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Ungermann EM, Balikowski M, Hemker J, Feld K. Case report: Electrocardiographic (ECG) recording during the hanging process. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00869-6. [PMID: 39129046 DOI: 10.1007/s12024-024-00869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 08/13/2024]
Abstract
A 48-year-old woman was found hanged in the bathroom. She was wearing a Holter monitor, which was later analysed by a cardiologist. During autopsy, findings congruent with atypical hanging were collected. The ECG showed a 20 s asystole and four minutes later bradycardia, which progressed to a second-degree AV-block Mobitz I, then Mobitz II, then to a third-degree AV-block. Finally, only P waves could be observed, before heart action ceased. This is one of few cases reporting ECG-changes during hanging and might give further insight into the complex pathophysiology of this type of death.
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Affiliation(s)
- E M Ungermann
- Institute of Forensic and Legal Medicine, University Hospital Heidelberg, Vossstrasse 2, 69115, Heidelberg, Germany.
| | - M Balikowski
- Institute of Forensic and Legal Medicine, University Hospital Heidelberg, Vossstrasse 2, 69115, Heidelberg, Germany
| | - J Hemker
- Zero Praxen Ludwigshafen, Erzbergerstraße 113, 67063, Ludwigshafen, Germany
| | - K Feld
- Institute of Forensic and Legal Medicine, University Hospital Heidelberg, Vossstrasse 2, 69115, Heidelberg, Germany
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2
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Bevione F, Panero M, Abbate-Daga G, Cossu G, Carta MG, Preti A. Risk of suicide and suicidal behavior in refugees. A meta-review of current systematic reviews and meta-analyses. J Psychiatr Res 2024; 177:287-298. [PMID: 39059026 DOI: 10.1016/j.jpsychires.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Despite the exposure to a wide combination of risk factors, evidence concerning risk of suicide among refugees is mixed. AIMS We aimed to establish more precise estimates of suicide and suicidal behavior in refugees and asylum seekers, investigate the role of somatic and psychiatric comorbidities, and the effectiveness of preventative interventions. METHODS We searched PubMed/Medline, EMBASE, CINAHL, and PsycInfo without time limitations from inception until June 5, 2024. Studies were included if systematic reviews or meta-analyses reporting data on suicide or suicidal behavior in refugees or asylum seekers, or detailing the results of preventive interventions. Quality was assessed using the National Institutes of Health Quality Assessment Tool for Systematic Reviews and Meta-Analyses. RESULTS Out of 49 papers, 10 systematic reviews and meta-analyses were included. Refugees showed significantly higher suicide death rates and suicidal ideation, suicide plan and suicide attempt prevalence compared to people living in the host countries. Refugees who arrived in low-income and lower-middle-income countries displayed lower suicidal ideation, but higher suicide death rates and suicide attempt prevalence compared to refugees who arrived in high-income and upper-middle-income countries. However, no review provided data regarding somatic comorbidity, psychiatric comorbidity, or the effectiveness of treatments, and evidence on specific categories of refugees is scarce. CONCLUSION Refugees have been proven to be at risk for suicide and suicidal behavior. More research is required to identify the targets and procedures of intervention.
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Affiliation(s)
| | - Matteo Panero
- Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy.
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Tralla L, Gustavsson S, Söderberg C, Jönsson AK, Kugelberg FC. Fatal Intoxications with Zopiclone-A Cause for Concern? Drug Saf 2024; 47:687-697. [PMID: 38536627 PMCID: PMC11182790 DOI: 10.1007/s40264-024-01424-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Zopiclone, a controlled substance prescribed for insomnia, has become a common toxicological finding in forensic autopsy cases. This study investigated the role and extent of zopiclone use in fatal intoxications in Sweden. METHODS All forensic autopsy cases positive for zopiclone in femoral blood during 2012-2020 were selected. Among these cases, fatalities caused by intoxication according to the cause of death certificates issued by the forensic pathologist were identified. Intoxications where zopiclone contributed to the cause of death were included in the study. The Swedish Prescribed Drug Register was utilized to examine whether the included cases were prescribed zopiclone or not. RESULTS In total 7320 fatal intoxications underwent a forensic autopsy during the study period, 573 of them were caused by zopiclone. Among the zopiclone fatalities, 87% (n = 494) had a prescription for zopiclone, and 8% (n = 43) were monointoxications. Most fatalities, 62% (n = 354) were suicides, and zopiclone was involved in about 17% (n = 354) of all intoxication suicides in Sweden. Women were significantly (p < 0.01) overrepresented in suicides with zopiclone, comprising 56% (n = 291) of fatalities. The median age was 55 years among zopiclone intoxications compared with 44 years amongst all fatal intoxications. CONCLUSION This study demonstrates that the toxicity of zopiclone can be lethal both in combination with other substances and on its own. Most individuals dying in fatal zopiclone intoxications were prescribed zopiclone, which potentially indicates that a more restrictive prescribing rate could prevent future intoxication deaths, especially when caring for patients with an increased suicide risk.
