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Spittal MJ, Mitchell R, Clapperton A, Laughlin A, Sinyor M, Page A. Age, period and cohort analysis of suicide trends in Australia, 1907-2020. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 51:101171. [PMID: 39247208 PMCID: PMC11379668 DOI: 10.1016/j.lanwpc.2024.101171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 07/25/2024] [Accepted: 07/28/2024] [Indexed: 09/10/2024]
Abstract
Background Suicide rates have been increasing in Australia since the mid-2000s, especially for women aged ≤25 years. We conducted an age-period-cohort study to investigate these recent trends in the context of historical Australian suicide rates. Methods Data on annual suicides in Australia from 1907 to 2020 were extracted from the General Record of Incidence of Mortality. We modelled age-specific effects for a reference cohort, after adjustment for period effects. Findings We found evidence of age, cohort and period effects. For males, compared to the cohort born in 1946-1950, rates were higher for all cohorts born after this year. The period effect showed peaks in the risk of male suicide in the mid 1960s and the early 1990s, followed by a decline in risk until early 2010, after which the risk began to rise again. For females, compared to the cohort born in 1946-1950, the risk of suicide was higher for all cohorts born after this, with the highest risk for those born in 2006-2010. The period effect for females showed an elevated risk of suicide in the mid 1960s followed by a sharp decline, and an increase in risk after 2009. Interpretation Suicide rates in Australia have fluctuated substantially over time and appear to be related to age trends as well as period and cohort trends. Advocacy and policy making tends to focus on contemporaneous changes in suicide rates. However, this study shows that focusing only on year-on-year changes in suicide rates ignores underlying trends for specific population birth-cohorts. Funding None.
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Affiliation(s)
- Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Rachel Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Angela Clapperton
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Adrian Laughlin
- Department of General Practice and Primary Care, The University of Melbourne, Melbourne, Australia
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
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2
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Vigna E, Balkom IV, Bresnahan M, Cheslack-Postava K, Musa G, Ryan M, Skokauskas N, Hoven C, Carli V. Unravelling the threads: understanding the interplay of Cultural values, female workforce engagement, human development index and suicide rates. Arch Womens Ment Health 2024:10.1007/s00737-024-01502-9. [PMID: 39207511 DOI: 10.1007/s00737-024-01502-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Suicide is a major public health problem across the world. Extensive research on the field shows that suicide is affected by several sociological, economic, and cultural risk factors. Over the last century, social changes have driven the reshaping of traditional gender roles, often in an uneven fashion, strongly depending on context. This study proposes updated findings on the impact that changes in traditional gender roles could have on suicide rates METHODS: It will do so by examining the correlation between female labor force participation (FLPR) and sex-specific suicide rates. Moreover, it will examine this association depending on human development (HDI) and Hofstede's individualism index. To do so, data from 2010 to 2019 from 47 countries is collected from the WHO, ILOSTAT and UN agencies' websites. RESULTS Analysis show a significant interaction between FLPR, HDI and individualism index scores on male suicide rates (p = 0.002). There is a negative association between FLPR and male suicide rates in relatively lower HDI countries, while in very high HDI countries an increase in FLPR is correlated with an increase in male suicide rates. Similar trends but no significant interaction is observed for female suicide rates. CONCLUSION This study suggests that female participation is beneficial for male population as it reduces male suicide rates. However, this association appears to be context dependent. In countries where institutional adjustment is already established, and human development is very high, other factors might be of interest in examining the trends of suicide rates among men and women.
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Affiliation(s)
- Elisa Vigna
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
| | - Ingrid van Balkom
- Jonx, department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Michaeline Bresnahan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, US
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, New York, US
| | - Keely Cheslack-Postava
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, New York, US
| | - George Musa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, US
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, New York, US
| | - Megan Ryan
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, New York, US
| | - Norbert Skokauskas
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christina Hoven
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, US
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, New York, US
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden
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Chen YY, Fong TCT, Yip PSF, Canetto SS. Female Labor-Force Participation as Suicide Prevention: A Population Study in Taiwan. Arch Suicide Res 2024:1-19. [PMID: 38661334 DOI: 10.1080/13811118.2024.2337182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Female labor-force participation (FLFP) has been theorized as contributing to higher suicide rates, including among women. Evidence on this relationship, however, has been mixed. This study explored the association between FLFP and suicide in an understudied context, Taiwan, and across 40-years. METHODS Annual national labor-participation rates for women ages 25-64, and female and male suicide-rates, for 1980-2020, were obtained from Taiwan's Department of Statistics. The associations between FLFP rates and sex/age-stratified suicide-rates, and between FLFP rates and male-to-female suicide-rates ratios were assessed via time-series regression-analyses, accounting for autoregressive effects. RESULTS Higher FLFP rates were associated with lower female suicide-rates (ß = -0.06, 95% CI (Credibility Interval) = [-0.19, -0.01]) in the adjusted model. This association held in the age-stratified analyses. Associations for FLFP and lower male suicide-rates were observed in the ≥45 age-groups. FLFP rates were significantly and positively associated with widening male-to-female suicide-rates ratios in the adjusted model (ß = 0.24, 95% CI = [0.03, 0.59]). CONCLUSION This study's findings suggest that FLFP protects women from suicide, and point to the potential value of FLFP as a way of preventing suicide. In Taiwan, employed women carry a double-load of paid and family unpaid care-work. Child care-work is still done by mothers, often with grandmothers' support. Therefore, this study's findings contribute to evidence that doing both paid work and unpaid family care-work has more benefits than costs, including in terms of suicide-protection. Men's disengagement from family care-work may contribute to their high suicide rates, despite their substantial labor-force participation.
