Suicide among Italian adolescents: 1970-2002

Spatial, geographic, and demographic factors associated with adolescent and youth suicide: a systematic review study

Background

Suicide is a public health issue and a main cause of mortality among adolescents and the youth worldwide, particularly in developing countries.

Objectives

The present research is a systematic review aiming to investigate the spatial, geographical, and demographic factors related to suicide among adolescents and the youth.

Methods

In this systematic review, two researchers examined PsycINFO, Web of Science, Scopus, and PubMed databases on December 7th, 2022 with no time limits from the beginning of publication until 2022 to identify the primary studies on spatial and geographic analysis on adolescent and youth suicides. Once duplicate studies were identified and removed, the titles and abstracts of studies were examined and irrelevant studies were also removed. Finally, 22 studies were reviewed based on the inclusion criteria.

Results

Our findings show that suicide rates are generally higher among men, residents of rural and less densely populated regions, coastal and mountainous regions, natives, 15-29 age group, less privileged populations with social fragmentation, unemployed, divorced or lonely people, those who live in single parent families, people with mental health issues, and those with low levels of education.

Conclusions

Stronger evidence supports the effects of geographic and demographic variables on youth and adolescent suicide rates as compared with spatial variables. These findings suggest that policy makers take spatial and demographic factors into consideration when health systems allocate resources for suicide prevention, and that national policymakers integrate demographic and geographic variables into health service programs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023430994.

Suicide in the press: an analysis of newspaper coverage of adolescent versus adult suicides in Italy

BACKGROUND

An association between sensationalized media reporting and subsequent increase in suicidal behavior has been documented, and adolescents are especially vulnerable to imitative influences. The aims of this study were to examine the characteristics of the articles reporting adult and adolescent (under age 18) suicides in the Italian press and to assess adherence to the World Health Organization (WHO) guidelines for responsible reporting. Methods: The print versions of the three newspapers with the widest national distribution in Italy were searched for all the articles on incident suicides printed over a 7-month period (July 2022 to February 2023). Articles were examined for adherence to the WHO guidelines. Results: Overall, 213 articles were identified, reporting on 122 individual suicide cases (88.5% adults and 11.5% adolescents). Of the articles, 78.9% were on adults and 21.1% on adolescents, with a ratio articles/suicide cases of 1.6 for adults and 3.2 for adolescents (p < 0.0001). Adolescent suicide articles had more words (mean 612.5 ± SD 275.6) than adult ones (462.1 ± 267.7, p = 0.001). Potentially harmful reporting features were present in both the adult and adolescent articles (12-82%). Few articles (0-15%) included protective features. Articles on adolescents were more adherent to the WHO guidelines for omitting specific information of suicide method and location. Conclusions: Significant differences were found in the press reporting of adolescent versus adult suicides, with adolescent suicides receiving more attention in terms of the number of articles and article length. Suicide press reporting can be improved. A close collaboration between journalists and suicide prevention experts may be beneficial.

Gender Differences in the Psychopathology of Mixed Depression in Adolescents with a Major Depressive Episode

BACKGROUND

Gender differences have been reported in the severity and psychopathological features of major depressive disorders among adults but are poorly reported in adolescent samples.

OBJECTIVE

This study aimed to examine gender differences in the psychopathology of mixed depression among adolescents.

METHODS

We analyzed 341 outpatients with the current major depressive episode (MDE) retrospectively to identify patients with DSM-5 MDE with mixed features. We compared examiner-rated depressive and (hypo)manic symptoms and self- and parent-reported symptoms between sexes.

RESULTS

We identified 76 patients with an MDE with mixed features (67.1% females, 32.9% with bipolar disorder). Depression severity was significantly greater in females versus males (CDRS-R total score 56.2 vs. 48.2, p = 0.014). Depressive symptoms were significantly and independently found to be more severe among females in a logistic regression model, including excessive fatigue (OR 1.68; p = 0.025), low self-esteem (OR 1.67; p = 0.04), excessive weeping (OR 1.62; p = 0.021), and CBCL AAA index (OR 1.04; p = 0.015). None of the depressive symptoms scored greater in males. Males had higher levels of motor activity (2.12 vs. 1.69; p = 0.048) and pressured speech (1.80 vs. 1.24; p = 0.004). Self-rated anxiety (69.3 vs. 56.8, p = 0.047) and CBCL AAA index (207 vs. 189; p = 0.007) were higher in females.

