Gender differences in suicide attempters: a retrospective study of precipitating factors for suicide attempts at a critical emergency unit in Japan

Forensic analysis of suicide deaths: Comparing forensic information with public information and investigating factors contributing to psychiatric consultations

Aim

This study aimed to examine the usefulness of forensic information on suicide deaths in Japan for epidemiological studies on suicide and determine the factors that lead people with suicidal ideation to seek psychiatric care prior to attempting suicide.

Methods

We focused on forensic information of 514 suicide deaths that occurred in Osaka City in 2019. First, to examine whether the data used in this study can be generalized to these cases, we compared the information on suicide deaths officially published by Osaka City with that used in this study, utilizing Pearson's χ 2 test. Next, the forensic data were analyzed using multivariate logistic regression analysis to confirm the relationship between demographic factors and the likelihood of having a history of psychiatric consultation before suicide.

Results

Both the official information and the data used in this study showed a higher number of males than females who died by suicide, with no significant differences in values between the data sets. Multivariate logistic regression analysis showed significant correlations. More females were associated with seeking a psychiatric consultation. However, those with regular jobs or students were more likely to avoid a psychiatric consultation.

Conclusion

The findings of this study provide insights into the phenomenon of suicide deaths by using a forensic perspective. The results of this study suggest that psychiatric consultation may be effective in reducing deaths by suicide. Forensic data should be incorporated into the formulation of suicide-prevention policies in Japan to conduct a more multifaceted analysis and improve suicide-prevention measures.

Suicidal Behavior and Its Association With Psychological Distress, Coping Mechanisms, and Resilience: A Cross-Sectional Study

Introduction Recent literature reveals that psychological factors such as resilience and coping mechanisms can act as buffers against suicide risk. Indian literature on the interplay between psychological risk and protective factors of suicidal behavior is scarce. Methods A cross-sectional descriptive study was done among suicide attempters in a tertiary care hospital in Southern India. A semi-structured proforma was used to obtain sociodemographic data and suicide attempt characteristics. Suicide intent, lethality, stressful life events, perceived stress, subjective distress, coping strategies, and resilience were recorded using standard rating scales. Inferential analyses were carried out with p≤ 0.05 set as statistical significance. Results Pesticide poisoning (46.7%) was the most common mode of suicide attempt. Significant gender differences emerged in the mode of suicide attempt, coping strategies, and resilience. Depression (48.7%) was the most common psychiatric comorbidity. Increased perceived stress was associated with the presence of psychiatric comorbidity, past history of suicide attempts, and high-intent suicide attempts. Maladaptive coping strategies were associated with substance abuse and a history of past suicide attempts. Low resilience levels were associated with hanging attempts, psychiatric or substance use disorder comorbidity, past history of suicide attempts, high-intent suicide attempts, and less lethal suicide attempts. Conclusion Perceived stress levels, coping strategies, and resilience have significant relationships with suicidal behavior and act as avenues for suicide prevention efforts.

A Qualitative Study on the Psychological Experience of Emergency Department Medical Staff Caring for Patients with Suicide Attempts in Northeastern Sichuan

The purpose of this study was to explore the psychological experiences of emergency department staff in northeastern Sichuan when treating patients with suicide attempts and to provide a theoretical basis for developing appropriate clinical interventions and improving mental health services for suicidal patients. Sixteen emergency department staff members who met recruitment requirements at two hospitals in Nanchong, China, were interviewed using Colizzi descriptive phenomenological analysis. The interviews were in-depth and semi-structured. The qualitative analysis of this study revealed three main themes: (1) aspects of the emotional experience that may be detrimental to helping people in crisis (e.g., sympathy and regret, confusion and bewilderment, worry and stress); (2) aspects of the cognitive experience (e.g., inability to deal with patients' psychological issues and having new perspective on the medical profession); and (3) raising awareness of mental health services. Future reform efforts should consider training medical staff in suicide prevention knowledge and communication skills, using a compassion-centered approach to alleviate the suffering of patients who attempt suicide, using the Safety Screening Scale (PSS-3), providing counselors for patients, developing family-focused interventions, and involving family members in suicide risk prevention and treatment.