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Affiliation(s)
- Lova Tralla
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Sara Gustavsson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Carl Söderberg
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Anna K Jönsson
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Fredrik C Kugelberg
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
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Ramezani Z, Rahimi-Movaghar V, Zafarghandi M, Fakharian E, Saeed-Banadaky SH, Sadeghi-Bazargani H, Mohammadpour Y, Farahmand Rad R, Sadeghian F, Isfahani MN, Rahmanian V, Ghadipasha A, Shahidi M, Piri SM, Mirzamohamadi S, Naghdi K, Salamati P. The Profile of Self-Harm and Suicide in Iran Considering Gender Differences: A Multicenter Study Affiliated with the National Trauma Registry of Iran. IRANIAN JOURNAL OF PSYCHIATRY 2024; 19:285-294. [PMID: 39055515 PMCID: PMC11267124 DOI: 10.18502/ijps.v19i3.15805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/03/2024] [Accepted: 05/26/2024] [Indexed: 07/27/2024]
Abstract
Objective: The main objective of this study was to determine various characteristics and outcomes of self-harm and suicide in men and women with data obtained from the National Trauma Registry of Iran (NTRI). Method : This retrospective multicenter study using data from the NTRI included all patients who went to the emergency department (ED) due to self-harm and suicide, considering the NTRI's specific inclusion criteria, from September 2016 to January 2023. We evaluated patients regarding demographics and clinical characteristics, various outcomes, and factors influencing in-hospital death. Statistical analyses were conducted using the STATA software version 15.0. The chi-square test was used to compare the distribution of variables between men and women. Also, the logistic regression models were applied to assess the predictors of in-hospital death. Results: Self-harm and suicide cases were gathered from eleven geographically diverse hospitals across the country, and our study included 511 men and 347 women out of 50,661 registered trauma cases. Among them, 443 men (86.7%) and 267 women (76.9%) were between 18 and 49 years old (P < 0.001). Single women constituted 130 (37.3%) of the female cases, while single men were 313 (61.6%) of the male cases (P < 0.001). The three most common methods among our patients were poisoning with 234 (45.8%) of men and 245 (70.6%) of women cases, stab/cut with 208 (40.7%) of men and 54 (15.6%) of women cases, and fall with 16 (3.1%) of men and 26 (7.5%) of women cases (P < 0.001). The risk of death in patients with a Glasgow Coma Scale (GCS) score of 3 to 8 was 46.22 (95% CI = 18.66 to 114.45) times more than patients with a GCS score of 13 to 15. Conclusion: Data on self-harm and suicide traumatology were gathered from eleven hospitals in Iran. Our findings indicated differences in the distribution of age and marital status between genders. Moreover, both genders used similar methods for self-harm and suicide, and gender did not affect the outcome.
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Affiliation(s)
- Zahra Ramezani
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Houssein Saeed-Banadaky
- Trauma Research Center, Rahnemoon Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | | | - Reza Farahmand Rad
- Clinical Research Development Center, Imam Ali and Taleghani Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farideh Sadeghian
- Center for Health-Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mehdi Nasr Isfahani
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Trauma Data Registration Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Rahmanian
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Amir Ghadipasha
- Shahid Modarres Hospital, Saveh University of Medical Sciences, Saveh, Iran
| | - Mohammad Shahidi
- Department of Emergency Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Mirzamohamadi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Khatereh Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Al-Sabaileh S, Abusamak M, Al-Buqour AK, Mehaisen L, Sabayleh RS, Abusamak TM. Autopsy-Based Study of Non-accidental Violent Neck Asphyxia in Jordan: A Retrospective Study. Cureus 2024; 16:e62883. [PMID: 39040751 PMCID: PMC11262747 DOI: 10.7759/cureus.62883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 07/24/2024] Open
Abstract
Background There is a global increase in the number of deaths caused by violent neck asphyxia, which includes both suicides and homicides. This research presents autopsy-based findings and analytical demographic data that are pertinent to significant medicolegal cases. Methods A retrospective examination of 113 autopsy reports of non-accidental violent neck asphyxia reported to the forensic pathology department of Al-Balqa Governorate in Jordan within the period from January 2010 to March 2023. Age, gender, and autopsy results were documented, along with medicolegal records that included toxicology reports. Conversely, information on the manner of death was derived from police inquest records. For the purpose of this research, all the cases of throttling and ligature strangulation have been determined to be homicidal, and all cases of hanging were classified as suicide. Results Males were predominant in hanging (72%), while females were predominant in ligature strangulation (82%). The mean age group in hanging was 21-35 years (51%), while the range for throttling was 36-50 years, and that in strangulation was 2-20 years. Most hanging and throttling cases showed typical external neck findings. Seventy-two percent of hanging cases (n = 68) did not exhibit any internal neck findings, while all throttling cases yielded positive results. Both hanging and strangulation by ligature cases exhibited an absence of thyroid cartilage fracture (83%). Eighty-nine cases (95%) of hanging did not exhibit any injuries to the rest of the body. However, all cases of throttling and ligature strangulation had an almost positive external body injury. In all cases of throttling and ligature strangulation, ocular petechial hemorrhage was present, whereas one-third of the hanging cases had it. Conclusion The forensic doctor must observe the pattern of ligature marks and other signs of physical assault found on the neck, meticulously examine the rest of the body, rule out other causes of death, and cooperate with the legal authorities regarding the collection of the history and death scene findings to accurately determine the manner and mechanism of death in cases of violent neck asphyxia.
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Affiliation(s)
- Shrouq Al-Sabaileh
- Department of Forensic Medicine, Al-Balqa Applied University, As-Salt, JOR
| | - Mohammad Abusamak
- Department of Special Surgery, Al-Balqa Applied University, As-Salt, JOR
- Department of Ophthalmology, Amman Eye Clinic, Amman, JOR
| | - Ali K Al-Buqour
- Department of Forensic Medicine, Ministry of Health Al-Hussein/Salt New Hospital, As-Salt, JOR
| | - Lama Mehaisen
- Department of Obstetrics and Gynecology, Al-Balqa Applied University, As-Salt, JOR
| | | | - Talal M Abusamak
- Department of Pharmacology, School of Pharmacy, The University of Jordan, Amman, JOR
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Freedland AS, Sundaram K, Liu NH, Barakat S, Muñoz RF, Leykin Y. Self-harm behaviors and their intentions: a cross-cultural analysis. J Ment Health 2024; 33:295-303. [PMID: 37577971 DOI: 10.1080/09638237.2023.2245887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Self-harm behaviors (performed with either lethal and non-lethal intentions) are common, especially among individuals suffering from mood disorders, and the reasons individuals self-harm vary both by person and by the type of behavior. Understanding these variations may help clinicians determine levels of risk more accurately. AIMS To understand whether culture and gender are associated with the likelihood of engaging in specific self-harm behaviors and whether the intention (lethal, ambivalent, non-lethal) of these behaviors vary with culture and gender. METHODS 2826 individuals took part in an international multilingual online depression/suicidality screening study and reported at least one instance of self-harm in the past year. Participants were grouped into six broad cultural categories (Latin America, South Asia, Russian, Western English, Chinese, Arab). RESULTS 3-way (culture x gender x intent) interactions were observed for several self-harm behaviors (overdosing, self-burning, asphyxiating, poisoning, and jumping from heights), suggesting that individuals engage in each of these behaviors with different intentions depending on gender and culture. Cultures and genders likewise differed in the likelihood of engaging in several self-harm behaviors. CONCLUSIONS Clinicians should consider culture and gender when assessing for suicide risk, as similar self-harming behaviors may reflect different intentions depending on an individual's culture and gender.
