Suicide among Young People and Adults in Ireland: Method Characteristics, Toxicological Analysis and Substance Abuse Histories Compared

Sociodemographic and psychosocial risk factors of railway suicide a mixed-methods study combining data of all suicide decedents in the Netherlands with data from a psychosocial autopsy study

BACKGROUND

Railway suicide has profound implications for the victims and their family, and affects train drivers, railway personnel, emergency services and witnesses. To inform a multilevel prevention strategy, more knowledge is required about psychosocial and precipitating risk factors of railway suicide.

METHODS

Data from Statistics Netherlands of all suicides between 2017 and 2021 (n = 9.241) of whom 986 died by railway suicide and interview data from a psychosocial autopsy of railway suicide decedents (n = 39) were integrated. We performed logistic regression analyses to identify sociodemographic predictors of railway suicide compared to other methods of suicide. The Constant Comparative Method was subsequently employed on interview data from the psychosocial autopsy to identify patterns in psychosocial risk factors for railway suicide.

RESULTS

The strongest predictors of railway suicide compared to other suicide methods were young age (< 30 years old), native Dutch, a high educational level, living in a multi-person household (especially living with parents or in an institution), living in a rural area and a high annual household income of > 150.000 euros. Several subgroups emerged in the psychosocial autopsy interviews, which specifically reflect populations at risk of railway suicide. These subgroups were [1] young adult males with autism spectrum disorder who strived for more autonomy and an independent life, [2] young adult females with persistent suicidal thoughts and behaviours, [3] middle-aged males with a persistent mood disorder who lived with family and who faced stressors proximal to the suicide in personal and professional settings, [4] male out-of-the-blue suicides and [5] persons with psychotic symptoms and a rapid deterioration.

CONCLUSIONS

based on our findings we propose and discuss several recommendations to prevent railway suicide. We must continue to invest in a safe railway environment by training personnel and installing barriers. Additionally, we should adopt prevention strategies that align the needs of subgroups at increased risk, including young females who have attempted other methods of suicide and young males with autism spectrum disorder. Future research should determine the cost-effectiveness and feasibility of low-maintenance, automated interventions near crossings and psychiatric facilities.

The burden of attempted hanging and drowning presenting to hospitals in Ireland between 2007 and 2019: a national registry-based study

PURPOSE

To measure the impact of hospital-treated self-harm by hanging and drowning in Ireland in 2007-2019 and identify risk factors for these methods of self-harm.

METHOD

Data on all self-harm presentations to Irish hospitals between 2007 and 2019 were obtained from the National Self-Harm Registry Ireland, a national self-harm surveillance system. Multinomial regression was used to explore factors associated with attempted hanging and drowning.

RESULTS

The age-standardised incidence rate of attempted hanging and drowning increased by 126% and 45%, respectively, between 2007 and 2019. The incidence of both methods was highest among young people aged 15-24 years. The odds of presenting to hospital for attempted hanging were highest in males (aOR 2.85, 95% CI 2.72-3.00), people experiencing homelessness (aOR 1.32, 95% CI 1.16-1.49) and individuals living in the capital, Dublin (aOR 1.23, 95% CI 1.17-1.29). The odds of presenting for attempted drowning were highest in males (aOR 1.68, 95% CI 1.58-1.78) and people experiencing homelessness (aOR 2.69, 95% CI 2.41-2.99).

CONCLUSION

The incidence of hospital-treated self-harm by hanging and drowning is increasing in Ireland and is highest among adolescents and young adults. Males and people experiencing homelessness may be at highest risk and warrant targeted preventive interventions.

Guiding principles for the implementation of a standardized psychological autopsy to understand and prevent suicide: a stakeholder analysis

Background

Around 700,000 people die by suicide each year. While the global number of suicides declined over the last decade, the rates remained unchanged in the Netherlands. With this study, we aimed to provide guiding principles for the implementation of a national standardized psychological autopsy to better understand and prevent suicide, by exploring stakeholder perceptions and needs, and barriers to implementation.

Methods

We interviewed 47 representative stakeholders from various fields (e.g., mental healthcare professionals, policy advisors, researchers). A semi structured interview design was used, based on the RE-AIM and Consolidated Framework for Implementation Research (CFIR) theoretical frameworks.