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Jiang M, Han L, He F. Clinical characteristics of patients with cardiac arrest induced by pesticide poisoning: Analysis of 15 cases. Med Clin (Barc) 2022; 159:543-548. [PMID: 36089421 DOI: 10.1016/j.medcli.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND OBJECTIVE Pesticide poisoning induced cardiac arrest (PPICA) has rarely been reported before, and can easily be overlooked by physicians. The aim of the study was to investigate the clinical characteristics of PPICA patients. METHODS This was a single-center, retrospective analysis in the emergency intensive care unit (EICU) at tertiary medical facility, from January 2015 to December 2018. RESULTS A total of 15 patients with PPICA in EICU were included, of which nine were females, where suicide was the only cause of poisoning. Thirteen were in-hospital cases and only three cases showed an initial shockable rhythm. On admission, patients' median acute physiology and chronic health evaluation II score was 20 (12, 21) and median sequential organ failure assessment score was 7 (4, 10). All cases required invasive mechanical ventilation and vasopressors therapy. Seven patients received blood purification therapy. The primary toxic agent was organophosphorus pesticide (OP) and all OP cases (8/15) received pralidoxime and atropine therapy. Thirteen patients received gastric decontamination. The primary complications were cardiogenic shock (10/15) and acute kidney injury (3/15). Seven patients survived at discharge. Of these, three made a full recovery without neurological sequelae. CONCLUSIONS Cardiac arrest has rarely been reported in pesticide poisoning before, and can easily be overlooked. Physicians therefore should pay attention to specific therapy and best supportive treatment, which could be critical to improve the disease outcomes.
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Affiliation(s)
- Min Jiang
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Ling Han
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Fei He
- Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
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5
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Kartal E, Demir U, Hekimoglu Y, Keskin S, Asirdizer M. Suicides in Turkey: 25-year trend (1995-2019). J Forensic Sci 2022; 67:1858-1866. [PMID: 35754207 DOI: 10.1111/1556-4029.15086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 12/01/2022]
Abstract
The assessment of national suicide risks is considered critical in many countries for the establishment of suicide prevention initiatives aimed at considerably lowering suicide rates. The aim of this study is to identify at-risk suicide populations by reviewing the suicides in Turkey over a 25-year period. The Turkish Statistical Institute's suicide statistics for 1995-2019 in Turkey was retrospectively reviewed in current article. The data collected in the study was statistically analyzed using the MINITAB vn 14 software. Between 1995 and 2019, the total number of suicides in Turkey was 66,819, and suicide rates, especially in males, showed an increasing trend in this period. Males comprised 68.3% of the total cases, and most (27.2%) were aged 15-24 years. Suicides mostly occurred between May and July (27.7%), of individuals with a primary school level of education (51.7%) and who were married (6.0 per 100,000). Illness was most important risk factor for suicide (36.8%) and hanging (47.5%) was the leading suicide method in all age groups and in both genders. Despite the fact that Turkey's suicide rate is lower than many other countries, the growth in male suicide rates is concerning. Suicides are likely to become a severe problem in Turkey in the near future unless measures like education, psychiatric evaluations, the reactivation of psychological counseling service phone lines, and the establishment of youth counseling centers, as described in this paper, are taken.
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Affiliation(s)
- Erhan Kartal
- Department of Forensic Medicine, Medical Faculty of Van Yuzuncu Yil University, Van, Turkey
| | - Ugur Demir
- Forensic Medicine Unit, Tokat State Hospital, Tokat, Turkey
| | - Yavuz Hekimoglu
- Forensic Medicine Unit, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Siddik Keskin
- Department of Biostatistics, Medical School of Van Yuzuncu Yil University, Van, Turkey
| | - Mahmut Asirdizer
- Department of Forensic Medicine, Medical School of Bahcesehir University, Istanbul, Turkey
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Lew B, Lester D, Kõlves K, Yip PSF, Chen YY, Chen WS, Hasan MT, Koenig HG, Wang ZZ, Fariduddin MN, Zeyrek-Rios EY, Chan CMH, Mustapha F, Fitriana M, Dolo H, Gönültaş BM, Dadfar M, Davoudi M, Abdel-Khalek AM, Chan LF, Siau CS, Ibrahim N. An analysis of age-standardized suicide rates in Muslim-majority countries in 2000-2019. BMC Public Health 2022; 22:882. [PMID: 35509027 PMCID: PMC9066769 DOI: 10.1186/s12889-022-13101-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/22/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Bob Lew
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - David Lester
- Stockton University, Galloway, New Jersey, United States
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland, Australia
| | - Paul S F Yip
- Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China
| | - Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
| | - Won Sun Chen
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - M Tasdik Hasan
- Jeeon Bangladesh Ltd., Dhaka, Bangladesh.,Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Harold G Koenig
- Duke University Medical Center, Durham, NC, USA.,King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zhi Zhong Wang
- Department of Epidemiology and Statistics, School of Public Health at Guangdong Medical University, Dongguan, Guangdong, China
| | - Muhamad Nur Fariduddin
- Faculty of Education, Universiti Teknologi MARA, Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
| | | | - Caryn Mei Hsien Chan
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Feisul Mustapha
- Non-Communicable Diseases Section, Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - Mimi Fitriana
- Department of Psychology, International University of Malaya-Wales, Kuala Lumpur, Malaysia.,Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Housseini Dolo
- Filariasis Unit, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali