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Affiliation(s)
- Anna S Freedland
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Kalpana Sundaram
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Nancy H Liu
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Suzanne Barakat
- Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Ricardo F Muñoz
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Yan Leykin
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
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Edwards AC, Abrahamsson L, Crump C, Sundquist J, Sundquist K, Kendler KS. Alcohol use disorder and risk of specific methods of suicide death in a national cohort. Acta Psychiatr Scand 2024; 149:479-490. [PMID: 38556255 PMCID: PMC11065572 DOI: 10.1111/acps.13683] [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: 01/25/2024] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Alcohol use disorder (AUD) is among the strongest correlates of suicide death, but it is unclear whether AUD status is differentially associated with risk of suicide by particular methods. METHODS The authors used competing risks models to evaluate the association between AUD status and risk of suicide by poisoning, suffocation, drowning, firearm, instruments, jumping, or other means in a large Swedish cohort born 1932-1995 (total N = 6,581,827; 48.8% female). Data were derived from Swedish national registers, including the Cause of Death Register and a range of medical registers. RESULTS After adjusting for sociodemographic factors and familial liability to suicidal behavior, AUD was positively associated with risk of suicide for each method evaluated (cumulative incidence differences: 0.006-1.040 for females, 0.046-0.680 for males), except the association with firearm suicide in females. AUD was most strongly associated with risk of suicide by poisoning. Sex differences in the effects of AUD and family liability were observed for some, but not all, methods. Furthermore, high familial liability for suicidal behavior exacerbated AUD's impact on risk for suicide by poisoning (both sexes) and suffocation and jumping (males only), while the inverse interaction was observed for firearm suicide (males only). CONCLUSIONS AUD increases risk of suicide by all methods examined and is particularly potent with respect to risk of suicide by poisoning. Differences in risk related to sex and familial liability to suicidal behavior underscore AUD's nuanced role in suicide risk. Future research should investigate targeted means restriction effectiveness among persons with AUD.
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Affiliation(s)
- Alexis C. Edwards
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, US
| | - Linda Abrahamsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Casey Crump
- Departments of Family and Community Medicine and of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center, Houston, TX, US
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, US
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Bandara P, Wickrama P, Sivayokan S, Knipe D, Rajapakse T. Reflections on the trends of suicide in Sri Lanka, 1997-2022: The need for continued vigilance. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003054. [PMID: 38630779 PMCID: PMC11023397 DOI: 10.1371/journal.pgph.0003054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/03/2024] [Indexed: 04/19/2024]
Abstract
Despite reductions in suicide rates in Sri Lanka during the past decades, largely by introduction of national bans on highly hazardous pesticides, the country continues to record a higher than global average rate of suicide. With the changing availability of methods of suicide over time, we aimed to examine the age-standardized suicide rates in Sri Lanka by sex, age, and method between 1997 to 2022 using national police suicide data to identify trends. The rate of suicide in Sri Lanka in 2022 was 27/100,000 and 5/100,000, in males and females respectively, with an overall suicide rate of 15/100,000 population. When considering the previous decades, the overall rate of suicide has declined from 1997 until about 2015, in both sexes, driven by a drop in the numbers of suicides due to pesticide ingestion. In females the overall rates of suicide plateaued around 2015, but in males there has been an upward trend in overall suicide that started in 2016, mostly due to an increase in rates of hanging. Since 2016 rates of suicide by hanging have increased among older males, and young females (17-25 years). Whilst the current suicide rate in Sri Lanka is substantially lower than it was during the 1990s, the upward trend in hanging seen in the last few years, particularly among older men and young women, is of concern. Ongoing monitoring of suicide rates should be a priority during the next few years, to detect and respond to changes as soon as possible. There is an urgent need to address current risk factors for suicide in Sri Lanka, such as significant financial insecurity, unemployment, depression, alcohol misuse, and domestic violence, and to minimize media glamourization of hanging by suicide.
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Affiliation(s)
- Piumee Bandara
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Prabath Wickrama
- Department of Psychiatry, University of Jaffna, Jaffna, Sri Lanka
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Lambe G, Dempsey P, Bolger M, Bolster F. Self-harm, suicide and brain death: the role of the radiologist. Clin Radiol 2024; 79:239-249. [PMID: 38341342 DOI: 10.1016/j.crad.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
Suicide is a leading cause of death worldwide and takes many forms, which include hanging, jumping from a height, sharp force trauma, ingestion/poisoning, drowning, and firearm injuries. Self-harm and suicide are associated with particular injuries and patterns of injury. Many of these patterns are apparent on imaging. Self-harm or suicidal intent may be overlooked initially in such cases, particularly when the patient is unconscious or uncooperative. Correct identification of these findings by the radiologist will allow a patient's management to be tailored accordingly and may prevent future suicide attempts. The initial role of the radiologists in these cases is to identify life-threatening injuries that require urgent medical attention. The radiologist can add value by drawing attention to associated injuries, which may have been missed on initial clinical assessment. In many cases of self-harm and suicide, imaging is more reliable than clinical assessment. The radiologist may be able to provide important prognostic information that allows clinicians to manage expectations and plan appropriately. Furthermore, some imaging studies will provide essential forensic information. Unfortunately, many cases of attempted suicide will end in brain death. The radiologist may have a role in these cases in identifying evidence of hypoxic-ischaemic brain injury, confirming a diagnosis of brain death through judicious use of ancillary tests and, finally, in donor screening for organ transplantation. A review is presented to illustrate the imaging features of self-harm, suicide, and brain death, and to highlight the important role of the radiologist in these cases.
