Changes in Scottish suicide rates during the Second World War

Suicide trends in Germany during the COVID-19 pandemic and the war in Ukraine

AIMS

The later phase of the COVID-19 pandemic overlaps with geopolitical and economic consequences from the Ukraine war. Financial hardship and concerns about gas supply may add to pandemic factors and lead to increased suicide rates in Germany.

METHODS

Age- and sex-stratified suicide data from police crime statistics covering 35 % of the German population were used for an interrupted time-series analysis and for a projection of total German suicides in 2022.

RESULTS

For both sexes, a trend reversal from constant or declining suicide rates to an increase was observed. This increase is particularly pronounced in 2022 and mainly relates to the 60+ age group that is highly vulnerable to suicide. The projection of the overall German suicide rate is at a level last observed in 2015.

CONCLUSIONS

The key challenge now is to combat potential causes of this rise in suicide rates to avert the emerging upward trend.

Despair in the time of COVID: A look at suicidal ingestions reported to the California Poison Control System during the pandemic

Background

Despite concern that the global pandemic will worsen depression and suicide rates, there remain little data on its actual effect. The purpose of this study was to determine the effect of the COVID‐19 pandemic on suicidal ingestions reported to the California Poison Control System (CPCS).

Methods

This was a cross‐sectional comparison of suicidal ingestions reported to the CPCS during the 2020 COVID‐19 pandemic compared to suicidal ingestions reported during the same period in 2018 and 2019.

Results

The CPCS received 19,607 call for suicidal ingestions during the study periods, of which 13,800 were in the pre‐COVID era (2018 and 2019) and 5,807 were in the COVID era. The median (IQR) number of suicidal ingestions per month decreased from 2,286 (2,240–2,364) to 1,940 (1,855–2,045; p = 0.02). This decrease was consistent and significant across all age groups except those age 70 or older. Ingestions without adverse events decreased by 101 cases/month (95% confidence interval [CI] = 136.8 to 65; p = 0.0003), minor outcomes decreased by 156.6 cases/month (95% CI = 226.2 to 87.1; p = 0.001), and moderate outcomes decreased by 96 cases/month (95% CI = 143.9 to 48.1; p = 0.00021). Major outcomes decreased from 793 (4.99%) cases in the pre‐COVID era to 315 (4.60%) cases in the COVID era (risk ratio = 0.92, 95% CI = 0.81 to 1.05). The number of deaths decreased by 3.7 cases/month (95% CI = –8.3 to 0.92, p = 0.10).

Conclusions

Despite concern for worsening suicidality, calls regarding suicidal ingestions to the nation's largest poison control center decreased during the COVID era compared to the pre‐COVID era. This study provides evidence that the pandemic's effects on modern society remain difficult to predict. Further effort is needed to understand how pandemic will affect American's mental health.

Revisiting suicide rate during wartime: Evidence from the Sri Lankan civil war

After the seminal work of Durkheim (1897), many subsequent studies have revealed a decline in suicide rates during wartime. However, their main focus was inter-state wars and whether the same argument holds for civil conflicts within a country is an important unresolved issue in the modern world. Moreover, the findings of the previous studies are not conclusive due to unobserved confounding factors. This study investigated the relationship between civil war and suicide rate through a more rigorous statistical approach using the Sri Lankan civil war as a case study. For this purpose, we employed a linear regression model with district and year fixed effects to estimate a difference-in-difference in the suicide rate between the peacetime and wartime periods as well as the contested and non-contested districts. The results indicate that the suicide rate in the contested districts in the wartime was significantly lower than the baseline by 11.8–14.4 points (95% CI 6.46–17.22 and 7.21–21.54, respectively), which corresponds to a 43–52% decline. The robustness of the possible confounding factors was analyzed and not noted to have so much effect as to alter the interpretation of the results. This finding supports the Durkheimian theory, which places importance on social integration as a determinant of suicide, even for civil conflicts.

Estimating indirect mortality impacts of armed conflict in civilian populations: panel regression analyses of 193 countries, 1990-2017

BACKGROUND

Armed conflict can indirectly affect population health through detrimental impacts on political and social institutions and destruction of infrastructure. This study aimed to quantify indirect mortality impacts of armed conflict in civilian populations globally and explore differential effects by armed conflict characteristics and population groups.

METHODS

We included 193 countries between 1990 and 2017 and constructed fixed effects panel regression models using data from the Uppsala Conflict Data Program and Global Burden of Disease study. Mortality rates were corrected to exclude battle-related deaths. We assessed separately four different armed conflict variables (capturing binary, continuous, categorical, and quintile exposures) and ran models by cause-specific mortality stratified by age groups and sex. Post-estimation analyses calculated the number of civilian deaths.

