Suicide rate in relation to the Human Development Index and other health related factors: A global ecological study from 91 countries

Evolution and differences of suicide rates in Peru by gender and department, 2017-2019

INTRODUCTION

Annual suicide rates are increasingly notably worldwide due to various accompanying risk factors. The objective of this study is to know the suicide mortality rates and their distribution between the years 2017 and 2019.

METHODS

The national death registries of the Ministry of Health of Peru were analysed, calculating the regional death rates from suicides adjusted for age and gender using the standardisation recommended by the World Health Organization.

RESULTS

A total of 1666 cases of suicide were identified (69.3% males); the age group with the highest frequency was that of 20-29 years (27.8%); the mean age at suicide was higher in males (37.49±18.96 vs. 27.86±15.42; P<.001). Hanging was the most common suicide method among both males (58.87%) and females (48.14%). For males, hanging was followed by poisoning (22.6%) and firearms (4.59%); for females, by poisoning (38.75%) and firearms (0.59%). The suicide rate increased from 2017 (1.44/100,000 inhabitants) to 2019 (1.95). The highest rates were identified in the departments of Arequipa, Moquegua and Tacna.

CONCLUSIONS

In recent years, there has been an increase in the number of suicide cases and the rates by department, with the highest number of cases reported in males. Males tend to use more violent suicide methods. The risk factors in the vulnerable populations that were identified in this study need to be known.

The association between nation-level social and economic indices and suicide rates: A pilot study

Ever since the pioneering work of Emile Durkheim, it has been known that regional or national suicide rates can be influenced by a variety of social and economic factors. Recent research has found a robust association between two country-level economic indices-gross national product and unemployment rate-and suicide rates, particularly in men. However, the association between other country-level social indices-such as measures of social integration, inequality, environmental preservation and political freedom-and suicide rates has not been studied at the cross-national level. In the current study, national suicide rates for men and women were examined in relation to seven indices measuring subjective wellbeing, sustainable development, type of political regime, economic and gender inequality, and social capital. It was found that the Happy Planet Index, a composite measure of subjective wellbeing and sustainable development, was negatively associated with suicide rates independent of gender, and even after adjusting for possible confounding factors. Economic inequality was associated with suicide in men, and social capital was associated with suicide in women. Moreover, the strength and direction of the associations observed between socioeconomic indices and suicide varied across income groups. These results highlight the need for a closer evaluation of the link between large-scale ("macro") social factors and individual ("micro") psychological factors, as well as the importance of integrating these factors into suicide prevention programmes at the national level.

Suicide attempts and related factors in patients referred to Gachsaran Hospital, Iran

Background

Suicide is considered as an important, widespread phenomenon in the world, causing numerous deaths annually. This study is going to investigate how suicidal attempts are affected by several demographic and other underlying factors.

Objective

The present study was designed to investigate suicide attempts and its related factors in patients referred to Gachsaran Hospital, Iran.

Materials and methods

This cross-sectional study was conducted on 348 people who had attempted suicide (Please note that 348 was the number of suicidal attempts not the number of suicidal deaths). The data were collected by consent of Shiraz University of Medical Sciences and necessary coordination with the Emergency Management Statistics Center of Shahid Rajaee Hospital in Gachsaran city. The data analysis was performed through the logistic regression test using SPSS software version 19. The significance level was considered 0.05.

Results

A total of 348 individuals with a mean age of 23.9 ± 8.1 had attempted suicide in Gachsaran. Of these, 185 were female (53.2%) and 163 were male (46.8%). The results of multivariate regression showed that, after controlling the effect of probable confounding variables, the following variables had a significant relationship with suicide attempts in the individuals who had attempted to suicide: male gender, unemployment, and love problems.

Conclusion

Considering the high rate of suicide attempts among unemployed male individuals during one year, counseling centers in Gachsaran city should pay special attention to this group of people. Measures such as creating jobs for young people can help prevent this social dilemma.

