Suicide around public holidays

Characteristics and related factors of suicide attempts among patients admitted to an Iranian poisoning center: Implications for suicide prevention

Background

Suicide is a major public health concern worldwide. Iran is no exception, with suicide rates increasing in recent years. Understanding the characteristics and related factors of suicide attempts can help inform suicide prevention efforts in Iran.

Methods

A cross-sectional study was conducted on patients who attempted suicide and were admitted to the poisoning emergency of an intoxication center in Shiraz, Iran, between November 2019 and January 2020. Data were collected using data sheets containing study variables completed by oral interviewers and analyzed using descriptive and inferential statistics.

Results

The study included 302 individuals, with the majority being females (63.6%), and the mean age was 28.19 (SD 19.25) years. The majority of patients were living in urban areas (82.5%) and unmarried (60.9%). Medical drug abuse was the most common method of self-poisoning (76.5%), followed by narcotics (15.6%). Suicide attempts were predominantly carried out at night (59.9%) and on working days (78.5%). Most patients had no history of previous suicidal attempts (64.2%), psychiatric problems (64.6%), or physical illnesses (84.8%). Female gender (P = 0.017) and the presence of an underlying disease (P = 0.016) were the two risk factors significantly associated with suicide on non-working days.

Conclusion

Our study highlights the need for comprehensive suicide prevention strategies that consider the complex interplay of individual, sociocultural, and environmental factors that contribute to suicidal behaviors. The high proportion of female suicide attempters and the timing of suicide attempts suggest the need for gender-specific suicide prevention programs and focused suicide prevention efforts during high-risk periods. Additionally, the association between physical illnesses and suicide attempts underscores the importance of integrated mental and physical health care services.

Who is afraid of Christmas? The effect of Christmas and Easter holidays on psychiatric hospitalizations and emergencies-Systematic review and single center experience from 2012 to 2021

BACKGROUND

Major holidays such as Christmas and New Year's Eve are regular occasions for get-togethers in families and other social groups. Socially, these days are often loaded with memories and expectations but also involve the potential for interpersonal tension and conflicts and disappointments. In addition, loneliness might also be most intense during these days. All these factors might lead to the expectation of increased mental distress and subsequently increased help-seeking in psychiatric contexts resulting in emergency psychiatric contacts, psychiatric hospitalizations, and even suicidal behavior. But is there evidence for increased psychiatric emergencies and hospitalizations around the days of Christmas?

METHODS

The existing evidence is systematically reviewed here (studies in PubMed in English investigating annual and Christmas-related variations in suicide (attempts), psychiatric emergencies and hospitalizations, last search date (13.07.2022) and complemented by an analysis of acute admissions at the University Psychiatry Clinics Basel, Switzerland, around Christmas and Easter holidays compared to the other days of the year. Easter was chosen as a comparison holiday.

RESULTS

In 25 reviewed studies, Christmas holidays were not associated with increased utilization of emergency psychiatric services. In contrast, hospitalizations were lower on Christmas and other holidays than the rest of the year. Analyzing the annual variation of 26,088 hospitalizations in our center between 2012 and 2021 revealed the same pattern.

CONCLUSION

The assumption of increased utilization of psychiatric emergency services on Christmas and other major holidays is not confirmed by multiple studies around the globe in various socio-cultural and medical settings. The study is registered in the international prospective register for systematic reviews (PROSPERO; 351057).

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier 351057.

The Social Aspects of Sexual Health: A Twitter-Based Analysis of Valentine’s Day Perception

Sentiment analysis (SA) is a technique aimed at extracting opinions and sentiments through the analysis of text, often used in healthcare research to understand patients’ needs and interests. Data from social networks, such as Twitter, can provide useful insights on sexual behavior. We aimed to assess the perception of Valentine’s Day by performing SA on tweets we collected between 28 January and 13 February 2019. Analysis was done using ad hoc software. A total of 883,615 unique tweets containing the word “valentine” in their text were collected. Geo-localization was available for 48,918 tweets; most the tweets came from the US (36,889, 75.41%), the UK (2605, 5.33%) and Canada (1661, 3.4%). The number of tweets increased approaching February 14. “Love” was the most recurring word, appearing in 111,981 tweets, followed by “gift” (55,136), “special” (34,518) and “happy” (33,913). Overall, 7318 tweets mentioned “sex”: among these tweets, the most recurring words were “sexy” (2317 tweets), “love” (1394) and “gift” (679); words pertaining to intimacy and sexual activity, such as “lingerie”, “porn”, and “date” were less common. In conclusion, tweets about Valentine’s Day mostly focus on the emotions, or on the material aspect of the celebration, and the sexual aspect of Valentine’s Day is rarely mentioned.