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Affiliation(s)
- G Lambe
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - P Dempsey
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - M Bolger
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - F Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
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Oliveira Alves FJ, Fialho E, Paiva de Araújo JA, Naslund JA, Barreto ML, Patel V, Machado DB. The rising trends of self-harm in Brazil: an ecological analysis of notifications, hospitalisations, and mortality between 2011 and 2022. LANCET REGIONAL HEALTH. AMERICAS 2024; 31:100691. [PMID: 38500959 PMCID: PMC10945432 DOI: 10.1016/j.lana.2024.100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 03/20/2024]
Abstract
Background Self-harm is considered an important public health issue and is comprised by a wide range of definitions and behaviours. It is estimated that suicide affects more than 700,000 individuals every year, although, globally, there is a lack of evidence on other self-harm behaviour, such as attempted suicide. The objective of this study is to report and examine temporal trends of notifications, hospitalisations related to self-harm and suicide rates in Brazil between 2011 and 2022, as well as investigating differences in sociodemographic characteristics, methods, and region. Methods This ecological study used secondary, Brazilian Health Information System data between 2011 and 2022. Self-harm notifications were collected from the Notifiable Diseases Information System (SINAN); self-harm hospitalisations from the Hospital Information System (SIH), and suicide data from the Mortality Information System (SIM). We calculated self-harm notifications, hospitalisations, and suicide rates by sex, age, race, region, and overall. We assessed time-related trends using Joinpoint regression analyses. Findings From 2011 to 2022, 720,480 self-harm notifications, 104,458 self-harm hospitalisations, and 147,698 suicides were recorded in Brazil. In this period, self-harm notifications (AAPC: 21.13 (CI: 17.50, 25.33)) and suicide (AAPC: 3.70 (CI: 3.05, 4.38)) have increased in the country. Male adults (25-59 years old) and the elderly (>60 years old) continue to be the groups most affected by suicide, with respective rates of 9.59 and 8.60/100,000 in 2022. However, the largest percentage increases have been seen in young people (AAPC: 6.14 (CI: 4.57, 7.88)). The Indigenous population had the highest self-harm notification (103.72, 10,000) and suicide (16.58/100,000) rates, but the lowest hospitalisation rates (1.14/100,000) in 2022), compared to the overall population (70.06, 7.27, and 4.69/100,000, respectively, in 2022). Interpretation The observed trend of increased self-harm notifications and suicide rates suggests the need for a greater allocation of resources to strategies to prevent self-harm and suicide. The Indigenous population seems to be the group with less access to healthcare. Funding Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award number R01MH128911-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Affiliation(s)
- Flávia Jôse Oliveira Alves
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Erika Fialho
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Jacyra Azevedo Paiva de Araújo
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Maurício L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Daiane Borges Machado
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
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Chen M, Wang X, Wang Y, Ren L, Jiang H, Xia L, Zhang L, Dong C. The characteristics of suicide attempters in Chinese patients: Comparison of adolescents, youths, middle-aged and elderly. J Forensic Leg Med 2024; 102:102658. [PMID: 38382217 DOI: 10.1016/j.jflm.2024.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/12/2023] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Potential risk factors for suicide differ by age group. Therefore, this study aims to investigate the characteristics of patients with suicide attempts according to age group and any the relevant risk factors. METHODS This study retrospectively reviewed the medical records of attempted suicide patients who were admitted to the emergency departments (ED) of the First Affiliated Hospital of Wenzhou Medical University between January 1, 2017, and December 31, 2021. Demographic information and clinical characteristics were collected. The participants were divided into four age groups and the characteristics of each group were compared. RESULTS A total of 834 participants were included in this study. Suicide attempts were more prevalent in females, and the gender difference decreased with age. Having religious belief and less educated suicide attempts were concentrated in the elderly groups. Adolescents suicide attempts were more likely to occur in the spring, autumn and during non-office hours. Mental disorders were the major motivation for suicide among adolescents, and interpersonal and social problems were more prevalent among youths. Psychiatric medication was the leading suicidal substances among adolescents, while pesticides and herbicides were more prevalent in adults. The history of psychiatric diagnosis was more common in adolescents, while the history of somatic disorder was more prevalent in the elderly. CONCLUSION This study confirmed differences in the demographic and clinical characteristics of patients in different age groups. Therefore, it is necessary to construct individualized intervention strategies for each age group based on the characteristics of the patients in order to reduce suicide.
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Affiliation(s)
- Meijia Chen
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Xinlu Wang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yuxin Wang
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China
| | - Liya Ren
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China
| | - Hao Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China
| | - Lin Xia
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Liping Zhang
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
| | - Chaoqun Dong
- School of Nursing, Wenzhou Medical University, Wenzhou, 325035, China.
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Çelik C, Ata U, Saka NE. Analysis of Forensic Death Statistics From 2013 to 2022 and Autopsy Practices in Türkiye. Balkan Med J 2024; 41:38-46. [PMID: 38008919 PMCID: PMC10767775 DOI: 10.4274/balkanmedj.galenos.2023.2023-9-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/23/2023] [Indexed: 11/28/2023] Open
Abstract
Background Autopsy rates are significantly lower that what they should be worldwide. Additionally, autopsy practices vary between countries. Aims To examine the autopsy rates, the distribution and temporal changes of forensic autopsy cases, so as to identify the areas in the death investigation system that require improvement in Türkiye. Study Design Cross-sectional study. Methods “Forensic Death Examination Statistics” of the Council of Forensic Medicine (CFM) and “Death Statistics” of the Turkish Statistical Institute were compared and analyzed for the years 2013-2022 in Türkiye. Results The number of forensic death cases sent to the CFM has increased over time. For all causes of deaths, the autopsy rate is approximately 3.6-4.8%. The cause-specific mortality rates for deaths due to sharp instrument trauma, blunt trauma, occupational accident, undetermined, and poisoning have increased over the years. “The percentage of “undetermined” deaths, which are important to demonstrate negative autopsies, was 14.2% in 2021. Conclusion Although the autopsy rates have slightly increased in a volatile trend over time in Türkiye, they are still not at the desired level. Thus, it is essential to further raise awareness among all professionals involved in death investigations about the importance of autopsies.
