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Alexandri M, Tsellou M, Antoniou A, Skliros E, Koukoulis AN, Bacopoulou F, Papadodima S. Prevalence of Homicide-Suicide Incidents in Greece over 13 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137736. [PMID: 35805394 PMCID: PMC9265995 DOI: 10.3390/ijerph19137736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022]
Abstract
Prevalence of homicide-suicides is difficult to determine in Greece due to the lack of a national tracking system. The aim of this study was to estimate the prevalence of the homicide-suicide incidents in Greece over the past 13 years, and to determine the circumstances under which they occurred, as well as the characteristics of perpetrators and victims. Two Internet search engines (google and yahoo), as well as the search engine of the major national news websites, were surveyed to identify the number of homicide-suicide cases that occurred in Greece from January 2008 to December 2020. Over the study period, 36 homicide-suicide incidents occurred in Greece, resulting in 36 suicides and 41 homicides. The above incidents reflect an annual homicide-suicide rate of 0.02 cases per 100,000 inhabitants. Most perpetrators were male (88.9%), whereas most victims were female (80.6%). Spousal-consortial cases accounted for 52.7% and familial cases for 41.7% of the total number of incidents. The use of firearms (mostly shotgun) was the most common method of homicide and suicide (58.3% and 63.9%, respectively). Women killed only their children, while men committed homicide and suicide mainly in the context of a former or current intimate partnership with the victim. Our results are in line with international homicide-suicide data. The establishment of a national surveillance system for homicides-suicides would be of paramount importance as it would facilitate accurate recording, identification of risk factors and characteristics of potential victims and perpetrators and it could ultimately be an aid to the prevention of such tragic events.
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Affiliation(s)
| | - Maria Tsellou
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (M.T.); (S.P.)
| | - Anastasia Antoniou
- 2nd Department of Psychiatry, “Attikon” University General Hospital, School of Medicine, National and Kapodistrian University of Athens, 124 62 Athens, Greece;
| | | | | | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair in Adolescence Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 115 27 Athens, Greece
- Correspondence: ; Tel.: +30-6973208208
| | - Stavroula Papadodima
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (M.T.); (S.P.)
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Fountoulakis KN, Fountoulakis NK. Climate rather than economic variables might have caused increase in US homicide but not suicide rates during the Great Depression. Psychiatry Res 2022; 309:114378. [PMID: 35051880 DOI: 10.1016/j.psychres.2021.114378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND It is widely believed that during the Great Depression (1929-1933) there was a rise in suicidal rates which was causally related to the increase in unemployment. There are no studies on the effect the Great Depression had on homicidal rates METHODS: The data concerning suicide, homicide, economic and climatic variables for the years 1900-1940 for the whole of the US were gathered from the US Center for Disease Control, the Maddison Project, the National Bureau of Economic Research and the National Climatic Data Center. Time Series Analysis was performed. RESULTS The results are inconclusive on the role of economic factors but preclude any role of climate on suicidal rates during the years 1900-1940 in the US. Suicidal rates might have a 24-years periodicity, however much longer time series are needed to confirm this. On the contrary they strongly suggest an effect of higher temperatures on homicidal rates after 1922. CONCLUSIONS The results of the current study suggest a direct and clear effect of climate (higher temperatures) on the increasing homicidal rates in the US after 1922 but failed to establish a causal relationship between suicide rates and economic or climate variables. These should be considered together with increasing concerns on the possible effect of climate change on mental health.
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Kamekis A, Rachiotis G, Markaki A, Samara V, Symvoulakis EK. Employment and suicidal rates during economic recession: A country-targeted integrative review. Int J Soc Psychiatry 2021; 67:801-815. [PMID: 33135535 DOI: 10.1177/0020764020969740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The economic crisis' effects on suicide rates for countries undergoing or exiting austerity measures have been widely debated. This integrative review aimed to identify, appraise, and synthesize available evidence of employment status effect on suicide mortality rates in Greece during the recent economic recession period. METHODS A literature review of studies evaluating suicides in the general Greek population, as well as across age and gender groups, in relation to employment during the economic crisis period was performed. PubMed electronic database was searched for relevant articles published in English or Greek language from 2009 up to February 2020. Appraisal was carried out based on the Hierarchy of Evidence Rating System and the GRADE guidelines. RESULTS A total of 24 articles met all inclusion criteria with 20 of them at level IV, 2 at level VII, and 2 at level VIII. A total of 18 studies reported increase of suicide rates during the economic recession period. About 12 studies examined the co-relation between unemployment and suicide rate, with ten studies showing a positive correlation. Moreover, thirteen studies reported data on the effect of gender and age variables on suicide rates. CONCLUSION Evidence shows that suicide mortality rates in Greece increased after the eruption of economic recession, particularly after the implementation of radical austerity measures (2011-2014). This increase was positively correlated with unemployment and was more prominent among males of working age. Further in depth epidemiological research of regional variations in terms of profile and contributing or enabling factors of suicidal behavior is needed.
