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Bareis N, Olfson M, Gerhard T, Rolin S, Stroup TS. Means of suicide among adults with schizophrenia across the life span. Schizophr Res 2023; 251:82-90. [PMID: 36592524 PMCID: PMC9872522 DOI: 10.1016/j.schres.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/26/2022] [Accepted: 12/06/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND HYPOTHESES Adults with schizophrenia have increased risk of suicide with highest risk among younger adults. We investigated whether means of suicide among these adults were different from the general population. STUDY DESIGN This retrospective longitudinal analysis used the National Death Index to characterize means of suicide among 4 cohorts of Medicare patients with schizophrenia (2007-2016) by age: 18 to 34, 35 to 44, 45 to 54, and aged 55+ years. Means of suicide were categorized by age at death and sex. Adjusted hazard ratios were calculated for common means. Mortality rates per 100,000 person-years were estimated by age group stratified by sex, and standardized to the general population by age, sex, and race-ethnicity using standardized mortality ratios. STUDY RESULTS 668,836 adults were included with 2218 suicide decedents: 1444 men and 774 women. The most common means of suicide was poisoning (36.8 %), with a significant sex difference by means: 55.9 % of women died by poisoning, 13.8 % by firearms, 11.0 % by hanging and 9.4 % by jumping, while among men suicide by poisoning (26.6 %), firearms (25.5 %), and hanging (24.2 %) were similar, followed by jumping (12.0 %). Suicide by poisoning among the schizophrenia cohort was 10 times that of the general population, while suicide by firearm was twice that of the general population. CONCLUSIONS Means of suicide differed for patients with schizophrenia compared to the general population: poisoning was the most common means among men and women with schizophrenia, while firearms accounted for over half of all suicides in the general U.S. POPULATION
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Affiliation(s)
- Natalie Bareis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America.
| | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America; Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Tobias Gerhard
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States of America
| | - Stephanie Rolin
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America
| | - T Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America
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Docherty AR, Bakian AV, DiBlasi E, Shabalin AA, Chen D, Keeshin B, Monson E, Christensen ED, Li Q, Gray D, Coon H. Suicide and Psychosis: Results From a Population-Based Cohort of Suicide Death (N = 4380). Schizophr Bull 2022; 48:457-462. [PMID: 34559220 PMCID: PMC8886603 DOI: 10.1093/schbul/sbab113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Approximately 5% of individuals with schizophrenia die from suicide. However, suicide in psychosis is still poorly characterized, partly due to a lack of adequate population-based clinical or genetic data on suicide death. The Utah Suicide Genetics Research Study (USGRS) provides a large population-based cohort of suicide deaths with medical record and genome-wide data (N = 4380). Examination of this cohort identified medical and genetic risks associated with type of suicide death and investigated the relative contributions of psychotic and affective symptoms to method of suicide. Key differences in method of suicide (common vs. atypical methods) were tested in relation to lifetime psychosis and genome-wide genetic risk for schizophrenia, major depressive disorder, and neuroticism. Consistent with previous studies, psychosis-spectrum disorders were observed to be common in suicide (15% of the cohort). Individuals with psychosis more frequently died from atypical methods, with rates of atypical suicide increasing across the schizophrenia spectrum. Genetic risk for schizophrenia was also associated with atypical suicide, regardless of clinical diagnosis, though this association weakened when filtering individuals with schizophrenia from the analysis. Follow-up examination indicated that high rates of atypical suicide observed in schizophrenia are not likely accounted for by restricted access to firearms. Overall, better accounting for the increased risk of atypical suicide methods in psychosis could lead to improved prevention strategies in a large portion of the suicide risk population.
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Affiliation(s)
- Anna R Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
- Department of Psychiatry, The Virginia Commonwealth University, Richmond, VA, USA
| | - Amanda V Bakian
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
| | - Emily DiBlasi
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
| | - Andrey A Shabalin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
| | - Danli Chen
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
| | - Brooks Keeshin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Eric Monson
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
| | - Erik D Christensen
- Utah State Office of the Medical Examiner, Utah Department of Health, Salt Lake City, UT, USA
| | - Qingqin Li
- Janssen Research & Development, LLC, Neuroscience Therapeutic Area, Titusville, NJ, USA
| | - Douglas Gray
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
- Health Sciences Center Core Research Facility, University of Utah, Salt Lake City, UT, USA
- Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network 19 (VISN 19), George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Hilary Coon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
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Bojanić L, Hunt IM, Baird A, Kapur N, Appleby L, Turnbull P. Early Post-Discharge Suicide in Mental Health Patients: Findings From a National Clinical Survey. Front Psychiatry 2020; 11:502. [PMID: 32581877 PMCID: PMC7296132 DOI: 10.3389/fpsyt.2020.00502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
Studies on suicide by recently discharged mental health patients have reported a high number of deaths in the early post-discharge period, which has led to recommendations of follow-up within 7 days (d). More recently, the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) proposed a more "stringent" follow-up period of 2-3 days (d) after discharge. Patients who died within this early time-frame post-discharge were more likely to die before the follow-up appointment occurred. They more often had a primary diagnosis of a personality disorder, self-discharged, and had a higher frequency of death by jumping from a height or in front of the vehicle compared to later deaths. This study provides practical implications for post-discharge management and safety planning. Clinicians should be aware of (1) the increased risk of immediate suicide in the post-discharge period by people with a diagnosis of personality disorder, (2) immediate suicide risk in patients who initiate their own discharge, and (3) the increased risk of death by jumping from a height or in front of the vehicle in the immediate post-discharge period. Our findings support the recent recommendation from NCISH that follow-up should occur within 3 d of discharge from in-patient care.
