Suicides in the former Soviet republics.

The suicide rate in the former Soviet Union rose from 17.1 per 100,000 inhabitants in 1965 to 29.6 in 1984. In regions of long-standing traditional lifestyles, strong religious faith and multi-generation families (the Caucasus and central Asia), the suicide rate was low, whereas in regions with sociopolitical antagonisms (Baltic States) and forced social changes (Russia), it was high. A significant decline in the suicide rate (34.5%), from 29.6 to 19.4 per 100,000 inhabitants, occurred in 1984-1988 throughout the Soviet Union, in the hopeful period of social democratization and stiff restrictions on the sale of alcohol. Rates varied widely between different republics - from 1.8 in Armenia to 26.3 in Lithuania and 24.3 in the Russian Soviet Federated Socialist Republic (RSFSR) in 1988. In contrast to the pattern in several countries in western Europe, the suicide rates in the Russian SFSR were much higher in the rural regions than in the urban ones.     

Electrodermal reactivity in male and female depressive patients who later died by suicide

On the basis of earlier studies on electrodermal responsiveness in patients with suicide attempts, an investigation on electrodermal activity (EDA) in former depressive inpatients was carried out. Male and female depressive inpatients who died of suicide later and participated in an habituation experiment during their inpatient treatment were identified retrospectively and compared (strictly matched by age and sex) to depressive suicide attempters with violent or nonviolent methods, suicide ideators and a nonsuicidal depressive group. In the first part of the study only male depressives (n= 12) who had committed suicide after or during inpatient treatment were compared with their controls. The hypothesis of a expected low electrodermal responsiveness and a fast habituation as an peripheral expression of a central impulse or violence control disturbance could not be confirmed. This was done in the second part of this study. We came to the following results: 1) a tendency to a faster habituation in the violent suicides compared with nonsuicidal depressives and violent suicide attempters plus violent suicide group in male depressives compared to suicide attempters (SA), nonviolent suicide ideators and nonsuicidal depressives. 2) A significant difference with faster habituation rates in a male and female violent suicide group compared with nonsuicidal depressives and again comparing a group of male and female violent suicides and SA with nonviolent SA, suicide ideator and nonsuicidal depressive controls. These results may reflect a dysregulation of violence and impulsivity control mechanism as an underlying disorder or personality trait.     

Epidemiology of suicide in the elderly population in Italy: 1958-1988

In this study we analyzed suicide rates. based on official ISTAT data published in the Health Statistics Year Book, relating to the Italian population aged over sixty-five, divided up into groups of five years, from 1958 to 1988. We calculated the rates of death by suicide (per 100,000 subjects) for each year and then. standardizing by sex, the mortality rates relative to each method of suicide for the overall population over sixty-five. Analysis of the results obtained shows that there was an increase in the suicide phenomenon in the elderly population in Italy over the tested period. The rates are at least three times higher in men than in women. The highest rates are reported for elderly men, but it seems that there has been a greater proportional increase with regard to the number of suicides committed by elderly women. The increase was statistically significant in both sexes (men: 0.81. p < 0.001, women: 0.85. p < 0.001). Over the thirty year study period, substantial changes have come about in the suicide methods used by old people. There seems to be an increase in poisoning by car exhaustion gases, poisoning by solid or liquid substances, jumping from heights. hanging, and the use of firearms. Apart from our prediction for the next twenty years (we calculated an increase of about 26.8%), it seems that suicidal behaviour is indeed on the increase among the elderly.     

