Association of temporal factors and suicides in the United States, 2000-2004

Inpatient Suicides in Late Life: A Retrospective Analysis of a Hospital Group with Nine Psychiatric Clinics

OBJECTIVE

Inpatient suicides are rare incidents; however, the impacts of such events on associated families and hospital staff are severe. Therefore, preventive strategies need to focus on risk factors. Clinical management in a hospital setting must integrate the home environment and social life of patients. Nevertheless, home leaves require careful preparation.

METHODS

Suicides were reported systematically from all psychiatric departments of the Landschaftsverband Rheinland (an assembly of municipalities) using a structured form during two periods (1995-2004, 2005-2014). From these reports we extracted data on suicide methods and sociodemographic and clinical variables. Only patients 65 years and older were included.

RESULTS

From a total of 551 reports on suicides in the period of 1995-2014, 103 patients 65 years and older (60 women, 43 men) died by suicide. In contrast to the general trend in Germany during this period, no decline in overall suicide rates was found. Most patients were treated because of depression (73.8%); schizophrenic psychosis was diagnosed in 11.7%; and dementia was only diagnosed in 1.9%. The most frequent suicide method was hanging (40%). All suicides within the hospital were hangings. The majority of suicides occurred outside the hospital during approved home leaves. Only 7% of suicides occurred when patients left the hospital without permission. Almost half of the patients (n = 44) died by suicide during the first month of treatment. With longer duration of hospitalization, the risk of suicide decreased. There were no significant trends with regard to suicide methods between the two periods.

CONCLUSIONS

In the first weeks of hospitalizations the patients are most endangered to die by suicide. Therefore, home leaves need careful consideration.

Temporal and diurnal variation in social media posts to a suicide support forum

BACKGROUND

Rates of suicide attempts and deaths are highest on Mondays and these occur more frequently in the morning or early afternoon, suggesting weekly temporal and diurnal variation in suicidal behaviour. It is unknown whether there are similar time trends on social media, of posts relevant to suicide. We aimed to determine temporal and diurnal variation in posting patterns on the Reddit forum SuicideWatch, an online community for individuals who might be at risk of, or who know someone at risk of suicide.

METHODS

We used time series analysis to compare date and time stamps of 90,518 SuicideWatch posts from 1st December 2008 to 31st August 2015 to (i) 6,616,431 posts on the most commonly subscribed general subreddit, AskReddit and (ii) 66,934 of these AskReddit posts, which were posted by the SuicideWatch authors.

RESULTS

Mondays showed the highest proportion of posts on SuicideWatch. Clear diurnal variation was observed, with a peak in the early morning (2:00-5:00 h), and a subsequent decrease to a trough in late morning/early afternoon (11:00-14:00 h). Conversely, the highest volume of posts in the control data was between 20:00-23:00 h.

CONCLUSIONS

Posts on SuicideWatch occurred most frequently on Mondays: the day most associated with suicide risk. The early morning peak in SuicideWatch posts precedes the time of day during which suicide attempts and deaths most commonly occur. Further research of these weekly and diurnal rhythms should help target populations with support and suicide prevention interventions when needed most.

Seasonal Trends in Hospitalization of Attempted Suicide and Self-Inflicted Injury in United States Adults

Introduction 

Suicide is the 10th leading cause of death in the United States (US) and the prevalence continues to increase. It is estimated that there is an average of 25 attempted suicides for every suicide death in the US, and the economic burden of suicide and attempted suicide is high. Identification of those at risk for suicide and attempted suicide can help with early and prompt intervention. Studies in Europe and Asia have shown that there is a relationship between seasonal patterns and suicidal risk. However, little is known about seasonal patterns of suicidal attempts in the US. Therefore, our study aimed to assess seasonal patterns by days of the week and months of the year in the US.

Methods

Hospitalized adult patients with suicide attempts and self-inflicted injury were identified using the discharge data from the National Inpatient Sample (NIS) from January 1, 2010 to December 31, 2014. We looked at the seasonal trends of patients with attempted suicide and self-inflicted injury by weekday vs weekend and month of the year over the five-year study period. We also assessed two groups, male and female with attempted suicide and compared trends and contributing risk factors over the study period using Student’s t-test and chi-square test.

