Trends in suicide in a Lithuanian urban population over the period 1984-2003

The trend in suicide methods in South Korea in 1997-2015

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.

Suicide rate trends in the Slovak Republic in 1993-2015

BACKGROUND

Suicide is a significant public health issue worldwide, resulting in loss of lives, and burdening societies.

AIMS

To describe and analyze the time trends of suicide rates (SRs) in the Slovak Republic in 1993-2015 for targeted suicide prevention strategies.

METHODS

Data for this study were obtained from the mortality database of the Statistical Office of the Slovak Republic. Crude and standardized annual SRs were calculated. Trends and relative risks of suicide according to age and sex were analyzed by joinpoint regression and negative binomial regression.

RESULTS

In total, there were 14,575 suicides in the Slovak Republic in the period 1993-2015 (85.3% were men). The overall average age-standardized SR for the study period was 11.45 per 100,000 person years. The rate increases with age, the highest is in men aged 75+ (42.74 per 100,000 person years). Risk of suicide is six times higher in men than in women and nine times higher in men than in women in the age group 25-34. The time trend of SRs is stable or decreasing from 1993 to 2007, but increasing after 2007, corresponding with increased unemployment rate in the country.

CONCLUSION

The SR in the Slovak Republic is slightly below the average of Organisation for Economic Co-operation and Development (OECD) nations. Highest SR is observed in men of working age and in retirement. Society might benefit from a strategy of education for improving the recognition of suicide risks.

The Economic Crisis in Greece and Its Impact on the Seasonality of Suicides in the Athens Greater Area

OBJECTIVE

The economic crisis and the implementation of austerity measures in Greece lead to significant socioeconomic changes. The effects of the crisis were mainly felt by the Greek population during the years 2011 and 2012. This study aimed to investigate the impact of Greece's economic crisis on the seasonality of suicides in the Athens Greater Area.

METHODS

Data were collected for all recorded cases of suicides committed over a 5-year period (from 2008 to 2012) from the Athens Department of Forensic Medicine. Two sub-periods were studied in relation to the economic crisis: 2008-2010 and 2011-2012. Seasonality was estimated with the Poison regression variant of the circular normal distribution.

RESULTS

Suicide seasonality appeared significant during 2008-2010 (relative risk, RR=1.36) and strengthened in the years 2011-2012 (RR=1.69), when the impact of the austerity measures was increasingly being felt by the Greek society. Regarding the latter sub-period, seasonality was established for males (RR=1.75), individuals aged 45 years or more (RR=1.75) and suicide by hanging (RR=1.96).

CONCLUSION

The economic crisis in Greece, especially in the period during its effects had a significant impact on the population's economic condition, seems to have strengthened the seasonality of suicides, while a noteworthy suicide risk of 96% was revealed for suicides by hanging (peak in early June).

The use of regression methods for the investigation of trends in suicide rates in Hungary between 1963 and 2011

PURPOSE

Suicide rates in Hungary have been analyzed from different aspects in recent decades. However, only descriptive rates have been reported. The aim of our epidemiological study was to characterize the pattern of annual rates of suicide in Hungary during the period 1963-2011 by applying advanced statistical methods.

METHODS

Annual suicide rates per 100,000 population (>6 years) for gender, age group and suicide method were determined from published frequency tables and reference population data obtained from the Hungarian Central Statistical Office. Trends and relative risks of suicide were investigated using negative binomial regression models overall and in stratified analyses (by gender, age group and suicide method). Joinpoint regression analyses were additionally applied to characterize trends and to find turning points during the period 1963-2011.

RESULTS

Overall, 178,323 suicides (50,265 females and 128,058 males) were committed in Hungary during the investigated period. The risk of suicide was higher among males than females overall, in all age groups and for most suicide methods. The annual suicide rate exhibited a significant peak in 1982 and remained basically constant after 2006. Different segmented patterns were observed for the suicide rates in the various age groups.

CONCLUSIONS

Suicide rates revealed segmented linear pattern. This is the first detailed trend analysis with risk estimates obtained via joinpoint and negative binomial regression methods simultaneously for age-specific suicide frequencies in Hungary.