Association between Suicide Rate and Human Development Index, Income, and the Political System in 46 Muslim-Majority Countries: An Ecological Study

Very little has been researched assessing the relationship between the suicide rate and the ecological perspectives of the country, especially in the Muslim majority countries. We aimed to determine the association between suicide rate and the ecological parameters of 46 Muslim majority countries. We extracted the Muslim majority countries and their suicide rate, income distribution, distribution of the WHO region and continents, and Human Development Index (HDI). We assessed the correlation of the proportion of Muslim populations, the total population of the countries, number of suicides, continent, income group, political system, and HDI score with the suicide rate. The median suicide rate was 5.45 (IQR = 4.8); 2.9 (IQR = 4) in females and 7.45 (IQR = 8.2) in males per 100,000 population. The males had a significantly higher rate and the highest suicide rate was found in Africa. There are inverse associations between the total suicide rate, the rate in males, and females with HDI, and the income of the country. Furthermore, the suicide rate was significantly higher in countries with democratic systems compared to non-democratic countries. The findings suggest that ecological parameters may have an etiological role on suicides in Muslim countries where HDI and income are inversely associated with suicide rates.

An analysis of age-standardized suicide rates in Muslim-majority countries in 2000-2019

BACKGROUND

This study examines the 20-year trend of suicide in 46 Muslim-majority countries throughout the world and compares their suicide rates and trends with the global average. Ecological-level associations between the proportion of the Muslim population, the age-standardized suicide rates, male-to-female suicide rate ratio, and the Human Development Index (HDI) in 2019 were examined.

METHODS

Age-standardized suicide rates were extracted from the WHO Global Health Estimates database for the period between 2000 and 2019. The rates in each country were compared with the age-standardized global average during the past 20 years. The countries were further grouped according to their regions/sub-regions to calculate the regional and sub-regional weighted age-standardized suicide rates involving Muslim-majority countries. Correlation analyses were conducted between the proportion of Muslims, age-standardized suicide rate, male: female suicide rate ratio, and the HDI in all countries. Joinpoint regression was used to analyze the age-standardized suicide rates in 2000-2019.

RESULTS

The 46 countries retained for analysis included an estimated 1.39 billion Muslims from a total worldwide Muslim population of 1.57 billion. Of these countries, eleven (23.9%) had an age-standardized suicide rate above the global average in 2019. In terms of regional/sub-regional suicide rates, Muslim-majority countries in the Sub-Saharan region recorded the highest weighted average age-standardized suicide rate of 10.02/100,000 population, and Southeastern Asia recorded the lowest rate (2.58/100,000 population). There were significant correlations between the Muslim population proportion and male-to-female rate ratios (r=-0.324, p=0.028), HDI index and age-standardized suicide rates (r=-0.506, p<0.001), and HDI index and male-to-female rate ratios (r=0.503, p<0.001) in 2019. Joinpoint analysis revealed that seven Muslim-majority countries (15.2%) recorded an increase in the average annual percentage change regarding age-standardized suicide rates during 2000-2019.

CONCLUSIONS

Most Muslim-majority countries had lower age-standardized suicide rates than the global average, which might reflect religious belief and practice or due to Muslim laws in their judicial and social structure which may lead to underreporting. This finding needs further in-depth country and region-specific study with regard to its implication for public policy.

Criminalisation of suicide and suicide rates: an ecological study of 171 countries in the world

OBJECTIVE

In the last half of the 20th century, many countries have already abolished antisuicide laws; however, more than 20 countries still adopt them. This paper is the first to systematically explore the association between criminalisation of suicide and national suicide rates in 171 countries/regions to examine the deterring effects of the antisuicide laws.

DESIGN

A cross-sectional ecological study.

SETTING

171 countries in the world.

PARTICIPANTS

In 2012, 25 countries were identified to carry antisuicide laws. A linear regression analysis was adopted to explore the association between national suicide rates (log transformed) and criminalisation of suicide in the world in 2012, having controlled for the Human Development Index (HDI), majority religious affiliations and the national unemployment rate.

MAIN OUTCOME MEASURE

Sex-specific age standardised suicide mortality rates.

