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Bojanić L, Turnbull P, Ibrahim S, Flynn S, Kapur N, Appleby L, Hunt IM. Suicide-related internet use among mental health patients who died by suicide in the UK: a national clinical survey with case-control analysis. THE LANCET REGIONAL HEALTH. EUROPE 2024; 44:100991. [PMID: 39040089 PMCID: PMC11262162 DOI: 10.1016/j.lanepe.2024.100991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/24/2024]
Abstract
Background Suicide-related internet use (SRIU) has been shown to be linked to suicide. However, there is limited research on SRIU among mental health patients, who are at 4 to 7 times increased risk of suicide compared to the general population. This study aims to address this gap by exploring the prevalence of SRIU among mental health patients who died by suicide in the UK and describing their characteristics. Methods The study was carried out as part of the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH). Data were collected on sociodemographic, clinical, suicide characteristics and engagement in SRIU of patients who died by suicide between 2011 and 2021. The study utilised a case-control design to compare patients who engaged in suicide-related internet use with those who did not. Findings The presence or absence of SRIU was known for 9875/17,347 (57%) patients; SRIU was known to be present in 759/9875 (8%) patients. The internet was most often used to obtain information on suicide methods (n = 523/759, 69%) and to visit pro-suicide websites (n = 250/759, 33%) with a significant overlap between the two (n = 152/759, 20%). Engaging in SRIU was present across all age groups. The case-control element of the study showed patients who were known to have engaged in SRIU were more likely to have been diagnosed with autism spectrum disorder (OR = 2.13, 95% CI: 1.43-3.18), have a history of childhood abuse (OR = 1.70, 95% CI: 1.36-2.13) and to have received psychological treatment (OR = 1.43, 95% CI: 1.18-1.74) than controls. Additionally, these patients were more likely to have died on or near a salient date (OR = 2.11, 95% CI: 1.61-2.76), such as a birthday or anniversary. Interpretation The findings affirm SRIU as a feature of suicide among patients of all ages and highlight that clinicians should inquire about SRIU during assessments. Importantly, as the most common type of SRIU can expand knowledge on suicide means, clinicians need to be aware of the association between SRIU and choice of methods. This may be particularly relevant for patients approaching a significant calendar event. Funding The Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Lana Bojanić
- National Confidential Inquiry Into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry Into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Saied Ibrahim
- National Confidential Inquiry Into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Sandra Flynn
- National Confidential Inquiry Into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Navneet Kapur
- National Confidential Inquiry Into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
- Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Louis Appleby
- National Confidential Inquiry Into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Isabelle M. Hunt
- National Confidential Inquiry Into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
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Helium Suicide, a Rapid and Painless Asphyxia: Toxicological Findings. TOXICS 2022; 10:toxics10080424. [PMID: 36006103 PMCID: PMC9412544 DOI: 10.3390/toxics10080424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023]
Abstract
Suicide by helium inhalation has become increasingly common in the last few decades in Europe and the US because it produces a quick and painless death. Inhaled-gas suicides can easily be assessed through death scene investigation and autopsy. However, helium is a colorless and odorless inert gas that unfortunately cannot be detected using standard toxicological analysis. A successful gas analysis was performed following the suicide of a 17-year-old female. For the detection of helium, central/peripheral blood samples and gaseous samples from the esophagus, stomach, and upper and lower respiratory airways (from the trachea and the primary left and right bronchia) were collected with a gastight syringe, ensuring minimal dilution. Qualitative analyses were positive in all gaseous samples. Quantitative analyses were performed using a special gas-inlet system with a vacuum by which the sample can be transferred to a mass spectrometer, reducing the risk of contamination. Helium concentrations were 20.16% from the trachea, 12.33% from the right lung, and 1.5% from the stomach. Based on the high levels of helium, the cause and manner of death were assessed as asphyxia suicide by inhalation of helium. Therefore, toxicological analyses should always be applied in order to gain evidence of inhaled gas in gaseous samples.
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Morales G, Fiero M, Albert J, Di Gennaro J, Gerbino A. Cerebral Arterial Gas Embolism due to Helium Inhalation from a High-Pressure Gas Cylinder. Case Rep Emerg Med 2022; 2022:1847605. [PMID: 35311225 PMCID: PMC8924607 DOI: 10.1155/2022/1847605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/22/2022] [Indexed: 11/20/2022] Open
Abstract
Cerebral arterial gas embolism (CAGE) is a rare but serious cause for acute neurologic deficit that occurs most often in divers who breathe compressed gas at depth or iatrogenically from a variety of invasive medical procedures. We present a rare case of CAGE caused by inhaling helium from an unregulated, high-pressure gas cylinder. Following inhalation, the patient experienced loss of consciousness, neurologic deficits, pneumomediastinum, and pneumothorax requiring transfer and treatment at a hyperbaric facility with resulting resolution of neurologic symptoms. This case highlights the importance of rapid diagnosis and hyperbaric oxygen treatment (HBO), facilitated by close coordination among community emergency departments, pediatric tertiary care centers, hyperbaric facilities, and poison control.
