Beyond risk theory: suicidal behavior in its social and epidemiological context

Suicide under the Nazi-regime: A Case-control Study among Amsterdam Jews

OBJECTIVE

Jewish suicides increased heavily under Nazi-rule. This research investigated risk factors for dying from suicide according to sociodemographic characteristics, local context, and time periods.

METHODS

Nazi-registration of Amsterdam residents of Jewish origin in 1941 linked to death and suicide lists. The added suicides after the Nazi-invasion (1940, n = 115) and the suicides when deportation trains ran (1942/1943, n = 182) were each matched to 25 controls using sex and age. Suicide was compared across migrant, occupational, marital, and religious status and neighborhood religiosity. Conditional logistic regression was applied, stratified by time period.

RESULTS

In 1940, immigrant (cf. native born, odds ratio (OR) 1.89, 95%CI 1.21-2.96, p = .005) and married Jews (cf. previously married) showed higher suicide risk; members of Israelite Congregations (cf. nonmembers, OR 0.35, 95%CI 0.22-0.56, p < .001) showed reduced risk. Jews living in low synagogue rate neighborhoods showed higher risk compared to those living in neighborhoods without any synagogues (OR 2.48, 95%CI 1.65-3.72, p < .001) while those living in high synagogue rate neighborhoods showed no increased risk (OR 0.58, 95%CI 0.30-1.11, p = .10). In 1942/1943, the association between religious status (OR 1.07, 95%CI 0.67, 1.72, p = .77), synagogue rate (OR 1.27, 95%CI 0.91-1.77, p = .16), immigrant status (OR 1.30, 95%CI 0.92-1.84, p = .14) and suicide attenuated; Jews in managerial/professional occupations (cf. workers) or unmarried (cf. married) showed higher risk.

CONCLUSIONS

In 1940, immigrants' higher suicide risk likely indicates greater fear of Nazis while religious affiliation's lower risk might indicate a protective effect of religious belief. In 1942/1943, risk differences markedly attenuated likely indicating increased fear of Nazis among all Jews.HighlightsReligiously affiliated Jews showed reduced risk of dying from suicide after the Nazi-invasionJewish immigrants showed higher risk of dying from suicide after the Nazi-invasionBy 1942/1943, these risks attenuated indicating fear of the Nazis spread and nullified religion's protection.

Precarious Suicide Behavior According to Housing Price Gap: A Case Study on South Korea

In 2018, the suicide rate in South Korea was the highest among the Organisation for Economic Co-operation and Development countries, and socioeconomic inequality has intensified. This study analyzes the impact relationship between suicidal impulses and economic inequality in South Korea. This study measures suicidal impulses thoughts National Health Survey Data and economic inequality based on the housing prices gap in the country. The primary analysis results were as follows: First, suicidal impulses were positively associated with the high index of housing price inequality; this correlation has become tight in recent years. Second, it was confirmed that the higher the income level, the higher the correlation between suicidal impulses with the index of housing price inequality. Third, the correlation between housing price inequality with suicidal impulse increased consistently in highly urbanized areas, but the statistical significance was low in non-urban areas.

Suicide Risk Assessment Using Machine Learning and Social Networks: a Scoping Review

According to the World Health Organization (WHO) report in 2016, around 800,000 of individuals have committed suicide. Moreover, suicide is the second cause of unnatural death in people between 15 and 29 years. This paper reviews state of the art on the literature concerning the use of machine learning methods for suicide detection on social networks. Consequently, the objectives, data collection techniques, development process and the validation metrics used for suicide detection on social networks are analyzed. The authors conducted a scoping review using the methodology proposed by Arksey and O'Malley et al. and the PRISMA protocol was adopted to select the relevant studies. This scoping review aims to identify the machine learning techniques used to predict suicide risk based on information posted on social networks. The databases used are PubMed, Science Direct, IEEE Xplore and Web of Science. In total, 50% of the included studies (8/16) report explicitly the use of data mining techniques for feature extraction, feature detection or entity identification. The most commonly reported method was the Linguistic Inquiry and Word Count (4/8, 50%), followed by Latent Dirichlet Analysis, Latent Semantic Analysis, and Word2vec (2/8, 25%). Non-negative Matrix Factorization and Principal Component Analysis were used only in one of the included studies (12.5%). In total, 3 out of 8 research papers (37.5%) combined more than one of those techniques. Supported Vector Machine was implemented in 10 out of the 16 included studies (62.5%). Finally, 75% of the analyzed studies implement machine learning-based models using Python.

