Suicide among Chinese schizophrenics in Hong Kong

Spinal Injuries in Suicidal Jumpers

STUDY DESIGN

This was a retrospective case series at a single institution.

OBJECTIVE

The study was performed to investigate the characteristics of spinal injuries in survivors of suicidal jumping.

SUMMARY OF BACKGROUND DATA

Spinal fracture/dislocation is associated with high-energy trauma such as that induced by motor vehicle accidents. Survivors of suicidal jumping sometimes sustain spinal injuries. However, the characteristics of such spinal injuries are unclear.

METHODS

We identified 87 survivors of suicidal jumping who sustained spinal injuries from 2007 to 2016 in our institution. We compared the demographic data, radiological findings, neurological status, associated injuries, treatments, and mental health conditions between these 87 survivors and 204 non-suicidal patients with spinal injury.

RESULTS

Suicidal jumpers were predominantly female (67%) and 10 years younger than non-suicidal patients. Mental health problems, mainly schizophrenia and depression, were diagnosed in 77% of suicidal jumpers. Neurological damage from spinal trauma was generally less severe in suicidal jumpers than in non-suicidal patients. Most spinal injuries in suicidal jumpers were located in the thoracic or lumbar spine region (85%). Among comorbid injuries, extremity injuries were highly associated with spine injury in suicidal jumpers. Nearly 70% of suicidal jumpers exhibited extremity injury in contrast to 33% of non-suicidal patients. Approximately, 25% of suicidal jumpers underwent surgical treatment. Surgical treatment was similarly performed on suicidal jumpers and non-suicidal patients regardless of the discrepancy in neurological damage between these two groups.

CONCLUSION

Spinal injuries in suicidal jumpers differed from spinal injuries in non-suicidal patients with regard to sex, age, mental health condition, injury location, neurologic damage, and associated injuries. Most survivors of suicidal jumping were young female patients with mental health problems. They tended to have thoracic and lumbar spine trauma rather than cervical trauma with less severe neurological deficits and a higher incidence of accompanying limb injury.

LEVEL OF EVIDENCE

3.

Suicide in schizophrenia

Suicide is recognised as the most devastating possible outcome of a schizophrenic illness. This study examined the characteristics of 15 schizophrenic patients who committed suicide. These patients were older and less socially isolated than noted in other research. Drowning was the commonest method of suicide and overall, the methods chosen were comparable to those reported among the general Irish population. A past history of deliberate self harm was common although no temporal relationship between such behaviour and suicide emerged. The findings are discussed in the light of the existing literature on this topic.

Rural-urban differences in suicide rates for current patients of a public mental health service in Australia

Rural versus urban rates of suicide in current patients of a large area mental health service in Australia were compared. Suicide deaths were identified from compulsory root cause analyses of deaths, 2003-2007. Age-standardized rates of suicide were calculated for rural versus urban mental health service and compared using variance of age-standardized rates with 95% confidence intervals. There were 44 suicides and the majority (62%) were rural. Only urban patients used jumping from heights as a method of suicide (4/17; p = 0.02). Rural patients had 2.7 times higher rates of suicide, similar to findings for rural versus urban community suicides and may reflect the underlying community rates, differences in mental health service delivery, or socioeconomic disadvantage.

Lifetime psychiatric symptoms in persons with schizophrenia who died by suicide compared to other means of death

The focus of this report is to compare the psychiatric symptomatology of individuals with schizophrenia who have died by suicide to those who have died by other means of death. This study includes individuals with a diagnosis of schizophrenia whose families donated their brain tissue to the Maryland Brain Collection between September 1989 and August 1998. The psychological autopsy method was used to assess the deceased individual's demographic and clinical characteristics, psychiatric symptoms and history of suicidal thoughts and attempts. Ninety-seven individuals with schizophrenia were identified for this study. Fifteen had committed suicide, while the remaining 82 died from other causes. Thoughts of suicide and previous suicide attempts were more frequent among the group that died from suicide (93% compared to 26%) (p < 0.0001). Suicide victims had a higher rate of depressive symptoms and were twice as likely to have a depressed mood. The incidence of thoughts of dying was 60% compared to 20% in those who did not commit suicide (p = 0.002). Loss of interest was reported to occur in 20% in the suicide group compared to 4% in the group of individuals that died from other causes (p = 0.05). Victims of suicide also had higher rates of positive symptoms throughout their lifetime including thought control, flight of ideas, and loose associations. Suicide is one of the leading cause of premature death in individuals with schizophrenia and identification of risk factors is of great importance. Individuals who die by suicide experience higher rates of depressive symptoms, suicidal thoughts and positive symptoms during their life.

Suicide attempts by firearms and by leaping from heights: a comparative study of survivors

OBJECTIVE

The purpose of this study was to compare the clinical and demographic profiles of patients who deliberately harmed themselves, either by jumping from a great height or by using firearms, and survived.

METHOD

The study consisted of an 18-year retrospective case history analysis of survivors of jumping and shooting identified from the database of consultation-liaison psychiatry referrals at a hospital in Sydney, Australia. Clinical and demographic information was collated and analyzed.