RESULTS

Criminalisation of suicide was associated with slightly increased national suicide rates (β estimate=0.29, 95% CI -0.04 to 0.61). Stronger association was found in women (β estimate=0.40, 95% CI 0.06 to 0.74), connecting criminalisation of suicide and higher suicide rates. The harmful effect of antisuicide laws on women was particularly prominent in non-Muslim countries and countries with lower HDI.

CONCLUSIONS

Laws penalising suicide were associated with higher national suicide rates and even more so in the female population in the low HDI, non-Muslim countries. The non-supportive patriarchal culture with laws penalising suicide may render women vulnerable to suicidality. Instead of criminalising suicide, alternative approaches such as providing good mental healthcare and adjusting the socioeconomic, legal and cultural factors that contribute to suicide should be considered.

Association between COVID-19 pandemic and the suicide rates in Nepal

BACKGROUND

Past works have linked the COVID-19 pandemic and subsequent public health responses such as isolation, quarantine, and lockdown to increased anxiety, sleep disorders, depressive symptoms, and suicidal ideation. Only a few studies, mostly carried out in high-income countries, have investigated the association between the pandemic and suicide rate. We seek to investigate the changes in the monthly suicide rates during the COVID-19 pandemic in Nepal, compared to the pre-pandemic suicide rates.

METHODS AND FINDINGS

This is a retrospective study investigating the changes in suicide rates in Nepal during the COVID-19 pandemic period (April 2020 to June 2021), compared to the pre-pandemic period (July 2017 to March 2020), adjusted for seasonality and long-term trend in the suicide rate. We performed analysis for the entire country as well as sub-sample analyses stratified by gender and provinces. A total of 24350 suicides deaths during four years of the study window were analyzed. We found an overall increase in the monthly suicide rate in Nepal with an average increase of 0.28 (CI: 0.12,0.45) suicide per 100,000 during the pandemic months. The increase in suicide rate was significant both among males (increase in rate = 0.26, CI: 0.02,0.50) and females (increase in rate = 0.30, CI: 0.18,0.43). The most striking increments in suicide rates were observed in June, July, and August 2020. The pattern of increased suicide rates faded away early on among males, but the effect was sustained for a longer duration among females. Sudurpaschim and Karnali provinces had the highest increase in suicide rates associated with the COVID-19 pandemic.

CONCLUSIONS

The COVID-19 pandemic is associated with an increased suicide rate in Nepal. The findings may inform policymakers in designing appropriate public health responses to the pandemic that are considerate of the potential impact on mental health and suicide.

SPATIAL ANALYSIS OF SUICIDE IN NORTHEASTERN BRAZIL AND ASSOCIATED SOCIAL FACTORS

ABSTRACT Objective: to analyze the spatial pattern of mortality due to suicide and social factors associated with its occurrence. Method: an ecological study that used data from the Mortality Information System (Sistema de Informação sobre Mortalidade, SIM) from 2008 to 2018. The unadjusted and Bayesian mean mortality rates were calculated for each northeastern municipality and the Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) non-spatial and spatial regression models were used. Results: the highest mortality rates due to suicide are especially concentrated in the municipalities of Piauí and Ceará. The predictive variables of suicide were as follows: Gini Index (p<0.001), unemployment rate ≥ 18 years old (p<0.001), Municipal Human Development Index (p<0.001), illiteracy rate ≥ 18 years old (p<0.001), per capita income (p<0.001), percentage of people in homes with inadequate walls (p=0.003), percentage of people in homes with inadequate water supply and sewage (p<0.001), and percentage of people vulnerable to poverty who commute for more than one hour to work (p<0.001). Conclusion: eight predictive variables of mortality due to suicide in the Northeast region were identified that act as risk or protective factors, depending on the municipality under study.

The Association Between Racism and Suicidality Among Young Minority Groups: A Systematic Review

INTRODUCTION

The World Health Organization states that suicide is the second leading cause of death among youngs, and racism has been proven to have detrimental effects on both physical and mental health. These two plagues represent a public health priority, especially for susceptible minorities.

METHOD

This systematic review analyzed 23 studies from multiple database searches, to understand the relationship between racism and suicidality in young minority groups.