Regional changes in charcoal-burning suicide rates in East/Southeast Asia from 1995 to 2011: a time trend analysis

BACKGROUND

Suicides by carbon monoxide poisoning resulting from burning barbecue charcoal reached epidemic levels in Hong Kong and Taiwan within 5 y of the first reported cases in the early 2000s. The objectives of this analysis were to investigate (i) time trends and regional patterns of charcoal-burning suicide throughout East/Southeast Asia during the time period 1995-2011 and (ii) whether any rises in use of this method were associated with increases in overall suicide rates. Sex- and age-specific trends over time were also examined to identify the demographic groups showing the greatest increases in charcoal-burning suicide rates across different countries.

METHODS AND FINDINGS

We used data on suicides by gases other than domestic gas for Hong Kong, Japan, the Republic of Korea, Taiwan, and Singapore in the years 1995/1996-2011. Similar data for Malaysia, the Philippines, and Thailand were also extracted but were incomplete. Graphical and joinpoint regression analyses were used to examine time trends in suicide, and negative binomial regression analysis to study sex- and age-specific patterns. In 1995/1996, charcoal-burning suicides accounted for <1% of all suicides in all study countries, except in Japan (5%), but they increased to account for 13%, 24%, 10%, 7%, and 5% of all suicides in Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore, respectively, in 2011. Rises were first seen in Hong Kong after 1998 (95% CI 1997-1999), followed by Singapore in 1999 (95% CI 1998-2001), Taiwan in 2000 (95% CI 1999-2001), Japan in 2002 (95% CI 1999-2003), and the Republic of Korea in 2007 (95% CI 2006-2008). No marked increases were seen in Malaysia, the Philippines, or Thailand. There was some evidence that charcoal-burning suicides were associated with an increase in overall suicide rates in Hong Kong, Taiwan, and Japan (for females), but not in Japan (for males), the Republic of Korea, and Singapore. Rates of change in charcoal-burning suicide rate did not differ by sex/age group in Taiwan and Hong Kong but appeared to be greatest in people aged 15-24 y in Japan and people aged 25-64 y in the Republic of Korea. The lack of specific codes for charcoal-burning suicide in the International Classification of Diseases and variations in coding practice in different countries are potential limitations of this study.

CONCLUSIONS

Charcoal-burning suicides increased markedly in some East/Southeast Asian countries (Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore) in the first decade of the 21st century, but such rises were not experienced by all countries in the region. In countries with a rise in charcoal-burning suicide rates, the timing, scale, and sex/age pattern of increases varied by country. Factors underlying these variations require further investigation, but may include differences in culture or in media portrayals of the method. Please see later in the article for the Editors' Summary.

Regional changes in charcoal-burning suicide rates in East/Southeast Asia from 1995 to 2011: a time trend analysis

BACKGROUND

Suicides by carbon monoxide poisoning resulting from burning barbecue charcoal reached epidemic levels in Hong Kong and Taiwan within 5 y of the first reported cases in the early 2000s. The objectives of this analysis were to investigate (i) time trends and regional patterns of charcoal-burning suicide throughout East/Southeast Asia during the time period 1995-2011 and (ii) whether any rises in use of this method were associated with increases in overall suicide rates. Sex- and age-specific trends over time were also examined to identify the demographic groups showing the greatest increases in charcoal-burning suicide rates across different countries.

