The Balkan Piedmont: male suicide rates pre-war, wartime, and post-war in Serbia and Montenegro.

The epidemiology of suicide in Serbia and Montenegro from 1989 to 2003, a period of civil war, is presented. Following the break-up of former Yugoslavia, Serbia and Montenegro underwent a period of war from 1991-1994 and another in 1999. During the war years, the number of suicides increased, reaching its peak in 1993. Male suicides outnumbered female suicides by a ratio of 2:1. Male suicides decreased slightly after the war of 1991-1994 only to rise in 1997 and continue at this higher level throughout the nineties. In Serbia alone, male suicide reached its peak in 2002 (nearly 29/100,000). The methods of suicide changed significantly, with the use of firearms doubling during and after the war years. Speculations are offered about the findings, many consistent with Durkheim's classical hypothesis concerning suicide and unpopular wars.     

The Balkan Piedmont: Male Suicide Rates Pre-war,Wartime, and Post-war in Serbia and Montenegro

The epidemiology of suicide in Serbia and Montenegro from 1989 to 2003, a period of civil war, is presented. Following the break-up of former Yugoslavia, Serbia and Montenegro underwent a period of war from 1991–1994 and another in 1999. During the war years, the number of suicides increased, reaching its peak in 1993. Male suicides outnumbered female suicides by a ratio of 2:1. Male suicides decreased slightly after the war of 1991–1994 only to rise in 1997 and continue at this higher level throughout the nineties. In Serbia alone, male suicide reached its peak in 2002 (nearly 29/100,000). The methods of suicide changed significantly, with the use of firearms doubling during and after the war years. Speculations are offered about the findings, many consistent with Durkheim's classical hypothesis concerning suicide and unpopular wars.     

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     

The relationship between suicide rates and age: an analysis of multinational data from the World Health Organization

BACKGROUND: Suicide rates generally increase with age. With the emergence of studies from several countries without an increase in suicides rates with aging, a cross-national study examining the relationship between suicide rates and age was undertaken. METHODS: The relationship between suicide rates and age was examined by ascertaining suicide rates in both sexes in seven age-bands 16-24 years, 25-34 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years and 75+ years, from the World Health Organization website for all the listed countries (N = 62). RESULTS: The main findings were: (i) there was a significant increase in suicide rates with increasing age in males and females in 25 and 27 countries respectively; (ii) there was no significant increase in suicide rates with increasing age in males and females in 31 and 29 countries respectively; (iii) suicide rates were the highest in the younger age-bands in countries without a significant increase in male suicides rates with increasing age; (iv) countries without a significant increase in the suicide rate with increasing age in both sexes, females only and males only demonstrated regional clustering; and, (v) in a small number of countries suicide rates declined with increasing age. CONCLUSIONS: Potential explanations for regional and cross-national variations in the relationship between suicide rates and age require further study.     

Seasonal variation in suicides re-examined: no sex difference in Hong Kong and Taiwan

The seasonal variation in suicides in Hong Kong and Taiwan during the period 1981 to 1993 was examined using harmonic analysis. A single cycle per year with lowest incidence in the winter months was found in both locations and for both sexes. Despite the regional differences in ascertainment procedures and preferred suicide methods, the absence of a biseasonal distribution of female suicides was consistently observed. This finding was contrary to that reported in many Western countries. A non-shared psychosocial process underlying the cross-cultural difference in the seasonality of female suicide is suggested.     

Reductions in postdischarge suicide after deinstitutionalization and decentralization: a nationwide register study in Finland

