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Stephenson L, Van Den Heuvel C, Humphries M, Byard RW. Recent trends in an uncommon method of carbon monoxide suicide. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00810-x. [PMID: 38600421 DOI: 10.1007/s12024-024-00810-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The most prevalent method of carbon monoxide (CO) suicide is inhalation of vehicle exhaust (VE). However, a new method of CO suicide has recently emerged involving charcoal burning (CB) in a confined space to produce fatal CO levels. This method has been reported from countries in Asia, associated with economic instability and media reporting of high-profile celebrity cases. The current study was undertaken to analyze rates and characteristics of CB suicides in South Australia (SA) for comparison with respect to their characteristics and scene, autopsy and toxicology findings. METHODS A search was undertaken for all intentional fatal carbon monoxide poisonings in SA between 2000 and 2019. Collected variables included age, sex, cause of death, location of death, decedent histories, scene, autopsy and toxicology findings and manner of death. Statistical analyses were performed using R (version 4.2.3). RESULTS There was a significant decrease in VE suicides (p < 0.05) and a significant increase in CB suicides (p < 0.001) over the 20-year period. Those who used CB were found to be, on average, between 1.5 and 15.8 years younger than those who used VE (p = 0.017). The risk factors for CB suicide included psychological/psychiatric conditions and financial problems, while VE suicides were associated with a history of physical problems and contact with the legal system. External and internal autopsy findings were consistent with the literature. CONCLUSION CB suicide is perceived to be widely accessible and painless and is therefore becoming a popular suicide method. Monitoring future trends will be important to determine whether intervention is required.
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Affiliation(s)
- Lilli Stephenson
- School of Biomedicine, The University of Adelaide, Adelaide, SA, 5000, Australia.
- School of Biomedicine Level 2 Helen Mayo North , The University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia.
| | | | - Melissa Humphries
- School of Computer and Mathematical Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Roger W Byard
- School of Biomedicine, The University of Adelaide, Adelaide, SA, 5000, Australia
- Forensic Science SA (FSSA), 21 Divett Pl, Adelaide, SA, 5000, Australia
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Chen YY, Chen F, Wu KCC, Lu TH, Chi YC, Yip PS. Dynamic reciprocal relationships between traditional media reports, social media postings, and youth suicide in Taiwan between 2012 and 2021. SSM Popul Health 2023; 24:101543. [PMID: 37965108 PMCID: PMC10641279 DOI: 10.1016/j.ssmph.2023.101543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/16/2023] Open
Abstract
Rising social media use over the past decade has been linked with increasing suicide rates among young people. Previous studies that assessed the impact of social media on suicide have typically focused on single social media platforms, such as Twitter, and assumed unidirectional associations, where social media posts leads to suicide. Our study focused on the past decade (2012-2021) which has witnessed a rapid increase of social media platforms and use. Poisson and negative binominal auto-regression models were employed to examine the dynamic reciprocity between social media, traditional media and youth suicides in Taiwan. Increased volume in suicide-related social media posts positively correlated with increased youth suicide rates (β = 2.53 × 10-5, 95% CI= (0.83 × 10-5, 4.24 × 10-5), P < 0.01), but increased rates of youth suicide was not related to an increase in suicide-related social media posts. Suicide-related posts on social media triggered reporting of suicide-related news on traditional media platforms (β = 3.35 × 10-2, 95% CI= (2.51 × 10-2, 4.19 × 10-2), P < 0.001), whilst traditional media reports of suicide led to increased suicide-related social media posts (β = 6.13 × 10-1, 95% CI = (4.58 × 10-1, 7.68 × 10-1); P < 0.001). However, suicide-related reports on traditional media platforms did not directly lead to an increase in youth suicide rates. Our findings highlight challenges for suicide prevention strategies in the 21st Century, in dealing with the increasing prominence of social media over traditional media. As social media is more difficult to regulate than traditional media, suicide prevention efforts must adapt to this new landscape by developing innovative strategies that address the unique risks and opportunities presented by social media.
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Affiliation(s)
- Ying-Yeh Chen
- 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
| | - Feng Chen
- School of Mathematics and Statistics, the University of New South Wales, Sydney, Australia
- UNSW Data Science Hub (uDASH), the University of New South Wales, Sydney, Australia
| | - 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
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Chen Chi
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
| | - Paul S.F. Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
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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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Yip PSF, Pinkney E. Social media and suicide in social movements: a case study in Hong Kong. JOURNAL OF COMPUTATIONAL SOCIAL SCIENCE 2022; 5:1023-1040. [PMID: 35252621 PMCID: PMC8886558 DOI: 10.1007/s42001-022-00159-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
Research has indicated that excessive and sensationalized suicide reporting can lead to copycat suicides, especially when deaths involve well-known people. Little is known, however, about the impact of the reporting of suspected protestor suicide deaths during social unrest, particularly in an age of social media. In June 2019, the most substantial social unrest in Hong Kong since its handover in 1997 was triggered by the proposed Anti-Extradition Law Amendment Bill (Anti-ELAB). The social unrest subsided when Hong Kong and many parts of the world were hit by Covid-19 and very strict quarantine measures were imposed on crowd gatherings in Hong Kong at the end of January 2020. A number of reported suicides and deaths of undetermined cause took place during this 8-month period that received considerable attention. To better understand the possible effects of these highly publicized deaths, we examined media reports of suspected suicide cases before, during and after the protest period, as well as topics of suicide-related threads and their replies in social media forums. We found no clear evidence of increased rates of suicide as a result of these incidents, or during the protest period; however, it is suggested that certain narratives and attention surrounding the suspected suicides and undetermined deaths may have contributed to collective emotions such as sadness and anxiety. Some implications for misinformation (intentionally or un-intentionally) and mitigation of suicide risk during social unrest are discussed.