Suicide among personality-disordered offenders: a follow-up study of 1943 male criminal offenders

Suicide mortality among all male criminal offenders in Sweden who had been subjected to a major forensic psychiatric examination 1988–1991 (n=1943) was studied, with special reference to offenders with personality disorders. The cohort was followed until the end of 1995. Altogether 135 individuals (6.9%) died during the follow-up period; the mode of death was suicide in 50 individuals (2.6%). The unadjusted suicide mortality ranged from 2.8% among those with personality disorders to 6.1% among those with drug-related psychosis. The standardised mortality ratio (SMR) among personality-disordered offenders was 1212, i.e. around 12 times that of the general population. Survival analyses by means of Cox regression models were performed to identify background factors associated with completed suicide. No specific principal diagnosis showed significantly increased risk for completed suicide. However, concomitant depression and drug abuse were significantly linked to suicide. Violent crime showed no association. Among personality-disordered offenders suicide methods did not differ from those of suicide victims in the general population. There was no association between violent index criminality or between life-time violent criminality and choice of a violent suicide method.     

Suicide among Children and Adolescents: Data from Çukurova,Turkey

The purpose of this study was to investigate the general properties of suicide among children and adolescents in our region, and to evaluate the results in the light of the literature. The autopsy records of the morgue of the Adana branch of the Turkish Forensic Medicine Council were investigated retrospectively. Focus of the study was shaped by suicide cases in children and adolescents (under 18) between the years of 1997–2005. All of the cases were analyzed with regard to age, sex, method of suicide, and year. The childhood and adolescent (0–18 years) deaths comprised 24.4% (n: 1390) of all medico-legal autopsy cases (n: 6808). The origin of death in 186 (13.4%) cases involving victims younger than 18 years of age was suicide. The majority of suicide cases (62.9% n: 117) were females. Adolescents of 16–18 years of age constituted the overwhelming majority (70.43% n: 131) of all childhood suicides. Mean age was 16.13. The most frequent method of suicide was shooting in males, and poisoning in females. However, hanging was the most frequent method (34.41% n: 64) overall.     

Brain gamma-aminobutyrate transaminase and monoamine oxidase activities in suicide victims

Summary The activity of gamma-aminobutyrate aminotransferase (GABA-T) and monoamine oxidase (MAOA and-B) was measured in 42 postmortem human brains. Three brain regions (frontal cortex, cingulate cortex and hypothalamus) from 23 controls without known neurological or psychiatric disorder and from 19 suicide victims were analysed. The suicide victims were classified according to the use of violent and non-violent methods and to the presence or absence of a known history of depressive disorder. No difference was found between the series of suicide victims and the control subjects with regard to GABA-T activity. Carbon monoxide poisoning and death by drug overdose, however, were found to reduce the activity. The MAO-B activity did not differ between the groups. With MAO-A, however, a significant elevation (t=2.01;P<0.05) was found in the hypothalamic region of the suicide victims. The difference seemed to be confined to the subgroup of suicides with a record of depressive disorder.     

Suicides hidden among undetermined deaths

The research phase of the National Suicide Prevention Project in Finland (from 1 April 1987 to 31 March 1988) included medico-legal investigation and psychological autopsy of all deaths suspected of being suicides, including 1397 official suicides and 61 undetermined deaths. In later analyses on suicide, undetermined cases were excluded. This paper presents an analysis of all officially classified undetermined deaths (n= 139) over the study period, consisting of all the initially suspected suicides (n=61) and the remaining undetermined deaths (n=78) where suicide could not be excluded. Poisoning by solids or liquids and drowning were the most common causes of all undetermined deaths. Suicidal intent was observed in 87% of undetermined deaths initially suspected of being suicides. In addition, 31 % of these subjects had previously attempted suicide, and 34% had made suicidal threats. Depression was diagnosed in 23% of cases and alcohol dependence or abuse in 31 % of cases. Undetermined deaths resembled suicides arid appeared to reduce the suicide rate by 10%.     

Gender and age differences in suicide mortality in the context of violent death: Findings from a multi-state population-based surveillance system

Objective

Males are more likely than females to die by all forms of violent death, including suicide. The primary purpose of the present study was to explore whether the gender difference in suicide rates is largely accounted for by males' general greater tendency to experience violent deaths. The current study examined gender and age differences in suicides and other violent deaths, using data from a population-based surveillance system.

