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Lin CY, Choi M, Lee YH, Ki M, Hsu CY, Chang SS. Exploring possible causes of lower-than-expected suicide rates in Taiwan and South Korea during the 2020-2021 COVID-19 pandemic: a time trend analysis by sex, age, and method. Psychiatry Clin Neurosci 2024. [PMID: 39354699 DOI: 10.1111/pcn.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/22/2024] [Accepted: 09/03/2024] [Indexed: 10/03/2024]
Abstract
AIMS Decreases in suicide rates during the coronavirus disease 2019 (COVID-19) pandemic were found in several countries, including Taiwan and South Korea. We investigated the pattern of the reduction in suicide by sex, age, method, and outbreak period in the two countries. METHODS Suicide data for Taiwan (2015-2021) and South Korea (2017-2021) stratified by sex, age, method, and month were extracted from national mortality data files in the two countries. Negative binomial regression was used to estimate suicide rate ratios and 95% confidence intervals across outbreak and inter-outbreak periods during the pandemic, relative to that expected based on pre-pandemic trends, and their associations with economic and outbreak control stringency indicators. RESULTS There were fewer-than-expected suicides in Taiwan (7%-16% fewer suicides over outbreaks and inter-outbreaks) and South Korea (17% fewer suicides in outbreaks III and IV). Fewer-than-expected suicides were found primarily in the working-age populations aged 25 to 64 years in Taiwan and those aged 45 to 64 years in South Korea. In both countries, fewer-than-expected suicides by charcoal burning during the pandemic were consistently found; the greatest reduction occurred when the outbreak control measures were most restricted. Increased time at residence was associated with decreased suicide rates in South Korea. CONCLUSION Taiwan and South Korea showed reduced suicide rates during the COVID-19 pandemic in 2020-2021. Potential reasons for the decrease in suicides may include reduced access to suicide means during outbreaks in the two countries.
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Affiliation(s)
- Chien-Yu Lin
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Minjae Choi
- Institute for Future Public Health, Graduate School of Public Health, Korea University, Seoul, South Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yo Han Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Myung Ki
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Chia-Yueh Hsu
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, 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
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
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Ortiz-Prado E, Izquierdo-Condoy JS, Fernandez-Naranjo R, Vásconez-González J, Encalada S, Mosquera J, Cordovez S, Camino N, Montenegro-Salazar D, Viscor G, Diaz AM, Paz C. The burden of suicide across different altitudes: 11-year geodemographic analysis conducted in 221 cantons in Ecuador ranging from 0 to 4300 m of elevation. BJPsych Open 2024; 10:e161. [PMID: 39313761 PMCID: PMC11457200 DOI: 10.1192/bjo.2024.736] [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: 02/03/2023] [Revised: 04/09/2024] [Accepted: 06/18/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND The World Health Organization and the Global Burden of Disease study estimate that almost 800 000 people die from suicide yearly. The role of non-traditional risk factors such as climate and high-altitude exposure are poorly understood. AIMS This study aims to determine a potential relationship between altitude exposure and suicide rates among 221 cantons located at different altitudes ranging from 0 to 4300 m. METHOD We conducted an 11-year, country-wide, population-based analysis on age- and gender-standardised suicide rates in Ecuador, based on the official data from the National Institute of Statistics, using all available self-harm death codes (ICD-10 codes X60-X84). RESULTS A total of 11 280 cases of suicide were reported during 2011-2021. Suicide rates were higher among men (11.48/100 000). In terms of elevation, suicide rates were significantly higher among people from high-altitude cantons (3.7/100 000) versus those from low-altitude cantons. When applying the International Society Mountain Medicine categorisation, suicide rates were significantly higher at moderate- (4.3/100 000), high- (3.6/100 000) and very-high-altitude cantons (4.4/100 000) when compared with low-altitude locations (2.5/100 000). CONCLUSIONS Ecuador is one of the few countries that has a vast range of cantons located at different altitudes. We found that living at higher elevations is positively associated with greater suicide rates. Although the rates are significantly greater as elevation increases, a clear linear relationship is not apparent, likely because of the interplay of socioeconomic factors, including urbanicity. The effect of chronic hypobaric hypoxia on mood cannot be ruled out, although the existence of causal mechanisms remains to be elucidated.
