New patterns of suicide by age and gender in the United Kingdom and the Western World 1974-1992; an indicator of social change?

Suicide attempts and job insecurity: a complex association

Objective:

Since Durkheim, epidemiological studies have revealed a significant, complex association between unemployment and suicidal behaviour. The aim of this study was to analyse the relationship between parasuicide and job instability, including unemployment, French social measures against unemployment and occasional work.

Method:

Demographic data, personal and familial characteristics were collected in 541 suicide attempters.

Results:

Seventy-seven per cent were socially active, with 61.5% in regular employment, and 38.5% in precarious employment. The female-to-male ratio approached 2 in the securely employed sample, and fell to 1 for those with poor social and professional integration. Depression, parasuicide, and alcohol abuse were more common in the families of repeaters in secure employment. The impact of the familial psychiatric background was no longer significant in the job insecurity group. Fostering in childhood was a risk factor for repeat suicidal behaviour in the group with job insecurity.

Age, period and cohort effects on suicide mortality in Russia, 1956-2005

Background

Russian suicide mortality rates changed rapidly over the second half of the twentieth century. This study attempts to differentiate between underlying period and cohort effects in relation to the changes in suicide mortality in Russia between 1956 and 2005.

Methods

Sex- and age-specific suicide mortality data were analyzed using an age-period-cohort (APC) approach. Descriptive analyses and APC modeling with log-linear Poisson regression were performed.

Results

Strong period effects were observed for the years during and after Gorbachev’s political reforms (including the anti-alcohol campaign) and for those following the break-up of the Soviet Union. After mutual adjustment, the cohort- and period-specific relative risk estimates for suicide revealed differing underlying processes. While the estimated period effects had an overall positive trend, cohort-specific developments indicated a positive trend for the male cohorts born between 1891 and 1931 and for the female cohorts born between 1891 and 1911, but a negative trend for subsequent cohorts.

Conclusions

Our results indicate that the specific life experiences of cohorts may be important for variations in suicide mortality across time, in addition to more immediate effects of changes in the social environment.

The historical development of suicide mortality in Russia, 1870-2007

Russia has one of the highest suicide mortality rates in the world. This study investigates the development of Russian suicide mortality over a longer time period in order to provide a context within which the contemporary high level might be better understood. Annual sex- and age-specific suicide-mortality data for Russia for the period 1870-2007 were studied, where available. Russian suicide mortality increased 11-fold over the period. Trends in male and female suicide developed similarly, although male suicide rates were consistently much higher. From the 1990s suicide has increased in a relative sense among the young (15-34), while the high suicide mortality among middle-aged males has reduced. Changes in Russian suicide mortality over the study period may be attributable to modernization processes.

Risk factors for suicidal ideation in Korean middle-aged adults: the role of socio-demographic status

BACKGROUND

The investigations of the risk factors for suicidal ideation among middle-aged adults may be especially important for predicting suicidal actions, given the steep increase in suicide among Koreans aged 45-54. Few studies have sought to investigate the effect of socio-demographic status on suicidal ideation among middle-aged adults.

OBJECTIVE

This study investigated the influence of socio-demographic status on suicidal ideation among middle-aged adults in South Korea.

METHODS

The sample consisted of middle-aged men (n = 3,214) and middle-aged women (n = 4,087) aged 40-64 years who had participated in the 2005 cross-sectional Seoul Citizens Health and Social Indicators Survey. Using multiple logistic regression analysis, we examined the effect of socio-demographic status, health behaviours and health status on suicidal ideation in middle-aged adults.

RESULTS

The outstanding finding was that suicidal ideation was most prevalent among middle-aged women who engaged in manual labour (i.e. blue-collar workers) (OR = 2.77, 95% CI = 1.20-6.42). The absence of a spouse was significantly associated with suicidal ideation among middle-aged men (OR = 2.10, 95% CI = 1.30-3.40).

CONCLUSIONS

The effect of enhanced security related to stable employment was strongest among middle-aged women in blue-collar jobs, and the effect of intensive counselling services was strongest among divorced or widowed middle-aged men.