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Affiliation(s)
- Paul S. F. Yip
- Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Edward Pinkney
- Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong
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Yip PSF, Yeung CY, Chen YC, Lai CCS, Wong CLH. An evaluation of the long-term sustainability of suicide prevention programs in an offshore Island. Suicide Life Threat Behav 2022; 52:4-13. [PMID: 33998032 DOI: 10.1111/sltb.12764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/06/2020] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In 2002, a suicide prevention program for visitors was implemented in Cheung Chau, an offshore island with 21,000 residents and many visitors. This research revisited the intervention and evaluated its long-term effectiveness. Insights are provided into implementing a sustainable intervention. METHODS Suicide death records (2007-2017) of Cheung Chau residents and visitors were retrieved. Information related to suicide method and sociodemographic characteristics of people who died by suicide were explored. Bivariate analyses were conducted to examine differences between visitors and residents; visitors and residents who died in Cheung Chau; and residents who died in or outside Cheung Chau. RESULTS After post-implementation period, suicide rate for visitors and residents increased. Visitors were generally younger than the residents with a different distribution of type of housing. Most of the visitors killed themselves by charcoal burning, and nearly half of the residents used hanging. CONCLUSION Long-term evaluation and monitoring of suicide prevention programs and sustained efforts are crucial to ensure program success. The prevention program in Cheung Chau was initially effective, but its long-term effects wore off. Both the mental health needs of visitors and residents should be addressed. Refinement of the current program and sustainable efforts are required for ensuring long-term success.
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Affiliation(s)
- Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR.,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, Pokfulam, Hong Kong SAR
| | - Cheuk Yui Yeung
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Yu-Chih Chen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Carmen Chui Shan Lai
- 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, Pokfulam, Hong Kong SAR
| | - Clifford Long Hin Wong
- 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, Pokfulam, Hong Kong SAR
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Han S, Cho YS. Hyperbaric Oxygen Therapy in Carbon Monoxide Poisoning: Still Controversial. J Emerg Med 2021; 61:619-620. [PMID: 34916058 DOI: 10.1016/j.jemermed.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/05/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
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Factors Predicting Acute Brain Injury in Cases of Carbon Monoxide Poisoning: A Prospective Registry-Based Study. TOXICS 2021; 9:toxics9060120. [PMID: 34071902 PMCID: PMC8229430 DOI: 10.3390/toxics9060120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/03/2022]
Abstract
Carbon monoxide (CO) is one of the most common poisoning substances worldwide. Since acute brain injury (ABI) is an important determinant of the neurological outcome in CO poisoning, screening for patients at a high risk of developing ABI is essential for the proper treatment. This study identified predictors of ABI in patients with CO poisoning. This prospective registry-based study was conducted in patients who visited a tertiary care hospital for CO poisoning from August 2016 to June 2020. ABI was defined as the presence of acute hypoxic lesions on diffusion-weighted magnetic resonance imaging. Multiple logistic regression analysis was performed to identify the predictors of ABI. Of 231 patients, 64 (27.7%) showed ABI. Multiple logistic regression analysis showed that a Glasgow Coma Scale (GCS) score <9 at presentation (odds ratio [OR] 3.28, 95% confidence interval (CI) 1.08–10.01), creatinine level >1.2 mg/dL (OR 3.04, 95% CI 1.16–8.01), and C-reactive protein (CRP) level >9.2 mg/L (OR 4.38, 95% CI 1.41–13.65) predicted ABI in cases of acute CO poisoning. In CO poisoning, the GCS score at presentation, and serum creatinine and CRP levels, were useful predictors of ABI, and may help clinicians identify high-risk patients for whom treatment should be prioritized.
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Huang CY, Tsai CW, Chi YC, Wu KCC, Chen YY. Changes in accessibility of suicide-related information on websites in Taiwan during 2016 and 2019. J Formos Med Assoc 2021; 121:335-341. [PMID: 34024719 DOI: 10.1016/j.jfma.2021.05.005] [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: 01/04/2021] [Revised: 04/20/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/PURPOSE To the best of our knowledge, no studies have examined longitudinal changes in the accessibility of suicide-related content on Chinese-language websites. We investigated changes between 2016 and 2019 in suicide-related materials likely to be accessed by individuals through websites in Taiwan. METHODS In March 2019, we searched the Taiwanese versions of Google and Yahoo! using six suicide-related terms and compared the results to a search performed in 2016. Website characteristics (e.g., pro- or anti-suicide) generated by various keywords were calculated and compared in 2016 and 2019. RESULTS The number of anti-suicide websites exceeded that of pro-suicide websites in 2016 and 2019. Between 2016 and 2019, the proportion of pro-suicide sites decreased slightly from 16.3% (61 out of 375 sites) to 12.3% (51 out of 417 sites) (p = 0.10). User-generated webpages constituted the primary source of pro-suicide content at both time points. Over the same period, the proportion of pro-suicide information on internet forums decreased from 59.1% to 17.8% (p < 0.001); by contrast, pro-suicide content on news websites increased significantly, from 1.9% to 11.3% (p = 0.005). Searches with the term "painless suicide" were more likely to yield pro-suicide websites and less likely to generate anti-suicide ones than searches with "suicide" in both 2016 and 2019. CONCLUSIONS Harmful suicide-related information circulating on websites remained easily accessible to internet users in Taiwan, particularly through user-generated and news websites. Proper site moderation and implementation of online suicide reporting guidelines are still warranted.