Method

Pearson's chi-square tests and logistic regression analyses were conducted with data for 32,107 decedents in the 2003–2005 National Violent Death Reporting System (NVDRS). Decedents were categorized by gender, age, and death by suicide versus other violent means.

Results

When suicides were examined in the greater context of violent death, the total proportion of violent deaths due to suicide did not differ across gender. When deaths were examined by age group, after controlling for ethnicity, marital status, and U.S. location in which the death occurred, males in early to mid childhood were significantly more likely than same-aged females to die by suicide relative to all other violent deaths. The portion of deaths due to suicide was for the most part equal across both genders in late childhood, young adulthood, and mid-adulthood. Older males were more likely than older females to die by suicide relative to other violent deaths.

Conclusion

Our findings suggest that that the risk of dying by suicide relative to other violent deaths may be more pronounced at certain developmental stages for each gender. This knowledge may be valuable in tailoring prevention strategies.     

Drinking frequency and quantity and risk of suicide among men

Background Individuals who die from suicide commonly have consumed alcohol immediately beforehand, often in large quantities. However, prospective cohort data on regular alcohol use as a risk factor for suicide are lacking. Method As part of the Health Professionals Follow-up Study, 47,654 men free of cancer prospectively reported their drinking habits, including average use, drinking frequency, and typical maximal use on repeated occasions beginning in 1986. Participants were followed for death to 2002. Results A total of 136 men died from suicide during follow-up. Quantity of alcohol consumed per drinking day tended to be associated with a greater risk of suicide mortality, with an adjusted hazard ratio among men consuming 30.0 or more grams (more than two drinks) per drinking day of 2.42 (95% confidence interval, 0.75–7.80; P-trend 0.05). Average alcohol consumption, drinking frequency, and binge drinking were not independently associated with risk. The apparent relationship of quantity consumed per drinking day with risk was not substantially changed by adjustment for serious illness or other dietary factors and was most notable for suicide associated with firearm use. Conclusions Among men, risk of death from suicide tends to be associated primarily with quantity of alcohol consumed per drinking day, not with drinking frequency or overall alcohol consumption. This finding supports guidelines that limit consumption among men who choose to drink alcohol to two drinks or less per drinking day.     

Serotonin receptor, SERT mRNA and correlations with symptoms in males with alcohol dependence and suicide

Thompson PM, Cruz DA, Olukotun DY, Delgado PL. Serotonin receptor, SERT mRNA and correlations with symptoms in males with alcohol dependence and suicide. Objective: This study tested the hypothesis that abnormalities in components of the serotonin (5HT) system in the prefrontal cortex are associated with suicide in alcohol‐dependent subjects. Second, we assessed the relationship of lifetime impulsivity and mood symptoms with prefrontal cortex 5‐HT measures. Method: Tissue was obtained from Brodmann’s areas (BA) 9 and 24 in postmortem samples of individuals who were alcohol dependent with suicide (n = 5), alcohol dependent without suicide (n = 9) and normal controls (n = 5). Serotonin receptor (5HT) and serotonin reuptake transporter (SERT) mRNA were measured. Interviews with next of kin estimated lifetime impulsivity and mood symptoms in the last week of life. Results: Serotonin receptor 1A (5HT1A) mRNA in BA 9 was elevated in the alcohol dependence without suicide group compared with controls. In the alcohol dependence with suicide group, anxiety symptoms were associated with decreased BA 24 SERT mRNA and depressive symptoms with BA 9 5HT1A mRNA expression. In the alcohol dependent only group impulsivity is correlated with increased BA 9, and BA 24 serotonin receptor 2A mRNA. Conclusion: Our data suggest region‐specific change, rather than global serotonin blunting is involved in alcohol dependence and suicide. It also suggests that symptoms are differentially influenced by prefrontal cortex serotonin receptor mRNA levels.     

Spain’s suicide statistics: do we believe them?