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Ecuador
| | | | | | | | - Sebastián Encalada
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Ecuador
| | - Johanna Mosquera
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Ecuador
| | - Simone Cordovez
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Ecuador
| | - Nicole Camino
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Ecuador
| | | | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Universidad de Barcelona, Spain
| | - Ana María Diaz
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Ecuador
| | - Clara Paz
- Wellbeing, Health and Society Research Group, School of Psychology and Education, Universidad de Las Américas, Ecuador
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Shin S, Pirkis J, Clapperton A, Spittal M, Too LS. Effectiveness of partial restriction of access to means in jumping suicide: lessons from four bridges in three countries. Epidemiol Psychiatr Sci 2024; 33:e38. [PMID: 39291543 PMCID: PMC11450421 DOI: 10.1017/s2045796024000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/26/2024] [Accepted: 06/02/2024] [Indexed: 09/19/2024] Open
Abstract
AIMS Restricting access to means by installing physical barriers has been shown to be the most effective intervention in preventing jumping suicides on bridges. However, little is known about the effectiveness of partial restriction with interventions that still allow jumping from the bridge. METHODS This study used a quasi-experimental design. Public sites that met our inclusion criteria were identified using Google search and data on jumping suicides on Bridge A (South Korea), Bridges B and C (the United States) and Bridge D (Canada) were obtained from the relevant datasets. Incidence rate ratios (IRRs) were estimated using Poisson regressions comparing suicide numbers before and after the installation of physical structures at each site. RESULTS Fences with sensor wires and spinning handrails installed above existing railings on the Bridge A, and fences at each side of the entrances and the midpoint of main suspension cables on the Bridge D were associated with significant reductions in suicides (IRR 0.37, 95% Confidence Interval (CI) 0.26 - 0.54; 0.26, 95% CI 0.09 - 0.76). Installation of bird spike on the parapet on the Bridge B, and fences at the front of seating alcoves on the Bridge C were not associated with changes in suicides (1.21, 95% CI 0.88 - 1.68; 1.49, 95% CI 0.56 - 3.98). CONCLUSIONS Partial means restriction (such as fences with sensor wires and spinning bars at the top, and partial fencing at selected points) on bridges appears to be helpful in preventing suicide. Although these interventions are unlikely to be as effective as interventions that fully secure the bridge and completely prevent jumping, they might best be thought of as temporary solutions before more complete or permanent structures are implemented.
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Affiliation(s)
- Sangsoo Shin
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Angela Clapperton
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Matthew Spittal
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Lay San Too
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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Mikolič P, Vinko M, Ropret N, Roškar S. Suicide Methods in Slovenia - Characteristics andTime Trends 2001-2020. CRISIS 2024; 45:93-99. [PMID: 37554045 DOI: 10.1027/0227-5910/a000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Background: Between 2001 and 2020, Slovenia lost 8,952 lives due to suicides, two thirds of them by hanging. Aim: To analyze trends in suicide methods between 2001 and 2020 and to explore relationships between suicide methods and selected sociodemographic characteristic. Methods: We focused on methods accounting for 95.7% of all suicides. We performed joinpoint regression to examine changes in suicide rates by respective methods and multivariate logistic regression analyses to study sociodemographics associated with specific suicide methods. Results: A gender-specific annual decrease in suicide rates was observed in all methods except for sharp objects and jumping or lying in front of a moving object. Age was statistically significant in the use of firearms and jumping or lying in front of a moving object, while gender was significant in all methods. Associations were found between education, marital status, region of residence, and various suicide methods. Limitations: The results are potentially culturally specific. Conclusion: Certain sociodemographics seem to be associated with the selection of the method.