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Affiliation(s)
- Cho-Yin Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chi-Wei Tsai
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan; Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Ying-Chen Chi
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, 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.
| | - Ying-Yeh Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei City, Taiwan.
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Han S, Nah S, Choi S, Kim GW, Lee YH. Optimal sessions of hyperbaric oxygen therapy in patients with carbon monoxide poisoning: A prospective observational study. Am J Emerg Med 2021; 44:132-136. [PMID: 33610831 DOI: 10.1016/j.ajem.2020.10.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/27/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Hyperbaric oxygen (HBO) therapy may be a useful treatment to prevent the development of delayed neuropsychiatric sequelae (DNS) in patients with acute carbon monoxide (CO) poisoning. However, there is no clear consensus regarding the optimal number of HBO therapy sessions in patients with CO poisoning. Here, we compared the development of DNS after 3 and > 3 sessions of HBO therapy in patients with acute CO poisoning. METHODS This prospective observational study recruited 299 patients with CO poisoning. Demographic and clinical information were obtained, including comorbidities, vital signs, and symptoms. Patients were divided into two groups according to whether they received 3 or > 3 sessions of HBO therapy (3 HBO vs. >3 HBO). A propensity score-matching process was used to balance potential prognostic factors in both groups. RESULTS Of the 299 patients with acute CO poisoning enrolled in this study, 183 (59.0%) were included in the analysis. Patients were excluded for the following reasons: age < 18 years, not underwent HBO therapy, discharged against medical advice, and loss to follow-up. The overall rate of DNS development was 17.5%. The >3 HBO group had a higher incidence of DNS development compared to the 3 HBO group (36.3% vs. 16.3%; p = 0.09). Propensity score-matching analysis revealed similar incidences of DNS (31.3% vs. 28.1%, respectively; p > 0.99). CONCLUSIONS There is a critical need to determine the optimal number of HBO therapy sessions for patients with acute CO poisoning. This study showed no difference in DNS development after 3 and > 3 sessions of HBO therapy.
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Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
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Han S, Choi S, Nah S, Lee SU, Cho YS, Kim GW, Lee YH. Cox regression model of prognostic factors for delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning: A prospective observational study. Neurotoxicology 2020; 82:63-68. [PMID: 33232744 DOI: 10.1016/j.neuro.2020.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A major challenge for physicians is to identify patients with acute carbon monoxide (CO) poisoning who are likely to develop delayed neuropsychiatric sequelae (DNS). DNS is defined as neuropsychological sequelae that develops after 2-40 days of lucid interval after CO intoxication. Currently, there is no consensus on factors that predict the prognosis of CO poisoning. Thus, the purpose of this study was to identify factors predicting the development of DNS using a Cox regression model. METHODS This prospective observational study included 310 CO-poisoned patients admitted to an emergency department in South Korea from July 2017 to February 2020. Demographic, clinical, and laboratory data were analyzed. Kaplan-Meier curves were constructed to estimate the cumulative incidence of DNS. A multivariate Cox regression model was used to identify the main predictors of the development of DNS. RESULTS The incidence of DNS was 18.8 %, and the median onset time was 23.7 days (interquartile range, 14-30 days). The Kaplan-Meier survival curve showed that a serum creatine kinase (CK) level > 175.5 U/L and initial Glasgow Coma Scale (GCS) score ≤ 9 were associated with a higher cumulative incidence of DNS (log-rank test; p < 0.01 and p = 0.02, respectively). Cox regression analysis showed that a serum CK level > 175.5 U/L (hazard ratio [HR]: 2.862, 95 % confidence interval [CI]: 1.491-5.496; p < 0.01) and an initial GCS ≤ 9 (HR: 2.081, 95 % CI: 1.048-4.131; p = 0.04) were significant prognostic factors. CONCLUSION In acute CO poisoning, an initial GCS score ≤ 9 and serum CK level > 175.5 U/L are significant predictors of DNS development.