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Affiliation(s)
- Gabriel Morales
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Marie Fiero
- Divsion of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Jesselle Albert
- Divsion of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Jane Di Gennaro
- Divsion of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Anthony Gerbino
- Sections of Critical Care and Pulmonary Medicine, Virginia Mason Medical Center, Seattle, WA, USA
- Center for Hyperbaric Medicine, Virginia Mason Medical Center, Seattle, WA, USA
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Schultz BV, Rolley MEpi A, Doan TN, Isoardi K. Epidemiology of out-of-hospital cardiac arrests that occur secondary to chemical asphyxiants: a retrospective series. Resuscitation 2022; 175:113-119. [DOI: 10.1016/j.resuscitation.2022.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
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Detection of helium in a fire victim: A case report. Forensic Sci Int 2020; 318:110613. [PMID: 33254094 DOI: 10.1016/j.forsciint.2020.110613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
We report here detection of helium in specimens derived from a burn autopsy case. A male was found in a burnt bedroom. Part of a heat-denatured plastic bag, sealing tape, and flexible tubing remained on his head and neck. In addition, five helium tanks were found near him. His history in conjunction with the discovery conditions suggested a suicide attempt by inhalation of helium. The body had extensive first to fourth degree burns caused by heat. A small amount of soot was deposited in the respiratory tract. Except for the thermal burns, no other injuries were found. Toxicologically, the blood carboxyhemoglobin saturation levels were less than 6%, while combustion-derived volatile hydrocarbons such as benzene or toluene were detected in the blood. In addition, tracheal gas, gastric gas, headspace gas of lung tissue, brain, and heart blood were collected during autopsy for detection of helium. Analysis was performed using headspace gas chromatography with a thermal conductivity detector. Helium was detected in all of the samples tested. Etizolam at a low limit of therapeutic concentration or less was detected in the blood. Neither ethanol nor other drugs of abuse were detected in his blood or urine. Autopsy findings and experiments suggest that the victim inhaled helium and was still alive when a fire broke out. The cause of his death was diagnosed as death from fire and flames. The present result suggests that helium may remain in a burned body and that investigation of helium in cases of fire-related deaths is informative for determination of the cause of death or confirmation of the ante mortem involvement of helium.
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van den Hondel KE, Punt P, Dorn T, Ceelen M, Aarts F, van der Zande D, van Kuijk S, Duijst W, Stumpel R, van Mesdag T, Vervoort W, IJzermans A, de Vries P, Verweij J, van Remmen J, Van Hooren R, Kruyver B, Buster M, Reijnders UJL. Suicide by helium inhalation in the Netherlands between 2012 and 2019. Forensic Sci Int 2020; 318:110566. [PMID: 33168418 DOI: 10.1016/j.forsciint.2020.110566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In 2012 and 2013 a movie and a book about a 'dignified end of life' were published in the Netherlands. These items described suicide using an 'exit bag' to establish asphyxiation using helium (the helium method). 'Right-to-die-organisations' inform the elderly about this method. The purpose of this study is to investigate whether the use of suicidal asphyxiation by means of the helium method substituted other, related, methods following its publication in the Netherlands. MATERIAL AND METHODS We analysed suicides in the Netherlands over the period from 1 July 2012 to 30 June 2019. We compared the number of deaths caused by the helium method with other, related, cases. Secondly, we related these deaths to the total number of inhabitants and suicides recorded by Statistics Netherlands. RESULTS The study showed a stable trend in the use of the helium method in the period 2012-2019 and this was the same for the other, related methods. Individuals using the helium method were significantly younger than those using other, related, methods. At the scene of death, information about suicide and suicide notes were found more often at 'helium method' cases than with the 'other, related, methods' cases. Family was significantly more often present during a helium method suicide than during suicide by other, related, methods. DISCUSSION The number of suicides by the helium method and other, related, cases is stable in the Netherlands over the past years. Therefore, we conclude that there is no substitution effect within this category of suicides. Whilst 'right-to-die-organisations' strive to inform the old and sick of the helium method, it is noteworthy that the individuals using the helium method are significantly younger than the individuals who choose other, related, methods.
