES quintiles). Results Socio-economic status (SES) differentials persisted across the study period for both males and females after adjusting for the effects of age, migrant status, and urban–rural residence, with the largest differences between low and high SES groups evident in males, and especially young males (20–34 years). For males, suicide rates increased significantly in all SES groups until 1998, before diverging significantly in the most recent 5-year period, particularly in younger males (P < 0.0001). In young males, suicide rates in the most recent period increased in the low SES group from 44.8 in 1994–1998 to 48.6 in 1999–2003 (an 8% increase). In contrast, suicide rates in the middle SES group decreased from a peak of 37.3 to 33.5 (a 10% decrease), and in the high SES group from a peak of 33.0 to 27.9 (a 15% decrease). A similar statistically significant divergence of a lesser magnitude was also evident in all age males and younger females (20–34 years). Conclusion This study shows that SES differentials in suicide persisted in Australia for most of the period 1979–2004. The decline in suicide in young males in the most recent quinquennium was limited to middle and high SES groups, while the low SES group displayed a continued increase. The continued increase in suicide in low SES males has implications for social and economic intervention and suicide control programs.     

Firearms and suicide in Australia

Australia has a moderate overall suicide rate but an extremely high male firearm suicide rate. Using data covering the years 1961-1985, a series of multiple regression based analyses were performed. During this period, overall suicide rates fell but firearm suicides remained constant with a resulting increase in the proportion of suicides by firearms. There has been an increase in suicides in the young offset by a decline in the elderly. Young males showed the greatest proportional increase in the use of firearms. A limited regional analysis supported the hypothesis that lack of legislative restrictions on long guns in Queensland with a greater household prevalence of such weapons and different cultural attitudes were associated with higher overall and firearm suicide rates. Such findings are consistent with reports from North America, although trends in Australia are more modest. Reducing the availability and cultural acceptance of firearms is likely to decrease suicide rates, especially in males.     

Suicide rates in China from 2002 to 2011: an update

Purposes

The aims of this study were: (1) to present the time trend of suicide rate among people aged 15 or above in China over the period 2002–2011 and (2) to examine the current profile of completed suicides during 2009–2011.

Methods

Data on suicide rate in 2002–2011 were provided by the Chinese Ministry of Health (MOH). The trends of region-, gender-, and age-specific suicide rates were examined using Poisson regression models. The mean number of completed suicides for each cohort during 2009–2011 was calculated and a mean national suicide rate was estimated.

Findings

The overall suicide rate decreased significantly over the past decade, but rates in young males and rural older adults did not reduce and in fact increased among older adults in both urban and rural areas towards the end of the study period. For 2009–2011, 44 % of all suicides occurred among those aged 65 or above and 79 % among rural residents. The estimated mean national suicide rate was 9.8 per 100,000 and was slightly higher for males than females.

Conclusion

The benefits of economic growth, such as higher employment and more educational opportunities for the rural population in particular, may have contributed to the reduced suicide rate in China. However, the recent rapid changes in socioeconomic conditions could have increased stress levels and resulted in more suicides, especially among the elderly. Despite the significant reduction reported here, the latest figures suggest the declining trend is reversing. It will be important to continue monitoring the situation and to examine how urbanization and economic changes affect the well-being of 1.3 billion Chinese.     

Rates and previous disease history in old age suicide

OBJECTIVE: Suicide rates in persons over 65 have been reported to be higher than those of younger age groups. Since the absolute number of suicides in the elderly is expected to rise, more precise ways to identify potential risk factors for elderly suicides are needed. METHODS: On the basis of forensic examinations suicide rates and methods in elderly Finns of northern Finland were compared with those of adults aged 18-64 years. Data from earlier illnesses of the suicide victims were scrutinized for records of multiple physical disorders. RESULTS: Over the 15-year period the mean annual suicide rate per population of 100,000 was significantly lower in the elderly (22.5) than adults aged 18-64 years (38.4). A decrease in suicide rates over time occurred in both groups. Suicide methods among elderly were more often violent, and they were seldom under the influence of alcohol. They also had a high prevalence of previous hospital-treated depressive episodes and hospital-treated physical illnesses. A lifetime history of hospital-treated depression was more common among elderly victims who had received hospital treatment for genitourinary diseases, injuries or poisonings after their 50th birthday. CONCLUSIONS: Our results from elderly suicide victims suggest an association between multiple physical illnesses and a history of depression. Especially, genitourinary diseases as well as hospital treatment due to injuries or poisonings were shown to associate with depression. Elderly Northern Finns showed lower suicide rates, and they decreased during the study period suggesting that active preventive measures against suicide are also feasible in the elderly.     

Deprivation versus importation: a model explaining the increase of suicide rates in custody

High suicide rates in jail, lock-up or prison settings have given rise to a debate about whether suicides result chiefly from the type of people confined, or from the types of places they are confined in, the types of confinement. This is summarily framed by the terms of an associated debate in criminology, between importation and deprivation theory. This paper describes the importation versus deprivation theory, concerning the circumstances in Austrian prisons and jails. The article reports on all completed suicides over the period from 1947 to 1999 (n = 410). The increase of suicide rates in Austrian jails and prisons is significant over the last fifty years. While the rate was stable between 1947 and 1975, we have a significantly increasing rate since 1975. In 1975 there was an important legislational reform of the criminal law in Austria. The implications of this reform are discussed in the light of the importation/deprivation theory.     

Gender-related changes in suicide rates and methods in Eastern Finland from 1988 to 1997

The first aim of the study was to investigate the changes in regional suicide rates for the province of Kuopio, Eastern Finland, from 1988 to1997 and compare rates with those for the whole Finland. The second aim was to investigate gender-related changes in suicide rates and methods during the study period. Altogether, 777 suicides were examined. Between 1988 and 1997, regional male suicide mortality decreased, approaching the mean national level, which was rising during the same interval. From 1992 to 1997, there was a rise in regional suicide mortality, which coincided with a decrease at the national level. Female suicide rates in Eastern Finland also initially decreased, but thereafter remained variable and slightly higher than the national level. Gender-related differences in suicide mortality diminished. The initial difference between genders in mean age (49.5 years in women, 41.8 years in men) disappeared towards the end of the study period (47.0 years in women, 45.2 years in men). The decline in mean ages of women was mostly due to change in urban suicides, whereas the increase in the mean age of men was caused by change in rural suicides. Among men, the relative proportion of self-poisoning suicides rose significantly. The divergent development of suicide rates from the province of Kuopio and the entire nation may reflect differences in the development of social structures in rural Eastern Finland compared to more densely populated parts of the country. Gender differences and local variation in suicide mortality should be taken into account when assessing and developing further suicide prevention strategies.