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Affiliation(s)
- Petra Mikolič
- Mental Health Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Matej Vinko
- Mental Health Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Nina Ropret
- Health Data Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Saška Roškar
- Mental Health Centre, National Institute of Public Health, Ljubljana, Slovenia
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Dabholkar S, Pirani S, Davis M, Khan M, Eddleston M. Suicides by pesticide ingestion in Pakistan and the impact of pesticide regulation. BMC Public Health 2023; 23:676. [PMID: 37041526 PMCID: PMC10088141 DOI: 10.1186/s12889-023-15505-1] [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: 08/23/2022] [Accepted: 03/22/2023] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Suicide is a major public health problem in Pakistan, accounting to approximately 19,331 deaths every year. Many are due to consumption of acutely toxic pesticides; however, there is a lack of national suicide data, limiting knowledge and potential for intervention. In this paper, we aimed to review the literature on pesticide self-poisoning in Pakistan to identify the most problematic pesticides in relation to national pesticide regulations. METHODS Information on the currently registered and banned pesticides was obtained from Ministry of National Food Security and Research while data on pesticide import and use was extracted from FAOSTAT. We searched the following sources for articles and research papers on poisoning in Pakistan: Cumulative Index to Nursing and Allied Health (CINAHL), Google Scholar, Applied Social Sciences Index and Abstracts (ASSIA), Excerpta Medica (EMBASE), National Library of Medicine's MEDLINE (PUBMED), PS102YCHINFO and Pakmedinet.com using the search terms 'self-poisoning', 'deliberate self-harm', 'suicide', 'methods and means of suicide', 'organophosphate', 'wheat pill', 'aluminium phosphide', 'acute poisoning', OR 'pesticides', AND 'Pakistan'. RESULTS As of May 2021, 382 pesticide active ingredients (substances) were registered in Pakistan, of which five were WHO hazard class Ia (extremely hazardous) and 17 WHO hazard class Ib (highly hazardous). Twenty-six pesticides, four formulations, and seven non-registered pesticides had been banned, of which two were WHO class Ia and five Ib. We identified 106 hospital-level studies of poisoning conducted in Pakistan, of which 23 did not mention self-poisoning cases and one reported no suicidal poisoning cases. We found no community or forensic medicine studies. Of 52,323 poisoning cases identified in these papers, 24,546 [47%] were due to pesticides. The most commonly identified pesticide classes were organophosphorus (OP) insecticides (13,816 cases, 56%) and the fumigant aluminium phosphide (3 g 56% tablets, often termed 'wheat pills'; 686 cases, 2.7%). Few studies identified the particular pesticides involved or the resulting case fatality. CONCLUSION We found pesticide poisoning to be a major cause of poisoning in Pakistan, with OP insecticides and the fumigant aluminium phosphide the main pesticides identified. Withdrawal of Class I pesticides (as proposed to occur nationally in 2022) and high concentration aluminium phosphide tablets should rapidly reduce suicidal deaths by reducing the case fatality for low-intention poisoning cases. National cause of death data and forensic toxicology laboratory data identifying the pesticides responsible for deaths will be important to assess impacts of the proposed national ban.
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Affiliation(s)
- Shweta Dabholkar
- Centre For Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Shahina Pirani
- Department of Psychiatry, & Brain & Mind Institute, Aga Khan University, Karachi, Pakistan
| | - Mark Davis
- Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Murad Khan
- Department of Psychiatry, & Brain & Mind Institute, Aga Khan University, Karachi, Pakistan
| | - Michael Eddleston
- Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
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Abstract
INTRODUCTION Suicide by charcoal burning has accounted for more than 100,000 deaths. It has become an increasingly common suicide method in Hong Kong since first reported in 1998, and it has spread into South Korea, Taiwan, Japan and other countries. This systematic scoping review aimed to explore current evidence on trends, risk factors, impact of media and prevention strategies for this suicide method, and to identify research gaps. METHODS A search for articles published from January 1998 to June 2021 was conducted through electronic databases (MEDLINE, EMBASE, SCOPUS and PsycINFO) with the keywords (suicide*) AND (charcoal). Articles describing prevalence, trends, characteristics, risk factors and prevention strategies of charcoal burning suicide deaths were included. Non-peer-reviewed articles, non-English articles, commentaries/editorials/letters, poster abstracts, reviews, meta-analyses and studies that documented only charcoal burning suicide attempters/survivors were excluded. RESULTS Eighty-eight studies were identified, most from East Asia. Charcoal burning suicide rates in Hong Kong, Taiwan and Japan has passed the peak, while continuing to increase in South Korea. Risk factors are changing and not static. Media appears to play an important role in triggering and spreading information. Restricting access to charcoal, and raising public awareness have been effective in the short term in preventing charcoal burning suicide, but there is little information on their long-term effectiveness or sustainability. DISCUSSION More research is required to update the development and dynamic changes of charcoal burning suicide and the contributing factors. The evidence from this review may assist in detecting and intervening early for future novel suicide methods.
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Affiliation(s)
- Cheuk Yui Yeung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Vera Yu Men
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, China
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Lin CY, Hsu CY, Gunnell D, Chang SS. Factors associated with fewer than expected suicides in Taiwan during the COVID-19 pandemic in 2020. Asian J Psychiatr 2023; 80:103379. [PMID: 36502779 PMCID: PMC9721156 DOI: 10.1016/j.ajp.2022.103379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Chien-Yu Lin
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan; Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Chia-Yueh Hsu
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, UK; National Institute of Health and care Research Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, UK
| | - 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; Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan.
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