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Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
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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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Kim H, Ryu JM, Kim HW. Characteristics and Trends of Suicide Attempt or Non-suicidal Self-injury in Children and Adolescents Visiting Emergency Department. J Korean Med Sci 2020; 35:e276. [PMID: 32830466 PMCID: PMC7445307 DOI: 10.3346/jkms.2020.35.e276] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/03/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) and suicidality are common reasons for child and adolescent psychiatric emergencies. We aimed to investigate the incidence of pediatric emergency department (PED) utilization for psychiatric problems in children and adolescents and to identify demographic and clinical characteristics of youths who visited the PED for suicide attempt (SA) and/or NSSI. METHODS The medical records of children and adolescents who visited the PED for psychiatric problems from January 2015 to November 2019 were reviewed retrospectively. Demographic and clinical variables including psychiatric disorders were collected. We compared the characteristics of youths who presented to the PED for SA and/or NSSI with those of youths without SA or NSSI. Student's t-test, χ² test, and multivariate logistic regression were used for statistical analysis. RESULTS During 59 months of observation, 194 youths visited the PED and the number of total PED visits was 336. Among them, 46 youths (23.7%) visited the PED for SA and/or NSSI at least once, and the number of visits was 91 (27.1% of PED visits). Youths with SA and/or NSSI were older (P = 0.001) and more likely to be a girl (P = 0.005) and to report parental absence (P = 0.023). Bipolar and related disorders (P = 0.032) and depressive disorders (P = 0.004) were more common in youths with SA and/or NSSI, while schizophrenia spectrum and other psychotic disorders (P = 0.030) and somatic symptom and related disorders (P = 0.007) were more common in those without SA and NSSI. After adjusting for age, sex, and parental marital status, bipolar and related disorders (odds ratio [OR], 6.72), depressive disorders (OR, 9.59), and somatic symptom and related disorders (OR, 0.12) were significantly associated with SA and/or NSSI. Youths with SA and/or NSSI also stayed longer in the PED (P = 0.007). CONCLUSION SA and NSSI are one of the main reasons for child and adolescent admittance to psychiatric services in the PED and are associated with psychiatric comorbidities. An appropriate risk assessment for suicidality and self-injury and proper management and referral to mental health services at the PED are of the utmost importance.
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Affiliation(s)
- Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Min Ryu
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Won Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Cai Z, Chang Q, Yip PSF. A scientometric analysis of suicide research: 1990-2018. J Affect Disord 2020; 266:356-365. [PMID: 32056899 DOI: 10.1016/j.jad.2020.01.121] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/05/2019] [Accepted: 01/20/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increasing knowledge on suicide prevention has been shown to be important for suicide prevention. This paper exams the accomplishment of research on suicide and examine how those research activities contribute to the change of suicide rates. METHODS Data of the publications relating to suicide from 1990 to 2018 were retrieved from the Web of Science and Scopus. Bibliographic information was analyzed and the relationships between suicide rates with the number of publications per million population and the average article citations per year were examined. RESULTS From 1990 to 2018, globally, publications on suicide have increased significantly. The United States ("USA") had the greatest number of publications. Research collaborations among different countries/regions have been flourishing and multinational centers have become more common than ever. Nonetheless, in some countries/regions with high rates of suicide, suicide research was scarce. It was found that the number of publications per million population and the average article citations per year were negatively correlated with the suicide rates at the global level (r = - 0.96, p < 0.001; r = -0.91, p < 0.001, respectively), but not in the higher SDI regions (r = -0.05, p = 0.81; r = 0.02, p = 0.91, respectively). Furthermore, research focusing on suicide intervention was also relatively limited. LIMITATION The origins of the publications were only based on the corresponding authors' regions. CONCLUSIONS There is significant imbalance in the amount of research effort especially in the regions with high suicide rates. In the higher socioeconomic level regions, the quantity and quality of publications sometimes do not transpire in the reduction of suicide rates. A better connection between the fundamental and practical suicide research should be established. More resources should be made available to the low- and middle-income countries/regions with higher suicide risks, then the effect of suicide prevention might be much more significant.
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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
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; 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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van Leeuwen L, Bommelé J, Hoogcarspel B. Responsibly Communicating Delays After Suicides on Railways. CRISIS 2019; 41:280-287. [PMID: 31859559 DOI: 10.1027/0227-5910/a000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: By communicating collision with a person as a reason for post-suicide railway delays, railway companies may involuntarily communicate to the public that colliding with a train is a suicide method. Aims: To compare the impact of the collision with a person delay announcement with an announcement about emergency services and one about collision with an animal (control announcement), we measured suicide-related emotions, associations with suicide, and announcement appreciation. Method: A randomized controlled online experiment (N = 664) was conducted. Results: After exposure to the collision with a person announcement, participants were 9.1 times more likely to indicate suicide as the most probable reason for the delay than after the emergency services announcement. The emotional impact of both announcements was low. Still, participants reported more anger toward the victim after exposure to the collision with a person announcement than after exposure to the emergency services announcement. Announcement appreciation was significantly higher after exposure to collision with a person. Limitations: This online experiment may have reflected real-life situations concerning train delays to only a limited extent. Conclusion: From the perspective of suicide prevention, the emergency services announcement is a more appropriate delay announcement than the collision with a person announcement.
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Affiliation(s)
- Lonneke van Leeuwen
- Youth and Risky Behavior Department, Trimbos Institute, Utrecht, The Netherlands
| | - Jeroen Bommelé
- Drug Monitoring and Policy Department, Trimbos Institute, Utrecht, The Netherlands
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Arendt F. Assessing responsible reporting on suicide in the nineteenth century: Evidence for a high quantity of low-quality news. DEATH STUDIES 2019; 45:305-312. [PMID: 31204892 DOI: 10.1080/07481187.2019.1626952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The press may have contributed to suicide as a mass phenomenon during the nineteenth century. There is limited knowledge on how the press reported on suicide. We utilized a content analysis of suicide news during the time period of suicide rate's strong increase in Austria (1855, 1865, 1875, 1885), assessing variables related to the responsible reporting on suicide (RRS). Analyses indicate that the press showed low levels of RRS and the quantity of low-quality reporting increased during the observation period. Although causal claims should be made with caution, the findings are consistent with the idea of a long-term Werther effect.