Time for time off? Secondary public holiday shows minimal net hospitalisation benefit

BACKGROUND

We aimed to use New Zealand's Anzac Day to test the public health effect of secondary public holidays; and to use weekly hospitalisation counts to identify which dates were more health suitable for a potential new public holiday.

METHODS

We conducted a retrospective population cohort study of hospital admissions in New Zealand between 23 April and 27 May 1988-2018. We compared acute and arranged hospitalisation and mortality rates in holiday (Anzac Day Monday to Friday) and non-holiday (Anzac Day Saturday or Sunday) years, for mid-week holidays and long weekends; and measured total weekly average acute and arranged hospitalisation counts.

RESULTS

Hospitalisation rates were lower in holiday years than non-holiday years (rate ratio (RR) 0.96, 95% CI 0.95 to 0.96, p<0.001), with fewer arranged admissions (RR 0.93, 95% CI 0.93 to 0.94, p<0.001), but no significant difference for acute admissions (RR 1.00, 95% CI 0.99 to 1.00, p=0.087). Holiday year acute admission rates were lower than non-holiday years for children aged 0-4 years, but higher for adults aged 15-44 years. Holidays reduced arranged admissions most in children and areas of higher socioeconomic deprivation. There was no significant difference for mortality. Average weekly acute hospitalisations were higher than arranged admissions between 10 June and 7 October.

CONCLUSION

Secondary holidays do not reduce deaths; or acute hospital admissions except in the holiday week; and may delay elective treatment. However, if New Zealand is to add a new public holiday, it would have least detrimental health effect scheduled between 10 June and 7 October.

Hot Weather and Suicide Deaths among Older Adults in Hong Kong, 1976-2014: A Retrospective Study

Findings of the association between hot weather and suicide in a subtropical city such as Hong Kong are inconsistent. This study aimed to revisit the association by identifying meteorological risk factors for older-adult suicides in Hong Kong using a time-series approach. A retrospective study was conducted on older-adult (aged ≥65) suicide deaths in Hong Kong from 1976 to 2014. Suicides were classified into those involving violent methods and those involving nonviolent methods. Meteorological data, including ambient temperature, were retrieved. Transfer function time-series models were fitted. In total, 7314 older-adult suicide deaths involving violent methods and 630 involving nonviolent methods were recorded. For violent-method suicides, a monthly average daily minimum ambient temperature was determined to best predict the monthly rate, and a daily maximum ambient temperature of 30.3 °C was considered the threshold. For suicide deaths involving nonviolent methods, the number of days in a month for which the daily maximum ambient temperature exceeded 32.7 °C could best predict the monthly rate. Higher ambient temperature was associated with more older-adult suicide deaths, both from violent and nonviolent methods. Weather-focused preventive measures for older-adult suicides are necessary, such as the provision of more public air-conditioned areas where older adults can shelter from extreme hot weather.

Developing an early warning system of suicide using Google Trends and media reporting

BACKGROUND

Conventional surveillance systems for suicides typically suffer from a substantial time lag of six months to two years. This study aims to develop an early warning system of possible suicide outbreaks in Hong Kong using Google Trends and suicide-related media reporting.

METHODS

Data on 3,534 suicides from 2011 to 2015 were obtained from Hong Kong Census and Statistics Department, and the Coroner's Court. Using data from Google Trends and features extracted from media reporting on suicide news, we fitted Poisson regression models to predict the number and estimate the intensity of suicides on a weekly basis, for six subgroups, defined by gender and age. We adopted the cumulative sum (CUSUM) control chart-based method to identify outbreaks of suicide.