CONCLUSION

Adolescent depression with mixed features is more severe in women, with a higher expression of core affective symptoms and excessive fatigue. While in males, slightly higher levels of psychomotor activation are reported, in females, emotional dysregulation and excessive weeping may subtend a difference in a broader spectrum of mixed features.

Suicide among adolescents in Italy: a nationwide cohort study of the role of family characteristics

Suicide is a leading cause of death among adolescents and is recognized as a serious public health problem. This study aimed to investigate the relationship between family characteristics and the risk of suicide among adolescents in Italy using nationwide official data. We carried out a cohort study based on the record linkage between the 15th Italian Population Census, the Italian Population Register, and the National Register of Causes of Death. Suicides in adolescents aged 10-19 years from 2012 to 2016 were analyzed. Hazard ratios of mortality from suicide were estimated through a multivariable Cox regression model using time-on-study as the time scale. We included 8,284,359 children and adolescents (51% males, 49% females). Over the 5-year follow-up, we registered 330 deaths from suicides (74% males), mostly occurred in the age class 15-19 years (86%). The suicide rate was 1.71 per 100,000 person-years among males and 0.65 among females. We found some familial characteristics associated with a higher risk of dying by suicide, including: living in single-parent or reconstructed families (among boys), a 40-year or more age gap between mother and child (among girls), having highly educated parents, an age difference between parents greater than 5 years. Furthermore, the study showed a lower risk for boys living in urban areas and for both boys and girls living in South Italy. Our results could help in identifying adolescents at high risk of suicide who could benefit from the planning of targeted intervention strategies.

Trends and ecological results in suicides among Italian youth aged 10-25 years: A nationwide register study

BACKGROUND

Documenting current trends and sources of variation in youth suicide rates is critical to inform prevention strategies. We aimed to document suicide mortality trends among Italian youth from 1981 to 2016 and to describe age-, gender- and urbanization-specific suicide rates.

METHODS

We used official mortality data for the period 1981-2016 for adolescents and young adults aged 10-25 years. We estimated standardized all-cause and suicide mortality rates per 100,000 individuals and used joinpoint regression analyses to determine annual mortality trends and significant changes in rate trends. Analyses were reported according to gender, age group (10-17 and 18-25 years), urbanization and suicide method.

RESULTS

From 1981 to 2016, 1,752 suicides were identified among youth aged 10-17 years (boy/girl ratio of 5.80 in 2016) and 9,897 suicides among youth aged 18-25 years (boy/girl ratio of 3.97 in 2016). Overall suicide rates remained stable for boys and showed a small decrease for girls. Suicide was most common in rural areas for boys and in metropolitan areas for girls. We observed a significant decrease in the use of firearms and poisoning; the most common suicide method was hanging for boys and falls for girls.

LIMITATIONS

We did not control for regional-level sociodemographic, economic and health care system characteristics.

CONCLUSIONS

Youth suicides were either stable (for boys) or slightly declining (for girls). We found differences according to urban versus rural areas, suggesting the need for a broader view of the phenomenon. Factors influencing these trends and gender differences in the geographical areas are important in delivering suicide prevention strategies.

Adolescent Admissions to Emergency Departments for Self-Injurious Thoughts and Behaviors

The objective of the present study was to describe the incidence and the characteristics of Self-Injurious Thoughts and Behaviors (SITBs), among adolescents aged 11–18 admitted, over a two year period, to all the Emergency Departments of a Region of North-eastern Italy through a comprehensive analysis of medical records. A two-step search was performed in the regional ED electronic database. First, we identified the cases that had been clearly diagnosed as SITBs by an Emergency Department physician. Secondly, suspect cases were detected through a keyword search of the database, and the medical records of these cases were hand screened to identify SITBs. The mean annual incidence rate of SITBs was 90 per 100,000 adolescents aged 11–18 years. Events were more frequent in females. Drug poisoning was the most frequently adopted method (54%). In 42% of cases a diagnosis of SITB was not explicitly reported by the physician. In 65% of cases adolescents were discharged within hours of admission. Only 9% of patients started a psychiatric assessment and treatment program during hospital stay. This research confirms the high incidence of SITBs among adolescents and highlights the difficulty in their proper diagnosis and management. Such difficulty is confirmed by the fact that only a few patients, even among those with a clear diagnosis, were sent for psychiatric assessment. Correct identification and management of SITB patients needs to be improved, since SITBs are an important public health problem in adolescence and one of the main risk factors for suicide.