Results

Themes relating to stakeholder perceptions and needs for a standardized psychological autopsy included valorization, accountability, integrability and the needs of the bereaved. Stakeholders believed that participation in a psychological autopsy can help bereaved in their process of grief but noted that evidence to frame the psychological autopsy as postvention is insufficient. The primary focal point should accordingly be to better understand and prevent suicide. Several key limitations of the proposed psychological autopsy approach were detailed, both methodological and implementational.

Conclusion

The stakeholder analysis delineates guiding principles for implementation. Stakeholders believe that a standardized psychological autopsy has merit, provided that key considerations, including valorization and accountability, are integrated in its design. Routine evaluation should be ensured. The findings may guide policy makers and researchers in their endeavors to support a learning, community-based approach for suicide prevention based on a standardized psychological autopsy.

Monday peak is unique to suicide? Comparison of weekly distribution by causes of death using national representative cohort database

INTRODUCTION

The excess suicide mortality on Monday was reported in numerous studies. However, it is uncertain that the uneven weekly distribution of deaths is observed among suicide, or common among various causes of death.

METHODS

Weekly distributions of suicide and other causes of death from 2012 to 2017 in South Korea were compared. Logistic regression models were fitted to investigate the association between causes of death and day-of-the-week effects. We also fitted conditional logistic regression models after age and gender matching.

RESULTS

A total of 1,622,213 deaths, including 80,492 suicide decedents, were analyzed. A total of 16.0% of suicide deaths occurred on Monday, whereas 12.4% on Saturday and 13.0% on Sunday. Suicide decedents were more likely to die on Monday than other causes of deaths after controlling sociodemographic factors in unmatched data. However, there was no evidence of excess suicide deaths on Mondays than other days in contrast to matched death controls.

CONCLUSION

While the increase in mortality on Mondays was not unique to suicide, our findings have suicide prevention implications. Mental health practitioners should consider providing additional mental health resources on earlier working days. Workplace mental health programs to reduce psychological burdens of employees could help to prevent suicide during working days.

Social media use of adolescents who died by suicide: lessons from a psychological autopsy study

BACKGROUND

while there are many benefits for young people to use social media, adverse effects such as cyberbullying, online challenges, social comparison and imitation may provoke and aggravate suicidal thoughts and behaviors. The influence of social media on mental health and suicidal thoughts and behaviours has been amply studied, but there is little empirical evidence for its potential role in adolescent suicides. The current study aimed to inform digital suicide prevention strategies by examining the meaning of social media in the lives of young suicide victims and elucidating the harmful and supportive effects of social media use on their wellbeing and distress.

METHODS

data were analyzed from a psychological autopsy study of 35 adolescents who died by suicide in the Netherlands (43% of all adolescents who died by suicide in that year). These were 18 girls and 17 boys. All were under the age of twenty years, with an average of seventeen years. Interpretative Phenomenological Analysis was performed of 55 semi structured interviews with peers and parents of the decedents.

RESULTS

young people benefitted from peer support and recovery stories. However, various themes were discussed relating to the harmful effects of social media, including dependency, triggers and imitation, challenges, cybervictimization and psychological entrapment. The themes of dependency and triggers and imitation were more salient in young females. A group of girls cultivated an online identity around their suicidal thoughts and behaviours. Next-of-kin, particularly parents, faced various challenges to talk to the adolescents about social media use, including technological illiteracy, online anonymity, and the youths' closedness.

CONCLUSIONS

based on the findings, we recommend education to stimulate the digital literacy of parents, health workers and educators, supporting conscientious social media use in young people, and extending the prevention of cyberbullying. We encourage future research to examine how virtual social networks may sustain suicidal thoughts and behaviour, and to further investigate the effectiveness of digital interventions, like moderated peer support and the use of positive role models.

The development and validation of a dashboard prototype for real-time suicide mortality data

Introduction/Aim

Data visualisation is key to informing data-driven decision-making, yet this is an underexplored area of suicide surveillance. By way of enhancing a real-time suicide surveillance system model, an interactive dashboard prototype has been developed to facilitate emerging cluster detection, risk profiling and trend observation, as well as to establish a formal data sharing connection with key stakeholders via an intuitive interface.

Materials and Methods

Individual-level demographic and circumstantial data on cases of confirmed suicide and open verdicts meeting the criteria for suicide in County Cork 2008–2017 were analysed to validate the model. The retrospective and prospective space-time scan statistics based on a discrete Poisson model were employed via the R software environment using the “rsatscan” and “shiny” packages to conduct the space-time cluster analysis and deliver the mapping and graphic components encompassing the dashboard interface.