| | - Burak M Gönültaş
- Social Work Department., Faculty of Letters, Sivas Cumhuriyet University, Sivas, Turkey
| | - Mahboubeh Dadfar
- Department of Addiction, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Davoudi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmed M Abdel-Khalek
- Department of Psychology, Faculty of Arts, Alexandria University, Alexandria, Egypt
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ching Sin Siau
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Norhayati Ibrahim
- Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Institute of Islam Hadhari, Universiti Kebangsaan Malaysia, Bangi, Malaysia
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7
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Wu KCC, Cai Z, Chang Q, Chang SS, Yip PSF, Chen YY. Criminalisation of suicide and suicide rates: an ecological study of 171 countries in the world. BMJ Open 2022; 12:e049425. [PMID: 35177441 PMCID: PMC8860012 DOI: 10.1136/bmjopen-2021-049425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Kevin Chien-Chang Wu
- Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ziyi Cai
- Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Hong Kong, Hong Kong
| | - Qingsong Chang
- School of Sociology and Anthropology, Xiamen University, Xiamen, China
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Hong Kong, Hong Kong
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ying-Yeh Chen
- General Psychiatry, Taipei City Psychiatric Centre, Taipei City Hospital, Taipei City, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
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8
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Cai Z, Chen M, Ye P, Yip PSF. Socio-economic determinants of suicide rates in transforming China: A spatial-temporal analysis from 1990 to 2015. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 19:100341. [PMID: 35024666 PMCID: PMC8671725 DOI: 10.1016/j.lanwpc.2021.100341] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background China has experienced dramatic social changes in the last three decades. This study aimed to investigate socio-economic factors related to suicide rates in China from 1990 to 2015, and examine how the impacts of these factors on suicide rates changed over time. Methods Suicide rates in 31 provinces in mainland China between 1990 and 2015 were obtained from the Global Burden of Disease (GBD) Study 2019. Temporal-spatial modelling was applied to assess the effects of GDP per capita, urbanization, migration, employment, divorce, proportions of children and older adults on provincial overall, male and female suicide rates. Findings The overall suicide rate in China declined from 18·1 /100,000 in 1990 to 8·6 /100,000 in 2015, with considerable spatial variation in the magnitude of decline across provinces. The protective effects of increasing in GDP per capita, and urbanization, on provincial suicide rate were strong in 1990 (log GDP: -3·56 [95% CI: -6·15, -0·96], urbanisation: -0·07 [-0·14, -0·01]), however these effects were negligible by 2015. The association between employment and suicide rates has shifted from positive to negative over the study period, while migration remained a constant risk factor for high suicide rates (0·04 [0.00, 0·09]). Interpretation This study highlighted the dynamic effects of economic and social factors on suicide rates in the context of transforming China. To maintain further reductions in suicide rates cannot rely simply on improving people's materialistic and economic conditions. A more holistic approach to improve overall population well-being is needed. Funding Humanities and Social Sciences Prestigious Fellowship (37000320) and the General Research Fund (17611619) at the University of Hong Kong.
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Affiliation(s)
- Ziyi Cai
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Mengni Chen
- Department of Sociology, University of Copenhagen, Denmark
| | - Pengpeng Ye
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China.,Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
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9
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Chen YY, Cai Z, Chang Q, Canetto SS, Yip PSF. Caregiving as suicide-prevention: an ecological 20-country study of the association between men's family carework, unemployment, and suicide. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2185-2198. [PMID: 33948679 DOI: 10.1007/s00127-021-02095-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Suicide rates are generally higher in men than in women. Men's higher suicide mortality is often attributed to public-life adversities, such as unemployment. Building on the theory that men's suicide vulnerability is also related to their private-life behaviors, particularly men's low engagement in family carework, this ecological study explored the association between men's family carework, unemployment, and suicide. METHODS Family-carework data for twenty Organization for Economic Co-operation and Development (OECD) countries were obtained from the OECD Family Database. Sex-specific age-standardized suicide rates came from the Global Burden of Disease dataset. The association between men's engagement in family carework and suicide rates by sex was estimated, with OECD's unemployment-benefits index and United-Nations' Human Development-Index (HDI) evaluated as controls. The moderation of men's carework on the unemployment-suicide relationship was also assessed. RESULTS Overall and sex-specific suicide rates were lower in countries where men reported more family carework. In these countries, higher unemployment rates were not associated with higher male suicide rates. In countries where men reported less family carework, higher unemployment was associated with higher male suicide rates, independent of country's HDI. Unemployment benefits were not associated with suicide rates. Men's family carework moderated the association between unemployment and suicide rates. CONCLUSION This study's findings that higher levels of men's family carework were associated with lower suicide mortality, especially among men and under high-unemployment conditions, point to the suicide-protective potential of men's family carework. They are consistent with evidence that where gender equality is greater, men's and women's well-being, health, and longevity are greater.