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Affiliation(s)
- Lana Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Isabelle M. Hunt
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Alison Baird
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Navneet Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Rodway C, Tham SG, Ibrahim S, Turnbull P, Windfuhr K, Shaw J, Kapur N, Appleby L. Suicide in children and young people in England: a consecutive case series. Lancet Psychiatry 2016; 3:751-759. [PMID: 27236279 DOI: 10.1016/s2215-0366(16)30094-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is concern about the mental health of children and young people and a possible rise in suicidal behaviour in this group. We have done a comprehensive national multi-agency study of suicide in under 20s in England. We aimed to establish how frequently suicide is preceded by child-specific and young person-specific suicide risk factors, as well as all-age factors, and to identify contact with health-care and social-care services and justice agencies. METHODS This study is a descriptive examination of suicide in a national consecutive sample of children and young people younger than 20 years who died by suicide in England between Jan 1, 2014, and April 30, 2015. We obtained general population mortality data from the Office for National Statistics (ONS). We collected information about antecedents considered to be relevant to suicide (eg, abuse, bullying, bereavement, academic pressures, self-harm, and physical health) from a range of investigations and inquiries, including coroner inquest hearings, child death investigations, criminal justice system reports, and the National Health Service, including data on people in contact with mental health services in the 12 months before their death. FINDINGS 145 suicides in people younger than 20 years were notified to us during the study period, of which we were able to obtain report data about antecedents for 130 (90%). The number of suicides rose sharply during the late teens with 79 deaths by suicide in people aged 18-19 years compared with 66 in people younger than 18 years. 102 (70%) deaths were in males. 92 (63%) deaths were by hanging. Various antecedents were reported among the individuals for whom we had report data, including academic (especially exam) pressures (35 [27%] individuals), bullying (28 [22%]), bereavement (36 [28%]), suicide in family or friends (17 [13%]), physical health conditions (47 [36%]), family problems (44 [34%]), social isolation or withdrawal (33 [25%]), child abuse or neglect (20 [15%]), excessive drinking (34 [26%]), and illicit drug use (38 [29%]). Suicide-related internet use was recorded in 30 (23%) cases. In the week before death 13 (10%) individuals had self-harmed and 35 (27%) had expressed suicidal ideas. 56 (43%) individuals had no known contact with health-care and social-care services or justice agencies. INTERPRETATION Improved services for self-harm and mental health are crucial to suicide prevention, but the wide range of antecedents emphasises the roles of schools, primary care, social services, and the youth justice system. FUNDING The Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Cathryn Rodway
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK.
| | - Su-Gwan Tham
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Kirsten Windfuhr
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Jenny Shaw
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK
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Pentone A, Innamorato L, Introna F. Her life ended jumping from the fifth floor: the importance of scene investigation and the need for restrictive means to prevent jumping suicide. Am J Forensic Med Pathol 2015; 36:75-78. [PMID: 25955975 DOI: 10.1097/paf.0000000000000149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In January 2014, a dead woman was found lying near the back entrance of a building belonging to Bari University Hospital compound. After the external examination and identification of the corpse, through history, circumstances, and postmortem findings, it was supposed that the woman probably committed suicide, by jumping from the nearby building. But only after additional investigation of the scene was it possible to locate the window through which the victim had jumped, by assessing the height from which she leapt. We underline the importance of the examination of the scene. It has to be done with circumspection, even in cases that could be considered routine, paying attention to details, not excluding things that, at first glance, seem to be unnecessary. Inspection needs time, patience and accuracy, knowledge, competence, and intuition and must be the result of an efficient team action. Furthermore the occurrence of suicides, particularly jumping from a height, among immediate postdischarge psychiatric patients, stresses the importance of immediate follow-up treatment and alternative preventive strategies, considering, of course, the feasibility of structural means.