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Affiliation(s)
| | - Priscilla Punt
- Forensic Physicians Rotterdam Rijnmond, Rotterdam, the Netherlands
| | - Tina Dorn
- Public Health Service, Department of Epidemiology, Health Promotion & Health Care Innovation/Department of Forensic Medicine, Amsterdam, the Netherlands
| | - Manon Ceelen
- Public Health Service, Department of Epidemiology, Health Promotion & Health Care Innovation/Department of Forensic Medicine, Amsterdam, the Netherlands
| | - Francée Aarts
- Public Heath Service, Department of Forensic Medicine, Nijmegen, the Netherlands
| | - Dianne van der Zande
- Public Heath Service, Department of Forensic Medicine, The Hague, the Netherlands
| | - Sieb van Kuijk
- Public Heath Service, Department of Forensic Medicine, Zwolle, the Netherlands
| | - Wilma Duijst
- Public Heath Service, Department of Forensic Medicine, Zwolle, the Netherlands
| | - René Stumpel
- Public Heath Service, Department of Forensic Medicine, Bussum, the Netherlands
| | - Taco van Mesdag
- Public Heath Service, Department of Forensic Medicine, Groningen, the Netherlands
| | - Will Vervoort
- Public Heath Service, Department of Forensic Medicine, Tilburg, the Netherlands
| | - Anke IJzermans
- Public Heath Service, Department of Forensic Medicine, Den Bosch, the Netherlands
| | - Philip de Vries
- Public Heath Service, Department of Forensic Medicine, Leiden, the Netherlands
| | - Jeroen Verweij
- Public Heath Service, Department of Forensic Medicine, Utrecht, the Netherlands
| | - Jacquo van Remmen
- Public Heath Service, Department of Forensic Medicine, Gelderland Midden, the Netherlands
| | - Roland Van Hooren
- Public Heath Service, Department of Forensic Medicine, Maastricht, the Netherlands
| | - Bart Kruyver
- Public Heath Service, Department of Forensic Medicine, Hollands Noorden, the Netherlands
| | - Marcel Buster
- Public Health Service, Department of Epidemiology, Health Promotion & Health Care Innovation/Department of Forensic Medicine, Amsterdam, the Netherlands
| | - Udo J L Reijnders
- Public Health Service, Department of Forensic Medicine, Amsterdam, the Netherlands
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Kinoshita H, Tanaka N, Yasumoto-Takakura A, Abe H, Maebashi K, Tsuboi A, Iwase H, Iwadate K, Osawa M, Kitamura O. Appropriate samples for helium detection in postmortem investigations. Leg Med (Tokyo) 2020; 47:101784. [DOI: 10.1016/j.legalmed.2020.101784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/12/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022]
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Smędra A, Łabętowicz P, Wochna K, Berent J. Helium suicide - A suffocation or a barotrauma? J Forensic Leg Med 2020; 76:102065. [PMID: 33032206 DOI: 10.1016/j.jflm.2020.102065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022]
Abstract
Helium is a chemically inert gas present in atmospheric air that is used in various branches of industry and in medicine. In the case of its improper use, various complications may occur, affecting mainly the respiratory tract and, in extreme cases, even result in death. Helium has also been used for committing suicide. Helium suicide is a method that does not leave characteristic macro- and microscopic post-mortem changes. A large amount of information on how to commit suicide with the use of helium can be found on the internet, which contributes to the popularization of this method in the world. In the case of incompetent use of the equipment theoretically dedicated to such suicide, death may occur not because of the suffocation, which is the most common mechanism in such cases, but because of a pressure injury of the respiratory tract, resulting in rapid damage to the alveoli in the rupture mechanism, causing massive bleeding. Helium dissipates quickly in the ambient air, and usually, its presence cannot be detected either in the blood or in the tissues. Thus, even if the material for toxicological tests is handled properly, detection of the presence of helium in a relatively short period of time after death is usually impossible or very difficult. If death due to inert gas inhalation is suspected during an autopsy, samples of biological material can be collected to be tested later by gas chromatography combined with mass spectrometry (GC-MS), but the results of the investigations are usually not helpful from the point of view of a forensic pathologist.
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Affiliation(s)
- Anna Smędra
- Department of Forensic Medicine of the Medical University of Lodz Chair of Forensic Medicine, Poland.
| | - Piotr Łabętowicz
- Department of Forensic Medicine of the Medical University of Lodz Chair of Forensic Medicine, Poland
| | - Katarzyna Wochna
- Department of Forensic Medicine of the Medical University of Lodz Chair of Forensic Medicine, Poland
| | - Jarosław Berent
- Department of Forensic Medicine of the Medical University of Lodz Chair of Forensic Medicine, Poland
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