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Affiliation(s)
- Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
- Department of Public Health, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - ZiYi Cai
- Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Qingsong Chang
- School of Sociology and Anthropology, Xiamen University, Xiamen, China
| | | | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong.
- Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong.
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10
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Chen YY, Canetto SS, Chien-Chang Wu K, Chen YL. Women's Suicide in the First-Year Postpartum: A Population-based Study. Soc Sci Med 2021; 292:114594. [PMID: 34844078 DOI: 10.1016/j.socscimed.2021.114594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/30/2021] [Accepted: 11/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In dominant suicidology there is a long traditionof theorizing that women are protected from suicide, particularly when mothers and during the postpartum. Studies have mostly confirmed the postpartum suicide-protection theory, with low suicide mortality generally observed among postpartum women. A limitation of these studies is that most were conducted in majority European-descent-population countries. A challenge to the more general maternal suicide-protection theory is that in East-Asia women of childbearing age exhibit substantial suicidality, nonfatal and fatal. This study evaluated whether suicide is less likely in first-year postpartum women as compared to women past the first-year postpartum. METHODS This population-based, nested case-control study focused on women whose live birth was between 2001 and 2016 in East-Asian Taiwan. To ascertain suicide outcomes, the women were followed until 2017. For each suicide case, four control cases were randomly selected from the Birth Certificate Application dataset, with a 1:4 matching ratio based on age of last live-delivery and parity (one delivery record vs. two or more records) (cases N = 1571; controls N = 6284). Conditional logistic regression analyses were conducted to assess whether suicide was less likely in women in the first-year postpartum relative to women past the first-year postpartum. RESULTS The odds ratios of suicide were elevated at 42 days postpartum [Odds Ratio (OR) = 2.06; 95% Confidence Interval (CI) = (1.04, 4.16)], six-months postpartum [OR = 2.28; 95% CI = (1.60, 3.29)] and one-year postpartum [OR = 2.26; 95% CI = (1.76, 2.96)], when controlling for sociodemographic and mental-disorder variables. Suicide was more likely in women who were single at index birth, had lower socioeconomic status, or had a mental disorder history. CONCLUSION Our findings suggest that the postpartum stage is not suicide-protective per se. Whether the postpartum stage is associated with suicide protection or suiciderisk appears to depend on context and culture.
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Affiliation(s)
- Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei City, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei City, Taiwan
| | | | - Kevin Chien-Chang Wu
- Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei City, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung, Taiwan; Department of Psychology, Asia University, Taichung, Taiwan.
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11
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Singh P, Das A, William J, Bruckner T. Fertility, economic development, and suicides among women in India. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1751-1759. [PMID: 33721038 DOI: 10.1007/s00127-021-02054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Indian states at greater levels of economic development report more suicides. This relation appears stronger among women relative to men. We test the hypothesis, suggested in the literature, that conflict between rapid economic growth and inadequate female autonomy (approximated using total fertility rate) varies positively with female suicides. METHODS We used state-level data on female suicides for all 35 Indian states and union territories, from 2001 to 2011, from the National Crime Records Bureau. We specified, as our outcome, age-adjusted female suicides per 100,000 population per state-year. We retrieved data on key covariates, namely, gross state domestic product (GSDP) per capita, total fertility rate (TFR), and other control variables from multiple national surveys and publicly available data sources. We examined whether and to what extent age-adjusted female suicides (per 100,000 population) correspond with total fertility rate (lower TFR indicates greater female autonomy and vice versa) within the context of greater economic development (GSDP per capita). Linear longitudinal mixed effect regressions controlled for state-specific random intercepts, son preference (male:female sex ratio at birth), literacy gap (percentage difference between literate males and females), access to health systems (institutional deliveries), female to male employment ratio, and linear time trends. RESULTS At constant levels of GSDP per capita, a one unit decline in TFR corresponds with 0.27 fewer female suicides per 100,000 population (P value = 0.008). Sensitivity tests indicate that this relation does not hold for male age-adjusted suicides (per 100,000 population). CONCLUSION Our findings, if replicated, indicate that at constant levels of economic development, lower TFR (indicating greater female autonomy) may reduce suicide risk among women.
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Affiliation(s)
- Parvati Singh
- Program in Public Health, University of California, 653 E. Peltason Drive, Irvine, CA, 92617, USA.
| | - Abhery Das
- Program in Public Health, University of California, 653 E. Peltason Drive, Irvine, CA, 92617, USA
| | - Jenesca William
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Tim Bruckner
- Program in Public Health, University of California, 653 E. Peltason Drive, Irvine, CA, 92617, USA.,Center for Population, Inequality, and Policy (CPIP), University of California, Irvine, USA
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12
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Bando DH, Prado de Mello Jorge MH, Waldman EA, Volpe FM, Lester D. Secular Trends of Suicide in the City of São Paulo, 1904-2017. CRISIS 2021; 43:476-485. [PMID: 34523350 DOI: 10.1027/0227-5910/a000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Few reports from developing countries have described long-term trends in suicide. Aims: To investigate the age-, sex-, and method-specific trends in suicide over the period 1904-2017 in São Paulo. Method: Mortality data were obtained from SEADE, DATASUS, and PRO-AIM. Results: Suicide peaked in the mid-1910s and mid-1950s, being higher among men. There was an upward trend from the 1920s for men and from the 1930s for women. Suicide rates have declined since the mid-1950s, reaching lower rates in the past 40 years. Men aged 60+ had higher rates at the beginning and a decreasing trend. Suicide rates among men aged 20-39 and 40-59 peaked in the mid-1950s and declined until the late 1970s, thereafter remaining stable. Women aged 20-39 years had the highest rates with decreasing trends from the mid-1950s. No trends were detected for the age group 40-59, and women aged 60+ presented a decreasing trend. Rates among women aged 0-19 declined after the late 1970s. Suicide by poisoning peaked in the 1950s, and there was a downward trend for firearms and an upward trend for hanging. Conclusion: Suicide trends vary by sex, age group, and method. Accurate monitoring of these trends is an important task for suicide prevention and public health agencies and personnel.