Results

A total of 249,845 patients with attempted suicide and self-inflicted injury were reported during the study period with a prevalence rate increase of 15%, among which 70% were males, 65.5% white and 38.8% were age 40-64 years. An overall prevalence rate of about 168-200 per 100,000 hospitalizations was reported. There was a higher admission rate on weekends as compared to weekdays (190-300 vs 150-178 per 100,000 hospitalizations). Attempted suicide and self-inflicted injury admissions peaked during the months of July and August with a peak period range of 200-230 per 100,000 hospitalizations in a year.

Conclusion

The prevalence of attempted suicide is steadily rising. Awareness of the seasonal and epidemiological trends of attempted suicide and self-inflicted injury is a very important step towards developing effective strategies to prevent suicide and attempted suicide.

Blue Monday Is Real for Suicide: A Case-Control Study of 188,601 Suicides

Many studies have reported that suicides tend to occur on Mondays. However, owing to a lack of controls, conclusive findings on the potential effects of a day of the week on suicides have been lacking. We analyzed public data for causes of death from 1997 to 2015 in the Republic of Korea. Accidental death was used as a control group. The probability of suicide on each day of the week according to age group was calculated. A total of 377,204 deaths (188,601 suicides and 188,603 accidental deaths) were used. The frequency of suicide was highest on Monday and decreased throughout the week until Saturday. Accidental death was highest on Saturday and showed no variations according to weekday. For people in their teens and 20s, the probabilities of suicide on Monday were 9% and 10% higher, respectively, than those on Sunday. As age increased, the differences in suicide probability according to the day of the week were attenuated. The so-called Blue Monday effect is real, particularly for people in their teens and 20s. Suicide prevention strategies that aim to attenuate the burden and stress of Mondays should be planned.

Suicide Timing in 18 States of the United States from 2003-2014

We investigated suicide timing over different time periods by age, sex and race/ethnicity. A total of 122,107 suicide deaths were identified from the population-based U.S. National Violent Death Reporting System in 18 U.S. states from 2003 through 2014. Suicides significantly increased (p < .05) from March to peak in September before falling, the first week of the month, and early in the week. Suicides also significantly increased (p < .05) in the morning, mainly peaking during the afternoon, although suicides in adolescents peaked in the evening and in those 65-years and older peaked in the morning. Comprehensive prevention efforts should focus on those at overall increased suicide risk and at peaks of high suicide frequency, especially among those vulnerable subgroups.

The androgen model of suicide completion

Suicide is a devastating public health issue that imposes severe psychological, social, and economic burdens not only for the individuals but also for their relatives, friends, clinicians, and the general public. Among the different suicidal behaviors, suicide completion is the worst and the most relevant outcome. The knowledge of biological etiopathological mechanisms involved in suicide completion is limited. Hitherto, no objective markers, either alone or in combination, can reliably predict who will complete a suicide. However, such parameters are strongly needed to establish and optimize prediction and prevention. We introduce here a novel ideation-to-completion framework in suicide research and discuss the problems of studies aiming at identifying and validating clinically useful markers. The male gender is a specific risk factor for suicide, which suggests that androgen effects are implicated in the transition from suicidal ideation to suicide completion. We present multiple lines of direct and indirect evidence showing that both an increased prenatal androgen load (with subsequent permanent neuroadaptations) and increased adult androgen activity are involved in suicide completion. We also review data arguing that modifiable maternal behavioral traits during pregnancy contribute to the offspring's prenatal androgen load and increase the risk for suicide completion later in life. We conclude that in utero androgen exposure and adult androgen levels facilitate suicide completion in an synergistic manner. The androgen model of suicide completion provides the basis for the development of novel predictive and preventive strategies in the future.

Examining the Association Between Apparent Temperature and Mental Health-Related Emergency Room Visits in California

The association between ambient temperature and morbidity has been explored previously. However, the association between temperature and mental health-related outcomes, including violence and self-harm, remains relatively unexamined. For the period 2005-2013, we obtained daily counts of mental health-related emergency room visits involving injuries with an external cause for 16 California climate zones from the California Office of Statewide Health Planning and Development and combined them with data on mean apparent temperature, a combination of temperature and humidity. Using Poisson regression models, we estimated climate zone-level associations and then used random-effects meta-analyses to produce overall estimates. Analyses were stratified by season (warm: May-October; cold: November-April), race/ethnicity, and age. During the warm season, a 10°F (5.6°C) increase in same-day mean apparent temperature was associated with 4.8% (95% confidence interval (CI): 3.6, 6.0), 5.8% (95% CI: 4.5, 7.1), and 7.9% (95% CI: 7.3, 8.4) increases in the risk of emergency room visits for mental health disorders, self-injury/suicide, and intentional injury/homicide, respectively. High temperatures during the cold season were also positively associated with these outcomes. Variations were observed by race/ethnicity, age group, and sex, with Hispanics, whites, persons aged 6-18 years, and females being at greatest risk for most outcomes. Increasing mean apparent temperature was found to have acute associations with mental health outcomes and intentional injuries, and these findings warrant further study in other locations.

