Associations between marital and educational status and risk of completed suicide in Hungary

Suicide attempts in the adult Mexican population: an analysis of sociodemographic characteristics and associated factors

OBJECTIVE

Suicide is the culmination of a process or continuum known as suicidal behavior that proceeds from ideation and planning to attempt. The objective was to estimate the prevalence of suicide attempts in the adult Mexican population and to analyze their main associated factors.

METHODS

We conducted an observational, cross-sectional, and descriptive study with information from the National Health and Nutrition Survey (2018). Self-reported lifetime suicide attempt was used in the analysis. We analyzed depression, obesity, tobacco smoking, and alcohol consumption as suicide attempt-associated factors using a multivariate logistic regression model.

RESULTS

The prevalence of adult suicide attempt was 2.0% (95%CI 1.8-2.2) and it was higher among women (2.4%; 95%CI 2.2-2.8) and young people (2.9%; 95%CI 2.4-3.4). Low education (OR=1.6; 95%CI 1.2-2.2), being single (OR=1.3; 95%CI 1.0-1.6), having obesity (OR=1.4; 95%CI 1.1-1.8), consumption of alcohol (OR=2.4; 95%CI 1.7-3.4) or tobacco smoking (OR=1.8; 95%CI 1.4-2.4), and having strong symptoms of depression (OR=10.1; 95%CI 6.2-16.3) were associated with a higher prevalence of suicide attempts.

CONCLUSION

These results help better understand suicidal behavior in Mexico and identify the factors that increase the likelihood of suicide attempts, which is essential to help reduce suicide mortality. This research is crucial for developing early interventions and prevention programs aimed at reducing suicide's public health burden.

The temporal relationship between marriage and risk for suicidal ideation

BACKGROUND

Marriage is consistently identified as a protective factor for suicidality, but it remains unclear whether this relationship varies by time elapsed since the transition to marriage.

METHODS

Participants were 15,870 individuals (52 % female, mean age = 44.63 years, age range = 18-99 years) from the Collaborative Psychiatric Epidemiology Surveys. Cox proportional hazards models were used to test the relationship between marriage, as well as time elapsed since the transition to marriage (0-5 years, 6-10 years, or 11+ years), and suicidal ideation. Years of education and race and ethnicity were included as covariates, and analyses were stratified by sex. Separate hazard ratios were estimated for individuals aged <30 years and 30+ years to address violations of the proportionality assumption.

RESULTS

Being married was associated with lower risk for suicidal ideation across age and sex. Among individuals aged <30 years, marriage was reliably associated with lower risk for suicidal ideation, regardless of the time elapsed since marriage. For individuals aged 30+ years, being married for 0-5 years or 6-10 years was associated with increased risk for suicidal ideation, particularly in females. Being married for 11+ years was associated with decreased risk across sex.

LIMITATIONS

Analyses focused on participants' first marriage and did not examine mediators of the association between marriage and suicidal ideation.

CONCLUSIONS

Overall, being married protects against suicidal ideation. However, among individuals aged 30 years or older, the first 10 years of marriage are associated with elevated risk for suicidal thoughts, and clinical outreach may be warranted.

Marital status and suicidal behavior in South Asia: A systematic review and meta-analysis

Background and Aims

The connection between marital status and suicidal behavior has been poorly assessed in South Asia. We aimed to see the proportion of marital status in individuals with suicidal behavior in South Asian countries.

Methods

We followed PRISMA guidelines and registered the protocol in advance (PROSPERO 2023 CRD42023399906). A systematic search was conducted in Medline, Embase, and PsycINFO. Meta-analyses were performed to pool the proportion of married individuals with suicidal behavior (total [suicide + suicide attempts], suicide, and suicide attempt) in South Asian countries. We considered suicidal behavior consist of suicide and suicide attempts (nonfatal).