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Affiliation(s)
- Daniel Hideki Bando
- Institute of Natural Sciences, Federal University of Alfenas - UNIFAL, Minas Gerais, Brazil
| | | | - Eliseu Alves Waldman
- Department of Epidemiology, Public Health School of the University of São Paulo - USP, Brazil
| | | | - David Lester
- The Richard Stockton College of New Jersey, Pomona, NJ, USA
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13
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Andrews GJ. Re-imagining world: From human health in the world to 'all-world health'. Health Place 2021; 71:102620. [PMID: 34330008 DOI: 10.1016/j.healthplace.2021.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
This article explores the concept of 'world' as it frequently appears across health studies; specifically largely humanistic and phenomenological variations in use of 'the world' and 'lifeworld' are considered as they have helped cast knowledge on health and care. Looking forward, it is argued that world might be reimagined post-humanistically and post-phenomenologically as a vital emergent material entity and property. This is a reimagination that pays dividends by drawing attention to all-world processes and productions, hence to 'all-world health'. On one level, all-world health involves consideration of the healths of all the world's material and biological entities (all parts of the world). On another level, all-world health involves understanding what an entity gains from its total surround as it moves through life (all parts of its world). Together these levels provide a more processual, relational and holistic understanding of health than that provided by traditional notions of human health states, determinants or meanings, and even by some environmental (ist) ideas on health. All-world health arguably provides a vision of interrelatedness on which greater unity, cooperation and care might be built.
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Affiliation(s)
- Gavin J Andrews
- Department of Health, Aging and Society KTH, McMaster University, Hamilton, Ontario, L8S 4M4, Canada.
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Cai Z, Canetto SS, Chang Q, Yip PSF. Women's suicide in low-, middle-, and high-income countries: Do laws discriminating against women matter? Soc Sci Med 2021; 282:114035. [PMID: 34147270 DOI: 10.1016/j.socscimed.2021.114035] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/16/2021] [Accepted: 05/10/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Women's suicide is a serious public health issue in low- and middle-income countries (LMIC). This study explored whether institutional discrimination against women, as manifested in formal and informal laws, is relevant to country's income-level variability in women's suicide mortality. It also examined which discriminatory laws are associated with LMIC women's suicides. METHODS Scores on laws discriminating against women, across 176 countries, were obtained from the Gender, Institutions and Development Database. Male-to-female (M/F) 2017 suicide ratios were the index of women's propensity for suicide. The mediating role of laws discriminating against women on the association between country's income level and M/F suicide ratio was analysed by bootstrapping method. Regression analyses examined which discriminatory laws were associated with LMIC women's suicide rates. RESULTS LMIC had significantly smaller M/F suicide ratios than high-income countries. Institutional discrimination mediated the association between country's income-level and M/F suicide ratio (total effect: β = -0.13, 95% CI [ -0.26, -0.01]; direct effect: β = -0.06, 95% CI [ -0.20, 0.08]; indirect effect: β = -0.07, 95% CI [ -0.15, -0.02]). In LMIC, higher levels of discrimination against women in laws about access to productive and financial resources (β = -0.69, p < 0.001), civil liberties (β = -0.60, p < 0.001), and in family law (β = -0.57, p < 0.001) were associated with smaller M/F suicide ratios after controlling for male suicide rates and sex ratios at birth. CONCLUSIONS The relatively high suicide rates recorded among women in LMIC might be related to the higher level of institutional discrimination women experience in these countries. In LMIC, where, by law, women had restricted access to productive and financial assets and to justice, and/or unequal rights with regard to citizenship, household-responsibilities, divorce, and inheritance, M/F suicide ratios were lower-that is, women's suicide rates were higher. Suicide theory, research, and prevention targeting women should incorporate social-context and social-justice perspectives.
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Affiliation(s)
- Ziyi Cai
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | | | - Qingsong Chang
- School of Sociology and Anthropology, Xiamen University, China.
| | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China; Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China.