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Affiliation(s)
- Cemil Çelik
- Forensic Medicine, Council of Forensic Medicine, Kahramanmaraş, Türkiye
| | - Uğur Ata
- Forensic Medicine, Council of Forensic Medicine, Kahramanmaraş, Türkiye
| | - Naile Esra Saka
- Forensic Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Türkiye
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Sahoo MK, Biswas H. Suicide Attempt by Hanging - A Study on Patients Admitted in Tertiary Care Hospital in Eastern India. Indian J Community Med 2024; 49:195-198. [PMID: 38425956 PMCID: PMC10900470 DOI: 10.4103/ijcm.ijcm_638_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/06/2023] [Indexed: 03/02/2024] Open
Abstract
Background Suicide is defined as a fatal self-injurious act with some evidence of intent to die. Despite the evolution of sophisticated methods to commit suicide, hanging remains one of the commonest methods to commit suicide across the world. To evaluate the individuals using hanging as a method of suicide and identify the contributing factors for this behaviour. Material and Methods The study was carried out in a tertiary care hospital, over a period of 1 year on the suicide attempters using the method of hanging. Semi-structured in-depth interviews were conducted with all the 46 attempters. The questions focused on the precipitating events present before the attempt. After the in interview the risk factors of the conversations were identified, tabulated and categorized using descriptive analysis. Results Findings from descriptive analysis reveals that significant age group using this method was below 19 years followed by 20-29 age group, female attempters were more compared to male. Psychiatric diagnosis was present in 8 attempters and 4 attempters had alcohol/substance dependence. The most common personality component in attempters was impulsivity. The most common immediate stressor found were financial stress, conflict with family, spouse, humiliation, substance abuse, exam stress and domestic violence. Conclusion This study demonstrates that the reasons for suicide attempt by hanging is multifactorial. which includes, psychiatric diagnosis, personality factors, immediate stressors, ease of use, and accessibility, Overall, our study adds to understanding the intricates of this method and will help in developing effective suicide prevention strategies.
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Affiliation(s)
- Manoj Kumar Sahoo
- Department of Psychiatry, Tata Main Hospital and Manipal Tata Medical College, Jamshedpur, Jharkhand, India
| | - Harshita Biswas
- Department of Psychiatry, Tata Main Hospital and Manipal Tata Medical College, Jamshedpur, Jharkhand, India
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Shin SJ, Kim YJ. Cardiac Manifestations after Ingestion of a Commercial Desiccant: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:55. [PMID: 38256316 PMCID: PMC10819129 DOI: 10.3390/medicina60010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The rise in suicidal attempts has led to an increase in unusual intoxication cases. The ingestion of anhydrous calcium chloride (CaCl2) causes direct injury to the gastrointestinal wall via a thermal burn. Therefore, previous reports on CaCl2 ingestion primarily considered the gastrointestinal injury. Severe CaCl2 intoxication can induce a hypercalcemic crisis, presenting with arrhythmia, acute pancreatitis, and acute kidney injury. This case report details a patient with hematemesis and hypercalcemia following the ingestion of a commercial desiccant. We aimed to report the progression of the case, with a focus on the electrocardiographic manifestations. Case Presentation: A 39-year-old female presented at a regional emergency center with blood in her vomit after the ingestion of a commercial desiccant. Bloody emesis was the initial symptom, and various electrolyte imbalances developed during admission. Electrocardiogram (ECG) changes occurred early after hospitalization and disappeared before the electrolyte levels normalized. The patient was maintained in an NPO (Nil Per Os) state throughout her hospital stay. The bloody emesis and abdominal pain resolved quite early, despite her minimal mention of symptoms, possibly due to her suspected negative psychiatric symptoms. Conclusions: In this case, we observed dynamic and prolonged multiple electrolyte imbalances along with the early-phase ECG changes, all of which responded well to supportive care. This report adds to the understanding of the diverse manifestations and management of CaCl2 intoxication.
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Affiliation(s)
- Su-Jeong Shin
- Department of Emergency Medicine, Yeungnam University Medical Center, Daegu 42415, Republic of Korea;
| | - Yun-Jeong Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
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15
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Roza TH, Marchionatti LE, Gosmann NP, do Canto GC, Machado PV, Massuda R, Passos IC, Kessler FHP, Magalhães PVDS, Telles LEDB. Characteristics of deaths by suicide in postmortem studies in Brazil: A systematic review and meta-analysis. Suicide Life Threat Behav 2023; 53:1086-1107. [PMID: 37864416 DOI: 10.1111/sltb.13009] [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: 06/05/2023] [Revised: 09/16/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Suicide is one of the leading causes of death, with a trend for its increase in Brazil in past decades. This study aimed to review the characteristics of suicides in Brazilian postmortem studies. METHODS Studies investigating suicide deaths in Brazil, and based on autopsy or psychological autopsy were included. Proportions were pooled across studies with the use of random and fixed effects models. RESULTS 6777 references were retrieved from six databases (searches up to January, 2023), and 45 studies included. In autopsy studies (k = 37, n = 16,231), substance use at toxicological analysis was found in 36.42% of cases (95% CI: 30.05-43.32), previous suicide attempts in 23.92% (95% CI: 6.73-57.78). In psychological autopsy studies (k = 8, n = 139), previous suicide attempts were reported in 28.09% (95% CI: 19.74-38.28), psychiatric conditions/symptoms in 90.67% (95% CI: 67.79-97.82), family history of suicidality in 21.33% (95% CI: 13.5-32.03). Most suicide deaths were reported in males and took place at the victim's home, hanging was the most frequent suicide method. Included studies presented significant limitations in quality assessment. CONCLUSION Future studies should present more robust methodology, including bigger samples, the use of controls, and validated methodology.