Results

Our search identified 47 studies for this review from 6 countries published from 1999 to 2022 with a sample size ranging from 27 to 89,178. The proportion of married individuals was 55.4% (95% CI: 50.1-60.5) for suicidal behavior, 52.7% (95% CI: 44.5-60.7) for suicides, and 43.1 (95% CI: 32.9-53.9) for suicide attempts. The proportion of married persons among suicide attempts varied significantly across countries (p = 0.016) which was highest (61.8%; 95% CI: 57.2-66.2) in India, followed by Bangladesh (52.5%; 95% CI: 41.8%-62.9%) and Pakistan (45.1%; 95% CI: 30.9-59.9). The pooled proportions did not differ significantly in relation to the quality of the studies (p = 0.633).

Conclusion

This review identified married persons died more than others by suicide in South Asian countries while single persons attempted suicide than married. As the current study did not assess any cause-and-effect association, a cautious interpretation is warranted while considering married marital status as a risk factor.

Single and combined effects of marital status, education attainment, and employment status on suicide among working-age population: A case-control study in South Korea

Background

Suicide in the working-age population is an important public health issue. This group is heterogeneous regarding marital status, education level, and employment status, which are generally important socioeconomic factors for suicide, and has a wide age range. This study aims to explore the individual and combined effect of these socioeconomic factors on suicide in different age groups among the working-age population.

Methods

This study utilized a population-based case-control design for the working-age population in South Korea. Suicide cases were identified in Korean Governmental Death Registry from 2008 to 2017, and eight controls from Korea Community Health Survey were matched to each case by gender, age group, and year of suicide. Conditional logistic regression models estimated the relationship between marital status and socioeconomic status (SES) including educational attainment and employment status and suicide and examined the combined effect of the SES indicators and marital status on suicide.

Results

Low education, single status, and unemployment or economically inactive status were associated with suicide, but their magnitude varied across SES indicators. The association between SES and suicide was more pronounced in younger adults. The suicide risk was highest among divorced women aged 25–34 years (OR = 7.93; 95% CI: 7.21–8.72). Individuals experiencing two social adversities among SES or marital status had a significantly increased suicide risk. Those who are divorced and unemployed or economically inactive have the highest suicide risk, specifically among men aged 24–35 years (OR = 17.53; 95% CI: 14.96–20.55).

Conclusions

Marital status, education attainment, and employment status have a separate and combined impact on suicide among the working-age population. Specifically, the divorced and unemployed or economically inactive status amplified suicide risk, predominantly among young adults. Monitoring and intervention for those young adults should be considered for suicide prevention.

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Using a case-control design, we were able to demonstrate single as well as the combined impact of socioeconomic status on suicide.

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Poor SES was associated with suicide, but its magnitude varied across SES indicators. The suicide risk was highest among divorced adults.

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Individuals with two different types of poor SES and single status had an increased suicide risk. Specifically, those who are divorced and unemployed or economically inactive have the highest suicide risk.

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The pattern of the association between socioeconomic status and suicide was dependent on age. The association between SES and marital status and suicide was more pronounced in younger adults.

The causal effect of education and cognitive performance on risk for suicide attempt: A combined instrumental variable and co-relative approach in a Swedish national cohort

BACKGROUND

The aim of this study was to clarify the possible causal associations between education phenotypes and non-fatal suicide attempts. In particular, we evaluated the roles of academic achievement (school grades), cognitive performance (IQ), and educational attainment (education level).

METHODS

Based on longitudinal Swedish registry data, we included 2,335,763 individuals (48.7% female) with available school grades, 1,448,438 men with IQ measures, and 4,352,989 individuals (48.4% female) with available data on education level. We combined two different approaches to aid in causal inference: 1) instrumental variables analysis, using month of birth as an instrument related to education but not suicide attempt, to control for measured and unmeasured confounders, and 2) co-relative analysis, comparing pairs of different genetic relatedness (cousins, half, and full siblings) to control for genetic and environmental influences.

RESULTS

High education was associated with reduced risk of suicide attempt. Instrumental variable analysis indicated evidence of a likely causal association between higher school grades and lower risk of suicide attempts (HR = 0.71). Co-relative analyses supported the causality between the three predictors and suicide attempt risk (school grades, HR = 0.80, IQ, HR = 0.83, education level, HR = 0.76). Finally, we examined the specificity of education phenotypes and found that both cognitive (IQ) and non-cognitive (school grades, education level) processes were involved in suicide attempt risk.

LIMITATIONS

IQ was only available in men, limiting the generalizability of this analysis in women.