Two decades of adolescent suicides assessed at Milan University's medicolegal unit: Epidemiology, forensic pathology and psychopathology

AIM

to analyze the cases of suicide committed by adolescents in and around the city of Milan over a 20-year period (1993-2012).

MATERIALS AND METHODS

cases of suicide involving individuals between 10 and 19 years of age were drawn from 20,757 autopsies performed by the Medico-legal Unit at Milan University. Seventy-eight cases were considered (20 females and 58 males, with the ratio of 1:2.9), and their clinical and circumstantial histories, epidemiology, forensic pathology and psychopathological issues were analyzed.

RESULT

Adolescents were involved in 2.23% of all suicides committed in Milan during the period examined. The "mean" victim is a male without psychiatric disease, aged between 16 and 19, that commits suicide outdoors.

CONCLUSIONS

In the majority of cases, there were no premonitory signs, nor any particular contingent or remote reason that might explain these violent deaths, which therefore remain "impulsive".

Gender differences among suicide attempters attending a Crisis Intervention Clinic in South India

BACKGROUND AND OBJECTIVES

Studying gender differences among suicide attempters is important for identifying gender-specific risk factors and for planning management and prevention. Our objective was to delineate gender differences among a well-defined group of suicide attempters.

MATERIALS AND METHODS

This record-based study was conducted among patients presenting to a Crisis Intervention Clinic in a Tertiary Care Hospital in South India. Information was gathered regarding sociodemographic and clinical characteristics. Hopelessness was measured using Beck Hopelessness Scale (BHS), and stress was evaluated using Presumptive Stressful Life Events Scale (PSLES).

RESULTS

The sample comprised of 162 males and 137 females. Males were significantly older and were more likely to be employed as compared to females. Alcohol use was significantly more in males and number of men who attempted suicide under intoxication was significantly higher. Females had a greater proportion of attempts with the use of plant poisons and medication overdose. There was no significant difference between two genders on BHS though differences were noted on types of stresses reported on PSLES.

CONCLUSION

Gender-specific differences were noted with regard to substance use, mode of attempt and types of stressors experienced. Identifying these factors might help us to design targeted interventions to prevent further attempts.

A focus on recent cases of suicides among Italian children and adolescents and a review of literature

Suicidal behaviors are among the leading causes of death worldwide. The large spread of suicide suggests that educational programs and literature to parents or guardians should include information about the potential risks and potential consequences of the onset of the idea of suicide in children. We identified 55 cases of suicide among children and young adults <18-year-old occurring in Italy between 1st January, 2011 and 31st December, 2013. The results point to the need to increase our understanding of the dramatic rise in suicidal behaviors during childhood/adolescence and of the causal pathways linking these behaviors to child-adolescent mental disorders. During routine care visits, pediatricians should be skilled to recognize risk factors for adolescent suicide in order to intervene appropriately.

Clinical and socio-demographic correlates of suicidal intent among young adults: a study from South India

BACKGROUND

Intent in attempted suicide is considered an indicator of subsequent suicide. Few studies in developing countries have examined correlates of suicidal intent among young adults.

AIMS

This study aimed to assess the intent score among a sample of young suicide attempters from South India and to identify the factors associated with suicide intent among them.

METHOD

The clinical charts of 64 consecutive subjects aged 15-24 years attending emergency services for attempted suicide were reviewed. All participants completed a semistructured proforma, the Presumptive Stressful Life Events Scale, the Beck Hopelessness Scale, the Pierce Suicide Intent Scale, and the Global Assessment of Functioning Scale. Psychiatric diagnoses were made according to the ICD-10 clinical descriptions and diagnostic guidelines.

RESULTS

The intent scores were in the moderate-to-high range for most subjects. Suicide intent score significantly varied depending on the presence or absence of psychiatric morbidity. In bivariate analysis, psychiatric morbidity and hopelessness correlated positively with suicide intent, and in linear regression, hopelessness emerged as a predictor of suicide intent.

CONCLUSION

A high intent of suicide in young is associated with psychiatric morbidity and presence of hopelessness. Hopelessness may be a key predictor of suicidal intent. Assessment of suicidal intent and hopelessness among young attempters is important and may help identify high-risk individuals who need intensive interventions.