Prevalence of and Risk Factors for Suicide Attempts Among Patients With Severe Psychiatric Disorders in Eastern Morocco

Background: Suicide attempts are common in patients with severe psychiatric disorders; however, they are rarely studied in this population. Aims: To investigate the prevalence and risk factors associated with suicide attempts among patients with severe psychiatric disorders. Method: This is a cross-sectional study of patients admitted to the Mohammed VI University Hospital of Psychiatry in Oujda, Morocco. Results: A total of 250 patients with a psychiatric disorder were recruited in this study. Among these, 78 cases (31.2%) had a personal history of suicide attempts. A personal history of suicide attempt was significantly higher among women compared to men (45.5% vs. 27.2%, p = .0099). The most common method of suicide attempts was jumping from heights (31%). Patients with a personal history of suicide attempts had a significantly higher prevalence of alcohol consumption (p = .0063), family history of psychiatric disorders (p = .002), family history of suicide attempt (p = .00004), and family history of suicide (p = .018) compared to those who had never made suicide attempts. Limitations: As suicidal behavior is highly stigmatized in Morocco, the number of patients who have made a suicide attempt may be underestimated. Conclusion: Our findings justify the need to provide specialized support to psychiatric patients with risk factors for suicide attempts.

Perceptions of social rigidity predict loneliness across the Japanese population

Loneliness is associated with mental and physical health problems and elevated suicide risk, and is increasingly widespread in modern societies. However, identifying the primary factors underlying loneliness remains a major public health challenge. Historically, loneliness was thought to result from a lack of high-quality social connections, but broader cultural factors (e.g. social norms) are increasingly recognized to also influence loneliness. Here, we used a large-scale survey (N = 4977) to assess to what degree the loneliness epidemic in Japan is associated with traditional measures of social isolation (number of close friends), cultural factors (perceptions of social rigidity, as measured by relational mobility), and socioeconomic factors (e.g. income). We confirmed that a lack of close friends is a dominant factor underlying loneliness in Japan. We also found that perceptions of the social rigidity in one’s environment was a major correlate of loneliness. Subjects who perceived lower levels of rigidity in their social environments felt significantly less lonely than those who perceived higher levels of social rigidity, though the association was weak in low income males. Thus, Japanese society and other high social rigidity cultures may need to reflect on the possibility that inflexible traditional norms of socialization are exacerbating loneliness.

Exploring the epidemiology of suicide attempts: Risk modeling in Kermanshah-Iran

Background

Suicide attempt is a serious global public health issue. The patterns of suicide may vary depending on the individual characteristics, methods, causes, and the geographical area-also socio-cultural context that determine it. This study identifies the spatial patterns of suicide attempts in Kermanshah province, Iran.

Method

The sample size of this cross-sectional study is 18,331 people (7234 males and 11097 females) who attempted suicide in Kermanshah province between 2006 and 2014. Data was collected from the records of patients referred to the emergency department of hospitals in Kermanshah and analyzed using tests of Mean Center, Standard Distance, and Average Nearest Neighbor.

Results

The results of the mean center and standard distance tests show that drug overdose, poisoning with toxins and pesticides, and chemicals mostly were used in the central areas of Kermanshah province. The mean center of suicide attempts by self-immolation, hanging and firearms was in the western parts of the province, while the suicide attempts with narcotic drug were concentrated in the eastern regions of the province. Out of the 18,331 cases, 74% attempted suicide with drug overdose, 13% with toxins and pesticides, 0.59% with chemicals, 4% with fire, 1% by self-immolation, 1% by hanging, 0.16% with firearms and 0.7% with cold weapons. The spatial pattern of all suicide attempts in Kermanshah was clustered (Z-score < -2.58).

Conclusion

The results of this study show that the methods of suicide attempt vary with geographical areas in the province. Therefore, it is suggested that planning tailored to the geographical location can reduce suicide attempts in Kermanshah.

Suicide decline and improved psychiatric treatment status: longitudinal survey of suicides and serious suicide attempters in Tokyo

BACKGROUND

Connecting individuals in need of psychiatric treatment with adequate medical services has been a major strategy for suicide prevention in Japan. By investigating serious suicide attempters admitted to our Critical Care Medical Center (CCM), we aimed to examine longitudinal changes in the psychiatric treatment status of high-risk suicidal individuals, and to explore the association between any improvement in psychiatric treatment status and suicide decline.