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Affiliation(s)
| | - George Rachiotis
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Adelais Markaki
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vasiliki Samara
- Department of Educational and Social policy, University of Makedonia, Thessaloniki, Central Macedonia, Greece
| | - Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
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Snowdon J. Spain's suicide statistics: do we believe them? Soc Psychiatry Psychiatr Epidemiol 2021; 56:721-729. [PMID: 32918553 DOI: 10.1007/s00127-020-01948-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/01/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE There is a widespread belief that suicides around the world are under-counted. A substantial proportion of suicides may have been inappropriately registered as accidental or of undetermined cause or intent. There is reason to explore to what extent low suicide rates in some nations could be partly attributable to under-counting. METHODS Mortality statistics of most countries are available on-line. Numbers of suicide deaths in Spain, and in England and Wales (E & W), in male and female 5-year age groups, in each year between 2014 and 2018, were documented, along with deaths coded to ICD-10 accident or 'undetermined death' categories. Crude mortality rates were calculated using official population figures. Single year suicide, undetermined death, and non-transport accidental death rates of 12 other nations were calculated. RESULTS Spain's crude suicide rate per 100,000 remains low (7.89) compared to other nations; its event of undetermined intent (EUI) death rate was 0.09 (contrasting with E & W's 1.74). Its accidental poisoning rate is much lower than that of E & W. The study showed much higher rates of ill-defined/unknown cause deaths in late life in Spain (both genders) than in E & W, and age-associated increases in accidental drowning rates parallel with increased suicide by drowning. CONCLUSIONS Reportedly low suicide rates in Spain could be partly attributable to increased rates of 'hidden suicide' (accidental drowning, male accidental poisoning, and possibly ill-defined/unknown cause deaths, but not EUIs). It would be appropriate (and not just in Spain) to increase numbers of verbal and/or forensic autopsies in questionable 'undetermined' cases.
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Affiliation(s)
- John Snowdon
- Discipline of Psychiatry, Sydney Medical School, Sydney, Australia. .,Centre for Mental Health, Concord Hospital, Sydney, Australia.
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Paraschakis A, Karageorgiou V, Efstathiou V, Douzenis A, Boyokas I, Michopoulos I. Characteristics of completed suicides after Greek financial crisis onset: A comparative time-series analysis study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:305-314. [PMID: 32803401 DOI: 10.1007/s00127-020-01939-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
Severe financial crises could influence a country's suicide trends and characteristics. We aimed to highlight differences among suicide completers before and after the onset of Greece's serious debt crisis of 2010 based exclusively on forensic data. The sample's size permitted a further elaboration by means of a time series analysis too. Data were collected from the Piraeus Department of Forensic Medicine for the period 1992-2016. We extracted information on sociodemographic parameters, psychiatric medication and alcohol intake, suicide method, place and month of suicide. The "after crisis onset" group (2011-2016) was significantly older (p = 0.039)-primarily due to differences in the 55-64 age group-, had more frequently used psychiatric medications (p < 0.001), less often alcohol (p = 0.001) and died more frequently by immolation (p = 0.001). These differences were-almost exclusively-due to changes regarding male suicidal behavior. Time series analysis indicates that no strong increasing trend in total (male + female) suicide count can be observed, despite a local increase in 2009-2010. Antidepressant-positive suicides show an increase after 2010, whereas alcohol-positive suicides show a decrease. Future predicted forecasts for antidepressant-positive suicides indicate a decrease (from 5.6 per year in 2018 to 4.3 per year in 2025) whereas an increase is predicted in alcohol-positive suicides (7.7 per year in 2017, 9.36 per year in 2025). Middle-aged men, compared to middle-aged women, presumably found it harder to adjust to economic hardship after the crisis onset. Finally, comparatively more men than women who died by suicide appear to have started and/or complied with psychiatric treatment after 2010.
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Affiliation(s)
- Antonios Paraschakis
- Psychiatric Hospital of Attica "Dafni", 374 Athinon Ave, Postal Code 12462, Athens, Greece.