Northern excess in adolescent male firearm suicides: a register-based regional study from Finland, 1972-2009

There are more firearms in Northern Finland as compared to Southern Finland, and a positive association between suicide rates and the number of firearms in a given region has been demonstrated in previous literature. Accordingly, the authors compared firearm suicide rates of Finnish adolescent (under 18 years) males in the two geographic regions. Young adult (18-24 years) and adult (25-44 years) males were used as reference groups. National data on cases of suicide in Northern and Southern Finland between 1972 and 2009 were obtained from Statistics Finland. Firearm suicides (n=5,423) were extracted according to ICD-classification (ICD-8/9: E955, ICD-10: X72-X75). The distribution of types of firearms (hunting gun, handgun, other) employed in suicides was also investigated. The adolescent male firearm suicide rate in Northern Finland was almost three times higher than that observed in Southern Finland, while there was no difference in rates of suicide by other methods. A northern excess in firearm suicide rates was also found among young adult and adult males. Hunting guns were the most common type of firearms employed in young male suicides, and their use was especially common in Northern Finland. Our results indicate that the use of firearms plays a major role in explaining the northern excess in young Finnish male suicide rates, and emphasize a need to advance suicide prevention according to specific regional characteristics.

Suicidal ideation, risk factors, and communication with parents. An HBSC study on school children in Estonia, Lithuania, and Luxembourg

BACKGROUND

Suicide is a leading cause of death among youth. In the year 2002, Lithuania had the 2nd, Luxembourg the 5th, and Estonia the 9th highest suicide rates among 15- to 19-year-olds across 90 countries worldwide. Suicidal ideation is a significant precursor to suicide.

AIMS

To report on the prevalence of and associations between suicidal ideation, smoking, alcohol consumption, physical fighting, bullying, and communication with parents among 15-year-old schoolchildren.

METHODS

The survey analyzes data from the 2005/2006 HBSC study from Estonia, Lithuania, and Luxembourg (N = 4,954). The risk factors were calculated through multinomial logistic regression analyses.

RESULTS

The overall prevalence of suicidal ideation in the preceding year was 17%. Suicidal thoughts were associated with communication difficulties with parents (OR from 2.0 to 4.6) and other risk factors, especially multiple risks (OR for 4-5 concurrent risk factors from 4.5 to 13.6). Parent-child communication had a significant mediating effect by decreasing the odds for suicidality and multiple risks.

LIMITATIONS

The prevalence estimates were obtained by self-reports. The causal relationships need further investigation.

CONCLUSION

The risk factors studied, particularly multiple risks, were associated with higher odds for suicidal ideation. Good parent-child communication is a significant resource for decreasing suicidal ideation among adolescents.

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

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

Youth suicide trends in Finland, 1969-2008

BACKGROUND

There are only a few recent studies on secular trends in child and adolescent suicides. We examine here trends in rates and methods of suicide among young people in Finland, where suicide rates at these ages are among the highest in the world.

METHODS

The data, obtained from Statistics Finland, consisted of all suicides (n = 901) committed by persons under 18 years of age over the period 1969-2008. Gender-specific trends were analysed separately for the years 1969-1989 and 1990-2008 using 3-year moving averages. Trends in methods of suicide were examined from 1975 to 2008 in five-year periods.

RESULTS

The male-to-female ratio in youth suicides was 3.6:1. The male rates increased in 1969-1989, while the rates among females were inconsistent. After 1990, the rates decreased for males but turned to an increase among females. Shooting was the most common suicide method among males throughout the period, while hanging exceeded poisoning as the most common method among females after 1990. All violent suicides decreased for males and increased for females in 1990-2008.

CONCLUSIONS

The increase in violent, i.e., more lethal, suicide methods among young females is alarming, as females are known to have higher rates of attempted suicide than males. Alcohol consumption, rates and treatment of depression and violent behaviour among adolescents are discussed as approaches towards explaining this phenomenon.

Measuring nepotism through shared last names: the case of Italian Academia

Nepotistic practices are detrimental for academia. Here I show how disciplines with a high likelihood of nepotism can be detected using standard statistical techniques based on shared last names among professors. As an example, I analyze the set of all 61,340 Italian academics. I find that nepotism is prominent in Italy, with particular disciplinary sectors being detected as especially problematic. Out of 28 disciplines, 9 – accounting for more than half of Italian professors – display a significant paucity of last names. Moreover, in most disciplines a clear north-south trend emerges, with likelihood of nepotism increasing with latitude. Even accounting for the geographic clustering of last names, I find that for many disciplines the probability of name-sharing is boosted when professors work in the same institution or sub-discipline. Using these techniques policy makers can target cuts and funding in order to promote fair practices.