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Affiliation(s)
- Thiago Henrique Roza
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Lauro Estivalete Marchionatti
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Natan Pereira Gosmann
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Section of Negative Affect and Social Processes, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Anxiety Disorders Outpatient Program, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Gustavo Cambraia do Canto
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Patrícia Vasconcelos Machado
- Seção de Perícias Psíquicas (Forensic Psychological and Psychiatric Examination Unit), Departamento-Médico Legal (Institute of Legal Medicine), Instituto-Geral de Perícias (General Crime Scene Investigation Institute), Porto Alegre, Brazil
| | - Raffael Massuda
- Department of Psychiatry, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Ives Cavalcante Passos
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Felix Henrique Paim Kessler
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Pedro Vieira da Silva Magalhães
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lisieux Elaine de Borba Telles
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Addiction and Forensic Psychiatry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Az A, Orhan C, Sogut O. Suicide attempts and the factors that lead to suicidal ideation: A 3-year analysis. North Clin Istanb 2023; 10:745-753. [PMID: 38328720 PMCID: PMC10846586 DOI: 10.14744/nci.2023.81598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/05/2022] [Accepted: 01/07/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE We explored the epidemiological characteristics of suicide attempts and identified suicide trends and associated factors. METHODS This retrospective, cross-sectional, observational, and single-center study included consecutive 412 patients who were admitted to Emergency Department for follow-up and treatment after a suicide attempt between June 2019 and June 2022. We assessed patient demographics, suicidal behavior, previous suicide attempts, psychiatric disorders, drug use, visits to the psychiatry clinic within the past 6 months, the persistence of suicidal ideation, and clinical outcomes. RESULTS The study population consisted of 259 females (62.86%) and 153 males (37.14%), with a mean age of 29.50±11.51 (range: 13-72) years. Females attempted suicide more often than males, but suicide completion was more common in males. Overall, 79.37% (n=327) of the suicide attempters were aged <40 years and most were 20-29 years old (n=147, 35.68%). Non-fatal suicide attempts were more common in single, unemployed, and poorly educated individuals, but this was not the case for suicide completers. However, there was no significant difference in marital status, education, and occupation among suicide completers. Drug poisoning was the major form of suicide attempt (n=345, 83.74%). Mental disorders, family or relationship conflicts, and separation from a partner were common causes of suicidal ideation. Patient numbers were particularly high in the autumn (i.e., September), and at night. CONCLUSION Females, young adults, singletons, the unemployed, and individuals with psychiatric disorders and low education levels are more likely to attempt suicide, particularly during hours when they are likely to be alone.
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Affiliation(s)
- Adem Az
- Department of Emergency Medicine, Istanbul Provincial Health Directorate Beylikduzu Public Hospital, Istanbul, Turkiye
| | - Cigdem Orhan
- Department of Emergency Medicine, Istanbul Provincial Health Directorate Beylikduzu Public Hospital, Istanbul, Turkiye
| | - Ozgur Sogut
- Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkiye
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Song IH, Lee JH, Shin JS. Firearm Possession Rates in Home Countries and Firearm Suicide Rates Among US- and Foreign-Born Suicide Decedents in the United States: Analysis of Combined Data from the National Violent Death Reporting System and the Small Arms Survey. JMIR Public Health Surveill 2023; 9:e44211. [PMID: 37773604 PMCID: PMC10576231 DOI: 10.2196/44211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/02/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Suicide by firearms is a serious public health issue in the United States. However, little research has been conducted on the relationship between cultural backgrounds and suicide by firearms, specifically in those born and raised in the United States compared to those who have immigrated to the United States. OBJECTIVE To better understand the relationship between cultural backgrounds and suicide, this study aimed to examine firearm suicide rates among US- and foreign-born suicide decedents based on the firearm possession rate in the decedent's home country. METHODS Multivariate logistic regression was performed to analyze data of 28,895 suicide decedents from 37 states obtained from the 2017 National Violent Death Reporting System data set. The firearm possession rate in the home countries of foreign-born suicide decedents was obtained from the 2017 Small Arms Survey. RESULTS The firearm suicide rate was about twice as high among US-born suicide decedents compared to their foreign-born counterparts. Meanwhile, suicide by hanging was about 75% higher among foreign-born compared to US-born suicide decedents. Those from countries with a low-to-medium firearm possession rate were significantly less likely to use firearms compared to US-born suicide decedents (adjusted odds ratio [AOR]=0.45, 95% CI 0.31-0.65, and AOR=0.46, 95% CI 0.39-0.53, respectively). Meanwhile, firearm suicide rates were not different between US- and foreign-born suicide decedents from countries with a similarly high firearm possession rate. CONCLUSIONS The results suggest that there is an association between using firearms as a means of suicide and the firearm possession rate in the decedent's home country. Suicide by firearms in the United States needs to be understood in the sociocultural context related to firearm possession.
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Affiliation(s)
- In Han Song
- ICONS Convergence Academy, Yonsei University, Seoul, Republic of Korea
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jin Hyuk Lee
- Department of Social Welfare, Ewha Womans University, Seoul, Republic of Korea
| | - Jee Soo Shin
- Interdisciplinary Program of Social Welfare Policy, The Graduate School, Yonsei University, Seoul, Republic of Korea
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Sivcova V, Moravansky N, Novakova D, Brazinova A. Suicide rates in the Slovak Republic in 2011-2020. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1171-1177. [PMID: 37169997 PMCID: PMC10174613 DOI: 10.1007/s00127-023-02486-0] [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: 06/16/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Suicide is a serious public health problem leading to premature mortality. The aim of the present study is to describe and analyze the trends of suicide rates in the Slovak Republic in 2011-2020. METHODS Trends of age-standardized suicide rates were described and incidence rate ratios of suicide were analyzed by negative binomial regression. The age-standardized rates of death by the undetermined intent and its ratio to suicide rate were calculated. RESULTS The overall suicide rate for the Slovak population was 7.58 per 100,000. Age-standardized suicide rate had a declining trend in the reported period, from 10.24 in 2011 to 6.65 per 100,000 in 2020. The highest suicide rate was in the oldest age groups. The male to female ratio was 6.09. The most common method of suicide in the Slovak population was hanging. The age-standardized rate of deaths by undetermined intent increased from 15.72 in 2011 to 18.46 per 100,000 in 2020. CONCLUSION We observed the overall declining annual suicide mortality trends in the Slovak Republic in 2011-2020. Further investigation is necessary to understand the exceptionally high undetermined intent mortality.