Birthdays are associated with an increased risk of suicide in Japan: Evidence from 27,007 deaths in Tokyo in 2001-2010

BACKGROUND

Previous research has produced conflicting findings concerning whether birthdays are associated with an increased risk of suicide. This study examined the association in Tokyo, Japan.

METHODS

Suicide data (ICD-10 codes X60-X84) for the period 2001-2010 were obtained from the Japanese Ministry of Health, Labour and Welfare. A time-stratified case-crossover design was used with conditional logistic regression analysis being performed to estimate within-subject 'birthday exposures' while controlling for meteorological conditions and public holidays.

RESULTS

There were 27,007 suicides in the study period. For males the 5 days before the birthday and the week after the birthday were associated with significantly higher odds for suicide with the odds ratio being highest on the actual birthday (OR =1.677, 95% CI: 1.294, 2.172). For females, significantly higher odds for completed suicide were observed 7-11 days before the birthday. Stratified analyses showed different at risk time patterns among men from different age groups, and that married men had higher odds for suicide on, and for the 4 days before and in the 2 weeks after their birthday.

LIMITATIONS

We lacked detailed information on suicides which would have enabled a better understanding of the observed associations.

CONCLUSIONS

Birthdays are associated with an increased risk for suicide in Tokyo, Japan. Health professionals who work with individuals at risk of suicide should be made aware that birthdays are associated with an elevated suicide risk. This information should also be communicated in wider suicide prevention campaigns.

Seasonality of suicide behavior in Northwest Alaska: 1990-2009

OBJECTIVES

Suicide is a leading cause of death worldwide, and disproportionately affects Indigenous populations. Seasonal suicide patterns are variable in the literature, and could offer novel approaches to the timing and focus of prevention efforts if better understood. With a suicide surveillance system in place since 1989, this study offers an unprecedented opportunity to explore seasonal variations in both fatal and non-fatal suicide behavior in an Indigenous Arctic region.

STUDY DESIGN

Cross-sectional.

METHODS

In this descriptive study, we analyzed data collected from 1990 to 2009 in the rural northwest region of Alaska, both graphically and using the chi-squared test for multinomials.

RESULTS

We found a significant monthly variation for suicide attempts, with a peak in suicide behavior observed between April and August (P = 0.0002). Monthly variation was more pronounced among individuals ≤29 years of age, and was present in both males and females, although the seasonal pattern differed by sex.

CONCLUSIONS

Our findings of a significant seasonal pattern in suicide behavior, with monthly variation (summer peak) in non-fatal suicide behavior among younger age groups, and among both males and females can assist planners in targeting subpopulations for prevention at different times of the year.

Climate change but not unemployment explains the changing suicidality in Thessaloniki Greece (2000-2012)

INTRODUCTION

Recently there was a debate concerning the etiology behind attempts and completed suicides. The aim of the current study was to search for possible correlations between the rates of attempted and completed suicide and climate variables and regional unemployment per year in the county of Thessaloniki, Macedonia, northern Greece, for the years 2000-12.

MATERIAL AND METHODS

The regional rates of suicide and attempted suicide as well as regional unemployment were available from previous publications of the authors. The climate variables were calculated from the daily E-OBS gridded dataset which is based on observational data

RESULTS

Only the male suicide rates correlate significantly with high mean annual temperature but not with unemployment. The multiple linear regression analysis results suggest that temperature is the only variable that determines male suicides and explains 51% of their variance. Unemployment fails to contribute significantly to the model. There seems to be a seasonal distribution for attempts with mean rates being higher for the period from May to October and the rates clearly correlate with temperature. The highest mean rates were observed during May and August and the lowest during December and February. Multiple linear regression analysis suggests that temperature also determines the female attempts rate although the explained variable is significant but very low (3-5%)

CONCLUSION

Climate variables and specifically high temperature correlate both with suicide and attempted suicide rates but with a different way between males and females. The climate effect was stronger than the effect of unemployment.