Influence of psychotherapist density and antidepressant sales on suicide rates

OBJECTIVE

Antidepressant sales and suicide rates have been shown to be correlated in industrialized countries. The aim was to study the possible effects of psychotherapy utilization on suicide rates.

METHOD

We assessed the impact of antidepressant sales and psychotherapist density on suicide rates between 1991 and 2005. To adjust for serial correlation in time series, three first-order autoregressive models adjusted for per capita alcohol consumption and unemployment rates were employed.

RESULTS

Antidepressant sales and the density of psychotherapists in the population were negatively associated with suicide rates.

CONCLUSION

This study provides evidence that decreasing suicide rates were associated with both increasing antidepressant sales and an increasing density of psychotherapists. The decrease of suicide rates could reflect a general improvement in mental health care rather than being caused by antidepressant sales or psychotherapist density alone.

Giving up or finding a solution? The experience of attempted suicide in later life

Older people constitute one of the highest risk groups for suicide. Existing research in this area has been largely dominated by a risk factor approach. This is of limited usefulness since only a minority of those at risk go on to make an attempt. Therefore, prediction, prevention and the management of risk remain challenging. The present study aimed to capture the subjective experience of older people who had recently made a suicide attempt through exploring their understanding of the pathway to and from this attempt, within the context of ageing. Fifteen participants were interviewed. Transcripts were analysed using Interpretative Phenomenological Analysis. Three broad themes emerged--Struggle (experiencing life as a struggle before and after the attempt, and in relation to growing older), Control (trying to maintain control over life before the attempt, and following it either failing or succeeding to regain control) and Visibility (feeling invisible or disconnected from others and trying to fight against this before the attempt and either becoming more or less connected afterwards). Risk factors identified in the literature were often absent or construed by participants as not relevant to their attempt. Individual accounts highlight the diversity and complexity of experience of older people who attempt suicide.

Epidemiology of Suicide by Hanging in Transkei, South Africa

To describe the epidemiology of suicide by hanging, in Transkei region of South Africa. This is a record review of the autopsy register from 1993 to 2003. There is an increasing trend of hangings from 5.2 per 100,000 to 16.2 in 2003. The highest was in the 20- to 29-year age group. The least number of hangings of 2.2 per 100,000 was in those over 70 years of age. Males (86.4%) outnumber females. The ratio of male to female suicide is 6.4:1. The 2 youngest suicide victims were also males aged 9 years. Peak of these hangings is in May and November and least in September. There is increasing trend of hanging especially among young adults between 20 and 29 years old.

A European comparative study of marital status and socio-economic inequalities in suicide

We assess (i) whether being married is a protective factor against socio-economic inequalities in suicide, and (ii) whether any such buffering effect varies between countries. We used the data from a European cross-national comparison project, a prospective follow-up of several European population censuses matched with vital statistics. The data encompass 99.5 million person-years aged 30 and above and 25,476 suicides in Austria, Belgium, Denmark, Finland, Turin, Madrid, Norway and Switzerland. Standardised rates were computed and logistic regressions were used to assess educational inequalities. Among the non-married, the lower educational group had an increased risk of dying of suicide compared to the higher group (Odds Ratio (OR) = 1.45). Inequalities among the married were lower (OR = 1.29). In all countries or regions except Austria, the lower educational group had a higher risk of suicide mortality among the non-married than among the married. The buffering effect of being married was not observed for elderly individuals (65 and over). Among younger individuals, the buffering effect of being married on relative inequalities in suicide was stronger in Madrid, Denmark, Norway and Switzerland (but significant only for Denmark and Norway). There was no indication that countries with stronger welfare policies or lower divorce rate had a lower buffering effect. We conclude that being married protects against inequalities in suicide and that this protective effect is not affected by the level of social capital at the country level.