| | - Vasilios Karageorgiou
- 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, "Attikon" General Hospital, Athens, Greece
| | - Vasiliki Efstathiou
- 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, "Attikon" General Hospital, Athens, Greece
| | - Athanassios Douzenis
- 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, "Attikon" General Hospital, Athens, Greece
| | - Ilias Boyokas
- Piraeus Department of Forensic Medicine, Piraeus, Greece
| | - Ioannis Michopoulos
- 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, "Attikon" General Hospital, Athens, Greece
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Papadodima SA, Karakasi MV, Pavlidis P, Nastoulis E, Fragkou K, Dimitriou K, Alexandri M, Markopoulou M, Douzenis A, Spiliopoulou C. Self-immolation Suicide in Greece: A Forensic Psychiatric Autopsy Study between 2011 and 2019. J Forensic Sci 2020; 65:1656-1668. [PMID: 32658387 DOI: 10.1111/1556-4029.14498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/08/2020] [Accepted: 06/05/2020] [Indexed: 01/26/2023]
Abstract
Self-immolation is a rare suicide method in the developed countries of the western world (0.06-1%); however, it has relatively higher prevalence rates in the developing countries of Asia and Africa (6-57%). The present study aims to examine self-immolation suicides within the Greek mainland (Attiki, Thrace, and Peloponnese) over a period of 9 years (2011-2019) in order to investigate the phenomenon in the Greek population forensically, identify the characteristics and motivations of suicide victims, explore its associations to socio-cultural or psychiatric factors, and describe a fatal case of suicide by self-immolation that was partially recorded on camera. The medical files (autopsy reports) of cases performed at the Departments of Forensic Medicine of the National and Kapodistrian University of Athens, Democritus University of Thrace, and the Forensic Service of Messinia-Peloponnese were retrospectively examined yielding 19 cases of suicides by self-immolation. A 3.7% prevalence of suicide by self-immolation among suicide fatalities within the Greek population was estimated. A distinctive feature of the Greek population regarding self-immolation was disclosed that it is being practiced predominantly by the elderly (mean age 2-3.5 decades higher than other countries). The phenomenon correlated strongly with poorly controlled mental disorders (mostly affective and adjustment disorders). Unlike other countries, there was no significant association with domestic or sexual violence, social or political protest, or religious issues. Therefore, the suicide victims preferred secluded or private outdoor locations (not public). Findings deriving from the examined variables localize Greek population culturally between the Western European and Asian African countries, but with its own idiosyncrasies.
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Affiliation(s)
- Stavroula A Papadodima
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Goudi, Athens, GR 11527, Greece
| | - Maria-Valeria Karakasi
- Third University Department of Psychiatry, AHEPA University General Hospital - Department of Mental Health, Aristotle University - Faculty of Medicine, Thessaloniki, GR 54124, Greece.,Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, GR 68100, Greece
| | - Pavlos Pavlidis
- Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, GR 68100, Greece
| | - Evangelos Nastoulis
- Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, GR 68100, Greece
| | - Kallirroi Fragkou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Goudi, Athens, GR 11527, Greece
| | - Konstantinos Dimitriou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Goudi, Athens, GR 11527, Greece
| | - Maria Alexandri
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Goudi, Athens, GR 11527, Greece
| | - Maria Markopoulou
- Department of Forensic Psychiatry, Psychiatric Hospital of Thessaloniki, Stavroupolis, Thessaloniki, GR 56429, Greece
| | - Athanassios Douzenis
- Second Psychiatry Department, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, GR 12462, Greece
| | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Goudi, Athens, GR 11527, Greece
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Fountoulakis KN. Suicides in Greece before and during the period of austerity by sex and age group: Relationship to unemployment and economic variables. J Affect Disord 2020; 260:174-182. [PMID: 31494368 DOI: 10.1016/j.jad.2019.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/04/2019] [Accepted: 09/01/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is disagreement on the specific mechanism through which the economic recession increased suicides in Greece. Unemployment is considered by many authors to be the determining factor but the data are inconclusive and often negative, especially concerning the temporal relationship between onset of increase in unemployment and increase in suicides AIMS: The aim of this paper was to clarify the specific role of unemployment as well as of other socioeconomic variables on specific age-by-gender groups concerning the increase in suicides. METHODS Data of the Hellenic Statistical Authority ELSTAT (www. STATISTICS gr) were analyzed with Linear Regression Analysis and Bonferroni correction for multiple testing RESULTS: Unemployment correlates with suicide rates only in males aged 20-24, 50-54 and 60-64 years (p < 0.001). Unemployment could held responsible for an additional 148 male deaths during the period 2009-2015, which accounts for 5.3% of the total (29 additional deaths per year). The changes in all the socioeconomic conditions could held responsible for 317 cases of suicide or 9.4% of total CONCLUSIONS: The results of the current study suggest that there was a 33% increase in deaths by suicide in Greece during the early years of recession (2009-2015); one third could be directly attributed to unemployment, one third to other consequences of recession while another third is of unknown origin. The effect of unemployment is specifically restricted to males at the beginning of their working career (20-24 years old) and to middle aged (45-49 and 55-59 years old).
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Affiliation(s)
- Konstantinos N Fountoulakis
- Professor of Psychiatry, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos str, 55535 Thessaloniki, Greece.
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