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Affiliation(s)
- Florian Arendt
- Department of Communication, University of Vienna, Vienna, Austria
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16
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Kim D. Economic cycle, fertility, and seasonal pattern of suicide rates in South Korea from 1995 to 2015. J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-018-0949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Implementation and outcomes of suicide-prevention strategies by restricting access to lethal suicide methods in Korea. J Public Health Policy 2019; 40:91-102. [PMID: 30478435 DOI: 10.1057/s41271-018-0152-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
For more than 10 years, the suicide rate in South Korea has been the highest among members of the Organization for Economic Cooperation and Development. Suicide-prevention strategies, such as restricting access to lethal suicide methods, have been implemented in Korea. In this paper, we discuss suicide-prevention strategies that restrict access to the five leading methods for committing suicide: pesticide ingestion, inhalation of charcoal fumes, jumping from heights, placing oneself in front of moving subway trains, and hanging oneself by the neck. Of the five suicide-prevention strategies outlined in our study, prohibition of the herbicide paraquat and installation of screen doors were proven to be effective, while others need further assessments. Yet, the overall decline in suicide rate from 31.7 per 100,000 people in 2011 to 27.3 per 100,000 people in 2014 suggests that these suicide-prevention strategies have successfully decreased the suicide rate in Korea.
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18
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Lee SY. Media coverage of celebrity suicide caused by depression and increase in the number of people who seek depression treatment. Psychiatry Res 2019; 271:598-603. [PMID: 30554108 DOI: 10.1016/j.psychres.2018.12.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/07/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022]
Abstract
We examined how media coverage of a celebrity who died by suicide due to depression was associated with the change in the number of people who visited a psychiatrist for depression. For this, of all news articles published in South Korea between 2010 and 2017, we identified all cases in which a celebrity died by suicide due to depression. Further, from the Korean health big data system, we collected monthly data on the number of people who visited a psychiatrist for depression. Regression analyses showed that, when there was media coverage of celebrity suicide due to depression in a particular month, more people visited a psychiatrist for depression-not in the same month but in the following month. We also found that, when there was media coverage of celebrity suicide due to depression, more news articles provided information about depression treatment or prevention. But, the increase in the number of such news articles did not play mediating roles between the media coverage of celebrity suicide, of which depression was known to be the main cause, and the increase in the number of visits to a psychiatrist.
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Affiliation(s)
- Sang Yup Lee
- Department of Communication, Yonsei University, Seoul, South Korea.
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19
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Abstract
BACKGROUND Suicide rates increased substantially in many countries during the 19th century. Little is known about news coverage on suicide in this period and its relationship to suicide rates. AIMS To test whether there was a covariation between the quantity of reporting and suicide rates and whether the press relied on sensational reporting. METHOD A content analysis of Austrian news coverage between 1819 and 1944 was conducted and compared with contemporary findings. RESULTS There were similar corresponding troughs and peaks in both time series, indicative of covariation. The analysis revealed that variations in the quantity of reporting predicted the following year's suicide rates, a pattern consistent with a long-term Werther effect. Conversely, suicide rates did not predict future values of the quantity of reporting. Furthermore, the press substantially overrepresented "vivid" firearm suicides compared with other more "pallid" methods such as drowning, indicative of sensational reporting. LIMITATIONS The causal order of the quantity of reporting and suicide rates should be interpreted with caution. CONCLUSION The press may have contributed to the establishment of suicide as a mass phenomenon in the 19th century. The contemporary comparison is indicative of temporal stability.
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Affiliation(s)
- Florian Arendt
- 1 Department of Communication Science and Media Research, University of Munich (LMU), Germany
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20
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Sinyor M, Schaffer A, Heisel MJ, Picard A, Adamson G, Cheung CP, Katz LY, Jetly R, Sareen J. Media Guidelines for Reporting on Suicide: 2017 Update of the Canadian Psychiatric Association Policy Paper. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63. [PMID: 29513631 PMCID: PMC5846968 DOI: 10.1177/0706743717753147] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This paper has been substantially revised by the Canadian Psychiatric Association's Research Committee and approved for republication by the CPA's Board of Directors on May 3, 2017. The original policy paper1 was developed by the Scientific and Research Affairs Standing Committee and approved by the Board of Directors on November 10, 2008.