METHODS AND FINDINGS

We used data on suicides by gases other than domestic gas for Hong Kong, Japan, the Republic of Korea, Taiwan, and Singapore in the years 1995/1996-2011. Similar data for Malaysia, the Philippines, and Thailand were also extracted but were incomplete. Graphical and joinpoint regression analyses were used to examine time trends in suicide, and negative binomial regression analysis to study sex- and age-specific patterns. In 1995/1996, charcoal-burning suicides accounted for <1% of all suicides in all study countries, except in Japan (5%), but they increased to account for 13%, 24%, 10%, 7%, and 5% of all suicides in Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore, respectively, in 2011. Rises were first seen in Hong Kong after 1998 (95% CI 1997-1999), followed by Singapore in 1999 (95% CI 1998-2001), Taiwan in 2000 (95% CI 1999-2001), Japan in 2002 (95% CI 1999-2003), and the Republic of Korea in 2007 (95% CI 2006-2008). No marked increases were seen in Malaysia, the Philippines, or Thailand. There was some evidence that charcoal-burning suicides were associated with an increase in overall suicide rates in Hong Kong, Taiwan, and Japan (for females), but not in Japan (for males), the Republic of Korea, and Singapore. Rates of change in charcoal-burning suicide rate did not differ by sex/age group in Taiwan and Hong Kong but appeared to be greatest in people aged 15-24 y in Japan and people aged 25-64 y in the Republic of Korea. The lack of specific codes for charcoal-burning suicide in the International Classification of Diseases and variations in coding practice in different countries are potential limitations of this study.

CONCLUSIONS

Charcoal-burning suicides increased markedly in some East/Southeast Asian countries (Hong Kong, Taiwan, Japan, the Republic of Korea, and Singapore) in the first decade of the 21st century, but such rises were not experienced by all countries in the region. In countries with a rise in charcoal-burning suicide rates, the timing, scale, and sex/age pattern of increases varied by country. Factors underlying these variations require further investigation, but may include differences in culture or in media portrayals of the method. Please see later in the article for the Editors' Summary.

Characteristics of intentional fall injuries in the ED

INTRODUCTION

This study was conducted to examine the characteristics of intentional fall injuries and the factors associated with their prognosis.

METHODS

The study included 8992 patients with unintentional falls from a height (nonintentional group) and 144 patients with intentional falls from a height (intentional group). General and clinical characteristics were compared between the 2 groups. Intentional fall cases were divided into severe and nonsevere groups, and the factors associated with severe injury were evaluated by comparing these groups.

RESULTS

The most common age group was younger than 14 years in the nonintentional group and between 30 and 44 years old in the intentional group. For the nonintentional group, 65% of the patients were male, and 48% were male in the intentional group. Fall heights of more than 4 m were most common in the intentional group. Discharge was the most common result in the nonintentional group; however, death before arrival at the emergency department (ED) or during ED treatment occurred in 54.9% of patients in the intentional group. In the severe injury group within the intentional group, patients were older, and the height of the fall was higher. Factors associated with severe injury in the intentional group included being a high school graduate rather than a college graduate and greater fall height.

CONCLUSION

The risk of severe injury increased with fall height in the intentional group, and a high school level of education rather than a college level of education was associated with more severe injury.

Suicide in young men

Suicide is second to only accidental death as the leading cause of mortality in young men across the world. Although suicide rates for young men have fallen in some high-income and middle-income countries since the 1990s, wider mortality measures indicate that rates remain high in specific regions, ethnic groups, and socioeconomic groups within those nations where rates have fallen, and that young men account for a substantial proportion of the economic cost of suicide. High-lethality methods of suicide are preferred by young men: hanging and firearms in high-income countries, pesticide poisoning in the Indian subcontinent, and charcoal-burning in east Asia. Risk factors for young men include psychiatric illness, substance misuse, lower socioeconomic status, rural residence, and single marital status. Population-level factors include unemployment, social deprivation, and media reporting of suicide. Few interventions to reduce suicides in young men have been assessed. Efforts to change help-seeking behaviour and to restrict access to frequently used methods hold the most promise.

Change in causes of injury-related deaths in South Korea, 1996-2006

Background

The aims of this study were to describe temporal patterns of injury-related mortality by sex, age group, and mechanism, and to identify changes in the leading causes of injury-related deaths in South Korea from 1996 through 2006.

Methods

This retrospective, descriptive study analyzed national data on all injury-related deaths reported in official death certificates from 1996–2006. Incidence rates of fatal injuries are presented as crude and age-standardized rates per 100 000 population, and percentage changes in injury-related mortalities over the 11-year period were calculated with respect to intention, sex, and age. The 4 most common mechanisms (fall, poisoning, suffocation, and drowning) were then classified as unintentional injuries or suicides.