CONCLUSIONS

Efforts to support causal associations in psychiatric research are needed to offer better intervention. Programs improving education during adolescence would decrease suicide attempt risk.

Investigation of the association between lithium levels in drinking water and suicide mortality in Hungary

BACKGROUND

In recent decades, a series of ecological studies from various countries have attempted to reveal whether there is an association between trace amounts of lithium in drinking water and suicide mortality. With some notable exceptions, results have indicated that there is an inverse association between these two variables. Since Hungary had extremely high rates of suicide with a persistent spatial pattern, we consider that our country is ideal to investigate this research question.

METHODS

We carried out our research on Hungarian data at the level of districts (n = 197). The dependent variable was the age- and gender-standardized mortality ratio for suicide (sSMR). Our main explanatory variable was the tap water lithium level (Li) from public drinking water supply systems using their own water source (n = 1 325). Those data, which give full national coverage, were aggregated to the level of districts. Confounding factors were religiosity, alcohol consumption and income. Various regression models were used for statistical calculations.

RESULTS

Findings from our most appropriate regression model - adjusted for relevant confounding variables and able to handle spatial autocorrelation and heteroscedasticity - suggest a significant (p < 0.05) and a trend-like (p < 0.1) negative association between Li and sSMR in the total population and among males, respectively. However, such an association was not found between these two variables among females.

CONCLUSION

In line with the majority of findings from other countries, our results indicate that the intake of lithium with drinking water may have a gender-dependent suicide-protective effect.

Suicide mortality among older adults in Brazil between 2000 and 2019 - estimates from the Global Burden of Disease Study 2019

INTRODUCTION

Older adults present a higher risk of suicide, and Brazil is experiencing a fast population aging. To understand the impact of demographic transition, we compared Brazilian suicide mortality rates (MR) among adults (50+ years) with global rates, those from one high-income country, and those from one middle-income country. Looking for regional disparities, the MR was analyzed among older adults (60+ years) by Brazilian states.

METHODS

This was an ecological study based on estimates from the Global Burden of Disease Study, from 2000 to 2019. Age-standardized MR and age-specific MR per 100,000 inhabitants were described, with 95% uncertainty intervals (UI).

RESULTS

During the period, the annual estimates and the declining trend in mortality were higher in the world than in the studied countries. In 2019, global age-standardized MR was 9.39 (95% UI 8.48-10.29), compared to 5.68 (95% UI 5.40-6.19), 6.01 (95% UI 5.10-7.04), and 6.63 (95% UI 6.43-6.95) in Brazil, Mexico, and England, respectively. In Brazil, despite a significant decline in national rates, stability was observed in 15 states. An increase in aging was only found for men, who presented 3-4 times higher MR than women. The states' rates presented large differences: in 2019, the rates among men aged 60-64 years varied from 7.24 (95% UI 5.31; 9.85) to 26.32 (95% UI 20.21; 34.50).

CONCLUSIONS

The smaller decline in suicide mortality among older Brazilian adults, the increasing risk with aging, and the higher mortality among men indicate the need for specific prevention policies. The variation within states suggests differences in the data quality or in socio-cultural and historical aspects, which requires further investigation.

Patterns of suicide deaths in Hungary between 1995 and 2017

Hungary has had one of the highest suicide mortality rates in the world for decades. Investigating seasonality of suicide deaths is essential as its findings could be key elements in the prevention. In our study we have analyzed the seasonal effect in suicide mortality in relation to possible risk factors in Hungary during 1995–2017.

Data on the numbers of suicide deaths were obtained from a published online database. Negative binomial regression was employed to investigate the effect of possible risk factors and seasonal and annual trends in suicide rates. The seasonal effect was further investigated, adding a significant risk factor from the “initial” negative binomial regression.

The suicide risk was significantly (p < 0.001) higher in men than in women (incidence rate ratio: 3.48), and it increased with age and decreased with education level. Marriage was a protective factor against suicide. Annual suicide mortality declined significantly (p < 0.001 for trend) from 36.7 (95% confidence interval: 35.5–37.9) to 16.5 (15.7–17.3) per 100,000 persons per year during the study period. Significant seasonality was found in suicide rates with a peak in late June. Similar peaks were observed at each level of each risk factor. There were differences in peaks by suicide method. The peak of non-violent suicides was in early June; suicides committed by violent methods peaked half a month later.