OBJECTIVE: This study analyzed trends in suicides occurring after a psychiatric hospitalization during more than a decade of significant structural changes in mental health services in Finland-that is, deinstitutionalization, downsizing of inpatient care, and decentralization. METHODS: Retrospective register data on completed suicides and psychiatric inpatient treatments were collected for the periods 1985-1991 and 1995-2001, representing service provision before and after significant structural changes. The data were used to produce an estimate for a change in postdischarge suicide risk. RESULTS: In both periods, a fifth of suicide victims had been psychiatrically hospitalized within the preceding year. Among persons hospitalized, the risk of suicide was greater in 1985-1991 than in 1995-2001 for both one week after discharge (risk ratio [RR]=1.50, 95% confidence interval [CI]=1.38-1.62) and one year after discharge (RR=1.25, CI=1.19-1.30). When types of disorders were analyzed separately, the relative risk of suicide one year postdischarge for those hospitalized in the earlier period was greater for patients with schizophrenia (RR=1.26, CI=1.17-1.36) and patients with affective disorders (RR=1.60, CI=1.48-1.73). In parallel with general development of inpatient psychiatric services, in 1995-2001 the inpatient treatment periods preceding suicides were significantly shorter (a mean+/-SD of 45+/-340 days in 1995-2001, compared with a mean of 98+/-558 days in 1985-1991), the number of individual patients treated in the hospital for schizophrenia spectrum disorders was lower (26% compared with 36%), and the number treated for affective disorders was higher (45% compared with 35%). CONCLUSIONS: The restructuring and downsizing of mental health services was not associated with any increase in suicides immediately (one week) or one year postdischarge. Instead, the risk of these suicides decreased significantly between the two time periods among several diagnostic categories. Although the role of psychiatric hospitalization in general may have changed over time, patients who are hospitalized now may be less suicidal after discharge. Our results indicate, in terms of postdischarge suicides, that the downsizing of psychiatric hospitals has been a success. However, there is still a substantial need for better recognition of suicidal risk among psychiatric patients.     

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.     

The occurrence of suicide in severe depression related to the months of the year and the days of the week

The purpose of the present study was to investigate the distribution of suicide during the months of the year and the days of the week in severe depression. A total of 1206 in-patients rated at discharge from the Department of Psychiatry, Lund, Sweden, on a multiaxial diagnostic schedule received the diagnosis severe depression/melancholia between 1956 to 1969. When followed up to 1998, a total of 114 depressed patients had taken their own life. Out of these, 98 patients appeared to have a primary depression. The monthly distribution of suicides showed a significant peak in October/November for men (41 % of all male suicides). No correlation with the onset of depression could be detected. Furthermore, there was a preponderance of suicide on Sundays for both sexes (31 % of all suicides). Received: 28 March 2001 / Accepted: 29 November 2001     

Copycat Suicide Induced by Entertainment Celebrity Suicides in South Korea

ObjectiveThroughout the past several years, there have been a number of entertainment celebrity suicides in South Korea. The aim of this study was to investigate the clustering of suicides following celebrities'' suicides in South Korea from 2005 to 2008, particularly according to certain characteristics.MethodsSeven celebrity suicides were examined and defined using the Korean Integrated Newspaper Database System (KINDS) and from these, we considered four affected periods occurring 28 days after each celebrity''s suicide. A Poisson time-series autoregression model was used to estimate the relative risk of the total suicide number for each affected period from 2005 to 2008. Logistic regression analysis was performed to investigate whether there were specific increases in the numbers of suicides in subgroups matching each celebrity.ResultsThere were significant increases in the risk of suicide during the affected periods. Remarkable increases were found in the subgroups matching each celebrity, especially in the group in which all factors (sex, age, and method) were similar.ConclusionThis study provides confirmation that a significant copycat effect was induced by these celebrities'' suicides, especially among people who identified more with the celebrities. This implies that countermeasures for upright media coverage of celebrity suicides should be discussed and practiced properly in South Korea.     