Results

Using the best-fit parameters, the retrospective scan statistic returned several emerging non-significant clusters detected during the 10-year period, while the prospective approach demonstrated the predictive ability of the model. The outputs of the investigations are visually displayed using a geographical map of the identified clusters and a timeline of cluster occurrence.

Discussion

The challenges of designing and implementing visualizations for suspected suicide data are presented through a discussion of the development of the dashboard prototype and the potential it holds for supporting real-time decision-making.

Conclusions

The results demonstrate that integration of a cluster detection approach involving geo-visualisation techniques, space-time scan statistics and predictive modelling would facilitate prospective early detection of emerging clusters, at-risk populations, and locations of concern. The prototype demonstrates real-world applicability as a proactive monitoring tool for timely action in suicide prevention by facilitating informed planning and preparedness to respond to emerging suicide clusters and other concerning trends.

Child suicides in Sweden, 2000-2018

Although child mortality is decreasing in Sweden, an increase in suicide rates has been previously observed among children and adolescents collectively. To increase knowledge about trends, demographics, and means in child suicides, data including all child (< 18 years) suicides in Sweden in 2000 through 2018 were retrieved from the Swedish National Board of Forensic Medicine. In all, a total of 416 child suicides were found in a 19-year period, accounting for an annual suicide rate of 1.1/100,000 child population. The number of suicides increased with 2.2% by each successive year during the study period (p < 0.001). The mean age in both sexes was 16 years; boys accounted for 55% and girls for 45% of all study cases. The majority of the children who died by suicide (96%) were teenagers (13-17 years old) and suicides in children younger than 10 years were uncommon. Suicide methods were 59% hanging, 20% lying/jumping in front of a moving object, 8% jumping from a height, 7% firearm injury, 4% poisoning, and 2% other methods. Sex differences were significant (p < 0.001) only for firearms being preferably used by boys. The vast majority of firearms used were licensed long-barreled weapons.Conclusion: The number of child suicides in Sweden is relatively low but increasing. Most of the children used a violent and highly lethal method. Prevention of premature mortality is an urgent concern with an emphasis on resolutely reducing the availability of suicide means. What is Known: • Suicide is a significant cause of death globally among children, bringing tragic consequences for young individuals, their family, and the entire society. • Suicide rates and distribution of suicide methods in children differ between countries and settings, but studies of time trends are scarce. What is New: • Increasing number of minors' suicides and the predominance of violent methods emphasize the importance of prevention strategies tailored for a child population. • Even in a setting of very restrictive firearm laws, firearm suicides in children must not be overlooked.

Neurobiological Basis of Increased Risk for Suicidal Behaviour

According to the World Health Organization (WHO), more than 700,000 people die per year due to suicide. Suicide risk factors include a previous suicide attempt and psychiatric disorders. The highest mortality rate in suicide worldwide is due to depression. Current evidence suggests that suicide etiopathogenesis is associated with neuroinflammation that activates the kynurenine pathway and causes subsequent serotonin depletion and stimulation of glutamate neurotransmission. These changes are accompanied by decreased BDNF (brain-derived neurotrophic factor) levels in the brain, which is often linked to impaired neuroplasticity and cognitive deficits. Most suicidal patients have a hyperactive hypothalamus–pituitary–adrenal (HPA) axis. Epigenetic mechanisms control the above-mentioned neurobiological changes associated with suicidal behaviour. Suicide risk could be attenuated by appropriate psychological treatment, electroconvulsive treatment, and drugs: lithium, ketamine, esketamine, clozapine. In this review, we present the etiopathogenesis of suicide behaviour and explore the mechanisms of action of anti-suicidal treatments, pinpointing similarities among them.

Additional Value of Peer Informants in Psychological Autopsy Studies of Youth Suicides

In this study, we examined the feasibility and added value of including peer informants in a psychological autopsy study of youth suicides. Peer semi-structured interview data from 16 cases were analyzed qualitatively and compared to parent data. Results show that peers added information to parents' narratives in general and particularly on social relationships, bullying, school experiences, social media, and family relations. Peers also provided additional information on the presence of certain issues (such as social media contagion) as well as on the emotional impact from certain adverse events that seemed to have functioned as precipitating factors. We conclude that including peers in psychological autopsy studies of youth suicides is feasible and of added value but that more research is desirable. The results initially can be used in the design of psychological autopsies so that the maximum amount of information about each suicide will be learned.