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Affiliation(s)
- Veronika Sivcova
- Faculty of Medicine, Comenius University Bratislava, Špitálska 24, 813 72, Bratislava, Slovak Republic
| | - Norbert Moravansky
- Faculty of Medicine, Comenius University Bratislava, Špitálska 24, 813 72, Bratislava, Slovak Republic
- Forensic.sk Institute of Forensic Medical Analyses, Expert Institution, Bratislava, Slovak Republic
| | - Dorota Novakova
- Faculty of Medicine, Comenius University Bratislava, Špitálska 24, 813 72, Bratislava, Slovak Republic
| | - Alexandra Brazinova
- Faculty of Medicine, Comenius University Bratislava, Špitálska 24, 813 72, Bratislava, Slovak Republic.
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Votruba N, Praveen D, Mellers L, Rajan E, Thout SR, Arora V, Malik Y, Kashyap A, Majumdar S, Hirst J, Maulik PK. SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India. Front Glob Womens Health 2023; 4:1143880. [PMID: 37575961 PMCID: PMC10416114 DOI: 10.3389/fgwh.2023.1143880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population. Methods/design This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health. Discussion The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.
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Affiliation(s)
- Nicole Votruba
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Devarsetty Praveen
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Mellers
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Eldho Rajan
- The George Institute for Global Health India, New Delhi, India
| | | | - Varun Arora
- Post Graduate Institute of Medical Science, Rohtak, India
| | - Yogender Malik
- Department of Psychiatry, Institute of Mental Health (IMH), University of Health Sciences PGIMS, Rohtak, India
| | - Aditya Kashyap
- SVS Institute of Neurosciences, Government Medical College, Siddipet, India
| | - Sreya Majumdar
- The George Institute for Global Health India, New Delhi, India
| | - Jane Hirst
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Pallab K. Maulik
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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20
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Al-Sabaileh S, Abusamak M, Jaber H, Al-Buqour A, Al-Salamat HA, Sabayleh RS, Hatamleh H, Deameh MG, Al-Amer RM. Suicide Trends in Jordan in Correlation With the COVID-19 Pandemic: A Forensic Medicine Perspective. Cureus 2023; 15:e42636. [PMID: 37644940 PMCID: PMC10461217 DOI: 10.7759/cureus.42636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
Background This study aimed to examine the suicide trends among Jordanians who died by suicide before and during the coronavirus disease 2019 (COVID-19) pandemic and assess their correlation with demographic data, including gender, age, marital status, and the method used for suicide, from a forensic medicine perspective. Methodology This was a retrospective, observational, autopsy-based study. Of the 731 medicolegal autopsies performed at the Al-Hussein New Hospital at Al Salt City between 2017 and 2022, 41 confirmed cases of suicide were identified. Results The study indicated that 75% of the subjects committed suicide during the COVID-19 pandemic period, of whom 13% were children. The average age of those who died by suicide was 32.1 (SD = 12.2) years. Overall, 58.5% were single, 61.0% unemployed, and 53.7% had a mental illness. Males were four times more likely to commit suicide than females. Hanging represented 60.61% of all male suicides, followed by firearms (27.27%); however, females used poisoning. Around 60% and 25% of the study subjects were in the age group of 21-40 years and 41 and more, respectively. The study also identified a statistically significant association between gender, age, and the time of suicide (during COVID-19). The findings of this study could not confirm any association between suicide and mental illness, marital status, and employment status. Conclusions The suicide rate in Jordan increased during the COVID-19 pandemic, and it is alarming that most of those who committed suicide were at a young age and in their productive years.
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Affiliation(s)
- Shrouq Al-Sabaileh
- Community, Pathology, and Forensic Medicine, Al-Balqa Applied University, As-Salt, JOR
| | - Mohammad Abusamak
- General and Special Surgery, Al-Balqa Applied University, As-Salt, JOR
- Ophthalmology, Amman Eye Clinic, Amman, JOR
| | - Hatim Jaber
- Epidemiology and Public Health, Al-Balqa Applied University, As-Salt, JOR
| | - Ali Al-Buqour
- Forensic Medicine, Ministry of Health Al-Hussein/Salt New Hospital, As-Salt, JOR
| | | | | | - Hamzeh Hatamleh
- Internal Medicine, Al-Balqa Applied University, As-Salt, JOR
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Kort I, Hmandi O, Grayaa M, Bellali M, Kouada R, Gharbaoui M, Zhioua M, Allouche M. A comparative study of the injury pattern between suicidal and accidental falls from height in Northern Tunisia. J Forensic Leg Med 2023; 97:102531. [PMID: 37210812 DOI: 10.1016/j.jflm.2023.102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/24/2023] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Falls from height are a common cause of marbidity and mortality. The aim of this study is to examine the characteristics of the victims, the circumstances of the fall and distribution of the injuries of accidental and suicidal falls from height. MATERIALS AND METHODS It was a retrospective cross-sectional study, based on autopsies performed over 16 years (January 2005 to December 2020). The recorded variables included demographic data of the victim, height of fall, death scene findings, length of hospital stay, autopsy findings, and toxicological results. RESULTS Of the 753 victims of fall from height, 607 were fallers and 146 were jumpers. We found that male victims were predominant in the accidental group (86.8% vs. 69.2%). The mean age at death was 43.6 ± 17.9 years. Suicidal falls occurred in a private house in the majority of cases (70.5%), while accidental falls occurred most frequently at workplace (43.8%). Suicidal falls were higher than accidental falls (10.4 ± 7.3 m vs. 7.1 ± 5.7 m). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequentl in the suicidal falls group. Pelvic fractures were 2.1 times more likely to occur in the suicidal falls. Head injuries were more frequent in the accidental falls group. The survival delay was shorter in the suicidal falls group. CONCLUSIONS our study highlights the differences in the profile of the victims and in the pattern of injuries caused by falls from height, depending on the victim's intention to fall.