RESULTS

We identified 1118 unique armed conflicts. Armed conflict was associated with increases in civilian mortality-driven by conflicts categorised as wars. Wars were associated with an increase in age-standardised all-cause mortality of 81.5 per 100,000 population (β 81.5, 95% CI 14.3-148.8) in adjusted models contributing 29.4 million civilian deaths (95% CI 22.1-36.6) globally over the study period. Mortality rates from communicable, maternal, neonatal, and nutritional diseases (β 51.3, 95% CI 2.6-99.9); non-communicable diseases (β 22.7, 95% CI 0.2-45.2); and injuries (β 7.6, 95% CI 3.4-11.7) associated with war increased, contributing 21.0 million (95% CI 16.3-25.6), 6.0 million (95% CI 4.1-8.0), and 2.4 million deaths (95% CI 1.7-3.1) respectively. War-associated increases in all-cause and cause-specific mortality were found across all age groups and both genders, but children aged 0-5 years had the largest relative increases in mortality.

CONCLUSIONS

Armed conflict, particularly war, is associated with a substantial indirect mortality impact among civilians globally with children most severely burdened.

Can we expect an increased suicide rate due to Covid-19?

Human disasters come in all shapes and sizes including wars, terrorist violence, natural events, economic recessions and depressions as well as infection. As a species more fragile than we often allow, humans would be expected to adversely react to these types of disasters in terms of mental ill health and possibly suicidal behaviour leading to increased demands on the Mental Health services. This narrative historical paper examines relevant studies into how previous disasters affected mental health and suicidal behaviour. The characteristics of what is known of the current Covid-19 disease are analysed and compared to other types of disasters with a view to gaining some insight into what we might expect. Of all the types of disasters, economic recession appears most toxic. Mitigating the worst effects of recession appears to be protective. Particularly vulnerable groups are identified in whom we might expect an increase in suicidal behaviour.

Suicide of Australians during the Vietnam War

OBJECTIVES

National suicide rates fall during times of war. This fits with the notion of the population coming together against a common foe. But, what happens in the case of a war which is not fully supported, which draws the population and families apart? We consider this question by examining the Australian suicide rates during the divisive Vietnam War.

METHODS

We graphed and examined the Australian suicide figures for 1921-2010.

RESULTS

We found clear evidence of a decrease in the suicide rate for World War II (consistent with other studies), but a marked elevation of suicide during the Vietnam War.

CONCLUSIONS

The elevation of the Australian suicide rate during the Vietnam War is consistent with Durkheim's social integration model - when social integration is lessened, either by individual characteristics or societal characteristics, the risk of suicide rises.

The Iraqi national study of suicide: Report on suicide data in Iraq in 2015 and 2016

BACKGROUND

Very little is known regarding the epidemiology of suicides in Iraq, given the lack of a national surveillance system. Therefore, the government initiated this project "The Iraqi National Study of Suicide METHODS: The study covered 13 (out of 18) provinces in Iraq. A data collection form was designed by the researchers. The forms were completed by police stations in the 13 provinces. Data were extracted from the legal investigation (which include police investigation, family reports and postmortem reports) of cases of when there was no clear cause of death and where there was final verdict of suicide made by judge after examining these reports.

RESULTS

There were 647 cases of suicide. The crude rate of suicide per 100 000 population was 1.09 (1.21 for males, 0.97 for females) in 2015 and 1.31 (1.54 for males and 1.07 for females) in 2016. The majority of cases (67.9%) were aged 29 years or below. The most common method was hanging (41%) followed by firearms (31.4%) and self-burning (19.2%). 24.1% of cases were reported to have psychiatric disorders, of which the most common diagnosis was depression (53.9%). In the majority of cases (82.1%) there were no previous attempts. Only a small minority were reported to have had psychological trauma (15.5%), financial problems (12.4%) or childhood abuse (2.2%).

LIMITATIONS

The study covered only 13 provinces in Iraq. We were able to calculate age-standardized rates for year 2016 only. Data are based on official police records and under-reporting and under-recognition of psychiatric disorders are possible.

CONCLUSION

On the basis of data available to this study, the suicide rate in Iraq is lower than the global rate. Suicide is more common in young people, where the gender distribution is almost equal. Social and cultural factors might have played a role in these patterns. The findings underscore the need of a national registry with a comprehensive and multipronged surveillance approach to correctly identify suicide events. This study aims to be the first step in this process.