Purpose

There is a widespread belief that suicides around the world are under-counted. A substantial proportion of suicides may have been inappropriately registered as accidental or of undetermined cause or intent. There is reason to explore to what extent low suicide rates in some nations could be partly attributable to under-counting.

Methods

Mortality statistics of most countries are available on-line. Numbers of suicide deaths in Spain, and in England and Wales (E & W), in male and female 5-year age groups, in each year between 2014 and 2018, were documented, along with deaths coded to ICD-10 accident or ‘undetermined death’ categories. Crude mortality rates were calculated using official population figures. Single year suicide, undetermined death, and non-transport accidental death rates of 12 other nations were calculated.

Results

Spain’s crude suicide rate per 100,000 remains low (7.89) compared to other nations; its event of undetermined intent (EUI) death rate was 0.09 (contrasting with E & W’s 1.74). Its accidental poisoning rate is much lower than that of E & W. The study showed much higher rates of ill-defined/unknown cause deaths in late life in Spain (both genders) than in E & W, and age-associated increases in accidental drowning rates parallel with increased suicide by drowning.

Conclusions

Reportedly low suicide rates in Spain could be partly attributable to increased rates of ‘hidden suicide’ (accidental drowning, male accidental poisoning, and possibly ill-defined/unknown cause deaths, but not EUIs). It would be appropriate (and not just in Spain) to increase numbers of verbal and/or forensic autopsies in questionable ‘undetermined’ cases.

     

Deliberate Self-Harm/Poisoning,Suicide Trends. The Link to Increased Alcohol Consumption in Sri Lanka

Sri Lanka has witnessed a fall in suicide rates in the period 1991 to 2010, however the incidence of self-harm remains high. Over the same period alcohol consumption has increased for both alcohol that is purchased legally and distilled privately. This paper investigates a number of secondary data sets from such bodies as the Department of Police, Registrar General's Office for Statistics, Ministry of Health and Nutrition, National Poisons Information Center and Lanka Library Forum to shed light on the link between suicide/self-harm and rising alcohol consumption. The authors conclude that there is a strong association between alcohol consumption and suicide/poisoning/deliberate self-harm in Sri Lanka and propose a number of research priorities.     

Suicide in cyprus 1988-1999.

Suicide is a universally observed human behavior related to bio-psychological, social and cultural factors. The aim of the present study was to examine suicide in Cyprus, an island that has known many civilizations and cultures. All completed suicide cases in the Christian population of Cyprus during the years 1988-1999 were included in the study and they were analyzed according to age, gender, reported reasons for suicide and suicide methods. The main results indicate that: 1. The mean age-standardized suicide rate is the lowest in Europe, in males (3.08/100,000) and also in females (1.05/100,000). 2. Mean suicide rates increase significantly with age in males only. 3. Female suicide rates are highest in the 15-24 age group. 4. Statistically significant rising trends of male and female suicide rates in the all-ages group. 5. Suicide methods were mostly violent. Among males, the most common methods were poisoning, firearms-explosives, and hanging, while in females, jumping, hanging and poisoning. 6. Mental disorders, physical illness, interpersonal and financial problems were the main reported reasons for suicide. The epidemiological characteristics of suicide in Cyprus might be attributed to a combined effect of social and cultural factors and probably reflect influences from countries to which Cyprus is ethnically, historically or geographically related.     

Psychiatric diagnoses are associated with means selection in united states suicide deaths

Purpose

The purpose of this study was to examine whether the choice of means by persons who die by suicide is associated with a prior psychiatric diagnosis.

Methods

In this cross-sectional study, we analyzed suicide surveillance data from 18 states reporting to the National Violent Death Reporting System (NVDRS) between 2003 and 2014. NVDRS compiled data from multiple sources (e.g., coroner’s reports, police reports, death certificates) on every violent death within reporting jurisdictions, including information on indicated psychiatric disorders and suicide means. We assessed whether the selected suicide means were associated with diagnoses using multinomial logistic regression.