Suicide in the capital of Serbia and Montenegro in the period 1997-2004 - sex differences

There are very few investigations about sex differences in suicide which include some other variables (e.g. age, profession etc). Data which concern suicide sex differences are obscure and usually are given in statistical accounts of causes of death. The aim of our study was to investigate sex differences in realized suicides within the city of Belgrade during the last eight year period. Data was taken from the index records of suicide in the city of Belgrade held at the Institute for Informatics and Statistics. We took sex as the main observed variable, and analyzed nine other variables as related to sex. Statistical analysis was done by using the crude specific rate. The variability of the rate was estimated by computing a confidence interval. The results of our study gave the profile of males and females who committed suicide in Belgrade in the period of the last eight years. Although there were significant quantitative differences, the female/male profile of completed suicides is similar, and differs only in the method of suicide: both males and females choose hanging, drowning and suffocation as the most common method of suicide, while poisoning is on the second most common method chosen by females and firearms the second most common method for males. The frequency of suicide, in both sexes, showed a tendency to decrease over the observed period (the highest suicide rate was in 2000- females 9.7, males 19.7, and the lowest in 2004- females 4.5 males 9.1). Male to female suicide rate ratio was 2 to 1. Sex differences were registered in all of the observed nine variables.     

Suicide in Lithuania

The data on the rate of the suicide in the periods of 1924–1939 and 1962–1993 are presented from the Statistics Annals and the Archives of the Statistics Department of Lithuania. In pre-war independent Lithuania (1924-1939) the suicide rate was 5-10 suicides per 100,000 citizens. During the Soviet occupation period it was constantly increasing until it reached 35.8 per 100,000 in the year of 1984. The changes towards a more democratic society resulted in a diminished suicide rate (to 25.1 per 100,000 in 1986); the same processes were taking place in other countries of the former Eastern block. In the period of the present economic hardships the rate of suicide in Lithuania has increased up to 42.0 per 100,000 (in 1993). Obvious increase in the rate of suicides among men and people of advanced age is observed. The article draws a comparison between the suicide notes of Lithuania and other European countries. The dependence of the suicide rate on socio-political changes, secularisation and anomie is also discussed in this article.     

Time patterns and seasonal mismatch in suicide

OBJECTIVE: Physical time-givers may have a modifying effect on the time patterns of death from suicide. METHOD: Data on a total of 1397 suicides in Finland over a year were collected using the method of psychological autopsy. We linked versatile information on each individual to meteorological data adjusted for local weather conditions, and to the universal astronomic data. RESULTS: The number of suicides with seasonal mismatch was greater than the expected in the northernmost region of the country (P = 0.03). The northern location was the most significant predictor of such suicides (P = 0.001). They were associated with the changes in ambient temperature during the preceding day (P < 0.00001), the changes to colder preceding suicides in the spring. CONCLUSION: Our findings show that mismatch between the changes in ambient temperature and those in the length of day may precede death from suicide in some individuals.     

The Effects of Publicized Suicide Deaths on Subsequent Suicide Counts in Israel

This study investigated associations between indiscriminate media reporting of suicides and later inflated suicide counts among Israel's general population between the years 2008 and 2012. Self-inflicted deaths that received post-suicide media exposure (referred to as “publicized suicides”) were selected via Google news search-hit appraisals. Distributions of suicides were inspected and risk ratios (RRs) estimated by comparing population suicide rates 4 weeks before and 4 weeks after each publicized suicide (“reference” vs. “affected” periods, respectively). Poisson time series regression was employed to account also for secular trends and seasonality. A total of 2,119 people died by suicide, 13 of whom received noticeable media attention throughout the study. No meaningful impact following the 13 deaths on subsequent suicide counts during the observation window (affected vs. reference phase) was found. Poisson regression confirmed that suicide counts following publicized suicides were independent of media coverage. Given the pronounced search hits following the publicized suicides developing regulation practices that constrain indiscreet media reporting should officially be included as part of suicide prevention practices. Future research should focus on imitation suicide effects as a function of post-suicide media exposure, while including both risk and protective factors.     