Effect of the First World War on suicide rates in Ireland: an investigation of the 1864-1921 suicide trends

SUMMARY

Since the proposition of the social integration theory by Émile Durkheim, macro-sociological changes have been speculated to affect suicide rates. This study investigates the effect of the First World War on Irish suicide rates. We applied an interrupted time series design of 1864-1921 annual Irish suicide rates. The 1864-1913 suicide rates exhibited a slow-rising trend with a sharp decline from the year 1914 onwards. The odds for death by suicide for males during the 1914-1918 period was 0.811 (95% CI 0.768-0.963). Irish rates of suicide were significantly reduced during the First World War, most notably for males.

DECLARATION OF INTEREST

None.

COPYRIGHT AND USAGE

© 2015 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Psychiatric admissions fall following the Christchurch earthquakes: an audit of inpatient data

OBJECTIVE

Following the devastating earthquake in Christchurch, New Zealand, there was the widespread perception that the demand for inpatient mental health services would increase. However, our clinical observation was to the contrary, with substantial reductions in inpatient utilisation being noted. We therefore examined psychiatric bed occupancy and admission data to improve understanding of the impact of the disaster on mental health services.

METHOD

We audited acute psychiatric bed occupancy and admission rates prior to and following a major earthquake.

RESULTS

After the earthquake, total bed occupancy reduced from an average of 93% to 79%. Daily admissions also reduced by 20.2% for the 30 days following the earthquake. All diagnostic groups, with the exception of the 'Schizophrenia, schizotypal and delusional disorders' category, contributed to the reduction. No rebound to increased occupancy or admissions was seen over the study period.

CONCLUSION

The study confirmed our clinical observation that demand for acute inpatient psychiatric services were markedly reduced after the February 2011 earthquake.

Wars and suicides in Israel, 1948-2006

This paper reports the characteristics of suicides which occurred during the existential and the non-existential wars in Israel. It provides a first approximation of whether the suicide patterns in each war are consistent with the findings of Morselli and Durkheim, and whether their theoretical interpretations can serve as a preliminary guideline to explaining the Israeli case, which is characterized by short periods of war, social integration during some of the non-existential wars, and a sharp rise in post-war male suicide rates following all of the existential wars. Implications for further studies on the subject in Israel and elsewhere are discussed.

Suicide incidence and risk factors in an active duty US military population

OBJECTIVES

The goal of this study was to investigate and identify risk factors for suicide among all active duty members of the US military during 2005 or 2007.

METHODS

The study used a cross-sectional design and included the entire active duty military population. Study sample sizes were 2,064,183 for 2005 and 1,981,810 for 2007. Logistic regression models were used.

RESULTS

Suicide rates for all services increased during this period. Mental health diagnoses, mental health visits, selective serotonin reuptake inhibitors (SSRIs), sleep prescriptions, reduction in rank, enlisted rank, and separation or divorce were associated with suicides. Deployments to Operation Enduring Freedom or Operation Iraqi Freedom were also associated with elevated odds ratios for all services in the 2007 population and for the Army in 2005.

CONCLUSIONS

Additional research needs to address the increasing rates of suicide in active duty personnel. This should include careful evaluation of suicide prevention programs and the possible increase in risk associated with SSRIs and other mental health drugs, as well as the possible impact of shorter deployments, age, mental health diagnoses, and relationship problems.

Can sports events affect suicidal behavior? A review of the literature and implications for prevention

BACKGROUND

Engagement in sports and physical activity, either actively as an athlete or in a passive way as a spectator, impacts interpersonal behavior and physical and mental health.

AIMS

The study reviews literature on the relationship between sports spectatorship and suicidal behavior to ascertain whether sports spectatorship has an impact on suicidal behavior, either increasing the risk or being a protective factor.

METHODS

The literature was searched via PubMed/MEDLINE and PsycINFO. Nine studies published between 1986 and 2006 were identified.

RESULTS

The reviewed studies focused on the impact of sports events on the societal level, and analyzed data regarding national or local suicide rates. Their results indicate that sports events can have an impact on suicide mortality and morbidity, but this relationship seems to be mediated by age, gender, marital status, and alcohol consumption, as well as the process and outcome of the game (e.g., victory vs. defeat of the favored team).

CONCLUSIONS

There is some evidence that sports events can reduce the rates of suicide on the societal level; however, there is a lack of studies exploring how sports spectatorship might influence levels of suicide risk in individuals and how mediating variables might operate on the individual level.

Association between terror attacks and suicide attempts

Based on Durkheim's 'Control theory,' we explored the association between frequency of terror attacks in Israel and the frequency of suicide attempts admitted to the Emergency Room of a major general hospital in Tel-Aviv (1999-2004). Analysis of the six-year study period as a whole revealed no significant correlation between the variables, with the exception of one 11-month segment within it (December 2000-October 2001) that did show a statistically significant positive correlation, and in opposition to Durkeim's hypothesis. It is suggested that suicide attempts as a phenomena should be seen as a product of a multivariate model, in which the social context plays a role as well.