This study suggests that there was a significant seasonal effect on suicide deaths between 1995 and 2017, which remained significant even in the presence of each risk factor. To our knowledge, this has been the first study to investigate the seasonal pattern so extensively in Hungary. Our findings confirm that the environmental effects are involved in the etiology of suicide mortality.

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Significant seasonality was found in suicide rates with a peak in late June.

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Seasonal effect remained almost unchanged after adjusting sociodemographic factors.

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There were differences in seasonal peaks by suicide method.

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Environmental effects are involved in the etiology of suicide mortality.

Early Trauma Is Associated With Suicidal Ideation in Patients With Panic Disorder

ABSTRACT

There are several predictors of suicidality in patients with panic disorder (PD). Being a woman, younger age, low education level, unmarried status, and symptom severity have been suggested. This study aimed to examine whether early trauma is associated with suicidal ideation in patients with PD. Our study included 267 patients with PD and 105 controls. Data on sociodemographic variables and data from the Early Trauma Inventory Self Report-Short Form, Beck Depression Inventory, Panic Disorder Severity Scale, Anxiety Sensitivity Inventory-Revised, Coping Scales, and Scale for Suicide Ideation were collected, and correlation and regression analyses were performed. This study suggests that clinicians should consider early trauma when assessing suicidal ideation in patients with PD. Clinicians could consider alternative treatments, such as trauma-focused cognitive-behavioral therapy, eye movement desensitization, reprocessing approaches, and classical pharmacological and psychological treatments for patients with PD who have a history of early trauma and are expected to be at high risk for suicide.

Factors associated with suicidal ideation among Chinese adults in the labour force

This study aims to identify the risk factors of suicidal ideation (SI) in a large sample of Chinese adults in the labour force. A total of 4136 eligible participants in the labour force were recruited from the routine health check-up cohort. Univariate and multivariate logistic regression were used to identify the factors associated with 12-month and lifetime SI. 175 (4.2%) subjects reported SI in the past twelve months, and 223 (5.4%) reported SI during their lifetime. The results showed that being divorced or widowed, religious belief, personal history of chronic disease and mental illness, family history of mental illness and suicide, and self-assessed childhood happiness were associated with both 12-month and lifetime SI. Additional associations were found between 12-month SI and the following factors: working overtime frequently, low monthly income, and having bachelor's degree. Moreover, being single is a risk factor of lifetime SI while not significant for 12-month SI. The present study identified several risk factors of 12-month and lifetime SI, which could potentially help develop targeted interventions for high-risk suicidal Chinese adults in the labour force.

A systematic review of suicidal behaviour in men: A narrative synthesis of risk factors

RATIONALE

Suicides by men outnumber those by women in every country of the world. To date, there has not been a comprehensive systematic review of risk factors for suicidal behaviour in men to better understand the excess deaths by suicide in men.

OBJECTIVE

The present systematic review seeks to determine the nature and extent of the risk factors to predict suicidal behaviour in men over time.

METHODS

A range of databases (CINAHL, PsycINFO, Web of Science Core Collection, Pubmed, Embase, and Psychology and Behavioural Sciences Collection) were searched from inception to January 2020 for eligible articles. The findings were collated through a narrative synthesis of the evidence.

RESULTS

An initial 601 studies were identified. Following the inclusion and exclusion criteria, there were 105 eligible studies (62 prospective and 43 retrospective) identified. Overall, the risk factors with the strongest evidence predicting suicidal behaviour in men were alcohol and/or drug use/dependence; being unmarried, single, divorced, or widowed; and having a diagnosis of depression. In the prospective studies, the most consistent evidence was for sociodemographic factors (19 risk factors), mental health/psychiatric illness (16 risk factors), physical health/illness (13 risk factors), and negative life events/trauma (11 risk factors). There were a small number of psychological factors (6 factors) and characteristics of suicidal behaviour (3 factors) identified. The findings from the retrospective studies provided further evidence for the risk factors identified in the prospective studies.