METHODS

Subjects from two periods, 2006-2011 and 2012-2017, were enrolled. We collected the data of 32,252 suicides in Tokyo from police reports and the data of 942 suicide attempters admitted to CCM from medical records. Data were annually collected by both age and gender for the number of suicide completers, the number of suicide attempters, and the psychiatric treatment rates, respectively. ANOVA and t-test were used to examine whether there were differences in the number of suicides and attempers between the two periods. The difference in psychiatric treatment rate between the two periods was examined by chi-square test. Additionally, we used Pearson's correlation coefficient to analyze any correlation between annual treatment rate and the number of suicide completers in subgroups with altered psychiatric treatment rates.

RESULTS

The number of suicide attempters in the 20-39-year age group of decreased together with the number of suicides. Psychiatric treatment rates of male attempters aged 20-59 years improved significantly from 48.7 to 70.6% and this improvement correlated with a decrease in suicides. However, psychiatric treatment rates in the elderly, which have the highest number of suicides in both genders, did not improve and remain low.

CONCLUSIONS

The number of suicide attempters, as well as that of suicides, decreased in Tokyo. Improvement of psychiatric treatment status in high-risk suicidal male adults may have contributed to the reduction of suicides in Tokyo. However, the continuing low rate of psychiatric treatment in the elderly is a pressing issue for future suicide prevention.

Comparison of Work-Related Stress in Cluster of Workers' Suicides in Korea: Analysis of Industrial Accident Compensation Insurance, 2010-2017

Background: There is limited research on the heterogeneity of worker suicides. We compared differences in workers’ suicides by clustering suicide deaths. Methods: From 2010 to 2017, 353 suicide deaths were claimed in the Industrial Accident Compensation Insurance; variables were coded using a standardized methodology. A two-step cluster analysis classified the clusters based on demographic and employment conditions. Details of the suicide, clinical variables, personal stresses, and work-related stresses were compared using the chi-square test and one-way analysis of variance. Results: We identified five clusters and they differed particularly in work-related stress. “Responsibility-burdened type” experienced excessive responsibility as managers; “role-changed type” experienced a sudden and unpredictable role change as clerks or sales workers; “risk-exposed type” experienced physical risk factors at work (working alone, outdoors, and in shifts) as machine operating and assembling workers, or craft and related trades workers; “job-insecurity type” experienced unstable employment (irregular, nonpermanent) as elementary or service workers; “workplace-violence type” was mainly unmarried women who lived alone, and experienced interpersonal conflict and violence as professionals and related workers. There were no differences between clusters in clinical variables (except problem drinking) and personal stresses. Conclusion: Interventions to alleviate work-related stress in worker clusters are needed to prevent suicide in workers.

Early marriage, stressful life events and risk of suicide and suicide attempt: a case-control study in Iran

BACKGROUND

Early Marriage (EM) and associated Stressful Life Events (SLEs) and consequences such as psychological and physical well-being issues can lead to suicide and suicide attempts (SA). The study aimed to investigate the risk of suicide and SA among early married people who experienced SLEs.

METHODS

A case-control study was conducted based on the registry for suicide in Malekan county in Iran during 2016-18. Cases included 154 SAs and 32 suicides. Simultaneously, 201 outpatients from the emergency department were chosen as controls. Holms and Rahe life event questionnaire was used to assess SLEs. Sub-group analysis (Mantel-Haenszel) by sex and age groups and multiple logistic regression were used to calculate adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for the association between EM and suicide risk after adjusting for the potential confounders.

RESULTS

The proportion (female vs male) of EM among suicides, controls, and SAs was 31.25% (18.7 vs 12.5%), 15.92% (11.9 vs 4.0%), and 13.0% (11.7 vs 1.3%), respectively. In subgroup analyses by sex, EM was associated with an increased risk of suicide in both females and males 2.64 and 2.36 times, respectively. Likewise, subgroup analysis by age groups revealed that EM increased suicide risk in subjects aged 10-15 years, while no association was found for age groups of 26-40 and > 40. After adjusting for the potential confounders, EM (OR: 3.01; 95% CI: 1.15 -7.29), financial problems (OR = 4.50; 95% CI: 1.83 -9.07), and family problems (OR = 2.60; 95% CI: 1.19-9.59), were associated with an increased risk of suicide. However, no association was found between EM, various types of SLEs, and the risk of SA.

CONCLUSIONS

We found EM and SLEs were correlated with suicide risk, while no evidence found that EM increased the risk of SA. Progress in reducing EM and addressing its serious consequences can occur by a stronger political commitment and by sharing the experiences and voices of the early married. Our study provided preliminary findings to guide future studies; however, methodological and longitudinal studies are needed to understand and address the effect of EM on suicidal behaviors.