Temporal variations in suicide attempt rates: A hospital-based study from India

Background:

Temporal variations of suicide attempts can help to better understand correlates of suicidal behavior. This study attempted to find the diurnal, weekly, and seasonal variations in suicide attempts at a tertiary care hospital in India.

Materials and Methods:

This record-based study was conducted among patients evaluated at a crisis intervention clinic over a 4-year period at a tertiary care teaching hospital in Southern India. Patients who attempted suicide in recent past and had been medically stabilized were evaluated in this clinic. The distribution of suicide attempts across the time of the day, the day of the week, and month of the year was assessed.

Results:

Of the 407 patients who were included in the analysis, the frequency of suicide attempts varied across time of the day (χ² = 134.504, P < 0.001). The most common period of the day for the attempt was evenings (6 pm to 9 pm). There were no significant temporal associations between month of the year or day of the week and suicide attempts though peaks were observed for June among the months and Sundays among days of the week.

Conclusion:

Diurnal variations exist in the suicide attempts. This has implications on clinical caseloads on emergency departments, especially during the times when staffing might be sub-optimal.

Relationship of suicide rates with climate and economic variables in Europe during 2000-2012

BACKGROUND

It is well known that suicidal rates vary considerably among European countries and the reasons for this are unknown, although several theories have been proposed. The effect of economic variables has been extensively studied but not that of climate.

METHODS

Data from 29 European countries covering the years 2000-2012 and concerning male and female standardized suicidal rates (according to WHO), economic variables (according World Bank) and climate variables were gathered. The statistical analysis included cluster and principal component analysis and categorical regression.

RESULTS

The derived models explained 62.4 % of the variability of male suicidal rates. Economic variables alone explained 26.9 % and climate variables 37.6 %. For females, the respective figures were 41.7, 11.5 and 28.1 %. Male suicides correlated with high unemployment rate in the frame of high growth rate and high inflation and low GDP per capita, while female suicides correlated negatively with inflation. Both male and female suicides correlated with low temperature.

DISCUSSION

The current study reports that the climatic effect (cold climate) is stronger than the economic one, but both are present. It seems that in Europe suicidality follows the climate/temperature cline which interestingly is not from south to north but from south to north-east. This raises concerns that climate change could lead to an increase in suicide rates. The current study is essentially the first successful attempt to explain the differences across countries in Europe; however, it is an observational analysis based on aggregate data and thus there is a lack of control for confounders.

Hanging suicides in northern Finland: A descriptive epidemiological study

The authors examined all hanging-suicides during 1988-2013 (N = 851) in the province of Oulu, northern Finland. Using death-certificate data and ICD-diagnoses from the Finnish Hospital Discharge Register, we focused on gender differences in suicide, mental health, and somatic health. Male victims were more likely to have intoxication or problematic alcohol use; female victims were more likely to have somatic or mental hospitalization. Previous physical or mental hospitalization was related with absence of intoxication at the time of suicide. Suicide prevention should focus on acute alcohol abuse in the presence of acute stressors, suicidal thoughts and mental illness.

Understanding weekly cycles in suicide: an analysis of Austrian and Swiss data over 40 years

BACKGROUND

Seasonal as well as weekly cycles in suicide have been described, replicated and poorly understood for a long time. In Western countries, suicides are typically least frequent on weekends and most frequent on Mondays and Tuesdays. To improve understanding of this phenomenon a strategy is required which focuses on anomalous findings beyond the regular patterns. Here, we focused on instances where the weekly suicide patterns disappear or are interrupted.

METHODS

We used data from Swiss and Austrian mortality statistics for the periods 1969-2010 and 1970-2010, respectively. First, the data were cross-tabulated by days of the week and the available socio-demographic information (sex, age, religious affiliation and region). Second, time series of cumulated daily frequencies of suicide were analysed by seasonal Autoregressive Integrated Moving Average (ARIMA) models which included intervention effects accounting for Easter and Pentecost (Whit) holidays.