CONCLUSIONS

This systematic review has highlighted the wide range of risk factors for suicidal behaviour in men, in this review alone 68 different risk factors were identified. Many factors can interact and change in relevance throughout an individual's life. This review has identified extensive gaps in our knowledge as well as suggestions for future research.

Pattern of Suicide Methods and Postmortem Toxicological Findings in Suicide-Related Deaths: A Retrospective 7-Year Forensic-Based Study in Iran

ABSTRACT

Suicide is a public health threat that leads to morbidity and mortality worldwide. In this study, we evaluated postmortem toxicological finding among forensic autopsies on suicidal deaths from 2010 to 2016 at the Legal Medicine Center of Zanjan Province (northwest of Iran). All suicide fatal cases were investigated to define the cause and manner of death. Toxicological analyses were performed using thin-layer chromatography, high-performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography, and gas chromatography equipped with nitrogen phosphorus detector. Demographic data (age, sex, educational level, residential location, and marital status), cause of death, and postmortem toxicological findings were extracted from forensic reports and were entered into the designed questioners. During this period, a total of 181 cases of suicide deaths were investigated. Among them, 74% were male. The most often used suicide method was hanging, followed by self-poisoning in young people. Aluminum phosphide was the most frequent poison detected in the fatal suicidal cases (33 cases), followed by opioids. Hanging and self-poisoning were the frequent suicidal method in young male population. It seems that psychological and social supports in young people along with restriction to easy access to drugs and poisons should be considered by policy making and healthcare authorities.

Predictors and Confounders of Suicidal Ideation and Suicide Attempts among Adults with and without Depression

This research aims to explore whether sex, race, age, education, and marital status can significantly predict suicide ideation (SI) and suicidal attempts (SA) among adults with and without MDE; and to examine whether the association between MDE, SI, and SA changes after adjusting for age, education, and marital status as confounding factors while keeping race-sex as a constant variable. To reach this goal, data from the 2018 National Survey on Drug Use and Health were extracted and analyzed, producing 42,551 records. Study results show that among adults with MDE, adults <50 years old, adults without a college degree, never married, divorced/separated, and White males were at increased risk for SI. Among adults without MDE, adults<50, with some college education, never married, or divorced/separated were more likely to experience SI. Black males were at increased risk for SA, whether they had MDE or not. There is a diverse at-risk population for SI and SA among adults with and without MDE. Special attention should be paid to Black males.

Estimation of the relationship between the persistent decrease of the suicide rate and the changes in sociodemographic composition in Hungary between 1990 and 2011

From the end of the 1980s, the Hungarian suicide rate, which had been until that point the highest in the world for decades, has decreased drastically. The reason behind this decrease was probably due to the changes in numerous and often interlinked risk factors. Studies on this topic have mostly ignored to interrogate to what extent the change of the population composition, for example the improvement of educational level, contributed to the decrease of the rate in the given period? Our aim was to assess the contribution of changes in some sociodemographic factors to the decrease of the suicide rate in Hungary. During the analysis, data from 1990 were compared with data from 2011. For the statistical calculations, the method of “Standardization and Decomposition (SDA)” was used, which according to our best knowledge, has not yet been applied in Hungarian suicide studies. The results show that the improvement of educational level helped to decrease the rate for men by about a third, while for women only by about a tenth. However, the benefit of the improvement in educational attainment during the period investigated was significantly offset by the changes primarily in marital status (the ratios of unmarried and divorced subjects increased for both genders) and in age distribution (the ratio of the elderly persons increased for both genders). The results of our study emphasise the inverse relationship between suicide and educational level and support the hypothesis that we can regard educational policy as indirect health policy.

Seasonal variation of mortality from external causes in Hungary between 1995 and 2014

Objective

To analyze trends in external mortality in Hungary between 1995 and 2014 by sex.

Methods

Data on the numbers of deaths due to external causes were obtained from the published nationwide population register. Negative binomial regression was applied to investigate the yearly trends in external-cause mortality rates. Cyclic trends were investigated using the Walter-Elwood method.