A comparison of suicides in psychiatric in-patients,after discharge and in not recently hospitalized individuals

ObjectiveTime of in-patient treatment and the first weeks after hospital discharge have repeatedly been described as periods of increased suicide risk. This study compared demographic, clinical and suicide related factors between in-patient, post-discharge and not recently hospitalized suicides.MethodsSuicide data from the Tyrol Suicide Register were linked with registers of three psychiatric hospitals in the state of Tyrol, Austria. Suicide cases then were categorized as in-patient suicides, post-discharge suicides (suicide within 12 weeks after discharge) or never/not within 12 weeks before death hospitalized suicides. Data were collected between 2004 and 2011.ResultsOf the total of 711 cases, 30 were in-patient, 89 post-discharge and 592 not recently hospitalized suicides. The three groups differed with regard to male-to-female ratio (lower in both hospitalized groups), marital status, suicide method used (jumping in in-patients, hanging in not recently hospitalized suicides), history of attempted suicide and suicide threats (highest in in-patients) and whether suicides had been in psychiatric or general practitioner treatment shortly before death. In most variables with significant differences there was a gradual increase/decrease with post-discharge suicides taking the middle place between the two other groups.ConclusionsThe three suicide populations differed in a number of variables. Varying factors appear to influence suicide risk and choice of method differently in in-patient, post-discharge and not hospitalized suicides.     

Autumn peak in shooting suicides of children and adolescents from northern Finland

Suicide is one of the leading causes of death among adolescents worldwide. Studies on the seasonal pattern of youth suicides are rare and the results are very contradictory and heterogeneous. Generally, suicide methods affect the pattern of suicide seasonality. Shooting is the most common suicide method among Finnish adolescents. We investigated whether shooting suicides of victims aged less than 18 years are correlated with a specific period of the year. Also, the seasonal pattern of shooting suicides in adolescents was compared with that of adult victims. Our data comprised 42 adolescent suicide victims and, for comparison, 1,926 adult suicide victims over the years 1988 to 2004 from Northern Finland. Of these, 59.5% (n = 25) of the adolescents and 28.8% (n = 554) of the adults had committed suicide by shooting.We observed that shooting suicides among the under-aged showed a significant peak in autumn (ratio 2.70, 95% CI: 1.97-3.42), while those of adult victims peaked in spring (ratio 1.19, 95% CI: 1.05-1.35). The monthly pattern of suicides correlated significantly with the mean duration of daily sunshine hours (trailing by 3 months) in the under-aged (r = 0.67, p = 0.016), but not in the adults (r = 0.06, p = 0.854). The role of firearm availability, psychosocial factors such as start of the school year, and some biological factors are discussed.     

Assessing the impact of media guidelines for reporting on suicides in Austria: interrupted time series analysis

OBJECTIVE: Media guidelines for reporting on suicides are a widely used means of preventing imitative suicides, but scientific accounts of their impact on suicide numbers are sparse. This report provides an evaluation of the Austrian guidelines that were introduced in 1987 as a natural experiment. METHODS: The impact of the guidelines was tested by applying an autoregressive integrated moving average (ARIMA) model and a linear regression model. In addition to a nationwide evaluation, Austria was divided into three areas according to regional differences in coverage rates of the collaborating newspapers and the impact of the intervention was tested for each area separately. Main outcome measures were the overall annual suicide numbers, and the numbers of Viennese subway suicides that were exceptionally newsworthy for the mass media. In order to test intermediate impacts, also quantitative and qualitative changes in media reporting after the introduction of the guidelines were analysed. RESULTS: There was some evidence of a nationwide impact of the guidelines, calculated as a significant reduction of 81 suicides (95% confidence interval: -149 to -13; t = -2.32, df = 54, p <0.024) annually. This effect was particularly due to a significant reduction in the area with the highest coverage rates of the collaborating newspapers. Viennese subway suicides showed a highly significant level shift (t = -4.44, df = 19, p <0.001) and a highly significant trend change (t = -4.20, df = 19, p <0.001) after the introduction of the guidelines. These effects corresponded to significant changes in the quality and quantity of media reporting. CONCLUSIONS: The present results clearly support the hypothesis that the media guidelines have had an impact on the quality of reporting as well as on suicidal behaviour in Austria, and stress the importance of collaborating with nationwide, but also with regional media to achieve efficacy. Further research is needed to provide an international insight into this public health issue.     

Elderly suicide in Alberta: difference by gender.