RESULTS

The review demonstrated the correlation between racism and suicidality with the consequent development of mental disorders. There is strong evidence that the main suicide risk factor is acculturation, interpreted as the assimilation of the dominant culture with the loss of values from one's cultural background.

DISCUSSION

Health care professionals should not underestimate the risk of suicidality associated with racism. Prevention is crucial and it should be implemented from a young age, in schools, through a joint intervention with children and their families, aiming toward integration without acculturation.

Macro-level mental health system indicators and cross-national suicide rates

Background

The relationship between macro-level mental health system indicators and population suicide rates is an area of contention in the literature, necessitating an analysis of current cross-national data to document any new trend in the relationship.

Objective

This study investigated whether mental health system indicators are associated with national suicide rates.

Method

Using an ecological study design and multivariate non-parametric robust regression models, data on suicide rates and mental health system indicators of 191 countries retrieved from WHOs 2017 Mental Health Atlas were compared.

Results

Findings revealed that the average suicide mortality rate was significantly higher in high- income countries, relative to low-income countries. High-income countries are significantly more likely to have high number of mental health professionals, mental health policies and legislation, independent mental health authority and suicide prevention programs. These mental health system indicators demonstrated significant and positive association with suicide, suggesting that countries scoring high on these factors have higher odds of being categorized as high suicide risk countries.

Conclusion

The findings have several implications for policy and practice, including the need to make existing mental health systems very responsive to suicide prevention.

Evolution and Differences of Suicide Rates in Peru by Gender and Department, 2017-2019

INTRODUCTION

Annual suicide rates are increasingly notably worldwide due to various accompanying risk factors. The objective of this study is to know the suicide mortality rates and their distribution between the years 2017 and 2019.

METHODS

The national death registries of the Ministry of Health of Peru were analysed, calculating the regional death rates from suicides adjusted for age and gender using the standardisation recommended by the World Health Organization.

RESULTS

A total of 1,666 cases of suicide were identified (69.3% males); the age group with the highest frequency was that of 20 to 29 years (27.8%); the mean age at suicide was higher in males (37.49±18.96 vs. 27.86±15.42; p<0.001). Hanging was the most common suicide method among both males (58.87%) and females (48.14%). For males, hanging was followed by poisoning (22.6%) and firearms (4.59%); for females, by poisoning (38.75%) and firearms (0.59%). The suicide rate increased from 2017 (1.44/100,000 inhabitants) to 2019 (1.95). The highest rates were identified in the departments of Arequipa, Moquegua and Tacna.

CONCLUSIONS

In recent years, there has been an increase in the number of suicide cases and the rates by department, with the highest number of cases reported in males. Males tend to use more violent suicide methods. The risk factors in the vulnerable populations that were identified in this study need to be known.

Predictors of completed suicide: Results from the suicide registry program in the west of Iran

Suicide is a crucial public health problem with a serious harmful impact on individuals, families, and societies. Therefore, the current study aimed to evaluate the predictors of death or serious injury related outcome regarding this lethal phenomenon in Hamadan Province. In this registry-based study we used all of suicide attempt entered in Hamadan Suicide Registry Program from January 2016 to the end of 2017. Serious injury and death were considered as suicide worse outcome and its prognostic factors were examined using logistic regression model. From 2493 patients with suicide attempts in 5.61 % and 4.09 % of them, suicide behaviour led to serious injury and death, respectively. Males had 2.83 times higher odds of the worse suicide outcomes ([OR = 2.83, 95 % CI: 1.71, 4.68)], P < 0.001). Moreover, the odds of worse outcomes of suicide in individuals with low level of education, advanced age and with the history of suicidal ideation was significantly higher (P < 0.05). Among different suicide methods, the highest odds of suicide worse outcomes were related to self-immolation, falls, hanging, self-harm, poisoning, and drugs (P < 0.001). We found that the increase odds of suicide worse outcomes were associated with individuals advance age, low level of education, time of suicide attempt, previous history of suicidal ideation and choosing self-immolation, falls, hanging, self-harm, poisoning, and drugs as a suicide method.