Gender differences in suicide-related communication of young suicide victims

OBJECTIVES

There is limited insight into gender differences in suicide-related communication (SRC) in youths. SRC is defined as "the act of conveying one's own suicide ideation, intent or behaviours to another person". Increasing our understanding of SRC in youths will enable us to recognize and specify needs of female versus male youths. The current study explores SRC in a sample of Dutch suicide victims aged under 20 and examines gender differences.

METHODS

Interview data from a psychological autopsy study of 35 youths who died by suicide in the Netherlands in 2017 were analysed. Qualitative analyses were performed to examine explicit SRC throughout the youths' lives and implicit SRC during the last months prior to suicide. We employed the Constant Comparative Method to explore patterns in the debut, form, frequency, medium, content, type of recipient, and SRC in the last months prior to suicide death.

RESULTS

We identified commonalities in the SRC of youths, including the content of suicide notes and an emphasis on suicide method and preparation in the last months. Girls, however, had an earlier debut of SRC, a higher frequency of explicit SRC, and more often directed SRC towards varied types of recipients compared to boys. Moreover, SRC of girls seemed focused on coping and achieving support from others more than SRC of boys. The SRC of boys in comparison to girls was often ambiguous or diluted by "humorous" connotations.

CONCLUSION

Unique patterns in SRC of boys and girls posed corresponding challenges for next of kin to interpret communications and respond adequately to SRC. The early debut of girls' SRC highlights the importance of early screening and prevention efforts in girls, while the late debut and ambiguity in boys' SRC implores professionals and next of kin to encourage young males to be unequivocal about suicide ideation or intent.

Pattern of Suicide Methods and Postmortem Toxicological Findings in Suicide-Related Deaths: A Retrospective 7-Year Forensic-Based Study in Iran

ABSTRACT

Suicide is a public health threat that leads to morbidity and mortality worldwide. In this study, we evaluated postmortem toxicological finding among forensic autopsies on suicidal deaths from 2010 to 2016 at the Legal Medicine Center of Zanjan Province (northwest of Iran). All suicide fatal cases were investigated to define the cause and manner of death. Toxicological analyses were performed using thin-layer chromatography, high-performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography, and gas chromatography equipped with nitrogen phosphorus detector. Demographic data (age, sex, educational level, residential location, and marital status), cause of death, and postmortem toxicological findings were extracted from forensic reports and were entered into the designed questioners. During this period, a total of 181 cases of suicide deaths were investigated. Among them, 74% were male. The most often used suicide method was hanging, followed by self-poisoning in young people. Aluminum phosphide was the most frequent poison detected in the fatal suicidal cases (33 cases), followed by opioids. Hanging and self-poisoning were the frequent suicidal method in young male population. It seems that psychological and social supports in young people along with restriction to easy access to drugs and poisons should be considered by policy making and healthcare authorities.

The mental and physical health profile of people who died by suicide: findings from the Suicide Support and Information System

PURPOSE

There is limited research on the associations between factors relating to mental and physical health in people who died by suicide.

METHODS

Consecutive suicide cases were included in a psychological autopsy study as part of the Suicide Support and Information System in southern Ireland. Chi-square tests and logistic regression analysis were used to examine factors associated with recorded presence or absence of mental and physical health problems.

RESULTS

The total sample comprised 307 suicide cases, the majority being male (80.1%). Sixty-five percent had a history of self-harm and 34.6% of these cases had not been seen or treated following previous self-harm, although most (80.3%) had a history of recent GP attendance. Mental health diagnoses were present in 84.8% of cases where this variable was documented, and among these, 60.7% had a history of substance misuse and 30.6% had physical health problems. Variables associated with mental illness included gender, older age, previous self-harm episode(s), and presence of drugs in toxicology at time of death. Variables associated with physical illness included older age, death by means other than hanging, and previous self-harm episode(s).

CONCLUSIONS

Different factors associated with suicide were identified among people with mental and physical illness and those with and without a diagnosis, and need to be taken into account in suicide prevention. The identified factors highlight the importance of integrated care for dual-diagnosis presentations, restricting access to means, and early recognition and intervention for people with high-risk self-harm.