Occupation, work-related stress, and personal characteristics among suicide deaths with occupation-related compensation claims in Korea

Objectives

This study compared differences in age‐standardized suicide mortality rates, personal characteristics (demographics, employment conditions, and details of suicide), and work‐related stress by gender and occupation among workers who had committed suicide in Korea.

Methods

Data comprised 413 suicide death claims lodged with the Industrial Accident Compensation Insurance (IACI) from 2010 to 2018, which were coded. We calculated age‐standardized suicide mortality rates by gender and occupation. The chi‐square test, Fisher's exact test, and t‐test were conducted to examine gender differences. Frequency and percentage distribution by gender and occupation were calculated using descriptive statistics.

Results

Regardless of gender, age‐standardized suicide mortality rate was highest among “Managers.” Women who died by suicide were significantly younger and more likely to be unmarried, live alone, and have fewer years of continuous employment than men. “Managers,” “Professionals and Related Workers,” and “Clerks” experienced similar work‐related stresses, including “Difficult work to achieve,” “Fail to achieve allocation workload,” and “Change of job contents or workload.” “Skilled Agricultural, Forestry and Fishery Workers,” “Craft and Related Trades Workers,” and “Equipment, Machine Operating and Assembling Workers” had higher work‐related stress related to “Severe disease/injury” or “Causing a serious accident” compared with other workers.

Conclusions

Work‐related stress related to suicide deaths differed by gender and occupation. The gender gap of labor market participation in Korea may affect gender differences in terms of demographics and employment conditions among workers who died by suicide. Our study suggests that gender‐ and occupation‐specific strategies and policies to reduce work‐related stress can prevent suicide among workers.

Predictive factors for the medical hospitalisation of patients who visited the emergency department with suicide attempt

BACKGROUND

Suicide is a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before suicide. The emergency department (ED) is the first location where individuals are brought after a suicide attempt. This study investigated the factors related to delays in the medical hospitalisation of patients who attempted suicide and aimed to provide criteria for hospitalisation decisions by physicians.

METHODS

This study included patients who had deliberately self-harmed (age ≥ 19 years) and presented at the EDs of two tertiary teaching hospitals between March 2017 and April 2020. Those for whom relevant demographic and clinical information were unavailable and those admitted to the psychiatric wards were excluded.

RESULTS

This study included 414 patients in the hospitalisation group and 1346 in the discharged group. The mean patient age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalised and discharged groups (p < 0.001), respectively. The mean ED length of stay (LOS) was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalised and discharged groups, respectively. In the hospitalised group, the odds ratio and confidence interval for aged 35 ~ 64 (2.222, 1.343-3.678), aged over 65 (2.788, 1.416-5.492), sex -male (2.041, 1.302-3.119), and consciousness (1.840, 1.253-2.466). The Risk-Rescue Ratio Scale (RRRS) was (1.298, 1.255-1.343). A receiver operating characteristics analysis of RRRS for the decision to hospitalise patients who attempted suicide showed a cut-off value of 42, with sensitivity, specificity, and area under the curve being 85.7, 85.5%, and 0.924, respectively.

CONCLUSION

The level of consciousness and the RRRS of patients who attempted suicide can be the factors to decide medical hospitalisation and reduce ED LOS and crowding.

Suicide and suicide attempts in adults: exploring suicide risk 24 months after a psychiatric emergency room visit

Objective:

Suicide risk (including attempted and completed suicide) should be measured over short periods of time after contacting health services. The objective of this study was to identify the patterns of attempted and completed suicides within 24-months of a psychiatric emergency department visit, as well as to investigate predictive risk factors, including sociodemographic and clinical variables, previous suicidal behavior, and service utilization.

Method:

A convenience sample (n=147), recruited at a general hospital’s psychiatric emergency room, included patients with suicidal ideation, suicidal plans or previous suicide attempts. These patients were followed for 24 months, focusing on two main outcomes: attempted and completed suicides.

Results:

After six months there were no completed suicides and 36 suicide attempts, while after 24 months there were seven completed suicides and 69 suicide attempts. A final logistic regression model for suicide attempts at 24 months identified somatic pathology and the number of previous psychiatric hospitalizations as predictive factors, with a good area under the receiver operating characteristic curve.

Conclusions:

The findings showed distinct patterns of attempted and completed suicides over time, indicating the importance of a systematic multidisciplinary suicide risk evaluation in psychiatric emergency rooms.