Changing patterns of female suicide: 1986–2000

A study was undertaken of the rates and methods of female suicide observed at the Forensic Science Centre in South Australia over a 15 year period from 1986 to 2000. A total of 609 cases of female suicide were found (age range= 13-88 yrs; mean= 44 yrs), with 249 drug overdoses, 114 hangings, 100 deaths due to carbon monoxide (CO) toxicity, 40 drownings, 35 firearm deaths and 71 miscellaneous deaths (including deaths due to self-immolation, jumping from heights and incised wounds). The most common age range was 26-50 yrs in all categories except for drowning where victims tended to be older. While overall suicide rates in females remained unchanged, with no changes in the rates at different ages, significant increases in hanging and CO deaths occurred over all age groups (p < 0.05), with significant falls in drug overdose deaths in the 10-25 year age group (p < 0.01), and significant overall falls in suicides due to gunshot wounds (p < 0.05). No changes were observed in female suicides due to drowning. This study has demonstrated, therefore, that although no changes in overall suicide rates for females occurred, there have been alterations in the types of methods being used. Although drug related deaths remained the largest category, hanging deaths, which were once uncommon in females, have increased markedly.

Changing patterns of adult (45–74 years) neurological deaths in the major Western world countries 1979–1997

OBJECTIVES

To compare changes in 'adult' (45-74 years) 'all-cause deaths' (ACDs) with all neurological death categories by age and gender in the 10 major Western countries between the 1970s (1979-1981) and the 1990s (1995-1997).

METHOD

World Health Organization standardized mortality data for age and gender (1979/97) were used to examine changes in adult mortality rates per million based upon ICD-9 categories for ACDs, 'neurological deaths' and the special neurological categories of 'other neurological deaths' (ONDs) and 'mental disorder deaths' (MDDs), which include the dementias. Ratios of ratios were calculated to demonstrate how each individual country's pattern changed over the period by age and gender, resolving the problem of cross-national comparisons. Rates of change across the endpoints and between age groups (45-54, 55-64, 65-74 and 75+ years) were examined using analysis of variance, stepwise regression analysis and cross-tabulation analyses.

RESULTS

Meningitis deaths fell substantially, but there was little change in multiple sclerosis or epilepsy deaths. OND rates for the 1990s increased compared with the 1970s rates for males and female, in actual terms and relative to ACDs for almost all countries. Many of the relative rates of increase were substantially higher than 20%. There were significant statistical differences with respect to relative rates of ONDs between the 1970s and the 1990s data, even when the 75+ years age group was excluded. Significant differences were also found between age groups, but only in the 1990s data. MDD rates showed similar trends. Analyses of actual rates of increase in these causes of death showed that males outnumber females in all ages below 74 years. The extent of this difference remained constant across the endpoints. However, in those aged 75 years and over, females outnumbered males at both endpoints, but this disparity widened significantly in the 1990s data.

CONCLUSIONS

The 1990s data indicate substantial increases compared with the 1970s data for ONDs (especially amongst 65-74 year olds), and rises in MDDs in 55-64 year olds in five countries, including England and Wales and Germany, and in 65-74 year olds in most countries, suggesting earlier onsets of the underlying conditions. Further country-specific research is required to explain the emerging morbidity and mortality.

Adolescent suicide in Hong Kong during 1980-2000

Analyses of adolescent suicide statistics in Hong Kong for the period 1980 to 2000 revealed several phenomena. First, while adolescent suicide rates (10-24 age group) in Hong Kong were relatively stable for the period under study, there was a gradual rising trend where adolescent suicide rates in the 1990s were higher than those in the 1980s. Second, suicide rates for adolescents aged 10-24 were lower than those of other adult age groups. Third, while adolescent suicide rates in Hong Kong were lower than those reported in some English-speaking countries and Mainland China, the figures were higher than those reported in Taiwan. Fourth, suicide rates among teenagers in early adolescence were lower than those among adolescents in late adolescence. Fifth, although male adolescent suicide rates were in general higher than female adolescent suicide rates (10-24 age group), gender differences in suicide rates appeared to be moderated by age. Sixth, there was a gradual rising trend in adolescent proportional mortality rates for suicide in the 1990s. Seventh, proportional mortality rates for suicide among teenagers in early adolescence were lower than those among adolescents in late adolescence. Finally, while jumping from a height was a common method of adolescent suicide, there was a rising trend of using other methods such as taking drugs, hanging and charcoal burning. The observed adolescent suicide phenomena are discussed with reference to the socio-cultural context of Hong Kong.