Results

Overall injury-related mortality decreased 31.7% during the study period (1996–2006). Despite this overall decreasing trend, injury-related mortality increased among adults aged 65 years or older. In particular, injury-related mortality among women older than 80 years doubled since 1996. Suicide replaced transport as the leading cause of injury-related deaths between 2003 and 2006. With regard to intention, sex, and age, the most noticeable changes during the study period were increases in unintentional fall among elderly adults and suicidal fall among adolescents.

Conclusions

The incidence rate for all injuries generally decreased from 1996–2006. However, the incidence rate of fall injuries increased among elderly adults, and suicide increased among adolescents. These findings suggest that further investigation of the characteristics and trends of injuries is necessary to develop and implement effective interventions.

The epidemiology of injury in the Republic of Lithuania

Aims: The overall goal of this paper is to highlight the epidemiology of injury in Lithuania between 1998 and 2006. Such a situation analysis will inform the important dialogue happening in Lithuania with respect to renewal of the trauma programme and help to profile the burden of injury in the country. Methods: Review of the literature, and secondary analysis of data from the Lithuanian Health Information Center and the European Detailed Mortality database. Results: Sixteen articles were identified as population-based studies; only incidence of burn injuries was reported as 240 per 100,000 per year. According to our analysis, the overall incidence of injury increased from 76 cases per 1,000 individuals in 1998 to 121 cases per 1,000 individuals in 2006. The total number of deaths from external causes remained similar with an average of 5,301 per year, as did the age-standardized mortality rates of 152 in 1998 and 150 per 100,000 in 2006. The mortality rate in men was four times higher than in women. Suicide was the most frequent cause of death (34% in 2006); while road traffic injuries were the second most frequent accounting for 17—19% of deaths. There were 429 deaths due to exposure to natural cold in 2006, which constituted 8% of all deaths due to injury. Conclusions: Injury incidence and mortality from external causes in Lithuania has not declined over an eight year time frame. New efforts should be launched in the health sector to address this major cause of deaths.

Lethal means reduction: what have we learned?

PURPOSE OF REVIEW

Suicide is an important global public health problem. Across nations, suicide rates are linked to the availability of lethal means. Three methods dominate country-specific suicide rates: firearms, pesticides, and hanging. There is increasing international support for reducing the availability of lethal means to prevent suicide. This article reviews evidence regarding lethal means reduction as a suicide-prevention strategy.

RECENT FINDINGS

Most evidence in support of means reduction comes from ecological studies examining the association between population-level decreases in the availability of a given lethal means of suicide and method-specific suicide rates. Substantial declines in method-specific suicide rates were shown following reductions in availability of lethal means through initiatives such as the passage of firearm control laws, detoxification of domestic gas, modification of drug packaging and toxicity, and installation of barriers at jump sites. The vast majority of the evidence for the effectiveness of lethal means reduction relates to reducing the availability of firearms and pesticides.

SUMMARY

Implementing means reduction at both the population and individual levels poses many challenges, particularly when political issues arise during regulation of firearms or pesticides. Nevertheless, evidence strongly suggests that means reduction is effective and should be an important part of a suicide-prevention strategy.

The ten-year trend in suicide methods. Evidence from an Asian population

OBJECTIVE

Despite the wealth of studies investigating methods of committing suicide, very few studies have been undertaken in which the focus has been placed on the long-term trend in suicide methods. The aim of this study is therefore to examine the changes in suicide methods in Taiwan.

METHODS

Our study uses 1995-2004 'cause of death' data, obtained from the Department of Health in Taiwan, to explore the trend in suicide methods among different age and gender groups. The autoregressive integrated moving average model is applied to examine the change in suicide methods among 25,062 suicide deaths during the ten-year study period.