Sex differences in psychotic and non-psychotic major depressive disorder in a Chinese Han population

BACKGROUND

Sex differences between psychotic depression (PD) and non-psychotic depression (NPD) have received little systematic study. This study was conducted to investigate sex difference in patients with psychotic and non-psychotic major depressive disorder in a Chinese Han population.

METHODS

In this cross-sectional study, a total of 1718 first-episode and drug-naïve outpatients with major depressive disorder were recruited. Demographic and clinical characteristics were collected. All subjects were rated on the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA) and the Positive and Negative Syndrome Scale (PANSS).

RESULTS

The prevalence of PD in female patients (10.97%) was higher than that in male patients (7.99%). Analysis of variance (ANOVA) showed that female patients were older compared with male patients in NPD group, but there were no significant differences in demographic and clinical variables between female and male PD patients. Further, there were no sex differences in the scores of HAMD, HAMA and positive symptom subscale of PANSS in both PD and NPD groups. Two-way ANOVA showed that PD patients had significantly higher scores on the HAMD, HAMA and positive symptom subscale of PANSS than non-PD patients. However, there were no significant effects of sex and sex* subtypes.

LIMITATIONS

The main limitations are cross-sectional design and inability to control selection bias.

CONCLUSIONS

Our findings show significant differences in clinical profiles between PD and NPD patients; however, no sex difference has been observed in the either PD or NPD patients.

System Entrapment: Dehumanization While Help-Seeking for Suicidality in Women Who Have Experienced Intimate Partner Violence

Attention to power imbalances when seeking help for suicidality after having been controlled within intimate partner violence (IPV) is crucial in improving health care delivery. Well documented in the literature is the correlation between suicidality and IPV and that help-seeking for each is difficult; however, a gap exists when both intersect. The process of women's help-seeking is explored in this feminist grounded theory and photovoice multiple qualitative method study. Analysis of interviews with 32 women from New Brunswick, Canada, and photovoice meetings with seven women revealed a basic psycho-social problem. System Entrapment or being dehumanized while seeking help for suicidality occurred as a result of perceived invalidation from health care providers' lack of empathy. Further harm while providing services to women feeling suicidal can be prevented with a shift from an individualist model toward a trauma and violence informed approach. Understanding the contextual factors influencing women's suicidality may reduce victim blaming.

Sex Differences in Poisonings Among Older Adults: An Analysis of the Toxicology Investigators Consortium (ToxIC) Registry, 2010 to 2016

PURPOSE

Adults aged >65 years are susceptible to intentional and unintentional poisoning, with contributing factors that include polypharmacy, comorbidity, susceptibility to medication error, and gaps in research. Although toxicologists are often tasked with managing and preventing poisoning among older adults, little is known about sex differences in these poisonings. The aim of this study was to review sex differences in poisonings among older adults managed at the bedside by medical toxicologists.

METHODS

All case subjects aged >65 years in the Toxicology Investigators Consortium (ToxIC) registry between January 2010 and December 2016 were reviewed. Data included reasons for exposure and consultation, exposure agents and routes, presenting clinical findings, and treatment provided. Cases missing age, sex, or primary reason for toxicology consultation data were excluded. We used χ² tests to assess differences in distribution of study variables according to participant sex.

FINDINGS

Among 51,441 total registry cases, 542 (1.05%) were excluded because of missing data. Among the remaining 50,899 cases, 2930 (5.8%) were included for age >65 years; 52.3% of older adults were female. Race was missing or unknown for 49.2% of cases. Adverse drug reactions were more commonly encountered in female subjects than in their male counterparts (9.6% vs 6.4%; P = 0.001). No statistically significant sex differences were observed for total numbers of intentional, unintentional pharmaceutical, and nonpharmaceutical exposures. The most common medications involved were cardiovascular (16.8%) and analgesics/opioids (14.8%). Female subjects were more likely than male subjects to be evaluated by a toxicologist for cardiovascular medications (18.7% vs 14.7%; P = 0.004) and analgesics/opioids (17.6% vs 11.8%; P < 0.001). Male subjects were more likely than female subjects to be evaluated for ethanol toxicity (7.4% vs 1%; P < 0.001) and for envenomations (4.2% vs 1.8%; P < 0.001). The most common route of exposure was oral ingestion (81.3%). Signs/symptoms were noted in 54.8% of cases, with the most common abnormal vital sign being bradycardia (17.2%). Pharmacologic support was the most common intervention and was more common in male subjects than in female subjects (17.7% vs 12.3%; P < 0.001). Deaths were reported in 38 female subjects (2.45%) and 46 male subjects (3.34%); there was no statistically significant difference in death rate according to sex (P = 0.148).