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15
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Chen L, He X, Xian J, Liao J, Chen X, Luo Y, Wang Z, Li N. Development of a framework for managing severe burns through a 17-year retrospective analysis of burn epidemiology and outcomes. Sci Rep 2021; 11:9374. [PMID: 33931691 PMCID: PMC8087787 DOI: 10.1038/s41598-021-88507-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/07/2021] [Indexed: 11/09/2022] Open
Abstract
Burns are one of the most common injuries in daily life for all ages of population. This study was to investigate the epidemiology and outcomes among burn patients in one of the largest burn centers in the southwest of China. The study was performed at the Institute of Burn Research in the first affiliated with the Army Medical University (AMU). A total of 17,939 burn patients were included in this retrospective study. Information regarding burn epidemiology and outcomes in 17 years were collected, calculated and compared. The age ranged from 257 days to 95 years old. Scalding and flame were the two most common causes to burn injuries, comprising of 91.96% in total. Limbs, head/face/neck, and trunk were the most frequently occurred burn sites, with the number and the percent of 12,324 (68.70%), 7989 (44.53%), and 7771 (43.32%), respectively. The average total body surface area (TBSA) was 13.64 ± 16.83% (median 8%) with a range of 0.1–100%. A total of 874 (4.9%) patients had TBSA > 50%. The presence of a burn with an inhalation injury was confirmed in 543 patients (3.03%). The average LOS was 32.11 ± 65.72 days (median: 17 days). Eventually, the retrospective analysis resulted in the development of a burn management continuum used for developing strategies to prevent and manage severe burns. The annual number of burn injuries has kept decreasing, which was partially attributed to the increased awareness and education of burn prevention and the improved burn-preventative circumstances. However, the burn severity and the economic burden were still in a high level. And the gender difference and age difference should be considered when making individualized interventions and rehabilitative treatments.
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Affiliation(s)
- Ling Chen
- Department of Emergency, The 958th Hospital of PLA, The Affiliated Hospital of Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400020, People's Republic of China
| | - Xiaochong He
- School of Nursing, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Jishu Xian
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Jianmei Liao
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Xuanji Chen
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yue Luo
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street No.30, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Zonghua Wang
- School of Nursing, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China.
| | - Ning Li
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street No.30, Shapingba District, Chongqing, 400038, People's Republic of China.
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16
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Lew B, Kõlves K, Lester D, Chen WS, Ibrahim NB, Khamal NRB, Mustapha F, Chan CMH, Ibrahim N, Siau CS, Chan LF. Looking Into Recent Suicide Rates and Trends in Malaysia: A Comparative Analysis. Front Psychiatry 2021; 12:770252. [PMID: 35069279 PMCID: PMC8766712 DOI: 10.3389/fpsyt.2021.770252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Suicide is a preventable cause of death. Examining suicide rates and trends are important in shaping national suicide prevention strategies. Therefore, the objectives of this study were to analyze age-standardized suicide trends of Malaysia between 2000 and 2019 using the WHO Global Health Estimates data, and to compare the 2019 rate with countries from the Association of South-East Asian Nations (ASEAN), Muslim majority countries, and the Group of Seven (G7). Methods: The age-standardized suicide rates data were extracted from the WHO Global Health Estimates. We calculated the average age-standardized suicide rates of the last 3 years from 2017 to 2019. Joinpoint regression analysis was conducted to calculate the average annual percentage change (APC) of the age-standardized suicide rates in Malaysia from 2000 to 2019. Results: Between 2000 and 2019, the minimum and maximum suicide rates for both sexes in Malaysia were 4.9 and 6.1 per 100,000 population respectively, whilst the past 3-year (2017-2019) average rates were 5.6, 8.8, and 2.4 for both sexes, males, and females, respectively. The suicide rates decreased significantly for both sexes between 2000 and 2013. Between 2014 and 2019, the suicide rates increased significantly for males. In 2019, Malaysia recorded the rate of 5.8 per 100,000 population, with an estimated 1,841 suicide deaths, i.e., ~5 deaths per day. The Malaysian suicide rate was the second highest amongst selected Muslim majority countries, in the middle range amongst ASEAN countries, and lower than all G7 countries except Italy. Conclusions: There is a need to further explore factors contributing to the higher suicide rates among Malaysian males. In light of the rising suicide rates in Malaysia, national mental health and suicide prevention initiatives are discussed and the importance of high-quality suicide surveillance data is emphasized.
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Affiliation(s)
- Bob Lew
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.,World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, QLD, Australia
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ, United States
| | - Won Sun Chen
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Nurashikin Bt Ibrahim
- Non-communicable Diseases Section, Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - Noor Raihan Bt Khamal
- Non-communicable Diseases Section, Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - Feisul Mustapha
- Non-communicable Diseases Section, Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - Caryn Mei Hsien Chan
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Ibrahim
- Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Institute of Islam Hadhari, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Ching Sin Siau
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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17
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Chen YY, Yang CT, Cha ES, Sha F, Yip PSF. Quantifying the contributions of age, sex, methods, and urbanicity to the changing suicide rate trends in South Korea, 2001-2016. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1121-1132. [PMID: 32189039 DOI: 10.1007/s00127-020-01855-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/28/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Suicide rates in South Korea have been one of the highest in the world. The aim of this study is to quantify the contributions of age, sex, method, and place of residence to the trends of the suicide rates between 2001 and 2016 in South Korea. METHODS Using the suicide data obtained from the South Korean National Death Registration data set for the years 2001-2016, a Joinpoint regression analysis was conducted to determine if there was a significant change in the trend of suicide rates. Next, a decomposition analysis method was used to quantify the contributions of age, sex, method, and places of residence to the changes in the suicide rates. RESULTS Suicide rates increased between 2001 and 2010, and decreased between 2010 and 2016. Among all the age groups, the 65-79 age group contributed most to the rise (18% in men and 7% in women) and fall (- 15% in men and - 14% in women) of suicide rates. Men contributed much more than women to the increasing trend of suicide rate (63.0% vs. 37.0%). Hanging was the key method of suicide, dominating the ups and downs of the suicide rates. The rates of suicide by pesticide poisoning have been decreasing since 2005 and suicide by charcoal burning continued to increase against a decreasing trend of suicide rate during the period of 2010-2016. The gap of the metropolitan-city-rural suicide rates was narrowing during the period under study, although the rural areas remained to have the highest suicide rates. CONCLUSION The ups and downs of suicide rates in South Korea were not uniform across different sociodemographic groups. Age, sex, method, and place of residence contributed differently to the changes in suicide rates. Suicide prevention measures can be more focused on certain age-sex-method-region subgroups.