RESULTS

Fifty-one patients who had shot themselves and 31 patients who had jumped, all of whom had survived, were assessed by the consultation-liaison psychiatry team. There were clear differences between the two groups. Those who jumped were more likely to be single, unemployed, and psychotic. Those who used firearms were more likely to be male, abuse alcohol, have a forensic history, and have an antisocial or borderline personality disorder.

CONCLUSIONS

In this study, the subjects who attempted suicide by shooting themselves and those who did so by jumping had different profiles of mental state, personality function, and psychiatric diagnosis. The importance of mental state and specific psychiatric diagnosis as determinants of the method used has been neglected in studies of suicide. These factors should be considered along with others such as accessibility and acceptability of means, since these differences may be important when suicide prevention is considered. It is also important for psychiatrists providing consultation-liaison services to be aware of these differences in order to ensure optimal treatment of survivors.

Suicide by jumping

This review summarizes the published literature on suicide by jumping, in particular focusing on the social and psychological characteristics of people who have chosen this method of suicide, and the opportunities for prevention. Suicide by jumping accounts for 5% of suicides in England and Wales, and there are marked variations in the use of this method world-wide. A number of locations have gained notoriety as popular places from which to jump. Such sites include The Golden Gate Bridge and Niagara Falls in the USA, and Beachy Head and the Clifton Suspension Bridge in the UK. There is no consistent evidence that those who commit suicide by jumping differ sociodemographically or in their psychopathology from those who use other methods of suicide, although this method is more often used for in-patient suicides, possibly due to lack of access to other means. Survivors of suicidal jumps experience higher subsequent rates of suicide and mental ill health, but the majority do not go on to kill themselves, suggesting that preventive efforts may be worthwhile. This view is supported by other evidence that restricting access to the means of suicide may prevent some would-be suicides. Such measures may also reduce the emotional trauma suffered by those who witness these acts. Health authorities and coroners should consider reviewing local patterns of suicide by jumping, and if necessary institute preventive measures.

Suicide in Hong Kong 1971-1990: age trend, sex ratio, and method of suicide

This study gives an overview of the suicide rates in Hong Kong in the last 2 decades (1971-1990). It was found that the average suicide rate for the whole population was 11.3 per 100,000 population and it has been quite steady in recent years. The male and female adolescent (age-group 10-24 years) suicide rates were approximately the same, while the ratio of the overall male to female rate was 1.3:1. This indicated a relatively high female rate as compared with other countries. An examination of the suicide rates for various age-groups showed that the rate increased with age. The adolescent suicide rate was not particularly high (4.7 per 100,000 population for the age-group 10-24 years), but that for the elderly was 4-5 times the overall rate (49.5 per 100,000 population for those aged over 70 years). As regards the method of suicide, jumping from a height and hanging predominated in all age-groups. These methods were in great contrast to those used in other countries.

Suicide attempts of high medical seriousness in schizophrenic patients

A retrospective study was conducted that included all patients who in the previous 6 years had required admission to our hospital for medical reasons following attempted suicide (N = 253). Those diagnosed as schizophrenic (n = 43) in accordance with DSM-III-R criteria were compared with the other nonschizophrenic suicide attempters. Schizophrenic patients were significantly different in that they were younger and generally unmarried, usually used violent methods, made more attempts while in a psychiatric center, and presented a lower incidence of concurrent organic illness than the nonschizophrenics; almost all of them were chronic. A large majority (80%) showed delusional and hallucinatory symptoms at the time of the attempt. In contrast, depressive symptoms were noted in an appreciably lower percentage of subjects than that in other studies of suicidal behavior in schizophrenics.

A clinical study of schizophrenic suicides. 42 cases in Taiwan

A clinical study of 25 male and 17 female schizophrenic suicides is presented. Jumping from a height was the most common method used. The 42 suicidal schizophrenics in Taiwan were compared with both 84 sex- and age-matched and 60 5-year illness course non-suicidal schizophrenic control groups. The suicidal schizophrenics were not significantly different from the non-suicidal counterparts of both control groups with regard to age, sex, ethnicity, religion, educational background, the presence of suicide cases in the family history, and the presence of insight, but were significantly different in characteristics of a history of previous suicide attempts, presence of psychotic symptoms during their final month, depression during their final month, a history of depression, a history of previous psychiatric hospitalizations, and the number of hospitalizations. We discuss the findings from this study and others in the literature in the context of the different clinical and socio-cultural backgrounds of these Taiwanese schizophrenic suicides.

Risk factors of suicide among schizophrenics

This case control study included 74 Chinese schizophrenics (DSM-III criteria) who died of suicide and 74 age- and sex-matched nonsuicide schizophrenics. Sociodemographic variables were unrelated with suicide. Associations were found between suicide and severity of illness (more frequent admissions, higher dose of medication and earlier appointments), history of major depressive episodes and suicidal attempts, last admission for reasons other than schizophrenic symptoms alone, and suicidal ideas on mental state examination. The last 2 factors, together with the maintenance dose of medication, were identified as the most important risk factors by logistic regression analysis.