IMPLICATIONS

Older female adults were more commonly evaluated by a medical toxicologist for an adverse drug reaction than older male adults. Female patients were more likely than male patients to be evaluated for poisoning related to analgesic/opioids and cardiovascular medications, and older male patients more frequently received pharmacologic support than older female patients. No significant sex differences were observed in numbers of toxicology consultations for intentional, unintentional pharmaceutical, and nonpharmaceutical exposures.

Identification of high risk groups with shorter survival times after onset of the main reason for suicide: findings from interviews with the bereaved in Japan

Objectives

We sought to (1) measure survival lengths after the onset of the main reason for the target’s suicide, (2) identify the highest-risk groups and the contributors to early death, in Japan, and (3) clarify peculiar traditional Japanese values concerning suicide.

Results

Data for 523 deceased individuals (median age 43.0 years) were collected from bereaved persons. Average survival time from the onset of the main reason for suicide was 1956 days (5.4 years). After controlling for confounding factors, being middle-aged, male, self-employed, and a founding company president were identified as the highest-risk groups. Half of the self-employed founding presidents died within 2 years. Many of the bereaved had observed some signs of the suicide 2 weeks ago. The traditional Japanese idea is that one means of compensating for a serious mistake is to commit suicide, and we observed that many Japanese people still regard suicide as a respectable death, even among the interviewed. The possible intervention time is quite limited; however, those who have contact with the high-risk groups should be alert to behavioral changes or signals of impending suicide.

Suicidal patients presenting to secondary and tertiary emergency departments and referral to a psychiatrist: a population-based descriptive study from Japan

BACKGROUND

In Japan, although many suicidal studies were previously conducted in tertiary emergency department (ED) settings, no published studies have reported on suicidal patients presenting to the secondary EDs. The aim of the study was to describe the characteristics of suicidal patients and the referral rates to a psychiatrist overall and by type of facility.

METHODS

Questionnaires were sent to all secondary and tertiary EDs in Tochigi prefecture, Japan. Data were collected for cases who presented in September 2009. Chi-square, Fisher's exact, and t-tests compared the results by gender and type of ED.

RESULTS

All 74 EDs responded to the survey. There were 81 patients who attempted or died by suicide (36 men and 45 women). The most common method of suicide attempt was drug overdose (57%) followed by stabbing (17%). About a half used prescription drugs to attempt or die by suicide. The majority had a history of psychiatric disorders, and 35% had previous suicide attempt. About a half were admitted to medical or surgical unit; 33% were discharged home; and 9% died. After excluding those who died, 53% were referred to a psychiatrist, but 47% were not referred to a psychiatrist. The referral rate was lower for cases seen at secondary EDs (38%) compared to tertiary EDs (67%).

CONCLUSION

Although professional organizations suggest that suicidal patients are seen by a psychiatrist, many were not, especially at secondary EDs. Further research is needed to assure that suicidal patients presenting to EDs receive appropriate psychiatric assessment and follow-up after discharge.

Mental disorders and suicide attempt in rural China

The prevalence of various mental disorders and their age and gender specific characteristics among suicide attempters remains unclear in rural China. This study using 1:1 paired case-control design included 409 suicide attempters and 409 paired controls matched on age, gender and place of residence. Mental disorders were assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders. The prevalence of mental disorders was 32.3% for suicide attempters and 4.9% for paired controls. Mental disorder constituted a significant risk factor for suicide attempt with an adjusted odds ratio of 7.16 (95%CI: 3.65-14.04). The prevalence of mental disorders was higher among male than female suicide attempters. Major depressive disorder was most common in female suicide attempters while alcohol use disorder was most common in the males. The prevalence of mental disorders seemed to increase with age. Suicide attempters of higher ages were more prone to have mood disorders, especially a major depression. Suicide attempters with mental disorders differed from those without mental disorders on a number of socio-economic characteristics and suicidal behavior features. These insights should be taken into account in strategies and efforts to improve mental health care and ultimately to reduce suicidal behavior among residents in rural China.