Results

Suicide and accidents accounted for approximately 84% of the all-external-cause of deaths in Hungary. Annual suicide, unintentional falls and traffic accidents mortality declined significantly (p-value for annual trend: p < 0.001) from 30.5 (95% CI: 29.5–31.5) to 15.8 (15.1–16.5), from 31.2 (30.2–32.2) to 12.2 (11.7–12.8) and from 17.2 (16.4–18) to 5.4 (5–5.8) per 100 000 persons per year, respectively, during the study period. A significant declining trend in annual mortality was also found for assault, cold/heating-related accidents and accidents caused by electric current. However, the declining trend for drowning-related accidents was significant only for males. Significant winter-peak seasonality was found in the mortality rates from accidental falls, cold/heat-related accidents, other accidents caused by submersion/obstruction and other causes. Seasonal trends with a peak from June to July were observed in death rates from suicide/self-harm, accidental drowning/submersion and accidents caused by electric current. A significant seasonal variation with a peak in September was revealed in the mortality due to traffic accidents.

Conclusions

This Hungarian study suggests that there was a significant seasonal effect on almost all kinds of deaths from external causes between 1995 and 2014. Environmental effects are involved in the aetiology of suicide and accidents.

Can Suicide Attempt be Related to Problem Drinking: Cohort Study

Aims

Alcohol consumption is a well-established risk factor in suicidal behaviour, but there is still discussion about which factor might imply greater suicide risk-acute alcohol intoxication or being a problems drinkers. The aim of this study was to analyse the association between a suicide attempt and the drinking pattern and to evaluate the risk factors for suicide attempt among problem drinkers versus non-problem drinkers.

Short summary

We found that problem drinking (CAGE ≥2) is an important issue in suicide attempts. Factors predicting suicide attempt among problem drinkers were male gender, younger age, being married or in a partnership status, low education and acute alcohol intoxication prior a suicide attempt.

Methods

A cohort study was performed including all cases of patients (n = 425) hospitalized in the Lithuanian University of Health Sciences after a suicide attempt. Participants completed a self-administered questionnaire that included questions on sociodemographic characteristics, the nature of the suicide attempt, the question of alcohol consumption prior to the suicide attempt and a CAGE questionnaire screening for problem drinking (CAGE ≥ 2).

Results

Two-thirds (70.9%) of male and 43.2% of female suicide attempters were problem drinkers. Problem drinking versus non-problem drinking increased the risk of suicide attempt especially according to gender (3.2 times for male), age (1.08 times for younger age), marital status (among married or in a partnership-1.58 times), education level (among < 12 years-2.04 times) and acute alcohol intoxication prior a suicide attempt (8.15 times-among intoxicated).

Conclusions

Our results highlight that being a problem drinker as well as the use of alcohol at the time of the event is an important issue in suicide attempt,.

Suicide mortality and marital status for specific ages, genders, and education levels in South Korea: Using a virtually individualized dataset from national aggregate data

BACKGROUND

Previous studies in Eastern as well as Western countries have shown a relationship between marital status and suicide mortality. However, to date, no Korean study has calculated national suicide rates by marital status for specific genders, ages, and education levels. This study investigated whether the relationship between marital status and suicide differs by age, gender, and educational attainment, and analyzed the effect of marital status on suicide risk after controlling for these socio-demographic variables.

METHODS

Using national mortality data from 2015, and aggregated census data from 2010 in South Korea, we created a virtually individualized dataset with multiple weighting algorithms, including individual socio-demographic characteristics and suicide rates across the entire population.

RESULTS

The findings show that the following groups faced the highest relative suicide risks: 1) divorced men of all ages and men aged more than 75 years, particularly divorced men aged more than 75; and 2) never-married men aged 55-64 years, and never-married women of lower education status.

LIMITATIONS

We did not account for important variables such as mental health, substance abuse, employment insecurity, social integration, perceived loneness, and family income which we were unable to access.

CONCLUSIONS

This current research extends prior theoretical and methodological work on suicide, aiding efforts to reduce suicide mortality in South Korea.