RESULTS

Dramatic rises were identified in the proportions of suicides committed by poisoning by means of gases and vapors (both p < 0.001) in the <34 and 35-64 years age groups between 1995 and 2004, as compared to steady declines in the proportions of suicides committed by hanging, strangulation or suffocation, and poisoning by solid or liquid substances (all p < 0.001). However, for the >64 years age group, the proportions remained steady throughout the study period for all suicide methods, with the one exception of jumping from heights.

CONCLUSIONS

Poisoning by gases and vapors is identified as being an increasingly popular method of committing suicide in Taiwan among both genders under the age of 65 years.

Time trends in suicide mortality vary in choice of methods: an analysis of 145,865 fatal suicide cases in Germany 1991-2002

BACKGROUND

Overall, decreasing suicide mortality rates were observed in the last decades in most Western populations. However, it remains unclear, whether these favourable trends occurred uniformly in particular suicide methods. Therefore, the present study evaluated time trends of suicide mortality by method in Germany over the period 1991-2002.

METHODS

A total of 145,865 fatal suicide cases of men and women aged >or=15 years and with available suicide method were recorded by the Federal Statistical Office of Germany (suicides coded "death following a suicide attempt" were excluded). Based on these data, seven different suicide methods were defined. Poisson regression was used to estimate the age-adjusted annual percentage change (AAPC) of the number of each suicide method.

RESULTS

The most frequently used suicide methods in both sexes were hanging, strangling or suffocation (HSS) with 55.8% in men and 39.9% in women, followed by self-poisoning. Statistically significant declines of the number of suicides were observed, in descending order, for self-poisoning, drowning and HSS in both sexes. In contrast, methods using firearm discharges or stab with a sharp object remained in roughly constant level. Modifications of time trends were observed for several methods by age classes.

CONCLUSIONS

The present study demonstrates different time trends for suicide methods. Further examinations are recommended in particular concerning possible reasons for the choice of a suicidal method.

Self-perceived mental health and job satisfaction among Lithuanian dentists

The aim of this study was to document dentists' self-perceived mental health complaints and job satisfaction, and to assess any correlations between the two. A postal questionnaire survey was mailed to all (N=2,449) licensed dentists registered with the Lithuanian Dental Association. The questionnaire investigated dentists' mental health and job satisfaction during the previous year (overall response rate: 68.2%). The majority of respondents (80.7%) reported being satisfied with their job. Self-perceived lack of self-esteem (OR: 0.59, 95% CI: 0.43-0.82), loneliness (OR: 0.72, 95% CI: 0.53-0.98), and especially depression (OR: 0.52, 95% CI: 0.35-0.77) had a high negative impact on dentists' job satisfaction. Nervousness (89.2%) and burnout (83.6%) were the most prevalent mental complaints and they also tended to be the most chronic of all reported mental disorders. Increasing age significantly reduced the possibility of nervousness or depression and increased the possibility of being satisfied with dental practice. Increasing working hours increased the risk of burnout, anxiety and loneliness. Overall, this study suggests that the majority of Lithuanian dentists are satisfied with their job and also enjoy their professional lives. However, a considerable proportion still reported impairment of mental health which influenced their levels of job satisfaction.

Sexual differences in the completed suicides in Turkey

The aim of this study was to determine whether there is a difference between men and women in terms of suicide age, suicide method and suicide reason in Turkey. This study recruited 17,327 cases that had committed suicide between 1990 and 2000. Of all the cases who committed suicide during a period of 11 years, 61.1% were men, 38.9% women. The highest suicide score fell into the age group 15-24 (P<0.001). The most frequently used methods for suicide were self-hanging (48.2%) and use of firearms (19.2%) (P<0.001). The proportion of those committing suicide taking chemicals (drugs, etc.) was higher in women than in men (P<0.001). The most frequently seen reasons for suicide were illness and (33.8%) unsatisfactory relationships (33.0%) (P<0.001, each one). Women committed suicide much more because of unsatisfactory relationships, whereas for men it was due to illness (20.8% and 14.6%, respectively). There were significant differences between men and women in terms of suicide age, suicide method and suicide reason in Turkey. When evaluating suicide cases it is essential that the differences between sexes be taken into consideration.