"All My Problems Go Away for 90 Minutes": How Football and Psychotherapy Improves Young Men's Mental Health

This qualitative research sought to establish the impact of an 8-week program combining football and one-to-one psychotherapy on young males' mental health, determining the factors that predict help-seeking behaviors in this group of men. Pre- and post-participation focus groups were used as the method of data collection. Six males (19-35 years old; M = 25.5) completed both pre-intervention and follow-up focus groups. Help-seeking behaviors were influenced by the appeal of football and the perception of the counselor being accessible. Barriers included gender norms, socialization, financial difficulties, and challenging social landscapes. Post-participation focus groups revealed that positive social and counseling relationships facilitated improved mental health. Sport was deemed an acceptable medium to deliver a mental health intervention as it increased social connections and facilitated help-seeking. Findings support previous research indicating that combining sports and psychotherapy positively impacts young males' mental health.

A multi-method psychological autopsy study on youth suicides in the Netherlands in 2017: Feasibility, main outcomes, and recommendations

OBJECTIVES

In the Netherlands, there was a sharp increase in the number of suicides among 10- to 19-year-olds in 2017. A multi-method psychological autopsy study (PA) was conducted to assess feasibility, identify related factors, and study the interplay of these factors to inform suicide prevention strategies.

METHODS

Coroners identified youth suicides in 2017 in their records and then general practitioners (GPs) contacted the parents of these youths. Over a period of 7 months, 66 qualitative interviews were held with the parents, peers, and teachers, providing information on precipitating factors and five topics involving 35 cases (17 boys and 18 girls, mean age 17 years). Furthermore, 43 parents and care professionals filled in questionnaires to examine risk and care-related factors. Qualitative and quantitative analyses were performed.

RESULTS

Although registration problems faced by coroners and resistance to contacting bereaved families by GPs hampered the recruitment, most parents highly appreciated being interviewed. Several adverse childhood experiences played a role at an individual level, such as (cyber) bullying, parental divorce, sexual abuse, as well as complex mental disorders, and previous suicide attempts. Two specific patterns stood out: (1) girls characterized by insecurity and a perfectionist attitude, who developed psychopathology and dropped out of school, and (2) boys with a developmental disorder, such as autism, who were transferred to special needs education and therefore felt rejected. In addition, adolescents with complex problems had difficulty finding appropriate formal care. Regarding potential new trends, contagion effects of social media use in a clinical setting and internet use for searching lethal methods were found.

CONCLUSION

This first national PA study showed that, as expected, a variety of mostly complex clusters of problems played a role in youth suicides. An infrastructure is needed to continuously monitor, evaluate, and support families after each youth suicide and thereby improve prevention strategies.

Demographic Risk Factors for Suicide among Youths in The Netherlands

In 2000 to 2016 the highest number of suicides among Dutch youths under 20 in any given year was 58 in 2013. In 2017 this number increased to 81 youth suicides. To get more insight in what types of youths died by suicide, particularly in recent years (2013-2017) we looked at micro-data of Statistics Netherlands and counted suicides among youths till 23, split out along gender, age, regions, immigration background and place in household and compared this to the general population of youths in the Netherlands. We also compared the demographics of young suicide victims to those of suicide victims among the population as a whole. We found higher suicide rates among male youths, older youths, those of Dutch descent and youths living alone. These differences were generally smaller than in the population as a whole. There were also substantial geographical differences between provinces and healthcare regions. The method of suicide is different in youth compared to the population as a whole: relatively more youth suicides by jumping or lying in front of a moving object and relatively less youth suicides by autointoxication or drowning, whereas the most frequent method of suicide among both groups is hanging or suffocation.

Psychosocial, psychiatric and work-related risk factors associated with suicide in Ireland: optimised methodological approach of a case-control psychological autopsy study

BACKGROUND

Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls.

METHODS

The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners' registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners' records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources.

CONCLUSIONS

The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicide.

Prevalence and correlates of suicidal ideation among college students: A mental health survey in Jilin Province, China

BACKGROUND

The prevention of suicidal ideation plays a key role in reducing suicide rates. This study aimed to determine the prevalence of suicidal ideation among college students in Jilin Province, China, and to analyse the risk factors associated with suicidal ideation.

METHODS

A total of 6284 valid data collection sheets were collected using the stratified cluster sampling method. The data collected were divided into four sections, namely, socio-demographic information, family and social interactions, daily habits, and mental health self-rating scales.