Changing patterns of diabetic deaths in youth and young adults by gender in the major developed countries 1974-97

The objective was to examine any changes in "Diabetic Deaths" in major developed countries 1974-97 and to determine whether youth (aged 15-24 years) and young adult (aged 25-44 years) males are at greater risk of Diabetic Death (DD) than women by comparing DD with "All Cause Deaths" (ACD) by gender.

DESIGN

Based upon WHO standardized mortality data, three year average death rates for 1974-76 were contrasted against three year average for 1995-97 for ACD and DD rate per million, by gender. Ratios of change for each country were calculated, which were then used for comparison between countries, thus ensuring comparison of like with like, resolving the inherent problem of differential recording between countries. Ratios of ratios were calculated between the ACD and DD ratios by gender indicating any changes between mortalities by gender over the period. Chi square tests examined differences between the gender.

RESULTS

ALL CAUSE DEATHS: Wide range of male ACD, lowest Japan 939 (per million p.m) to USA 2039 p.m. but there were substantial falls (< 0.2) in five countries. Female ACD ranged from Japan 485 p.m. to USA 889 but fell substantially in every country except the Netherlands. DIABETIC DEATHS: Male DD highest in USA at 24 p.m., lowest Italy 6 p.m. with substantial falls in 8 countries. Female DD were 17 p.m. in USA and 3 p.m. in France and Spain. Fell substantially in every country except the USA. DD:ACD male rates saw substantial improvements in Ratio of Ratios (RoR) in France, Italy and Spain but rose 1.22 in USA. Female RoR showed better improvements in DD in France, Netherlands and Spain but substantial rises in Canada and USA. DD AND GENDER: In every country there were more male than female DD and over time male DD worsened significantly compared to female DD in Japan, Netherlands, Spain and USA.

CONCLUSIONS

Whilst diabetes continues to be associated with greater mortality, over the period there have been major improvements in DD relative to ACD deaths, especially amongst females. Nonetheless, there are still gains to be made if compliance can be further improved amongst male patients.

Suicide, gender, and age variations in India. Are women in indian society protected from suicide?

A new set of data concerning the pattern of suicide in India between 1991-1997 are presented. Suicide rates rose over this period despite a small decline in the Indian suicide rate in 1995 and 1996. It was found that between 1995 and 1997 there was a modest fall in the suicide rates among under 29-year-olds of both sexes, and an increase among those 30 years and older. The pattern of suicides in India is bimodal: the incidence of suicides is highest for those in the 30-44-year-old category of both sexes and tends to decline in higher age categories. Suicide rates were nearly equal for young women and men, a contrast with the pattern of suicide sex ratios in eight developed countries.

Elderly suicide rates in Asian and English-speaking countries

OBJECTIVE

Asian culture venerates elderly people. It was hypothesized that elderly suicides would be proportionately lower in Asian societies than in English-speaking countries (ESC).

METHOD

Elderly (i.e. aged 75 years or more) to general population suicide ratios were compared for six Asian societies and six ESC, based upon the latest 5-year suicide rates.

RESULTS

Males: The general population suicide rate was highest in rural China (227 per million) and third highest in Japan (217 per million), but other countries with high rates were all ESC (ranging from 224 to 198 per million). Asian countries had the six highest elderly suicide rates, 1327-1373 per million, whilst the highest ESC elderly rate was in the United States (507 per million). Asian societies had the widest range of elderly/general ratios, ranging from 6.62 to 2.6. Females: The overall suicide rates were higher in Asian countries (57-95 per million) than in ESC (40-56 per million). Asian elderly suicide rates differed (932 per million in rural China to 154 per million in Korea) but the highest ESC rate was in Australia (76 per million). The Asian countries elderly/general ratios ranged from 5.82 : 1 to 2.70 : 1, but the widest ESC ratio was 1.71 : 1, in the United Kingdom.