RESULTS

First, the cross tabulations showed that weekly cycles may be smoothed above all in young persons and smoothed in drowning, jumping and car gas exhaustion suicides. Second, the ARIMA analyses displayed occasional preventive effects for holidays Saturdays and Sundays, and more systematic effects for holiday Mondays. There were no after effects on Tuesdays following holiday Mondays.

CONCLUSIONS

In general, the weekend dip and the Monday backlog effect in suicide show striking similarities to the Advent season effect and are interpretable within the same template. The turning points between low and high frequencies possibly provide promising frames for the timing of prevention activities.

Impact of religious feast days on youth suicide attempts in Istanbul, Turkey

BACKGROUND

Suicidal behaviour is related to psychosocial and biological factors. Although suicide is strictly forbidden by the Islamic faith, there are non-confirmed observations of increased suicidality on religious feast days. The objective of the present study was to find out if suicide attempts of youths living in Istanbul increase on religious feast days compared to ordinary and non-religious holidays.

METHODS

We retrospectively analyzed all suicide attempts (N = 2,232) of young people up to 25 years of age seeking support at various hospitals in Istanbul in 2010. The main hypothesis was that the number of suicide attempts would increase during religious feast days.

RESULTS

The number of suicide attempts was higher on religious feast days and non-religious holidays except for New Year's Day and International Labour Day than the daily average number of the actual months. Like on ordinary days, more female than male youth (84.9% vs. 15.1%) attempted suicide on feast days.

CONCLUSION

We speculate that changes of the daily rhythm and increased family interaction on feast days and non-religious holidays could lead to unexpected confrontations and disputes instead of the expected positive family climate. This "Broken-Promise Effect" and changes of the daily rhythm could contribute to the observed increased suicidal behaviour.

Seasonal variation of suicide in the city of São Paulo, Brazil, 1996-2010

BACKGROUND

In light of the few reports from intertropical latitudes and their conflicting results, we aimed to replicate and update the investigation of seasonal patterns of suicide occurrences in the city of São Paulo, Brazil.

METHODS

Data relating to male and female suicides were extracted from the Mortality Information Enhancement Program (PRO-AIM), the official health statistics of the municipality of São Paulo. Seasonality was assessed by studying distribution of suicides over time using cosinor analyses.

RESULTS

There were 6,916 registered suicides (76.7% men), with an average of 39.0 ± 7.0 observed suicides per month. For the total sample and for both sexes, cosinor analysis estimated a significant seasonal pattern. For the total sample and for males suicide peaked in November (late spring) with a trough in May-June (late autumn). For females, the estimated peak occurred in January, and the trough in June-July.

CONCLUSIONS

A seasonal pattern of suicides was found for both males and females, peaking in spring/summer and dipping in fall/winter. The scarcity of reports from intertropical latitudes warrants promoting more studies in this area.

Methods of committing suicide among 2,347 people in Ohio

The present study explored gender differences in suicidal methods, aiming to identify ways to improve our identification of individuals at risk for suicide. Preferred suicide methods vary by demographics; however, method-specific risk factors have not been consistently identified. All suicidal deaths (N=2,347) in a large urban county were identified over a 15-year period (1994-2008). The majority of men used shooting and hanging. In contrast, women relied on a variety of methods, including self-poisoning, shooting, hanging, and carbon monoxide poisoning. Significant demographic differences are evident among individuals who die by shooting and self-poisoning.

Atendimento a tentativas de suicídio por serviço de atenção pré-hospitalar

Objetivo: Investigar as características das vítimas de tentativa de suicídio atendidas em serviço pré-hospitalar e os intervalos de tempo consumidos nessa fase de atendimento. Métodos: Estudo transversal utilizando dados da fase pré-hospitalar de atendimento às vítimas de tentativa de suicídio no município de Arapiraca, no ano de 2011. Para análise dos dados, foram realizados teste exato de Fisher, teste t de Student e regressão logística múltipla. Resultados: Foram atendidas 80 vítimas de tentativa de suicídio pelo serviço de atenção pré-hospitalar. As mulheres, com idade superior a dos homens, foram as que mais tentaram suicídio (n = 44, 55%), e a intoxicação por medicamentos foi o método mais utilizado (n = 44, 55%). As tentativas de suicídio ocorreram com maior frequência no outono (n = 29, 36,25%), no dia de domingo (n = 18, 22,5%), principalmente no período vespertino (n = 33, 41,25%). O tempo gasto para o atendimento pré-hospitalar variou entre 34,4 e 40,5 minutos. As variáveis que estiveram associadas às tentativas de suicídio por sexo foram idade (p = 0,03) e tempo de transporte (p = 0,01). Conclusão: Foram encontradas diferenças entre os sexos das vítimas de tentativa de suicídio atendidas pelo serviço de atenção pré-hospitalar. As mulheres apresentaram maior idade que os homens e o tempo de transporte foi maior em vítimas do sexo masculino, sugerindo maior gravidade nas tentativas de suicídio cometidas por esse grupo.