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Affiliation(s)
- Mark Sinyor
- 1 Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Psychiatrist, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Ayal Schaffer
- 2 Interim Psychiatrist-in-Chief and Head, Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario; Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Vice-President, Education, International Society for Bipolar Disorders
| | - Marnin J Heisel
- 3 Associate Professor and Research Director (Psychiatry), Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario; Scientist, Lawson Health Research Institute, London, Ontario; Adjunct Faculty, University of Rochester Center for the Study and Prevention of Suicide, Rochester, New York
| | - André Picard
- 4 Health Columnist, The Globe and Mail, Toronto, Ontario
| | - Gavin Adamson
- 5 Associate Professor, School of Journalism, Ryerson University, Toronto, Ontario
| | - Christian P Cheung
- 6 Research Student, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Laurence Y Katz
- 7 Professor, Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Rakesh Jetly
- 8 Head, Centre of Excellence, Directorate of Mental Health, Canadian Armed Forces Health Services, Ottawa, Ontario; Chair, Military Mental Health, Royal Ottawa Hospital, Ottawa, Ontario; Assistant Professor, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | - Jitender Sareen
- 9 Professor and Head, Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Paul E, Mergl R, Hegerl U. Has information on suicide methods provided via the Internet negatively impacted suicide rates? PLoS One 2017; 12:e0190136. [PMID: 29284015 PMCID: PMC5746214 DOI: 10.1371/journal.pone.0190136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 12/10/2017] [Indexed: 12/03/2022] Open
Abstract
Suicide rates in Germany consistently decreased from 1991 to 2006, but this trend was reversed in 2007. Underlying this reversal were large increases in suicides due to gassing in females and in being overrun in males. During a similar time period (2005-2013), Asian and some Western countries have also observed abrupt increases in suicides due to certain gasses, and the availability of "how-to" information on the Internet about these painless methods of suicide is thought to play a role in their increased use. This study used data from the Federal Statistics Office of Germany to examine current trends in overall suicide mortality in Germany (2007-2015) as well by age, gender, and suicide methods. Also assessed was whether suicides via newly emergent methods are associated with the frequency of corresponding Internet searches using data from Google Trends. Joinpoint regression analyses indicated significant increases in the overall suicide rate (Average Annual Percentage Change (AAPC) = 2.37%) for females, but not males. The largest annual increases were observed in gassing self-intoxication suicides (AAPC = 13.93%), the majority of which involved carbon monoxide. The increase in gassing suicides was larger in females (500%), compared to males (164%). The frequency of suicides by gassing was significantly associated with Internet searches for "carbon monoxide poisoning" for both male and female subgroups, independent of age group. This study provides the updated suicide surveillance data that are necessary for suicide prevention activities. Results are congruent with the recent abrupt rises in carbon monoxide suicides in other countries.
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Affiliation(s)
- Elise Paul
- Depression Research Centre of the German Depression Foundation, Leipzig, Germany
| | - Roland Mergl
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich Hegerl
- Depression Research Centre of the German Depression Foundation, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
- European Alliance against Depression, Leipzig, Germany
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Abstract
South Korea exhibited the highest crude suicide rate in the world. To better understand this phenomenon, the author analyzed all suicides in South Korea from 1997 to 2015 and charted the trend in suicide methods by gender. Over time, both genders rapidly chose hanging for suicide at the expense of drug/pesticide poisoning. Gassing was hardly used in the beginning, but its recent gain in use is noteworthy. Including undetermined deaths did not change the main results. The author regressed hanging on demographics and found that hanging was particularly chosen by ever-married men of prime working age with a respectable level of education.
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Affiliation(s)
- Kitae Sohn
- a School of Economics and Finance , Curtin University , Perth , Australia
- b Department of Economics , Konkuk University , Seoul , South Korea
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23
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Gunnell D. A Population Health Perspective on Suicide Research and Prevention. CRISIS 2016; 36:155-60. [PMID: 26266821 DOI: 10.1027/0227-5910/a000317] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- David Gunnell
- 1 School of Social and Community Medicine, University of Bristol, UK
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24
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Park J, Choi N, Kim SJ, Kim S, An H, Lee HJ, Lee YJ. The Impact of Celebrity Suicide on Subsequent Suicide Rates in the General Population of Korea from 1990 to 2010. J Korean Med Sci 2016; 31:598-603. [PMID: 27051245 PMCID: PMC4810344 DOI: 10.3346/jkms.2016.31.4.598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/14/2016] [Indexed: 11/20/2022] Open
Abstract
The association between celebrity suicide and subsequent increase in suicide rates among the general population has been suggested. Previous studies primarily focused on celebrity suicides in the 2000s. To better understand the association, this study examined the impacts of celebrity suicides on subsequent suicide rates using the data of Korean celebrity suicides between 1990 and 2010. Nine celebrity suicides were selected by an investigation of media reports of suicide deaths published in three major newspapers in Korea between 1990 and 2010. Suicide mortality data were obtained from the National Statistical Office of Korea. Seasonal autoregressive integrated moving average models with intervention analysis were used to test the impacts of celebrity suicides, controlling for seasonality. Six of the 9 celebrity suicides had significant impacts on suicide rates both in the total population and in the same gender- or the same age-subgroups. The incident that occurred in the 1990s had no significant impact on the overall suicide rates, whereas the majority of the incidents in the 2000s had significant influences for 30 or 60 days following each incident. The influence of celebrity suicide was shown to reach its peak following the suicide death of a renowned actress in 2008. The findings may suggest a link between media coverage and the impact of celebrity suicide. Future studies should focus more on the underlying processes and confounding factors that may contribute to the impact of celebrity suicide on subsequent suicide rates.