Inequalities and Impact of Socioeconomic-Cultural Factors in Suicide Rates Across Italy

Background: Suicide is a major cause of premature death in Italy and occurs at different rates in the various regions. Aims: The aim of the present study was to provide a comprehensive overview of suicide in the Italian population aged 15 years and older for the years 1980–2006. Methods: Mortality data were extracted from the Italian Mortality Database. Results: Mortality rates for suicide in Italy reached a peak in 1985 and declined thereafter. The different patterns observed by age and sex indicated that the decrease in the suicide rate in Italy was initially the result of declining rates in those aged 45+ while, from 1997 on, the decrease was attributable principally to a reduction in suicide rates among the younger age groups. It was found that socioeconomic factors underlined major differences in the suicide rate across regions. Conclusions: The present study confirmed that suicide is a multifaceted phenomenon that may be determined by an array of factors. Suicide prevention should, therefore, be targeted to identifiable high-risk sociocultural groups in each country.

Completed suicide and marital status according to the Italian region of origin

Completed suicide is associated with marital status; being unmarried is associated with a higher suicide rate as compared with being married or living with a partner. Moreover, the region of origin may be particularly important when trying to explain major inequalities in suicide rates across a country. Data were obtained from the Italian Database on Mortality, collected by the Italian Census Bureau (ISTAT) and processed by the Italian National Institute of Health-Statistics Unit. The Italian population in the last Italian census (October 2001) was used to estimate age-standardized mortality rates from suicide by marital status (ICD-9 revision: E950-959) and "natural" causes (ICD-9 revision: 0-280; 320-799). Rate Ratios and 95% confidence intervals were calculated using married individuals as a reference. All analyses were conducted separately for men and women for 2000-2002, the most recent years with data available. Logistic regression analysis was used to compare differences by marital status for suicide versus death from natural causes. There are major inequalities in suicide rates in Italy. The North region has the highest suicide rates both for married and non-married individuals. Sardinia Island has the highest male suicide rate in Italy-23.07 per 100,000 per year-compared with the average national male suicide rate of 13.80, a difference which is significantly higher by 67% (RR: 1.67; 95%CI = 1.40-1.99). In contrast, Sardinia has one of the lowest female suicide rates among the Italian regions, close to that of the South and the Center regions. The North-East is the only region where the suicide rate among divorced men is significantly higher than that of married men. In the South, widowers have the highest suicide rate, with a rate 6-times that of married men (RR = 5.66; 95%CI = 4.46-7.18). Major inequalities in suicide rates by region may derive from different socio-cultural backgrounds, confirming the notion that suicide is a multifaceted phenomenon. The results of the present study indicate that suicide prevention must take into account the social and cultural characteristics of different communities. Moreover, these findings support the notion that marital status may play a central role in influencing suicide.

Suicide in the Northern Territory, 2001-2006

OBJECTIVE

The aim of the present study was to characterize suicide in the Northern Territory (NT) for the 6 year period 1 January 2001-31 December 2006.

METHOD

Suicide death rates by area (Australia, NT), sex, and Indigenous status for the period of 2001-2006 were obtained from the National Coroners Information System through the Victorian Institute of Forensic Medicine. Population figures were obtained from the Australian Bureau of Statistics.

RESULTS

For this period the suicide rate of NT (21.6 per 100 000) was double the national rate ( 11 ), and the rate for NT Indigenous people (36.7) was significantly higher (p < 0.001) than that of NT non-Indigenous people (14.7). There was a decline in the suicide rate for Australia of -8.6%; for NT, -6.3%; for NT non-Indigenous, -3.3%; and for NT Indigenous, -9.0%. The sex difference was significant (p < 0.001) for both Australia and the NT with male subjects having a higher suicide rate than female subjects. With respect to age group, some evidence suggested an earlier peak for NT Indigenous compared to NT non-Indigenous people. Hanging was more common in NT than in the rest of the country and accounted for 87% of Indigenous suicide.

CONCLUSION

Suicide is more common in NT than in Australia generally, and more common in NT Indigenous than NT non-Indigenous people. There is evidence of a decline in suicide rates across the board.