Comparison of causes for suicidal ideation and attempt: Korean Longitudinal Survey of Women and Families

The purpose of this study was to identify factors that influence suicidal ideation and attempts among Korean women, using longitudinal data. Data from wave 4 (n = 7227), wave 5 (n = 6892), and wave 6 (n = 6632) of the Korean Longitudinal Survey of Women and Families collected on 2012, 2014, and 2016 were subjected to Kaplan-Meier and Cox regression analysis. Number of cases for suicidal ideation was 4.7% of the total cases (n = 20,751) between wave 4 through 6; number of cases for suicidal attempts was 5.7% of the cases from suicide ideation (n = 979). Depressive feelings, bad or worst health, and increased stress had significant impacts on suicidal ideation (χ² = 1867.84, p < .001; χ² = 983.61, p < .001; χ² = 884.01, p < .001) and suicidal attempts (χ² = 5.36, p < .05; χ² = 11.19, p < .01; χ² = 7.46, p < .05; χ² = 6.21, p < .05) over time, respectively. From the Cox regression analysis, non-marital status (OR = 2.50, CI = 1.40-4.48) and having more than two children (OR = 2.55, CI = 1.18-5.51) compared to not having children were identified as predictors for suicidal attempt. Although the negative effect of number of children on suicidal attempts conflicts with previous evidence, socially determined mother roles and the significance of children should be considered in culturally sensitive terms when interpreting our findings.

Association between naturally occurring lithium in drinking water and suicide rates: systematic review and meta-analysis of ecological studies

BACKGROUND

The prevalence of mental health conditions and national suicide rates are increasing in many countries. Lithium is widely and effectively used in pharmacological doses for the treatment and prevention of manic/depressive episodes, stabilising mood and reducing the risk of suicide. Since the 1990s, several ecological studies have tested the hypothesis that trace doses of naturally occurring lithium in drinking water may have a protective effect against suicide in the general population.

AIMS

To synthesise the global evidence on the association between lithium levels in drinking water and suicide mortality rates.

METHOD

The MEDLINE, Embase, Web of Science and PsycINFO databases were searched to identify eligible ecological studies published between 1 January 1946 and 10 September 2018. Standardised regression coefficients for total (i.e. both genders combined), male and female suicide mortality rates were extracted and pooled using random-effects meta-analysis. The study was registered with PROSPERO (CRD42016041375).

RESULTS

The literature search identified 415 articles; of these, 15 ecological studies were included in the synthesis. The random-effects meta-analysis showed a consistent protective (or inverse) association between lithium levels/concentration in publicly available drinking water and total (pooled β = -0.27, 95% CI -0.47 to -0.08; P = 0.006, I2 = 83.3%), male (pooled β = -0.26, 95% CI -0.56 to 0.03; P = 0.08, I2 = 91.9%) and female (pooled β = -0.13, 95% CI -0.24 to -0.02; P = 0.03, I2 = 28.5%) suicide mortality rates. A similar protective association was observed in the six studies included in the narrative synthesis, and subgroup meta-analyses based on the higher/lower suicide mortality rates and lithium levels/concentration.

CONCLUSIONS

This synthesis of ecological studies, which are subject to the ecological fallacy/bias, supports the hypothesis that there is a protective (or inverse) association between lithium intakes from public drinking water and suicide mortality at the population level. Naturally occurring lithium in drinking water may have the potential to reduce the risk of suicide and may possibly help in mood stabilisation, particularly in populations with relatively high suicide rates and geographical areas with a greater range of lithium concentration in the drinking water. All the available evidence suggests that randomised community trials of lithium supplementation of the water supply might be a means of testing the hypothesis, particularly in communities (or settings) with demonstrated high prevalence of mental health conditions, violent criminal behaviour, chronic substance misuse and risk of suicide.