The trend in mortality due to suicide in urban and rural areas of Colombia, 1979-2014

Introduction: Suicide is a serious social and public health problem that affects the population in most countries in the world. Differences in suicide rates in rural and urban areas have been previously described. Objective: To study the trend of mortality rates by suicide in Colombia, in rural and urban areas by gender, age group, and suicide method during the years 1979-2014. Materials and methods: We conducted a temporal trend ecologic study using death certificates from the Departamento Administrativo Nacional de Estadística, DANE. Specific and adjusted by age and gender mortality rates were calculated. We estimated negative binomial and inflection point regression models to study the trends in mortality rates stratified by gender, age group, and suicide method. Results: A total of 56,448 suicides was reported in Colombia between 1979 and 2014. The risk of suicide was higher in urban areas for men, individuals between 25 and 44 years, and 65 and over; and for those who used hanging as the suicide method. Also, the risk of suicide was higher in the rural area for men between 45 and 64 years old, and those who used firearms, sharp weapons, hanging, and others as suicide methods. The trend of suicide rates in urban areas showed its maximum peak in 1999 and in the rural ones in 2000. Then, in the two areas, there was a gradual decrease. Hanging in both areas presented a tendency to rise in men. Conclusions: Suicide has shown a tendency toward reduction after the year 2000, with differences between urban and rural areas.

Addressing Suicide Risk According to Different Healthcare Professionals in Spain: A Qualitative Study

This study analyzes the views of four groups of healthcare professionals who may play a role in the management of suicidal behavior. The goal was to identify key factors for suicide prevention in different areas of the healthcare system. Qualitative research was conducted using focus groups made up of different healthcare professionals who participated in the identification, management, and prevention of suicidal behavior. Professionals included were primary care physicians, psychologists, psychiatrists, and emergency physicians. 'Suicide' was amongst the most relevant terms that came up in discussions most of the times it appeared associated with words such as 'risk', danger', or 'harm'. In the analysis by categories, the four groups of professionals agreed that interventions in at-risk behaviors are first in importance. Prevention was the second main concern with greater significance among psychiatrists. Primary care professionals call for more time to address patients at risk for suicide and easier access to and communication with the mental health network. Emergency care professionals have a lack of awareness of their role in the detection of risk for suicide in patients who seek attention at emergency care facilities for reasons of general somatic issues. Mental health care professionals are in high demand in cases of self-harm, but they would like to receive specific training in dealing with suicidal behavior.

Use of New Technologies in the Prevention of Suicide in Europe: An Exploratory Study

BACKGROUND

New technologies are an integral component of today's society and can complement existing suicide prevention programs. Here, we analyzed the use of new technologies in the prevention of suicide in 8 different European countries.

OBJECTIVE

The aim of this paper was to assess the opinions of professionals in incorporating such resources into the design of a suicide prevention program for the region of Zamora in Spain. This investigation, encompassed within the European project entitled European Regions Enforcing Actions against Suicide (EUREGENAS), includes 11 regions from 8 different countries and attempts to advance the field of suicide prevention in Europe.

METHODS

Using a specifically designed questionnaire, we assessed the opinions of 3 different groups of stakeholders regarding the use, frequency of use, facilitators, content, and format of new technologies for the prevention of suicide. The stakeholders were comprised of policy and public management professionals, professionals working in the area of mental health, and professionals related to the social area and non-governmental organizations (NGOs). A total of 416 participants were recruited in 11 regions from 8 different European countries.

RESULTS

The utility of the new technologies was valued positively in all 8 countries, despite these resources being seldom used in those countries. In all the countries, the factors that contributed most to facilitating the use of new technologies were accessibility and free of charge. Regarding the format of new technologies, the most widely preferred formats for use as a tool for the prevention of suicide were websites and email. The availability of information about signs of alarm and risk factors was the most relevant content for the prevention of suicide through the use of new technologies. The presence of a reference mental health professional (MHP) was also considered to be a key aspect. The countries differed in the evaluations given to the different formats suggesting that the cultural characteristics of the country should be taken into account.