RESULTS

The proposed model was able to predict the number of suicides with reasonably low normalized root mean squared errors, ranging from 15.6% for young females to 24.16% for old females. The suicide intensity curves were well captured by the proposed models for young males and females, but not for other groups. The Sensitivity, Precision and F1 Score of the CUSUM-based method were 50%, 100% and 67% for young females, and 93%, 54% and 68% for young males.

LIMITATIONS

This study focused only on predicting the number of suicides in the current week, not in the future weeks. The model did not include social media, socioeconomic and climate data.

CONCLUSIONS

Our results indicate that Google Trends search terms and media reporting data may be valuable data sources for predicting possible outbreak of suicides in Hong Kong. The proposed system could support effective and targeted interventions.

Blue Monday Is Real for Suicide: A Case-Control Study of 188,601 Suicides

Many studies have reported that suicides tend to occur on Mondays. However, owing to a lack of controls, conclusive findings on the potential effects of a day of the week on suicides have been lacking. We analyzed public data for causes of death from 1997 to 2015 in the Republic of Korea. Accidental death was used as a control group. The probability of suicide on each day of the week according to age group was calculated. A total of 377,204 deaths (188,601 suicides and 188,603 accidental deaths) were used. The frequency of suicide was highest on Monday and decreased throughout the week until Saturday. Accidental death was highest on Saturday and showed no variations according to weekday. For people in their teens and 20s, the probabilities of suicide on Monday were 9% and 10% higher, respectively, than those on Sunday. As age increased, the differences in suicide probability according to the day of the week were attenuated. The so-called Blue Monday effect is real, particularly for people in their teens and 20s. Suicide prevention strategies that aim to attenuate the burden and stress of Mondays should be planned.

[Time-related aspects of suicides - suicide frequency related to birthday, major holidays, day of the week, season, month of birth and zodiac signs]

BACKGROUND

Suicides are generally the consequence of overchallenged coping strategies of individual for psychological, social or internal and external biological strain factors. Timing of the suicide, too, may be influenced by external factors. Studies so far have yielded in part inconsistent results concerning the association of suicides with particular days or periods of the year. Even less is known regarding a potential effect of the time of birth on suicide risk.

METHODS

The Tyrol Suicide Register (TSR) provides data on suicides occurring in the Austrian State of Tyrol including birthday of the suicide victim and day of the suicide. In the present study the frequency of suicides was analyzed with regard to birthday, day of the week, major holidays and season over a period of 17 years. Further, a potential association with month of birth and zodiac signs was studied.

RESULTS

We found a significant variation in suicide frequency concerning day of the week with a peak on Mondays and Tuesdays and seasonality with increased numbers in spring and summer months.

CONCLUSIONS

The increase of suicide numbers at the beginning of the week may be explained by the "broken-promise effect" which has been described as the consequence of frustrated expectations concerning the weekend. Possible explanations for the suicide peaks in spring and summer may be biological, specifically serotonergic alterations as well as the experience of depressed patients perceiving the social and emotional contrast to people who are able to enjoy these periods of pleasure and outdoor activities.

Airborne pollen and suicide mortality in Tokyo, 2001-2011

Prior research has indicated that pollen might be linked to suicide mortality although the few studies that have been undertaken to date have produced conflicting findings and been limited to Western settings. This study examined the association between the level of airborne pollen and suicide mortality in Tokyo, Japan in the period from 2001 to 2011. The daily number of suicide deaths was obtained from the Japanese Ministry of Health, Labour and Welfare, with pollen data being obtained from the Tokyo Metropolitan Institute of Public Health. A time-stratified case-crossover study was performed to examine the association between different levels of pollen concentration and suicide mortality. During the study period there were 5185 male and 2332 female suicides in the pollen season (February to April). For men there was no association between airborne pollen and suicide mortality. For women, compared to when there was no airborne pollen, the same-day (lag 0) pollen level of 30 to <100 grains per cm² was associated with an approximately 50% increase in the odds for suicide (e.g. 30 to <50 grains per cm²: odds ratio 1.574, 95% confidence interval 1.076-2.303, p=0.020). The estimates remained fairly stable after adjusting for air pollutants and after varying the cut-points that defined the pollen levels. Our results indicate that pollen is associated with female suicide mortality in Tokyo.