Association of suicide rates, gun ownership, conservatism and individual suicide risk

OBJECTIVES

The purpose of the study was to examine the association of suicide rates, firearm ownership, political conservatism, religious integration at the state level, and individual suicide risk. Social structural and social learning and social integration theories were theoretical frameworks employed. It was hypothesized that higher suicide rates, higher state firearm availability, and state conservatism elevate individual suicide risk.

METHOD

Data were pooled from the Multiple Cause of Death Files. Multilevel logistic regression models were fitted to all deaths occurring in 2000 through 2004 by suicide.

RESULTS

The state suicide rate significantly elevated individual suicide risk (AOR = 1.042, CI = 1.037, 1.046). Firearm availability at the state level was associated with significantly higher odds of individual suicide (AOR = 1.004, CI = 1.003, 1.006). State political conservatism elevated the odds of individual suicides (AOR = 1.005, CI = 1.003, 1.007), while church membership at the state level reduced individual odds of suicide (AOR = 0.995, CI = 0.993, 0.996). The results held even after controlling for socioeconomic and demographic variables at the individual level.

CONCLUSION

It was concluded that the observed association between individual suicide odds and national suicide rates, and firearm ownership cannot be discounted. Future research ought to focus on integrating individual level data and contextual variables when testing for the impact of firearm ownership. Support was found for social learning and social integration theories.

Suicide deaths and nonfatal hospital admissions for deliberate self-harm in the United States. Temporality by day of week and month of year

BACKGROUND

No one knows whether the temporality of nonfatal deliberate self-harm in the United States mirrors the temporality of suicide deaths.

AIMS

To analyze day- and month-specific variation in population rates for suicide fatalities and, separately, for hospital admissions for nonfatal deliberate self-harm.

METHODS

For 12 states, we extracted vital statistics data on all suicides (n = 11,429) and hospital discharge data on all nonfatal deliberate self-harm admissions (n = 60,870) occurring in 1997. We used multinomial logistic regression to analyze the significance of day-to-day and month-to-month variations in the occurrence of suicides and nonfatal deliberate self-harm admissions.

RESULTS

Both fatal and nonfatal events had a 6%-10% excess occurrence on Monday and Tuesday and were 5%-13% less likely to occur on Saturdays (p < .05). Males were more likely than females to act on Wednesdays and Saturdays. Nonfatal admission rates were 6% above the average in April and May (p < .05). In contrast, suicide rates were 6% above the average in February and March and 8% below it in November (p < .05).

CONCLUSIONS

Suicides and nonfatal hospital admissions for deliberate self-harm have peaks and troughs on the same days in the United States. In contrast, the monthly patterns for these fatal and nonfatal events are not congruent.

Suicide and seasonality

OBJECTIVE

  Seasonal variation of deaths by suicide offers an important pathway in the study of possible suicide determinants of suicide and consequently suicide prevention.

METHOD

  We conducted a review of the literature on suicide seasonality, assessing articles published between 1979 and 2009.

RESULTS

  The majority of the studies confirm a peak in spring, mainly for men, older individuals, and violent methods of suicide. A secondary peak during autumn is observed. There is no common seasonality pattern for suicide methods. However, there are also certain studies that did not confirm seasonal variation. Inconsistent results with reduced, unchanged, and even increased suicide seasonality have been reported. Aspects on the association between seasonality and suicides are discussed. Except sex, age, and method of suicide, other parameters were taken into account to find more specific characteristics of seasonality in suicides as well. The influence of clinical, bioclimatic, sociodemographic as well as biological factors seems to affect the seasonal variation.

CONCLUSION

  Studies from both the Northern and the Southern hemisphere report a seasonal pattern for suicides. These studies are not only an important source of epidemiological data for suicides but also represent a global effort to uncover hidden parameters of this self-destructive behaviour.