CONCLUSIONS

New technologies are much appreciated resources; however they are not often underused in the field of suicide prevention. The results of this exploratory study show that new technologies are indeed useful resources and should be incorporated into suicide prevention programs.

Approach and treatment of suicidal behavior in the clinical practice of different groups of health professionals in Spain: results of the project euregena

According to the WHO (World Health Organization) and the European Union, suicide is considered to be a health problem of prime importance and to be one of the principal causes of unnatural death. In Spain, the number of suicides has increased 12% since 2005 . The Research Project "European Regions Enforcing Actions against Suicide (EUREGENAS), funded by the Health Program 2008-2013, has as main objective the description of an integrated model of Mental Health orientated to the prevention of suicide. The differences that allow distinguishing the meaning of prevention in suicide behavior are described and explained through a qualitative methodological strategy and through the creation of discussion groups formed by different groups of health professionals. The results highlight the existing differences between the diverse health professionals who come more in contact with this problem and it shows as well the coincidence of meaning that suicide has to be considered as a priority in the field of health.

The Racial-Cultural Framework

Suicide-related outcomes are a major public health challenge in communities of color in the United States. To address these challenges, this Major Contribution makes theoretical, empirical, and practice-related contributions to scholarship on suicide-related outcomes among people of color. In this article, the authors present a new framework to conceptualize previous suicidology scholarship, address existing literature gaps, and inform counseling psychologists’ future work on suicide-related outcomes in U.S. communities of color. The framework consists of three components and nine principles that highlight the types of constructs, populations, and preventive interventions that should be emphasized in theory, research, and practice addressing suicide-related outcomes in communities of color. The authors explain why suicide-related outcomes in communities of color deserve attention, describe the framework, and discuss implications of the framework for future practice and training. It is hoped that this framework can serve as a resource and impetus for new paradigms of suicidology work in communities of color.

Murder followed by suicide: filicide-suicide mothers in Italy from 1992 to 2010

The international literature shows that in 40-50% of the cases, homicides-suicides involving children under the age of 10 are committed by mothers. Here, we report some results on homicides-suicides, in the mother-child relationship, occurred in Italy between 1992 and 2010. We examined 36 cases of filicide-suicide mothers by consulting the archives of RAI, daily newspapers, and the ANSA news agency. We focused on: mothers and children's age, place of residence, date and place of the murder, number and sex of the murdered children, and modality of the homicide-suicide. At the time of the homicide-suicide, the average age of mothers was 35.4. The number of children killed by each mother was one, except in seven cases. All the women had underestimated psychopathological disorders and only six women were regularly treated. The dynamics and characteristics of the events were much more similar to suicides than homicides, so we can consider them as "extensive suicides."

Rebuilding community resilience in a post-war context: developing insight and recommendations - a qualitative study in Northern Sri Lanka

BACKGROUND

Individuals, families and communities in Northern Sri Lanka have undergone three decades of war trauma, multiple displacements, and loss of family, kin, friends, homes, employment and other valued resources. The objective of the study was understanding common psychosocial problems faced by families and communities, and the associated risk and protective factors, so that practical and effective community based interventions can be recommended to rebuild strengths, adaptation, coping strategies and resilience.

METHODS

This qualitative, ecological study is a psychosocial ethnography in post-war Northern Sri Lanka obtained through participant observation; case studies; key- informant interviews; and focus groups discussions with mental health and psychosocial community workers as well as literature survey of media and organizational reports. Qualitative analysis of the data used ethnography, case studies, phenomenology, grounded theory, hermeneutics and symbolic interactionism techniques. Quantitative data on suicide was collected for Jaffna and Killinochchi districts.

RESULTS

Complex mental health and psychosocial problems at the individual, family and community levels in a post-war context were found to impair recovery. These included unresolved grief; individual and collective trauma; insecurity, self-harm and suicides; poverty and unemployment; teenage and unwanted pregnancies; alcoholism; child abuse and neglect; gender based violence and vulnerability including domestic violence, widows and female headed-household, family conflict and separation; physical injuries and handicap; problems specific for children and elderly; abuse and/or neglect of elderly and disabled; anti-social and socially irresponsible behaviour; distrust, hopelessness, and powerlessness. Protective factors included families; female leadership and engagement; cultural and traditional beliefs, practices and rituals; and creative potential in narratives, drama and other arts. Risk factors that were impeding community rehabilitation and recovery included continuing military governance, depletion of social capital particularly lack of trust, hope and socio-economic opportunity structures for development that would engender a sense of collective efficacy.