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Fisher LB, Overholser JC, Dieter L. Methods of committing suicide among 2,347 people in Ohio. DEATH STUDIES 2015; 39:39-43. [PMID: 24932592 PMCID: PMC4268074 DOI: 10.1080/07481187.2013.851130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The present study explored gender differences in suicidal methods, aiming to identify ways to improve our identification of individuals at risk for suicide. Preferred suicide methods vary by demographics; however, method-specific risk factors have not been consistently identified. All suicidal deaths (N=2,347) in a large urban county were identified over a 15-year period (1994-2008). The majority of men used shooting and hanging. In contrast, women relied on a variety of methods, including self-poisoning, shooting, hanging, and carbon monoxide poisoning. Significant demographic differences are evident among individuals who die by shooting and self-poisoning.
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Affiliation(s)
- Lauren B Fisher
- a Department of Psychology , Case Western Reserve University , Cleveland , Ohio , USA
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Lukaschek K, Baumert J, Krawitz M, Erazo N, Förstl H, Ladwig KH. Determinants of completed railway suicides by psychiatric in-patients: case-control study. Br J Psychiatry 2014; 205:398-406. [PMID: 25257065 DOI: 10.1192/bjp.bp.113.139352] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Suicide prediction during psychiatric in-patient treatment remains an unresolved challenge. AIMS To identify determinants of railway suicides in individuals receiving in-patient psychiatric treatment. METHOD The study population was drawn from patients admitted to six psychiatric hospitals in Germany during a 10-year period (1997-2006). Data from 101 railway suicide cases were compared with a control group of 101 discharged patients matched for age, gender and diagnosis. RESULTS Predictors of suicide were change of therapist (OR = 22.86, P = 0.004), suicidal ideation (OR = 7.92, P<0.001), negative or unchanged therapeutic course (OR = 7.73, P<0.001), need of polypharmaceutical treatment (OR = 2.81, P = 0.04) and unemployment (OR = 2.72, P = 0.04). Neither restlessness nor impulsivity predicted in-patient suicide. CONCLUSIONS Suicidal ideation, unfavourable clinical course and the use of multiple psychotropic substances (reflecting the severity of illness) were strong determinants of railway suicides. The most salient finding was the vital impact of a change of therapist. These findings deserve integration into the clinical management of patients with serious mental disease.
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Affiliation(s)
- Karoline Lukaschek
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jens Baumert
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marion Krawitz
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Natalia Erazo
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hans Förstl
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karl-Heinz Ladwig
- Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Psychiatric and psycho-social characteristics of suicide completers: a comprehensive evaluation of psychiatric case records and postmortem findings. Ir J Psychol Med 2014; 32:167-176. [DOI: 10.1017/ipm.2014.47] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
ObjectivesTo explore the demographic, psychosocial and clinical characteristics of individuals known to the mental health services, who died by probable suicide in the West of Ireland.MethodsPostmortem reports between January 2006 and May 2012 detailed 153 individuals who died by probable suicide, 58 of whom attended the mental health services. Relevant socio-demographic and clinical data was extracted from individuals’ lifetime case notes.ResultsRecurrent depressive disorder (44%) was the most common diagnosis and hanging the most common method of death (58%). Of individuals who died by hanging, 79% previously attempted suicide by the same method. For individuals with a documented history of depression, only 32% had antidepressants detected in their toxicology reports. Similarly, only one individual (20%) with schizophrenia had antipsychotics detected in their toxicology report.ConclusionsIndividuals who died by probable suicide, most commonly died by hanging and drowning; with previous attempts of hanging particularly prevalent in the group who subsequently died by hanging. At the time of death, less than one-third of individuals according to toxicology reports were taking the medication that was last prescribed to them by the mental health services suggesting a high rate of treatment non-concordance in individuals who died by probable suicide.
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Sun SH, Jia CX. Completed suicide with violent and non-violent methods in rural Shandong, China: a psychological autopsy study. PLoS One 2014; 9:e104333. [PMID: 25111835 PMCID: PMC4128761 DOI: 10.1371/journal.pone.0104333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/11/2014] [Indexed: 01/19/2023] Open
Abstract
Background This study aims to describe the specific characteristics of completed suicides by violent methods and non-violent methods in rural Chinese population, and to explore the related factors for corresponding methods. Methods Data of this study came from investigation of 199 completed suicide cases and their paired controls of rural areas in three different counties in Shandong, China, by interviewing one informant of each subject using the method of Psychological Autopsy (PA). Results There were 78 (39.2%) suicides with violent methods and 121 (60.8%) suicides with non-violent methods. Ingesting pesticides, as a non-violent method, appeared to be the most common suicide method (103, 51.8%). Hanging (73 cases, 36.7%) and drowning (5 cases, 2.5%) were the only violent methods observed. Storage of pesticides at home and higher suicide intent score were significantly associated with choice of violent methods while committing suicide. Risk factors related to suicide death included negative life events and hopelessness. Conclusions Suicide with violent methods has different factors from suicide with non-violent methods. Suicide methods should be considered in suicide prevention and intervention strategies.