RESULTS

The prevalence of suicidal ideation in the past 12 months was 9.2%. A multivariate logistic regression analysis showed that being a senior (OR = 1.769, 95%CI:1.225-2.555), general family relationships (OR = 1.641, 95%CI:1.172-2.298), frequent parental quarrels (OR = 1.398, 95%CI:1.027-1.902)/parental separation (OR = 2.497, 95%CI:1.414-4.408), the level of satisfaction with motherly love (OR = 2.261, 95%CI:1.454-3.515), having only one or two friend(s) (OR = 1.530, 95%CI:1.038-2.254), frequent excursions to bars/ karaoke halls/ song and dance halls (OR = 1.673, 95%CI:1.257-2.229) or billiard halls with friends (OR = 1.865, 95%CI:1.270-2.740), smoking (OR = 2.175, 95%CI:1.603-2.951), moderate sleep quality (OR = 1.636, 95%CI:1.115-2.402), and depressive symptoms (OR = 2.078, 95%CI: 1.710-2.525) were risk factors for suicidal ideation. Family factors had the most influence on suicidal ideation, whereas depression symptoms were identified to be a mediating factor between family, social interactions, or daily habits and suicidal ideation, and it only exerted direct effects.

LIMITATIONS

This cross-sectional study cannot provide causal interpretations.

CONCLUSION

Our findings showed the prevalence of suicidal ideation among college students in Jilin province. Among all the risk factors associated with suicidal ideation, family factors should be the main concern in the prevention of suicidal ideation, and interventions that target depression symptoms are key to reducing suicidal ideation.

Higher Heart Weight in New Zealand Māori and Pacific Islanders

Heart weight is dependent on sex, age, height, and weight. Although previous autopsy studies showed no differences in heart weight between different ethnic groups, none have examined the New Zealand population of Māori and Pacific Islanders (Polynesians). The presented study compared heart weights between 101 European and 85 Polynesian suicide hanging deaths from New Zealand. Univariate linear regression coefficients for age, male sex, height, body weight, body mass index, and Polynesian ethnicity were positive and significant (P < 0.05). Apart from body mass index, subsequent multivariate analysis showed that all regression coefficients remained positive and significant (P < 0.05). Polynesian ethnicity seemed to be an independent predictor for increased heart weight in the study population. Apart from possible genetic factors, the higher heart weight in Polynesians may have other underlying reasons. Caution is required when interpreting heart weight in cases of sudden natural deaths, especially in this population.

Depressive Symptoms and Suicidal Ideation among Irish Undergraduate College Students

This study examined the prevalence of depressive symptoms and suicidal ideation among 220 first year undergraduate university students in Ireland. Data were collected using the Centre for Epidemiological Studies Depression Scale and the Suicidal Behaviours Questionnaire. Findings indicated that 59% of participants experienced depressive symptoms and 28.5% had suicidal ideation. Financial stress and poor relationships with both parents, increased the odds of experiencing depressive symptoms. Sexual orientation, financial stress, and poor relationships with fathers, increased the odds of experiencing suicidal ideation. Suicidal ideation was also higher in those who had sought help in the past from mental health professionals. Nurses need to be aware of the factors associated with mental ill-health in this population.

Forensic toxicology analysis of self-poisoning suicidal deaths in Tehran, Iran; trends between 2011-2015

Background

Suicide ranks among the top ten causes of death in all age groups all over the world. There are many methods for committing suicide including self-poisoning, firearm and hanging. The aim of the present study was to provide an overview of self-poisoning related suicidal deaths with special focus on forensic toxicology analysis results in Tehran, Iran from 2011 to 2015.

Methods

All suspicious cases with the the history of self-poisoning were investigated to define the cause and manner of death under the supervision of forensic medicine practitioners. Postmortem samples were analysed in forensic toxicology laboratory to confirm the presence of drugs in cadaver of suicidal cases. Drugs and poisons were analysed using thin layer chromatography, high performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography and gas chromatography equipped with nitrogen phosphorus detector. Demographic data were collected from autopsy reports of all cases with confirmed self-poisoning suicidal cause of death.

Results

Results showed that 674 cases of self-poisoning deaths were investigated during a five-year study period, of which 68.55% were male. The most often used suicide method was self-poisoning in young population. Phosphine gas liberated from aluminum phosphide tablets was the most toxic substance detected in postmortem samples (619 cases) followed by opioids, methamphetamine, organophosphates, cyanide and strychnine.

Conclusion

In conclusion self-poisoning suicidal death was predominant in young male population in Tehran, Iran. It seems that free access to suicide means such as drugs and poisons should be restricted by national and health authorities.

Trial registration

Not applicable.