CONCLUSION

There is a need for country-specific prevention measures in elderly people, and particularly for older women in Asian countries.

Trends in young adult mortality in three European cities: Barcelona, Bologna and Munich, 1986-1995

OBJECTIVE

In recent decades, in most European countries young adult mortality has risen, or at best has remained stable. The aim of this study was to describe trends in mortality attributable to the principal causes of death: AIDS, drug overdose, suicide and motor vehicle traffic accidents, among adults aged between 15 and 34 years in three European cities (Barcelona, Bologna and Munich), over the period 1986 to 1995.

METHODS

The population studied consisted of all deaths that occurred between 1986 and 1995 among residents of Barcelona, Bologna and Munich aged from 15 to 34 years. Information about deaths was obtained from mortality registers. The study variables were sex, age, the underlying cause of death and year of death. Causes of death studied were: drug overdose, AIDS, suicide and motor vehicle traffic accidents. Age standardised mortality rates (direct adjustment) were obtained in all three cities for the age range 15-34. To investigate trends in mortality over the study period Poisson regression models were fitted, obtaining the average relative risk (RR) associated with a one year increment.

RESULTS

Young adult mortality increased among men in Barcelona and Bologna (RR per year: 1.04, 95% confidence intervals (95%CI): 1.03, 1.06 in Barcelona and RR:1.03, 95%CI:1.01, 1.06 in Bologna) and among women in Barcelona (RR:1.02, 95%CI: 1.01, 1.04), with a change in the pattern of the main causes of death attributable to the increase in AIDS and drug overdose mortality. In Munich, the pattern did not change as much, suicides being the main cause of death during the 10 years studied, although they have been decreasing since 1988 (RR:0.92, 95%CI:0.88, 0.96 for men and 0.81, 95%CI: 0.75-0.87 for women).

CONCLUSION

The increase in AIDS mortality observed in the three European cities in the mid-80s and mid-90s has yielded substantial changes in the pattern of the main causes of death at young ages in Barcelona and Bologna. Munich presented a more stable pattern, with suicide as the main cause of death.

Major demographic, social and economic factors associated to suicide rates in Latvia 1980-98

OBJECTIVE

The aim of this study is to analyse the dynamics of suicide rates in Latvia 1980-98, when dramatic social and economical changes took place. Special attention is given to demographic risk groups and major socioeconomic correlates influencing the dynamics of suicide rates.

METHOD

Descriptive statistics of suicide rates and major social and economical correlates.

RESULTS

During 1980-98 there were rapid swings of suicide rates. The increase was generated mainly by males reaching a maximum of 72 per 100 000 population in 1993. The sudden drop in gross domestic product, the rapid increase in first-time alcohol psychosis and the percentage of people unemployed did not correspond strictly with the dynamics of suicide rates.

CONCLUSION

Demographic and socioeconomic factors could not explain sufficiently the rapid changes in suicide rates in Latvia during the years 1980-98; psychological factors also have to be considered.

Effects of age and gender on elderly suicide rates in Catholic and Orthodox countries: an inadvertent neglect?

When compared to suicide rates in the general population, it may be expected that elderly suicide rates would be lower in Catholic and Orthodox societies than in non-Catholic or non-Orthodox countries because of religious affiliations and extended family traditions. National suicide rates in the general population were compared with rates in the sub-population of those aged over 75 years. Proportionately, there are significantly higher suicide rates in elderly men in Catholic and Orthodox countries, compared to rates in other countries, with a trend for similar findings among women. There may be important implications on health and social policy and clinical practice in the efforts to reduce suicide rates among elderly people.