OBJECTIVE: To determine differences by gender among elderly persons who commit suicide on demographic characteristics, place of suicide, suicide method, previous suicide behaviour, and precipitant stressor. METHOD: This study included completed suicides of individuals aged 55 years and over during 1984-1995 in Alberta (n = 920). Information was abstracted from suicide records of medical examiners. RESULTS: Relative to elderly female suicides, elderly males who commit suicide characteristically use guns to commit suicide (43.8%), are single (12.5%), live in rural areas (46.7%), and have a lower frequency of previous suicide attempts (16.5%). Physical illness and financial difficulty as precipitant stressors of suicide are significantly more frequent among males (40.3% and 8.7% respectively) than females (29.9% and 1.8% respectively). Mental illness as a precipitant stressor is more common among females, 35.8% for women and 15.3% for men. CONCLUSIONS: Lethal methods of suicide and physical illness and financial difficulty as precipitant stressors of suicide are more common among elderly males than females who commit suicide.     

More tryptophan hydroxylase in the brainstem dorsal raphe nucleus in depressed suicides

Deficient serotonin neurotransmission in suicide is indicated by reduced brainstem serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA), fewer 5-HT(1A) autoreceptors and reduced cortical serotonin transporter binding in suicide victims. Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in the synthesis of 5-HT, and alterations in TPH could explain some of these findings. We sought to determine the amount of TPH immunoreactivity (TPH-IR) in the dorsal (DRN) and median (MRN) raphe nuclei in suicides and controls. Brainstems of suicide victims and controls (n = 11 pairs) were collected at autopsy, matched for age, sex and postmortem interval, frozen and sectioned (20 microm). Immunoautoradiography, using an antibody to label TPH, was performed, slides exposed to film and autoradiograms quantified by a computer-based image analysis system. We examined sections every 1000 microm throughout the whole length of the nucleus, performing statistical analysis only on those subjects for whom the raphe was complete (n = 8 pairs). TPH-IR (microCi/g) was higher in suicides than controls (S: 300.8 +/- 70.8 vs. C: 259.6 +/- 40.7, t = 2.57, df = 7, P = 0.04) in the dorsal raphe nucleus (DRN), and not different between suicides and controls (S: 251.3 +/- 44.2 vs. C: 235.9 +/- 27.4, t = 1.49, df = 7, P = 0.18) in the MRN. DRN TPH-IR was higher in male suicide victims (MS) compared to male controls (MC; MS: 318.4 +/- 54.4 vs. MC: 271.9 +/- 22.5, t = 2.66, df = 6, P = 0.03). The analysis of TPH-IR area and density at each DRN rostrocaudal levels showed higher area and density in suicides compared to controls in the rostral DRN and lower area and density in the caudal DRN. TPH-IR, an index of the amount of TPH enzyme, in the DRN is higher in depressed suicides. More TPH may be an upregulatory homeostatic response to impaired serotonin release or less autoreceptor activation. Alternatively, the serotonin impairment in suicide may be due to hypofunctional serotonin-synthesizing enzyme.     

Suicide in Austrian children and young adolescents aged 14 and younger

Introduction Research on suicide in childhood and early adolescence is sparse. We investigated suicide cases of children and young adolescents in terms of prevalence, gender differences, suicide methods and monthly distribution during a period of 32 years. Methods Registered suicides aged 14 or younger occurring between 1970 and 2001 (n = 275) in Austria were studied. Results The mean suicide rate for 10 to 14-year-olds was 1.4 per 100,000 with a male–female ratio of 3.1:1. The total child and young adolescent suicide rate and boys’ suicide rates decreased over the study period. However, there was no significant fluctuation in girls’ suicide rates. Hanging was the predominant suicide method in both genders. Use of this method decreased steadily over the study period, whereas the percentage of suicides by other methods, i.e., jumping and firearms suicides increased. Greater number of suicides in children and young adolescents was observed during the months of April/May and October/November. Conclusion Suicide rates of children and young adolescents in Austria are on the decrease, in accordance with a reported decrease in the general suicide rate in Austria.