Suicide Rate, Depression and the Human Development Index: An Ecological Study From Mexico

Objective: To assess the contribution of depression, the human development index (HDI) including the health, education and income indexes as well as the households structure to the suicide rate in Mexican population from 15 to 49 years old. Methods: An ecological cross-sectional study was carried out in people between 15 and 49 years old. The health index (HI), education index (EI), income index (II), and HDI were constructed. The suicide rate, educational level, per capita income, poverty, and rate of households were collected from official databases. Pearson's correlation coefficient (r) was used to determine the strength between the suicide rate and the per capita income, unemployment, poverty, HI, EI, II, HDI, non-family household, and depression incidence rate. A multiple linear regression model was used to know the association between suicide rates and HDI. Results: The suicide rate was 8.76/100,000 inhabitants. The HDI of the 32 Mexican states were low 16%, middle 41%, high 22%, and extremely high 13%. A direct and positive intensity relationship between suicide rate and non-family households, was found (r = 0.352; p < 0.001); on the other hand, the suicide rate is significantly and negatively related to family households with Pearson (r = -0.350; p < 0.001). Conclusion: The states of the Mexican Republic with the highest prevalence of non-family households had a positive association with the suicide rate. Based on the result of this study, it is possible to assume that, as the HDI increases, there is a greater possibility of living alone and having suicidal behavior.

Individual and socio-demographic determinants of suicide: An examination on WHO countries

BACKGROUND

Suicide cases have psychological, socio-economic and cultural aspects, and such cases may have catastrophic impacts in societies due to their outcomes.

PURPOSE

This study was aimed to reflect the effect of psychological, behavioral, socio-demographic and economic determinants on suicide.

METHODS

The Ordinary Least Square (OLS) Regression Analysis was utilized for the purposes of this study. Five models were established. In this contex, the first model includes the variables on psychological determinants; the second model with the variables on behavioral determinants; the third model with the variables on socio-demographic determinants; the fourth model with the variables on economic determinants and finally the fifth model with all of the independent variables.

CONCLUSION

According to the results, the variables of depression prevalence, alcohol consumption and unemployment rates had statistically significant effect on the suicide cases (p < .05). The study's outcomes are considered to contribute on the evidence-based policy development process.

Late life suicide in Italy, 1980-2015

AIM

Suicide trends in older adults were examined in Italy from 1980 to 2015. Age groups considered were 65-74 years, 75-84 and 85 + years.

METHODS

Data on suicide deaths were obtained from the Italian Mortality Database (IMDB) collected by the Italian National Institute of Statistics (ISTAT) and processed by the Statistics Unit of the Italian National Institute of Health (Istituto Superiore di Sanità). Joinpoint regression analyses were carried out for age subgroups by sex. In addition, data related to four main macro-areas of Italy were considered: North-West, North-East, Centre, and South with Islands (Sicily and Sardinia).

RESULTS

Starting by 1985, declines were noted in all age groups with more noticeable decreases in older adults aged 75-84 and 85 + years. Female subjects demonstrated more ample falls in rates than male individuals. Declines were detected in all macro-areas of Italy.

CONCLUSION

Improved health assistance and quality of life of older individuals have probably contributed to the decline of suicide rates of senior citizens, who also showed improved poverty indices in the country, differently from all other age groups.

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middle-income countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed.Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments.Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.

Mortality by suicide in the State of Pernambuco, Brazil (1996-2015)

ABSTRACT Objective: To describe the epidemiological characteristics of suicide mortality in the state of Pernambuco, from 1996 to 2015. Method: Study with data from the Sistema de Informações sobre Mortalidade. The simple linear regression model was used to verify the trend in the period analyzed. Results: There were 6,229 suicides, of which 3,390 (54.4%) occurred in the second decade of study. The mortality rate was 4.7 per 100,000 inhabitants. The temporal trend presented a decrease of 23.5% (p=0.031). For the male sex and the age range between 20 and 39 years, there was a decline in self-inflicted death of 23.8% (p=0.018) and 26.1% (p=0.046), respectively. Conclusion: The temporal analysis revealed a reduction in suicide mortality coefficients. This observation may contribute to better targeting of health interventions, optimizing resources and efforts, especially in suicide prevention.