CONCLUSIONS

In view of the widespread trauma at the individual, family and collective levels, community based programmes to increase local awareness, knowledge and skills to deal with common mental health and psychosocial issues; and training of community level workers and others in basic mental health and psychosocial problem solving are recommended to rebuild family and community agency and resilience. The use of cultural practices and school based programmes would rekindle community processes.

Suicide and employment status during Ireland's Celtic Tiger economy

BACKGROUND

 Studies have identified employment as a protective factor against suicide. We examined employment status and risk of suicide in Ireland during the 11-year period 1996-2006, a period of economic boom commonly known as the Celtic Tiger. 

METHODS

 Data relating to the 5270 suicides and 789 deaths of undetermined intent registered as occurring in Ireland in 1996-2006 and relevant population data were obtained from the Irish Central Statistics Office and analysed using Poisson regression. 

RESULTS

 Unemployment fell from 12% in 1996 to 4% in 2000, a level at which it remained until 2006. Male and female rates of suicide and undetermined death were stable during 1996-2006 though suicide among unemployed men increased. Relative to employment, unemployment was associated with a 2-3-fold increased risk of male suicide and undetermined death but generally a 4-6-fold increased risk in women. Unemployment was associated with greater increased risk of suicide and undetermined death when its level was low (2001-06) than in the period of decreasing unemployment (1996-2000). Unemployment was a stronger risk factor in men aged 35-54 years and with increasing age in women. Retired persons aged >55 years had a similar risk to their employed counterparts. Being a homemaker was associated with increased risk in women aged >35 years. 

CONCLUSION

 The current Irish context of rapidly increasing unemployment suggests that rates may rise again as in previous recessions. Appropriate social policy responses are required to mitigate the potential impact of unemployment on suicides.

Firearm suicide in New York City in the 1990s

OBJECTIVE

Across the US, firearms are used in approximately 60% of all suicide deaths. Little research has assessed the role and determinants of firearms in suicide in major urban areas.

METHODS

The authors collected data on all suicide deaths between 1990 and 2000 from the Office of the Chief Medical Examiner of New York City (NYC) and assessed trends and correlates of firearm related suicide deaths.

RESULTS

During the period studied, there were a total of 6008 suicides in NYC; 1200 (20.0%) were firearm related suicides. There was a decrease in total suicides, total firearm suicides, and the proportion of firearm related suicides. In multivariable modeling, characteristics of suicide decedents associated with a greater likelihood of firearm suicide were: male, black race, residing in the outer boroughs, and use of cannabis.

CONCLUSIONS

The proportion of suicides caused by firearms in NYC is low compared to other parts of the US; differential access to means of committing suicide and the differential importance of firearms in different racial and ethnic groups may contribute to this observation. Innovative, local population based interventions that target non-firearm related suicide may contribute to lower suicide mortality overall in urban areas.

Multilevel modeling was a convenient alternative to common regression designs in longitudinal suicide research

BACKGROUND AND OBJECTIVE

The prospective investigation of repetitive nonfatal suicidal behavior is associated with two methodological problems. Due to the commonly used definitions of nonfatal suicidal behavior, clinical samples usually consist of patients with a considerable between-person variability. Second, repeated nonfatal suicidal episodes of the same subjects are likely to be correlated. We examined three regression techniques to comparatively evaluate their efficiency in addressing the given methodological problems.

STUDY DESIGN AND SETTING

Repeated episodes of nonfatal suicidal behavior were assessed in two independent patient samples during a 2-year follow-up period. The first regression design modeled repetitive nonfatal suicidal behavior as a summary measure. The second regression model treated repeated episodes of the same subject as independent events. The third regression model represented a hierarchical linear model.

RESULTS

The estimated mean effects of the first model were likely to be nonrepresentative for a considerable part of the study subjects. The second regression design overemphasized the impact of the predictor variables. The hierarchical linear model most appropriately accounted for the heterogeneity of the samples and the correlated data structure.

CONCLUSION

The nonhierarchical regression designs did not provide appropriate statistical models for the prospective investigation of repetitive nonfatal suicidal behavior. Multilevel modeling provides a convenient alternative.