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Affiliation(s)
- Ying-Yeh Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan.,Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Chi-Ting Yang
- Department of Statistics and Actuarial Science, The University of Hong Kong, Pokfulam, Hong Kong
| | - Eun-Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Feng Sha
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Pokfulam, Hong Kong
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong. .,The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong.
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18
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Suicide rates in Iceland before and after the 2008 Global Recession: a nationwide population-based study. Eur J Public Health 2020; 30:1102-1108. [DOI: 10.1093/eurpub/ckaa121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Economic downturns have been associated with increased suicide rates. The 2008 global financial crisis varied across countries but hit Iceland relatively hard. We aimed to study potential changes in suicide rates in Iceland during this major economic transition.
Methods
Data were retrieved on all suicides in Iceland during 2002–14. The study period was divided into a pre-collapse period (2002–08) and a post-collapse period (2008–14). Poisson regression models were used to estimate the association between pre-to-post economic collapse and suicide rates, expressed as risk ratios (RR) with 95% confidence intervals (CIs). Analyses were stratified by age and sex.
Results
A total of 470 suicides were recorded during the study period. The mean age at death was 45 years and 75% were males. The overall suicide rates per 100 000 were 13.3 pre-collapse and 15 post-collapse revealing no overall differences in pre-to-post collapse (RR 1.12; CI 0.94–1.35). This was true for both men and women (RR 1.18; CI 0.96–1.46 and RR 0.96; CI 0.67–1.38, respectively). An increase in the unemployment rate was not associated with the overall suicide rate (RR 1.07; CI 0.86–1.33), and neither were changes in gross domestic product (RR 1.29; CI 0.94–1.79) or balance of trade (RR 1.08; CI 0.96–1.22).
Conclusion
The economic collapse and rising unemployment rates in Iceland did not result in an overall increase in suicide rates. A strong welfare system and investing in social protection during the economic crisis may have mitigated suicide risk.
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Chang YH, Gunnell D, Hsu CY, Chang SS, Cheng ATA. Gender difference in suicide in Taiwan over a century: a time trend analysis in 1905-1940 and 1959-2012. J Epidemiol Community Health 2020; 74:898-906. [PMID: 32665369 DOI: 10.1136/jech-2020-214058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/18/2020] [Accepted: 06/16/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Suicide rates are higher in men than in women in most countries, although the gender ratios vary markedly worldwide. We investigated long-term trends in suicide rates and the male-to-female ratios in relation to age, method and economic factors in Taiwan during the Japanese colonial (1905-1940) and postwar (1959-2012) periods. METHODS Suicide data were from the Statistical Reports of Taiwan Governor's Office (1905-1940), Vital Statistics (1959-1970) and cause-of-death mortality data files (1971-2012). Annual age-standardised and age-specific/method-specific suicide rates by gender and the gender ratios were calculated and examined graphically. The associations between trends in economic indicators, suicide and suicide gender ratio were investigated using Prais-Winsten regression. RESULTS The male-to-female suicide rate ratio increased from below 1 in the 1900s to around 2 by 2000; the reversal was mainly due to a marked reduction in suicide rates in young women coupled with a rise in male suicide between 1905 and 1940. The gender ratio increased again from the 1980s onwards. Poisoning was the most common method in the 1970s-1980s, but its use decreased afterwards, more in women than in men proportionally. The use of gassing for suicide increased markedly in the 2000s and contributed to the rises in overall suicide and the gender ratio. Unemployment rates were more strongly associated with male suicide than female suicide in 1959-2012. Unemployment rates and gross domestic product per capita were positively associated with suicide gender ratios. CONCLUSIONS Gender differences in suicide changed remarkably in Taiwan over the past century; such change may be related to cultural, socioeconomic and method-specific factors.