A systematic review of psychometric assessment of self-harm risk in the emergency department

BACKGROUND

Assessment of self harm risk is both a common and difficult task in emergency room settings. Psychometric measures have been developed to help with this assessment but it is uncertain how well these measures perform and which are clinically useful for assessment in this setting.

METHOD

Two reviewers independently assessed studies for relevance, inclusion, and study quality. Included studies classified mostly adult patients at risk for self-harm treated in an ED. The outcome variables selected were recurrence of self-harm/suicidal ideation or hospitalization. Only cohort study designs with follow-up were eligible.

RESULTS

From 556 potentially relevant abstracts, 12 studies were identified for inclusion in the review. Overall, the risk of bias was considered moderate to low in this review. Of the included studies reporting future self harm as an outcome measure, only the scales that are part of the Manchester self harm project, the Implicit Associations Test and the Violence and Suicide Assessment Form were found to successfully predict self harm. The four studies that assessed admission as an outcome utilized eight different actuarial methods. Of the scales assessed, six were found to be significant predictors of admission.

LIMITATIONS

It was not possible to perform a meta-analysis with the studies detected and it is uncertain whether publication bias or selection bias within the reviewed studies affected the results.

CONCLUSION

Overall, while many methods used in the ED to assess suicidal and parasuicidal patients have strong psychometric properties, there is little clinical evidence supporting their use.

Economic factors and suicide rates: associations over time in four countries

OBJECTIVE

Suicides account for more than 30,000 deaths per year in the US alone. Suicide rates change over time, and the factors influencing them remain poorly understood. Economic factors, in particular unemployment, have been suggested as a major influence. However, the evidence for this has been inconsistent, which may be partly explained by shortcomings of the statistical methods used.

METHODS

Time series analytical techniques (unit root and co-integration tests) were applied to test the associations over time between economic factors, i.e. unemployment, real gross domestic product per capita (RGDP) and the consumer price index (CPI) and death rates by suicide as collected by national agencies in the UK (1901-2006), US (1900-1997), France (1970-2004) and Italy (1970-2001). Traditional correlation analyses were used when appropriate.

RESULTS

Co-integration and correlation tests showed a long-run association between economic factors and suicide rates. Increase/decrease of unemployment predicted an increase/decrease of suicide rates over long historical periods and in different nations. RGDP and the CPI were also linked with suicide rates, but this was not consistently so and the direction of the association varied.

CONCLUSIONS

Unemployment is a major factor influencing suicide rates over long periods of time and in different national contexts. It needs to be considered as a confounding factor in evaluations of suicide prevention strategies.

Suicide by self-burning in Iraqi Kurdistan: description and risk factors

This study aims to provide evidence for the problem of suicide by self-burning in Iraqi Kurdistan. Data were collected prospectively from all patients admitted to the burn center in the province of Sulaymaniyah and cases of self-burning were compared with cases of accidental burns. There were 197 cases with an annual incidence rate of 8.4 per 100,000 per year and female to male risk ratio of 13.1. Independent risk factors for self-burning were female sex (odds ratio 13.75, 95% CI 6.91-27.36, P < 0.001); young age of 11 to 18 years (OR 3.92, 95% CI 2.20-7.0, P < 0.001); poor education (OR 2.50, 95% CI 1.15-5.45, P = 0.02); spring season (OR 2.39, 95% CI 1.3-4.41, P = 0.005); and small family size (OR 2.72, 95% CI 1.44-5.15, P = 0.002). Suicide by self-burning is common in Iraqi Kurdistan especially among women. Urgent action is required to provide a better understanding of the situation, and identify partners, capacities, and opportunities for action.

Analysis of suspected suicides using poison center data

Although there has been extensive research into the epidemiology and prevention of suicide, there continues to be a paucity of research on non-fatal suicides, in particular persons not treated in hospitals following a suicide attempt. In this study, we analyzed call data from the Illinois Poison Center from 2002 to 2007, which primarily comprises of non-fatal hospitalized and non-hospitalized attempts. We analyzed 43,057 calls by persons suspected of attempting suicide. The three most common groups of substances used were analgesics, antidepressants, and sedative/hypnotics/antipsychotics. The Poisson regression model showed significant declines in calls for suspected suicides during periods of holidays and vacations, and was more pronounced among youths. This study provides a current and detailed description of substances used primarily in non-fatal suicide attempts.