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Affiliation(s)
- Juhyun Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Nari Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Seog Ju Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soohyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Yu Jin Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
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Jung JH, Kim DK, Jung JY, Lee JH, Kwak YH. Risk Factors of Discharged Against Medical Advice among Adolescents Self-inflicted Injury and Attempted Suicide in the Korean Emergency Department. J Korean Med Sci 2015; 30:1466-70. [PMID: 26425044 PMCID: PMC4575936 DOI: 10.3346/jkms.2015.30.10.1466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/11/2015] [Indexed: 11/20/2022] Open
Abstract
Suicide is a leading cause of death among Korean adolescents. Many suicide attempting adolescents often are discharged against medical advice in the emergency department. The aim of the present study was to determine the risk factors for discharge against medical advice (DAMA) after self-inflicted injury or attempted suicide in the emergency department. We extracted data on adolescents (10-19 yr old) from the national emergency department information system; we used data from 2007 and 2011. A total of 6,394 adolescents visited EDs after self-inflicted injury or attempted suicide. Among these patients, the median age was 17 yr (Interquatile range, 15-18 yr), 83.2% were between 15-19 yr of age, and 63.3% were female. Poisoning was the most common method of attempted suicide, while hanging and fall were the most common methods of fatality. The rate of DAMA from the ED was 22.8%. Independent risk factors for DAMA included female gender (odds ratio [OR], 1.49), older age adolescents (OR, 1.96), residence in a metropolitan/large city area (OR, 1.49), and discharge at night (OR, 1.38). These risk factors should be considered in establishing management and counseling plans for patients discharged against medical advice by community services and EDs.
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Affiliation(s)
- Jin Hee Jung
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Abstract. Background: Helium gas suicides have increased in England and Wales; easy-to-access descriptions of this method on the Internet may have contributed to this rise. Aims: To investigate the availability of information on using helium as a method of suicide and trends in searching about this method on the Internet. Method: We analyzed trends in (a) Google searching (2004–2014) and (b) hits on a Wikipedia article describing helium as a method of suicide (2013–2014). We also investigated the extent to which helium was described as a method of suicide on web pages and discussion forums identified via Google. Results: We found no evidence of rises in Internet searching about suicide using helium. News stories about helium suicides were associated with increased search activity. The Wikipedia article may have been temporarily altered to increase awareness of suicide using helium around the time of a celebrity suicide. Approximately one third of the links retrieved using Google searches for suicide methods mentioned helium. Conclusion: Information about helium as a suicide method is readily available on the Internet; the Wikipedia article describing its use was highly accessed following celebrity suicides. Availability of online information about this method may contribute to rises in helium suicides.
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Affiliation(s)
- David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jane Derges
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Shu-Sen Chang
- Institute of Health Policy and Management, and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Lucy Biddle
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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The association of trends in charcoal-burning suicide with Google search and newspaper reporting in Taiwan: a time series analysis. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1451-61. [PMID: 25859754 DOI: 10.1007/s00127-015-1057-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Some East/Southeast Asian countries have experienced a rapid increase in suicide by charcoal burning over the past decade. Media reporting and Internet use were thought to contribute to the epidemic. We investigated the association between method-specific suicide incidence and both Internet search volume and newspaper reporting in Taiwan. METHOD Weekly data for suicide, suicide-related Google search volume, and the number of articles reporting suicide in four major newspapers in Taiwan during 2008-2011 were obtained. Poisson autoregressive regression models were used to examine the associations between these variables. RESULTS In the fully adjusted models, every 10 % increase in Google searches was associated with a 4.3 % [95 % confidence interval (CI) 1.1-7.6 %] increase in charcoal-burning suicide incidence in the same week, and a 3.8 % (95 % CI 0.4-7.2 %) increase in the following week. A one-article increase in the United Daily was associated with a 3.6 % (95 % CI 1.5-5.8 %) increase in charcoal-burning suicide in the same week. By contrast, non-charcoal-burning suicide was not associated with Google search volume, but was associated with the Apple Daily's reporting in the preceding week. CONCLUSIONS We found that increased Internet searches for charcoal-burning suicide appeared to be associated with a subsequent increase in suicide by this method. The prevention of suicide using emerging methods may include monitoring and regulating online information that provides details of these methods as well as encouraging Internet service providers to provide help-seeking information.
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Myung W, Lee GH, Won HH, Fava M, Mischoulon D, Nyer M, Kim DK, Heo JY, Jeon HJ. Paraquat prohibition and change in the suicide rate and methods in South Korea. PLoS One 2015; 10:e0128980. [PMID: 26035175 PMCID: PMC4452788 DOI: 10.1371/journal.pone.0128980] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 05/04/2015] [Indexed: 11/23/2022] Open
Abstract
The annual suicide rate in South Korea is the highest among the developed countries. Paraquat is a highly lethal herbicide, commonly used in South Korea as a means for suicide. We have studied the effect of the 2011 paraquat prohibition on the national suicide rate and method of suicide in South Korea. We obtained the monthly suicide rate from 2005 to 2013 in South Korea. In our analyses, we adjusted for the effects of celebrity suicides, and economic, meteorological, and seasonal factors on suicide rate. We employed change point analysis to determine the effect of paraquat prohibition on suicide rate over time, and the results were verified by structural change analysis, an alternative statistical method. After the paraquat prohibition period in South Korea, there was a significant reduction in the total suicide rate and suicide rate by poisoning with herbicides or fungicides in all age groups and in both genders. The estimated suicide rates during this period decreased by 10.0% and 46.1% for total suicides and suicides by poisoning of herbicides or fungicides, respectively. In addition, method substitution effect of paraquat prohibition was found in suicide by poisoning by carbon monoxide, which did not exceed the reduction in the suicide rate of poisoning with herbicides or fungicides. In South Korea, paraquat prohibition led to a lower rate of suicide by paraquat poisoning, as well as a reduction in the overall suicide rate. Paraquat prohibition should be considered as a national suicide prevention strategy in developing and developed countries alongside careful observation for method substitution effects.