Results

Adjusted models suggested that, compared to decedents using firearms, those using poisoning were more likely to have each psychiatric disorder examined, including bipolar disorder (aOR: 2.17 [95% CI 2.03–2.32]), schizophrenia (aOR: 1.81 [1.61–2.04]), depression (aOR: 1.64 [1.58–1.70]), anxiety disorder (aOR: 1.46 [1.35–1.57]), and PTSD (aOR: 1.41 [1.22–1.64]). A far greater proportion of individuals who died from less common means (other than firearms, suffocation, or poisoning) had schizophrenia (aOR: 4.52 [4.00–5.11]).

Conclusions

Many existing and proposed means restriction interventions have focused on firearms. Additional focus on access to potential agents of poisoning (e.g., the type and quantity of medication administered to patients) among individuals with psychiatric diagnoses may be warranted.

     

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.     

Excess mortality of suicide attempters

  Background: Excessive mortality of suicide attempters has emerged from many follow-up studies. Completed suicide is the main cause of excess deaths, but the increased risk of deaths from other unnatural and natural causes is also of major public health concern. We lack follow-up studies of the different causes of death in cohorts of suicide attempters. The present study aimed to determine the mortality by suicide and other causes of death and to investigate risk factors. Methods: This mean 5.3-year follow-up study was based on an unselected cohort of suicide attempts by both violent and non-violent methods, treated in hospitals in a well-defined urban catchment area in Helsinki. In total, 2782 patients aged 15 years and over admitted to the emergency rooms after suicide attempt between 1989 and 1996 were included in the follow-up analysis. Standardised mortality ratios (SMR) for suicide, disease, accident, homicide, and undetermined death were calculated. Results: Mortality from all causes was 15 times higher than that expected among men and nine times higher in women. SMRs in men were 5402 (95% CI 4339–6412) for suicide, 2480 (95% CI 925–4835) for homicide, and 11,139 (95% CI 6884–16,680) for undetermined cause, and for women 7682 (95% CI 5423–9585), 3763 (95% CI 52–5880) and 15,681 (95% CI 6894-22,294), respectively. Fifteen percent of all suicide attempters died during the average 5.3-year follow-up of the index attempt. Deaths from suicide accounted for 37% of all excess deaths in men and 44% in women. The mortality ratio was highest during the 1st follow-up year. The total number of lost years of life among the 413 suicide attempters who died during follow-up was 13,883. The risk factors for all causes of death were male sex, single, retirement, drug overdose as a method, an index attempt not involving alcohol, and a repeated attempt. Conclusion: A suicide attempt indicates a severe risk of premature death, and suicide is the main cause of excess deaths. However, it appears that concentrating efficient treatment only on the most suicidal patients could prevent no more than two of five premature deaths. More effort is therefore needed to prevent the excess mortality of suicide attempters by also addressing causes of death other than suicide. Accepted: 27 October 2000     

Coffee,caffeine, and risk of completed suicide: Results from three prospective cohorts of American adults

Objective.To evaluate the association between coffee and caffeine consumption and suicide risk in three large-scale cohorts of US men and women. Methods. We accessed data of 43,599 men enrolled in the Health Professionals Follow-up Study (HPFS, 1988–2008), 73,820 women in the Nurses’ Health Study (NHS, 1992–2008), and 91,005 women in the NHS II (1993–2007). Consumption of caffeine, coffee, and decaffeinated coffee, was assessed every 4 years by validated food-frequency questionnaires. Deaths from suicide were determined by physician review of death certificates. Multivariate adjusted relative risks (RRs) were estimated with Cox proportional hazard models. Cohort specific RRs were pooled using random-effect models. Results. We documented 277 deaths from suicide. Compared to those consuming ≤ 1 cup/week of caffeinated coffee (< 8 oz/237 ml), the pooled multivariate RR (95% confidence interval [CI]) of suicide was 0.55 (0.38–0.78) for those consuming 2–3 cups/day and 0.47 (0.27–0.81) for those consuming ≥ 4 cups/day (P trend < 0.001). The pooled multivariate RR (95% CI) for suicide was 0.75 (0.63–0.90) for each increment of 2 cups/day of caffeinated coffee and 0.77 (0.63–0.93) for each increment of 300 mg/day of caffeine. Conclusions. These results from three large cohorts support an association between caffeine consumption and lower risk of suicide.     