Early adolescent suicide: a comparative study

A study was undertaken of suicides in children and adolescents aged 16 years and under in South Australia, (Australia), and in San Diego County (USA) from January 1985 to December 1997. In South Australia there were 48 cases of youth suicide, representing 2% of the total number of 2251 suicides over that time. There were 34 males and 14 females (age range 13 to 16 years; mean = 15.3 years), with 22 hangings (46%), six gunshot wounds (13%), five train deaths (10%), four drug overdoses (8%), four jumping deaths (8%), three self immolations (6%), three carbon-monoxide inhalations (6%) and one electrocution (2%). In San Diego County there were 70 cases, representing 1.6% of the total number of 4492 suicides. There were 48 males and 22 females (age range 11 to 16 years; mean = 14.7 years), with 41 gunshot wounds (59%), 21 hangings (30%), six drug overdoses (9%), and two jumping deaths (3%). Preferred methods of suicide differed between the two areas, with significantly more gunshot suicides in San Diego compared to South Australia. The methods of suicide also differed in South Australia from older age groups, with more hangings, jumping deaths and self immolations, and fewer firearm and carbon monoxide inhalation deaths. Suicides in adolescents under the age of 17 years in both populations were, however, rare, with no demonstrable increase in numbers over the time of the study.

Urban/rural and gender differentials in suicide rates: east and west

BACKGROUND

Many epidemiological studies indicate suicide rates are higher for males than females and for urban than rural. Here we re-examine gender, urban and rural differentials in suicide in Australia and Beijing (China). More specifically, to test the two hypotheses (i) that the male to female ratio is larger than one; (ii) that the urban suicide rate is higher than the rural in both places.

METHODS

Suicide data with information of gender, rural and urban regions for Australia and Beijing (China) for the period of 1991-1996 were used. Ratios between the gender-specific urban and rural suicides rates with the associated confidence intervals were constructed to examine gender, urban and rural differentials in Australia and Beijing.

RESULTS

The rural suicide rate in Beijing for both genders was higher than for their urban counterparts. Further, the elderly had the highest suicide rate followed by women aged 20-29. Also, the male to female ratio in China was less than one. In Australia, the rural male suicide rate was higher than the urban whereas the urban female suicide rate was higher than the rural. The male to female ratio was 4 to 1. The differences in rural to urban and male to female ratios between Australia and Beijing are statistically significant.

CONCLUSIONS

In contrast to the west, male suicide rates are not higher than female rates in China. Urban rates are not necessarily higher than rural rates --not even in a western setting. Cultural factors and regional differences in socio-economic situation are significant in explaining the low gender ratio and the relatively higher suicide rates in rural China.

LIMITATIONS

The suicide rate in the Beijing region might not exactly reflect the same for the whole of China.

Suicide among the elderly in Italy: a descriptive epidemiological study (1969 to 1994)

Data regarding the elderly suicide trend in Italy between 1969 and 1994 were analyzed from an epidemiological point of view in order to verify hypotheses on suicide risk factors in old age. The data were obtained from the National Register of the Institute of Health (Italy) and were standardized at 1971 for age and sex. For the purposes of the study, only data for people aged 70 years and over were considered. The elderly suicide rate increased from 274 per 1,000,000 in 1969 to 354.7 per 1,000,000 in 1994 in males and from 59.7 per 1,000,000 in 1969 to 82.1 per 1,000,000 in 1994 in females. In the three macroareas (northern, central, and southern regions, indicated as N, C, and S), it is possible to observe different trends. In both genders, N and C rates are the highest in Italy (tending to be similar), while S rates are lower and distinct from the others. The most marked increase was observed in the S male rate, whereas N and C rates show a remission after the rate increase in 1980. The most important finding to emerge from this study is the interruption in the tendency for suicide rates to increase in recent years (dating back to the mid-1980s) and the nonuniformity of the nationwide distribution of suicides.

Suicide, religion, and socioeconomic conditions. An ecological study in 26 countries, 1990

STUDY OBJECTIVE

Relative risks are frequently assumed to be stable across populations but this may not apply in psychiatric epidemiology where sociocultural context may modify them. Such ecological effect modification will give curved associations between aggregated risk factor and outcome. This was examined in connection with the ecological association between suicide rates and an aggregate index of religiosity.