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Affiliation(s)
- Shi-Hua Sun
- Department of Epidemiology and Health Statistics, Shandong University School of Public Health, Jinan, China
| | - Cun-Xian Jia
- Department of Epidemiology and Health Statistics, Shandong University School of Public Health, Jinan, China; Shandong University Center for Suicide Prevention Research, Jinan, China
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10
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Abstract
BACKGROUND Suicide is a major public health concern. The elderly have the highest rate of suicide and they make more lethal suicide attempts and have fewer psychiatric interventions than young people. Furthermore, they have old-age specific psychosocial difficulties. The present study investigated psychosocial risk factors and characteristics of an index suicide attempt of the elderly suicide attempters. METHODS Subjects included 388 patients who were admitted to the emergency room following self-poisoning. Two age groups were defined: younger patients (aged less than 65 years) and older patients (aged over 65 years). Data including demographic factors, suicidal risk factors and information about the current suicide attempt were obtained from a retrospective chart review. RESULTS The number of suicide attempters over the age of 65 years old was 57, and their mean age was 73.5 ± 7.5 years. The elderly patients had more underlying medical illnesses than the under-65 group (p < 0.001). Depression was the most common psychiatric diagnosis. Psychotropics were the most commonly ingested drugs in both groups, but the use of pesticides was more notable in the elderly. The elderly suicide attempters had higher risk-rating scores (p < 0.001) and lower rescue-rating scores (p = 0.014) than the under-65 group. Male-to-female ratio of the elderly group was nearly 1:1 unlike the under-65 group (p = 0.004). CONCLUSION Elderly suicide attempters had different psychosocial stressors such as physical illness and more lethal suicide attempts. Our study suggests the need for development of specific preventive strategies and management guidelines for the elderly suicide attempters.
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Abstract
Reports on Chinese rural youth suicide indicated patterns different from those of the West. Only about 30% to 70% young victims had had diagnoses of psychiatric illnesses (Phillips et al., Lancet 359:835-840, 2002; Xiao et al., Chin J Psychiatry 36:129-131, 2003), and more than 60% of them used pesticides as suicide means (Wang et al., Lancet 372:1765-1773, 2008). To prevent suicides in rural China, it is important to know the choice of means by Chinese young suicide victims with and without mental disorders. Data on suicide cases in China's rural areas gathered from a big psychological autopsy study were studied for demographic characteristics, suicide methods, and the presence of mental disorders. The findings in the suicide victims with and without mental disorders showed significant differences in suicide method selecting. Victims with mental disorders tended to select violent methods compared with those without mental disorders (31.4% vs. 16.2%). Hanging is method more likely chosen by the mentally disordered victims (13.3%) than those without a mental disorder (7.8%). Mental status affects the means choice among the Chinese rural young suicide victims. Among them, the female victims without mental disorders tended to act on impulsivity and used nonviolent means such as pesticide consumption for suicide. This study informs suicide prevention measures in both China and rest of the world.
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12
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Windfuhr K, Kapur N. Suicide and mental illness: a clinical review of 15 years findings from the UK National Confidential Inquiry into Suicide. Br Med Bull 2011; 100:101-21. [PMID: 21948337 DOI: 10.1093/bmb/ldr042] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Suicide risk is most commonly associated with mental illness. In particular, suicide in people under mental health care presents distinct patterns of risk and opportunities for prevention due to their close proximity to specialist care. SOURCES OF DATA The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (Inquiry) is a unique UK-wide national database of all suicide cases in contact with mental health services in the 12 months preceding suicide. This review presents Inquiry findings from the beginning of the Inquiry in 1996 up to the present (2011) (15 years). AREAS OF AGREEMENT Suicide varies substantially by socio-demographic (age, gender) and clinical features (e.g. diagnosis; care variables). Effective suicide prevention initiatives should incorporate research findings to inform clinical practice and policy. AREAS OF CONTROVERSY Risk assessment remains one of the most difficult areas of clinical practice and management although all areas of clinical practice, research and policy development would benefit from continued high-quality studies. GROWING POINTS The Inquiry work has positively influenced mental health practice and policy in the UK. These changes include: falling suicide rates in mental health patients, informing suicide prevention strategies and developing safety checklists for mental health services. AREAS TIMELY FOR DEVELOPING RESEARCH Investigating suicide in non-mental health settings, investigating suicide following different treatment services and investigating models of service delivery could usefully inform future directions for improving patient safety.
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Affiliation(s)
- Kirsten Windfuhr
- Centre for Mental Health and Risk, 2nd Floor, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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