Demographic and Clinical Characteristics of Completed Suicides in Mexico City 2014-2015

Objective: To analyze sex differences in demographic and clinical characteristics of individuals who died by suicide in Mexico City. Method: Statistical analysis of residents of Mexico City whose cause of death was suicide, during two years period from January 2014 to December 2015, with a coroner's report. Suicide mortality rates were calculated by age, sex, and location within the city. The Chi-squared test was used to assess statistical differences. Results: From January 2014 to December 2015, 990 residents of Mexico City died by suicide (men: 78.28%, women: 21.72%). Among males, the highest mortality rates were among the groups of 20-24 and 75-79 years old, whereas in women, the group with the highest mortality rate was 15 to 19 years old. 74% of the sample used hanging as suicide method. However, men had higher rates of a positive result in the toxicology test (40%) (p < 0.05). There was no concordance between male and female suicide by city jurisdictions. Conclusion: Our results provide evidence that the characteristics of Mexico City's residents who committed suicide had significant sex-related differences, including where they used to live. Understanding the contributory factors associated with completed suicide is essential for the development of effective preventive strategies.

The Burden of Suicide in Rural Bangladesh: Magnitude and Risk Factors

The aim of the paper is to quantify the burden and risk factors of fatal and non-fatal suicidal behaviors in rural Bangladesh. A census was carried out in seven sub-districts encompassing 1.16 million people. Face-to-face interviews were conducted at the household level. Descriptive analyses were done to quantify the burden and Poisson regression was run to determine on risk factors. The estimated rates of fatal and non-fatal suicide were 3.29 and 9.86 per 100,000 person years (PY) observed, respectively. The risk of suicide was significantly higher by 6.31 times among 15-17 and 4.04 times among 18-24 olds compared to 25-64 years old. Married adolescents were 22 times more likely to commit suicide compared to never-married people. Compared to Chandpur/Comilla district, the risk of suicide was significantly higher in Narshingdi. Students had significantly lower risk of non-fatal suicidal behavior compared to skilled laborers. The risk of non-fatal suicidal behavior was lower in Sherpur compared to Chandpur/Comilla. Among adolescents, unskilled laborers were 16 times more likely to attempt suicide than students. The common methods for fatal and non-fatal suicidal behaviors were hanging and poisoning. Suicide is a major public health problem in Bangladesh that needs to be addressed with targeted interventions.

Mixed Methods Analysis of Sex Differences in Life Stressors of Middle-Aged Suicides

INTRODUCTION

Between 1999 and 2013, rates of suicide in mid-life increased more than 30%. The purpose of this study is to examine life stressors impacting middle-aged suicide, to determine whether these stressors vary by sex, and to explore their co-occurrence.

METHODS

A random sample of 315 men and 315 women aged 35-64 years was selected from 17 states implementing the National Violent Death Reporting System from its inception in 2003 to 2011. Data collection took place between 2003 and 2011 and analysis occurred in 2015. Analysis included coding circumstances of death noted in the law enforcement and coroner/medical examiner reports using an investigator-designed coding instrument. Using the most commonly cited life stressors as a basis, thematic analyses were conducted for cases. Quantitative comparisons of the most common circumstances by sex were calculated via multivariable logistic regression.

RESULTS

The five most common life stressors of suicide included intimate partner, job/financial, health, family, and criminal/legal problems. In adjusted analyses, job/financial problems and criminal/legal problems were more common among men, whereas health and family problems were more common among women. Men and women had similar rates of intimate partner problems. Life stressors also co-occurred, as found per qualitative and quantitative analyses.

CONCLUSIONS

Men and women in mid-life have both common and unique circumstances preceding suicide. Prevention strategies that consider these circumstances and co-occurring circumstances are warranted.

Sociodemographic Antecedent Validators of Suicidal Behavior: A Review of Recent Literature

Suicidal behavior and its prevention constitute a major public health issue. Etiology of suicidal behavior is multifactorial. Whereas current research is mostly focused on clinical and biological risk factors, the sociodemographic risk factors for suicidal behavior, first highlighted by Durkheim, have received less attention. Besides the well-known impact of age and gender, sociodemographic variables such as marital and parental status, education, occupation, income, employment status, religion, migration or minority status, and sexual orientation are repeatedly reported to play an important role in suicidal behavior. This narrative review aimed to summarize recent research on sociodemographic risk factors for suicidal behavior and to elicit possible implications for suicide prevention.