DESIGN

Ecological study of associations between suicide rates and an index of religiosity, adjusted for socioeconomic variation. The effect of stratification of the study sample according to levels of religiosity, was examined.

SETTING

26 European and American countries.

SUBJECTS

Interview data from 37,688 people aggregated by country.

OUTCOME MEASURES

Age and sex specific (1986-1990) suicide rates.

MAIN RESULT

Adjusted for socioeconomic variation, negative associations of male suicide rates with religiosity were apparent in the 13 least religious countries only (test for interaction F (1, 25) = 5.6; p = 0.026). Associations between religiosity and female suicide rates did not vary across countries.

CONCLUSION

The bent ecological association was apparent only after adjustment for socioeconomic variation suggesting that, rather than confounding, ecological modification of individual level links between religion and male (but not female) suicide risk is the responsible mechanism. This concurs with micro-level findings suggesting that suicide acceptance depends not only on personal but also on contextual levels of religious belief, and that men are more sensitive to this phenomenon than women. In psychiatric epidemiology, relative risks vary with the exposure's prevalence. This has important implications for research and prevention.

Secular trends in the rates and seasonality of violent and nonviolent suicide occurrences in Finland during 1980-95

BACKGROUND

Because secular trends in seasonality of different types of suicides has not been studied before, we utilized a novel statistical method to evaluate this phenomenon by using national Finnish suicide statistics during 1980-95.

METHODS

Rates were analyzed with ordinary linear regression analysis. Secular trends were evaluated using ratio-statistic and its 95% confidence intervals.

RESULTS

The rate of violent suicides increased before year 1990 and decreased since that. The nonviolent suicide rate increased continuously. The decreasing tendency of seasonality in nonviolent suicides and a slight decrease in violent suicides are seen within the three successive time periods studied.

CONCLUSIONS

Trends in rates and in seasonality of suicides might be related to changes in the health politics in Finland.

LIMITATIONS

The short time-series and lack of studying associations of suicides with socioeconomic, environmental or biological factors are limitations of our study.

CLINICAL RELEVANCE

Studying the time-dependent changes in rates and in seasonality of suicides provide a novel perspective for the evaluation of the aetiology of suicidal behaviour.

Homicidal and suicidal sharp force fatalities in Stockholm, Sweden. Orientation of entrance wounds in stabs gives information in the classification

A comparative study of 174 homicidal and 105 suicidal sharp force deaths in the Stockholm area is presented in order to identify variables of importance in the differentiation between homicides and suicides. In homicides, a significantly (p < 0.05) higher number of cut and stab wounds were seen in the head, upper and lower extremities and a significantly higher number of vertical stab wounds were found in the chest. Lower numbers were seen in the wrist and the crook of the arm. When counting the injured areas, irrespective of the number of injuries, abdominal wounds and horizontal chest stab wounds were also significantly more often found in victims of homicide. Injuries to the back and to the genitals were not seen in suicides. The suicide victims were significantly older and had significantly lower blood alcohol levels. A new variable pointing at a statistically significant difference between homicides and suicides was found: In homicides, stab wounds with a horizontal axis of entrance wound in the chest was found to be less common than those with a vertical axis. Other variables studied were prevalence of defence and tentative wounds, farewell notes and suicidal ideation, earlier parasuicides, venue, gender of the victims and the types of sharp objects used.

Suicide and 'violent' death in a six-year cohort of male probationers compared with pattern of mortality in the general population: evidence of accumulative socio-psychiatric vulnerability

The 'Health of the Nation' (Department of Health, 1992) suicide targets focus upon the mentally ill, but virtually ignore the mentally abnormal offender. Whilst forensic services deal with the severely disturbed, the majority of offenders remain in the community, despite long-standing psychosocial difficulties. This study explores the mortality rates of a six-year cohort of male probationers (1990-1995) with males in the general population. Male offenders (aged 17-54) had double the death rate, five times the 'external death' rate and nine times the suicide rate of the general population. This paper highlights the need to further improve the health-psychiatric-criminal justice collaboration.