Towards an Explanatory Model of Suicidal Ideation: The Effects of Cognitive Emotional Regulation Strategies, Affectivity and Hopelessness

Suicide constitutes a public health problem that has a significant economic, social and psychological impact on a global scale. Recently, the American Psychological Association has indicated that suicide prevention should be a public health priority. Suicidal ideation appears as a key variable in suicide prevention. The objective of this research was to verify the adjustment of an explanatory model for suicidal ideation, which considers the effects of cognitive emotion regulation strategies, affectivity and hopelessness. An open mode on-line sample of 2,166 Argentine participants was used and a path analysis was carried out. The results make it possible to conclude that the model presents an optimal fit (χ2 = .10, p = .75, CFI = .99, RMSEA = .01) and predicts 42% of suicidal thoughts. The model proves to be invariant based on age and gender. In conclusion, there is an importance of reducing the use of automatic strategies, such as repetitive negative thoughts of ruminative type, and increasing the use of more controlled strategies, such as reinterpretation or planning.

Epidemiology of suicide in 10-19 years old in southern Iran, 2011-2016: A population-based study on 6720 cases

OBJECTIVE

Globally, suicide is the second leading cause of death among young people. Although completed suicide is rare before puberty, the incidence of adolescent suicide has increased significantly at the late ages of 10-19. Hence, this study investigates the adolescent suicide, aged 10-19, in southern Iran.

METHODS

In this cross-sectional study, all data regarding the demographics, causes, methods, outcomes, past medical history of suicide attempts and suicide death were collected from the Mental Health and Suicide Surveillance Systems of Fars province between 2011 and 2016.

RESULTS

Overall 6-year incidence rate of suicide attempts and death were 193.49/100,000 and 7.91/100,000, respectively. Case-fatality rate was 4.09%. During the period of 6 years, an increasing trend has been observed for both the rates of suicide attempt and death. Family conflicts were the major cause and medication overdose was the main method of suicides. After controlling the effects of confounders by logistic regression, male gender, living in the rural area and age are among the risk factors of fatality in suicide attempts.

CONCLUSIONS

Suicide attempts and deaths have been increased in adolescents. Therefore, due to the vulnerability of this age group, we need to understand all components of suicide to educate families and to help policy makers.

Psychometric Characteristics of Duke Social Support Index Among Elderly Suicide in Rural China

We recruited 242 elderly suicides and 242 controls above 60 years to conduct face-to-face interviews by psychological autopsy to examine the psychometric characteristics of the Duke Social Support Index (DSSI) in rural China. DSSI had high internal consistency, with Cronbach's αs of .89 and .90 in suicides and controls, respectively. DSSI was significantly and negatively correlated to loneliness in both samples. Confirmatory factor analysis basically supported the original structure of DSSI, but Item 4 had low factor loading in controls. In conclusion, DSSI has satisfactory reliability and acceptable validity in evaluating social support in the elderly suicide study in China.

A Retrospective Administrative Database Analysis of Suicide Attempts and Completed Suicide in Patients With Chronic Pancreatitis

Background: The actual incidence rate of suicide attempt and the suicide-related fatality rate (completed suicide) in patients with chronic pancreatitis (CP) have not been mentioned in the literature. Methods: We conducted a nationwide population-based cohort study by analyzing data from Taiwan's National Health Insurance Research Database (NHIRD) to compare the rate of suicide attempt between a CP cohort and a non-CP cohort. For the study cohort, we identified 17,733 patients (age ≥ 20 years) diagnosed as having CP between 2000 and 2010 from the NHIRD in Taiwan. Beneficiaries with no history of CP were matched with the study cohort at a 2:1 ratio according to age, sex, and index date. To determine the incidence of suicide, all patients were followed until the end of 2011 or until their withdrawal from the Taiwan National Health Insurance program. Results: Patients with CP had an increased risk of suicide attempt, compared with those without CP (adjusted hazard ratio [aHR] = 2.72, 95% confidence interval [CI] = 1.69-4.37). The suicide-related fatality in the CP cohort was higher than that in the non-CP cohort, but the difference was not statistically significant (aHR = 1.21, 95% CI = 0.39-3.78). Conclusion: Our population-based cohort study reveals a close association between CP and subsequent suicide attempt. Compared with the non-CP cohort, the suicide-related fatality was higher in the CP cohort, although the result was not statistically significant. These findings necessitate surveying patients with CP and providing psychological support to prevent suicide.