Birthdays are associated with an increased risk of suicide in Japan: Evidence from 27,007 deaths in Tokyo in 2001-2010

BACKGROUND

Previous research has produced conflicting findings concerning whether birthdays are associated with an increased risk of suicide. This study examined the association in Tokyo, Japan.

METHODS

Suicide data (ICD-10 codes X60-X84) for the period 2001-2010 were obtained from the Japanese Ministry of Health, Labour and Welfare. A time-stratified case-crossover design was used with conditional logistic regression analysis being performed to estimate within-subject 'birthday exposures' while controlling for meteorological conditions and public holidays.

RESULTS

There were 27,007 suicides in the study period. For males the 5 days before the birthday and the week after the birthday were associated with significantly higher odds for suicide with the odds ratio being highest on the actual birthday (OR =1.677, 95% CI: 1.294, 2.172). For females, significantly higher odds for completed suicide were observed 7-11 days before the birthday. Stratified analyses showed different at risk time patterns among men from different age groups, and that married men had higher odds for suicide on, and for the 4 days before and in the 2 weeks after their birthday.

LIMITATIONS

We lacked detailed information on suicides which would have enabled a better understanding of the observed associations.

CONCLUSIONS

Birthdays are associated with an increased risk for suicide in Tokyo, Japan. Health professionals who work with individuals at risk of suicide should be made aware that birthdays are associated with an elevated suicide risk. This information should also be communicated in wider suicide prevention campaigns.

The Mexican Cycle of Suicide: A National Analysis of Seasonality, 2000-2013

INTRODUCTION

Suicide is a complex and multifactorial phenomenon with growing importance to public health. An increase in its occurrence has been observed in Mexico over the past 10 years. The present article analyzes the secular trend in suicide at the national level between the years 2000 and 2013.

MATERIALS AND METHODS

All suicides during the study period (n = 64,298, of which 82.11% were men) were characterized using a spectral decomposition of the time series and a wavelet analysis to evaluate the effect of seasonal changes, type of area (urban versus rural) and sex.

RESULTS

A seasonal pattern was observed with statistically significant cycles every 12 months, where peaks were identified in May but only for men in urban zones as of the year 2007. In addition, specific days of the year were found to have a higher frequency of suicides, which coincided with holidays (New Year, Mother's Day, Mexican Independence Day and Christmas).

CONCLUSION

A wavelet analysis can be used to decompose complex time series. To the best of our knowledge, this is the first application of this technique to the study of suicides in developing countries. This analysis enabled identifying a seasonal pattern among urban men in Mexico. The identification of seasonal patterns can help to create primary prevention strategies, increase the dissemination of crisis intervention strategies and promote mental health. These strategies could be emphasized during specific periods of the year and directed towards profiles with a higher risk.

Impact of religious feast days on youth suicide attempts in Istanbul, Turkey

BACKGROUND

Suicidal behaviour is related to psychosocial and biological factors. Although suicide is strictly forbidden by the Islamic faith, there are non-confirmed observations of increased suicidality on religious feast days. The objective of the present study was to find out if suicide attempts of youths living in Istanbul increase on religious feast days compared to ordinary and non-religious holidays.

METHODS

We retrospectively analyzed all suicide attempts (N = 2,232) of young people up to 25 years of age seeking support at various hospitals in Istanbul in 2010. The main hypothesis was that the number of suicide attempts would increase during religious feast days.

RESULTS

The number of suicide attempts was higher on religious feast days and non-religious holidays except for New Year's Day and International Labour Day than the daily average number of the actual months. Like on ordinary days, more female than male youth (84.9% vs. 15.1%) attempted suicide on feast days.

CONCLUSION

We speculate that changes of the daily rhythm and increased family interaction on feast days and non-religious holidays could lead to unexpected confrontations and disputes instead of the expected positive family climate. This "Broken-Promise Effect" and changes of the daily rhythm could contribute to the observed increased suicidal behaviour.