Replication of rs300774, a genetic biomarker near ACP1, associated with suicide attempts in patients with schizophrenia: Relation to brain cholesterol biosynthesis

The aim of this study was to determine if three biomarkers for suicide attempts previously identified and replicated in a genome-wide association (GWAS) study of bipolar disorder (BD) suicide attempters also predicted suicide attempts in patients prospectively diagnosed with schizophrenia (SCZ) or schizoaffective disorder (SAD). 162 genetically-verified Caucasian patients with SCZ or SAD were phenotyped for presence (45.7%) or absence of a lifetime suicide attempt. Three single nucleotide polymorphisms (SNPs) were genotyped or partially imputed from a GWAS dataset. After controlling for genetic architecture and gender, we replicated rs300774 (p = 0.012), near ACP1 (acid phosphatase 1), the top predictor of suicide attempts in the BD study. The result of Willour et al. (2012) was replicated in males (p = 0.046) but not in females (p = 0.205). The other two SNPs, rs7296262, and rs10437629, were not associated with suicide attempts in this study. rs300774 could be a cis-eQTL for ACP1, with minor allele carriers having lower expression levels (p = 0.002). This SNP also functioned as a trans-eQTL for genes related to cholesterol biosynthesis and the wnt-β-catenin pathway (p ≤ 0.0001). Further, co-expression analysis of candidate genes in brain suggested ACP1 is important to the regulation of a number of brain mechanisms linked to suicide, including cholesterol synthesis, β-catenin-mediated signaling pathway, serotonin, GABA, and the stress response via ARHGAP35 (p190rhogap), a repressor of glucocorticoid receptor (NR3C1) transcription. This study provides an additional validation of rs300774 as a potential transdiagnostic biomarker for suicide attempts and evidence that ACP1 may have an important role in regulation of the multiple systems associated with suicide.

Female suicides: Psychosocial and psychiatric characteristics identified by a psychological autopsy study in Japan

AIM

Although the female suicide rate in Japan is one of the highest among OECD countries, little has been done to assess the psychosocial and psychiatric characteristics of Japanese female suicide completers. This study aimed to examine sex differences in psychosocial and psychiatric characteristics of suicide completers using a psychological autopsy study method, and to identify female suicide factors and intervention points to prevent female suicides.

METHODS

A semi-structured interview was conducted with close family members of adult suicide completers. The interview included questions regarding sociodemographic factors, suicide characteristics, previous suicidal behaviors and a family history of suicidal behaviors, financial problems, and physical/psychiatric problems. Fisher's exact test and the Student's t-test were used to explore sex differences in these survey items, and individual descriptive information of female suicide cases was also examined.

RESULTS

Of the 92 suicide completers, 28 were female and 64 were male. Females had a significantly higher prevalence of a history of self-harm/suicide attempts (P < 0.001). The prevalence of eating disorders was significantly higher among females than males (P < 0.01).

CONCLUSION

The findings of this study highlight the importance of providing psychological and social support to caregivers of those who repeatedly attempt suicide and express suicidal thoughts, and to suggest the need to improve community care systems to be aware of suicide risk factors among female suicide attempters.

Epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge in Japan: An exploratory descriptive study using a nationwide claims database

Background

Little is known about the nationwide epidemiology of the annual rate, causative substance, and clinical course of overdose-related admission. We aimed to describe the epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge to home.

Methods

We assessed all cases of admission due to overdose (21,663 episodes) in Japan from October 2012 through September 2013 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan.

Results

The annual rate of overdose admission was 17.0 per 100,000 population. Women exhibited two peaks in admission rates at 19–34 years (40.9 per 100,000) and ≥75 years (27.8 per 100,000). Men exhibited one peak in the admission rate at ≥75 years (23.7 per 100,000). Within 90 days prior to overdose, ≥60% and ≥9% of patients aged 19–49 years received a prescription for benzodiazepines and barbiturates, respectively. In addition, 59% of patients aged ≥75 years received a prescription for benzodiazepines prior to overdose, 47% had a history of congestive heart failure, and 24% had a diagnosis of poisoning by cardiovascular drugs. The proportion of patients with recent psychiatric treatments decreased with age (65.1% in those aged 35–49 years and 13.9% in those aged ≥75 years).

Conclusions

The findings emphasize the need for overdose prevention programs that focus on psychiatric patients aged 19–49 years who are prescribed benzodiazepines or barbiturates and on non-psychiatric patients aged ≥75 years who are prescribed benzodiazepines or digitalis.