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Affiliation(s)
- Yi-Han Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.,Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - David Gunnell
- Population Health Sciences, University of Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Chia-Yueh Hsu
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan .,Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Andrew Tai-Ann Cheng
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
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Relationship of the high proportion of suicidal acts involving ingestion of pesticides to the low male-to-female ratio of suicide rates in China. Epidemiol Psychiatr Sci 2020; 29:e114. [PMID: 32299524 PMCID: PMC7214533 DOI: 10.1017/s2045796020000244] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIMS The 2014 World Health Organization report on global suicide identified large differences in the male-to-female ratio of suicide rates between countries: most high-income countries (HICs) report ratios of 3:1 or higher while many low- and middle-income countries (LMICs) - including China and India - report ratios of less than 1.5:1. Most authors suggest that gender-based social-cultural factors lead to higher rates of suicidal behaviour among women in LMICs and, thus, to relatively high female suicide rates. We aim to test an alternative hypothesis: differences in the method and case-fatality of suicidal behaviour - not differences in the rates of suicidal behaviour - are the main determinants of higher female suicide rates in LMICs. METHODS A prospective registry of suicide attempts treated in all 14 general hospitals in a rural county in China was established and data from the registry were integrated with population and mortality data from the same county from 2009 to 2014. RESULTS There were 160 suicides and 1010 medically-treated suicidal attempts in the county; 84% of female suicides and 58% of male suicides ingested pesticides while 73% of female attempted suicides and 72% of male attempted suicides ingested pesticides. The suicide rate (per 100 000 person-years of exposure) was 8.4 in females and 9.1 in males (M:F ratio = 1.08:1) while the incidence of 'serious suicidal acts' (i.e. those that result in death or received treatment in a hospital) was 81.5 in females and 47.7 in males (M:F ratio = 0.59:1). The case-fatality of serious suicidal acts was higher in males than in females (19 v. 10%), increased with age, was highest for violent methods (92%), intermediate for pesticide ingestion (13%) and lowest for other methods (5%). CONCLUSIONS The incidence of medically serious suicidal behaviour among females in rural China was similar to that reported in HICs, but the case-fatality was much higher, primarily because most suicidal acts involved the ingestion of pesticides, which had a higher case-fatality than methods commonly used by women in HICs. These findings do not support sociological explanations for the relatively high female suicide rate in China but, rather, suggest that gender-specific method choice and the case-fatality of different methods are more important determinants of the demographic profile of suicide rates. Further research that involves ongoing monitoring of the changing incidence, demographic profile and case-fatality of different suicidal methods in urban and rural parts of both LMICs and HICs is needed to confirm this hypothesis.
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Alothman D, Fogarty A. Global differences in geography, religion and other societal factors are associated with sex differences in mortality from suicide: An ecological study of 182 countries. J Affect Disord 2020; 260:67-72. [PMID: 31493641 DOI: 10.1016/j.jad.2019.08.093] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Over 800,000 individuals die as a consequence of suicide annually, and almost two thirds of these deaths are in males. This analysis aimed to explore sex differences in global suicide rates with regards to geographic location, religion and other societal factors. METHODS Data on sex-specific suicide rates were collated for 182 countries in 2015. The exposures of interest were geographical location, majority religion, life expectancy, total fertility rate (TFR), literacy percentage, gender development index and gross domestic product. RESULTS Both continent and predominant religion were strongly associated with the male:female ratio for deaths from suicide (p < 0.001 for both variables). The highest male:female suicide ratio was observed in the Americas with a median value of 4.0 (interquartile range IQR: 3.0-5.0) and the lowest gender suicide ratios were observed in Africa (2.7, IQR: 2.4-3.3) and Asia (2.7, IQR: 1.8-3.9). The predominantly Christian countries revealed the highest male:female suicide ratio (3.3, IQR: 2.7-4.4) whereas the predominantly Hindu countries revealed the lowest (1.3, IQR 1.3-3.8). The following variables were all positively associated with male:female ratio of suicide mortality: Life expectancy (Spearman's correlation coefficient r = +0.21, p = 0.004), GDP per capita (r = +0.26, p = 0.003), literacy percentage (r = +0.46, p < 0.0001), and Gender Development Index (r = +0.56, p < 0.0001). TFR was negatively associated with sex suicide ratio (-0.30, p < 0.0001). CONCLUSION There are significant differences between male and female suicide rates across continents and cultures. Markers of societal development are associated with a higher proportion of male suicides compared to females.
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Affiliation(s)
- Danah Alothman
- NIHR Biomedical Research Centre, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1 PB, UK
| | - Andrew Fogarty
- NIHR Biomedical Research Centre, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1 PB, UK.
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Gender inequality and suicide gender ratios in the world. J Affect Disord 2019; 243:297-304. [PMID: 30261445 DOI: 10.1016/j.jad.2018.09.032] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/15/2018] [Accepted: 09/15/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND To assess whether gender inequality determines the patterns of suicide gender ratios. METHODS Using suicide data obtained from the World Health Organization Statistical Information System, 2012, suicide gender ratios were calculated and a world map of the ratios constructed. Forest plots were utilized to assess whether gender inequality (indicated by the Gender Inequality Index ["GII"] and male to female sex ratios at birth) moderated the worldwide patterns of suicide gender ratios. Regression analyses were then performed to estimate the extent to which gender inequality affects suicide gender ratios before and after controlling for human development level ("HDI"). RESULTS Gradient relationships of suicide gender ratios across 3 tertiles of GII were observed (ratios = 2.03, 2.54, 3.51, respectively for high, moderate and low GII, P = 0.03). High sex ratio at birth was significantly associated with lower suicide gender ratio (ratio = 1.64 vs. 2.75, P = 0.00). Regression analyses showed that highest tertile of GII and high sex ratios at birth were significantly associated with lower suicide gender ratios (P = 0.00 and P = 0.00, respectively). When the level of human development level was controlled, high sex ratio at birth remained to be a significant determinant of suicide gender ratios (P = 0.00), whereas the significance of GII disappeared (P = 0.19). LIMITATIONS The cross-sectional data do not allow for causal inferences. CONCLUSIONS Male to female suicide ratios were higher in countries with more egalitarian gender norms. Strategies to eliminate culturally embedded gender discrimination have the potentials to prevent suicides.
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