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Affiliation(s)
- Woojae Myung
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Information Statistics, Korea National Open University, Seoul, Korea
- Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - Geung-Hee Lee
- Department of Information Statistics, Korea National Open University, Seoul, Korea
| | - Hong-Hee Won
- Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - Maren Nyer
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - Doh Kwan Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Yoon Heo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
- Department of Clinical Research Design and Evaluation and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, Korea
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Chan CH, Caine ED, Chang SS, Lee WJ, Cha ES, Yip PSF. The impact of improving suicide death classification in South Korea: a comparison with Japan and Hong Kong. PLoS One 2015; 10:e0125730. [PMID: 25992879 PMCID: PMC4439106 DOI: 10.1371/journal.pone.0125730] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/23/2015] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION The suicide rate of South Korea has increased dramatically during the past decades, as opposed to steadily decreasing trends in Japan and Hong Kong. Although the recent increase of suicide in South Korea may be related to changing socioeconomic conditions and other contextual factors, it may also reflect, in part, a reduction of misidentified suicide cases due to improving classification of manner of death. METHOD We compared the annual proportional change of suicide, undetermined death, and accidental death from South Korea with those of Japan and Hong Kong from 1992 to 2011; a greater proportional change of the manner-of-death categories during the period is indicative of a relatively less stable registration and hence a greater potential for misclassification bias on reported suicide trends. Subgroup analyses stratifying the deaths by methods were also conducted. To estimate the impact, the age-standardized rates of these three death categories in each site were calculated. RESULTS We found that, during the 20-year observation period, the proportional change of suicide, undetermined death, and accidental death in South Korea was significantly greater than Japan and Hong Kong. Similar observations were made in subgroup analyses. While death rates of the three manners in Japan and Hong Kong generally moved in a parallel fashion, the increase of suicide in South Korea occurred concomitantly with a significant reduction of its accidental death rate. 43% of the increase in suicides could be attributed to the decrease in accidental deaths, while 57% of the increase could be due to fundamental causes. CONCLUSION Our data suggest that, during the mid-1990s and after, the increasing burden of suicide in South Korea initially was masked, in part, by misclassification. Thus, the later apparently rapid increase of suicides reflected steadily improving classification of manner of death, as well as a more fundamental increase in the suicide rate.
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Affiliation(s)
- Chee Hon Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region, China
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric D. Caine
- The Injury Control Research Center for Suicide Prevention, Department of Psychiatry, University of Rochester Medical Center, Rochester, United States of America
| | - Shu Sen Chang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region, China
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Institute of Health Policy and Management, and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Korea University, Seoul, South Korea
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, Korea University, Seoul, South Korea
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region, China
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Special Administrative Region, China
- * E-mail:
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Choi YR, Cha ES, Chang SS, Khang YH, Lee WJ. Suicide from carbon monoxide poisoning in South Korea: 2006-2012. J Affect Disord 2015; 167:322-5. [PMID: 25016488 DOI: 10.1016/j.jad.2014.06.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/13/2014] [Accepted: 06/13/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUNDS Suicide from carbon monoxide poisoning by burning coal briquette or barbecue charcoal increased rapidly in some East Asian countries in the recent decade. The purpose of this study was to examine trends in suicides from carbon monoxide poisoning in South Korea and their epidemiologic characteristics. METHODS We presented age-standardized mortality rates of carbon monoxide suicide and compared them with those of suicide by other methods using registered death data from Statistics Korea (South Korea) from 2006 to 2012. Logistic regression analysis was conducted to estimate odds ratios of carbon monoxide suicide by socio-demographic characteristics before and after the marked increase in carbon monoxide suicide in September 2008. RESULTS The number of carbon monoxide suicides in South Korea was only 34 in 2006 but rapidly increased to 267 in 2008 and was 1125 in 2012, with the age-standardized rates of 0.06 (2006), 0.48 (2008), and 1.97 (2012) per 100,000 population respectively (a striking 3,183% increase in 2006-2012). Suicide by carbon monoxide poisoning showed greater odds ratios among men, younger age groups, single or the divorced, and those with high education and non-manual jobs compared with suicides by other methods. LIMITATIONS This study only used data for fatal self-poisoning by carbon monoxide (non-fatal cases not included) and had no information on the sources of carbon monoxide. CONCLUSIONS Carbon monoxide suicides substantially increased in South Korea over the relatively short study period and showed some distinct socio-demographic characteristics compared with suicides by other methods.
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Affiliation(s)
- Young-Rim Choi
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 136-705, South Korea
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 136-705, South Korea
| | - Shu-Sen Chang
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong SAR, China; Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 136-705, South Korea.
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