Increased suicides during new year,but not during Christmas in Sweden: analysis of cause of death data 2006–2015

Background: Previous studies have investigated the impact of the Christmas and New Year holiday on suicide rates. However, no such data has yet been published on Swedish suicides.

Aims: To examine the occurrence of suicides on these dates in Sweden between 2006 and 2015.

Methods: The suicide count for each date between December 15th and January 15th was obtained from the Swedish cause of death registry. The observations were transformed to Z-scores to enable calculation of p-values.

Results: A small but non-significant decrease in suicides was observed on Christmas and New Year’s Eve. A significant spike was found on New Year’s Day (NYD) (Z?=?3.40; p?Z?=??1.58; p?=?.115).

Discussion: The noted increase in suicide on NYD is in line with previous research from other countries. However, the decrease in suicides on the day before NYD suggests a delay rather than a spontaneous increase of suicides. Possible mechanisms to explain this phenomenon are discussed, such as the “broken promise effect”, increased alcohol consumption, or lower help-seeking and accessibility to care.     

Violence, alcohol, and completed suicide: a case-control study

OBJECTIVE: Violent behavior may represent a risk factor for suicide. The authors tested the hypothesis that violent behavior in the last year of life is associated with completed suicide, even after controlling for alcohol use disorders. METHOD: The authors analyzed data from the 1993 National Mortality Followback Survey, a nationally representative survey conducted by telephone interview with decedents' next of kin. Data on 753 victims of suicide were compared with data on 2,115 accident victims. Decedents ranged in age from 20 to 64. Dichotomous measures of violent behavior in the past year and history of alcohol misuse were derived by using the four-item CAGE questionnaire. Multiple logistic regression was used to evaluate the interactions of violent behavior with alcohol misuse, gender, and age, respectively, in predicting suicide versus accidental death. Education and race were included as covariates. RESULTS: Violent behavior in the last year of life was a significant predictor of suicide; the relationship was especially strong in individuals with no history of alcohol misuse, those who were younger, and women. CONCLUSIONS: Violent behavior distinguished suicide victims from accident victims, and this finding is not attributable to alcohol use disorders alone. Given that violent behavior increases the risk of suicide, violence prevention initiatives may serve to decrease the risk of suicide as well.     

Alcohol factors in suicide mortality rates in Manitoba.

OBJECTIVE: To identify alcohol-related factors that influence mortality rates from suicide. METHOD: We examined the impact of per capita consumption of total alcohol, spirits, beer, and wine; unemployment rate; and Alcoholics Anonymous (AA) membership rate on total, male and female suicide mortality rates in Manitoba during 1976 to 1997. Time series analyses with autoregressive integrated moving average modelling were applied to total, male and female suicide rates. The analyses performed included total alcohol consumption, spirits consumption, beer consumption, and wine consumption. Missing AA membership data were interpolated with cubic splines. RESULTS: Total alcohol consumption, and consumption of beer, spirits, and wine individually, were significantly and positively related to female suicide mortality rates. Spirits and wine were positively related to total and male mortality rates. AA membership rates were negatively related to total and female suicide rates. Unemployment rates were positively related to male and total suicide rates. CONCLUSIONS: The data confirm the important relations between per capita consumption measures and suicide mortality rates. Additionally, the results for AA membership rates are consistent with the hypothesis that AA membership and alcohol abuse treatment can exert beneficial effects observable at the population level.