•

Benzodiazepines were prescribed to ≥59% of overdose patients aged ≥19 years.

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Cardiovascular drugs were frequently ingested among overdose patients aged ≥75 years.

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The proportions of patients with recent psychiatric treatments decreased with age.

•

Overdose prevention should be optimized according to the age-related differences.

Sociodemographic Antecedent Validators of Suicidal Behavior: A Review of Recent Literature

Suicidal behavior and its prevention constitute a major public health issue. Etiology of suicidal behavior is multifactorial. Whereas current research is mostly focused on clinical and biological risk factors, the sociodemographic risk factors for suicidal behavior, first highlighted by Durkheim, have received less attention. Besides the well-known impact of age and gender, sociodemographic variables such as marital and parental status, education, occupation, income, employment status, religion, migration or minority status, and sexual orientation are repeatedly reported to play an important role in suicidal behavior. This narrative review aimed to summarize recent research on sociodemographic risk factors for suicidal behavior and to elicit possible implications for suicide prevention.

Completed suicide among University student in Eskisehir, Turkey

INTRODUCTION

In this study student suicides are classified as a distinct group in Eskisehir-a city located in the western part of our country and famous as a student city. The study aims at describing demographic and suicide specification of cases and compare some important issues between males and females.

METHOD

All the judicially deaths in Eskisehir in a 12 year period between 2004 and 2015 have been evaluated. 75 cases that were deemed as suicide cases as a result of criminal investigation have been included in the study.

RESULTS

It was determined that hanging method was the most frequently used method and the number of male was more. It was determined that the majority of them were the students living away from their families. Definite or possible psychiatric disorder was identified as the most important risk factor. It was observed that there were significant differences in terms of risk factors between male and female students. Males have been found as more prominent in case of definite or possible psychiatric disorders, alcohol and substance abuse, love and romantic tangles; females have been found as more prominent in case of family problems and social pressure, and repeated suicide attempts.

DISCUSSION

Compared to the general population love and romantic problems are more prevalent in this group. It is observed that university students left suicide notes more than the general population. Sharing this study with the university administrations could be helpful in undertaking the necessary precautions.

Family Dysfunction and Suicide Risk in a Community Corrections Sample

BACKGROUND

When comparted with the general population, the suicide rate in correctional populations is elevated. While predictors of suicide are well researched in jail and prison populations, much less work has been done to examine predictors of suicide in community corrections samples where 80% of the US correctional population is currently supervised.

AIMS

The goal of this study was to determine factors associated with suicide risk in a community corrections sample.

METHOD

Self-reported current ideation was examined in a sample of 512 individuals under supervision.

RESULTS

When univariate associations between current suicidal ideation and predictor variables were examined, current suicidal ideation was associated with being female, being White, reporting an increased level of stress, reporting an increased level of depression, meeting criteria for an anxiety disorder, an increased number of physical health complaints, and self-report of family dysfunction. In a multivariate analysis predicting suicide risk, only meeting criteria for an anxiety disorder, an increased number of physical health complaints, and self-report of family dysfunction were significant.

CONCLUSION

Mental and physical health complaints as well as self-report of family dysfunction are salient predictors of suicide risk in the community corrections population.

Gender differences among suicide attempters attending a Crisis Intervention Clinic in South India

BACKGROUND AND OBJECTIVES

Studying gender differences among suicide attempters is important for identifying gender-specific risk factors and for planning management and prevention. Our objective was to delineate gender differences among a well-defined group of suicide attempters.

MATERIALS AND METHODS

This record-based study was conducted among patients presenting to a Crisis Intervention Clinic in a Tertiary Care Hospital in South India. Information was gathered regarding sociodemographic and clinical characteristics. Hopelessness was measured using Beck Hopelessness Scale (BHS), and stress was evaluated using Presumptive Stressful Life Events Scale (PSLES).

RESULTS

The sample comprised of 162 males and 137 females. Males were significantly older and were more likely to be employed as compared to females. Alcohol use was significantly more in males and number of men who attempted suicide under intoxication was significantly higher. Females had a greater proportion of attempts with the use of plant poisons and medication overdose. There was no significant difference between two genders on BHS though differences were noted on types of stresses reported on PSLES.

CONCLUSION

Gender-specific differences were noted with regard to substance use, mode of attempt and types of stressors experienced. Identifying these factors might help us to design targeted interventions to prevent further attempts.