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Affiliation(s)
- Ikram Kort
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.
| | - Ons Hmandi
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Mariem Grayaa
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.
| | - Mohamed Bellali
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Rihem Kouada
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.
| | - Meriem Gharbaoui
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Mongi Zhioua
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Mohamed Allouche
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia; Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
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Ongeri L, Nyawira M, Kariuki SM, Bitta M, Schubart C, Penninx BWJH, Newton CRJC, Tijdink JK. Perspectives on reasons for suicidal behaviour and recommendations for suicide prevention in Kenya: qualitative study. BJPsych Open 2023; 9:e38. [PMID: 36797822 PMCID: PMC9970164 DOI: 10.1192/bjo.2023.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Little is known about the reasons for suicidal behaviour in Africa, and communities' perception of suicide prevention. A contextualised understanding of these reasons is important in guiding the implementation of potential suicide prevention interventions in specific settings. AIMS To understand ideas, experiences and opinions on reasons contributing to suicidal behaviour in the Coast region of Kenya, and provide recommendations for suicide prevention. METHOD We conducted a qualitative study with various groups of key informants residing in the Coast region of Kenya, using in-depth interviews. Audio-recorded interviews were transcribed and translated from the local language before thematic inductive content analysis. RESULTS From the 25 in-depth interviews, we identified four key themes as reasons given for suicidal behaviour: interpersonal and relationship problems, financial and economic difficulties, mental health conditions and religious and cultural influences. These reasons were observed to be interrelated with each other and well-aligned to the suggested recommendations for suicide prevention. We found six key recommendations from our thematic content analysis: (a) increasing access to counselling and social support, (b) improving mental health awareness and skills training, (c) restriction of suicide means, (d) decriminalisation of suicide, (e) economic and education empowerment and (f) encouraging religion and spirituality. CONCLUSIONS The reasons for suicidal behaviour are comparable with high-income countries, but suggested prevention strategies are more contextualised to our setting. A multifaceted approach in preventing suicide in (coastal) Kenya is warranted based on the varied reasons suggested. Community-based interventions will likely improve and increase access to suicide prevention in this study area.
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Affiliation(s)
- Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Miriam Nyawira
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Symon M Kariuki
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; and Department of Public Health, Pwani University, Nairobi, Kenya
| | - Mary Bitta
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; and Department of Psychiatry, University of Oxford, UK
| | - Chris Schubart
- Division of Mental Health, Tergooi Medical Centre, Hilversum, The Netherlands
| | | | - Charles R J C Newton
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; and Department of Psychiatry, University of Oxford, UK
| | - Joeri K Tijdink
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit, The Netherlands; and Department of Philosophy, Faculty of Humanities, VU Universiteit, The Netherlands
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23
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Transplantation of Organs From DCD and DBD Donors Who Died After Ligature Asphyxiation. Transplantation 2023; 107:529-539. [PMID: 36195070 DOI: 10.1097/tp.0000000000004296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The United Kingdom transplant registry data demonstrated similar transplant outcomes for recipients of kidneys from donors who died following ligature asphyxiation and those who received organs from donors dying from other causes. The impact that this donor cause of death has on the outcomes of other solid organ transplant recipients remains uncertain. METHODS The United Kingdom transplant registry analysis was undertaken to determine transplant outcomes in recipients of lungs, hearts, livers' and pancreases from donors who died following ligature asphyxiation. RESULTS Between January 01, 2003, and December 31, 2016, 2.7% (n = 521) of all potential United Kingdom donors died following ligature asphyxiation (mostly suicide by hanging). Of these, 416 (79.9%; 197 donation after brain stem death and 219 donation after circulatory death [DCD]) donated an organ for transplantation. These donors provided organs for 574 transplants (66 lung transplants, 75 heart transplants, 279 liver transplants, and 154 pancreas transplants). Patient and graft survival were similar for recipients of both donation after brain stem death and DCD hearts, livers, and pancreases from donors who died following ligature asphyxiation. Unadjusted graft and patient survival were significantly worse for recipients of lungs from DCD donors who died following ligature asphyxiation. This detrimental effect persisted after propensity score matching. CONCLUSIONS Livers, hearts, and pancreases from donors who die following ligature asphyxiation suffer an additional warm ischemic insult, but this does not negatively impact transplant outcomes. Outcomes for recipients of DCD lungs appear to be significantly worse.
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Söderberg C, Rodushkin L, Johansson A, Kugelberg FC. Postmortem reference concentrations of 68 elements in blood and urine. Int J Legal Med 2023; 137:655-669. [PMID: 36715753 DOI: 10.1007/s00414-023-02952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Fatal intoxications, both accidental and intentional, are a global issue. In the Western world, intoxications with pharmaceuticals dominate, but in other parts of the world, other substances are more common. In a forensic setting, elemental intoxications are of great importance when investigating both accidental, suicidal, and homicidal deaths. The current study presents normal postmortem reference concentrations of 68 elements in femoral blood and urine. In addition, possible sources of error such as contamination from sample tubes, preservative potassium fluoride (KF) solution, and storage time are evaluated. METHODS Paired femoral blood and urine samples from 120 cases of death by suicidal hanging in Sweden were collected. Additionally, multiple batches of sample tubes and multiple batches of KF solution were also analyzed. Concentrations of elements were determined by double focusing sector field ICP-MS. RESULTS Key descriptive statistics for 68 elements are provided in blood and urine. Contamination from sample tubes was minor compared to the overall mean elemental concentrations in both blood and urine. KF solution contained a large assortment of elements, but the overall contribution is relatively minor for most elements given the small amounts of solution added to samples. There were significant differences for 22 elements in blood and 17 elements in urine between samples with short and long storage time. CONCLUSION The present study provides an important tool when evaluating postmortem elemental concentrations. It fills a needed gap between large antemortem population studies and postmortem case reports or small case series of elemental intoxications.
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Affiliation(s)
- Carl Söderberg
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Artillerigatan 12, 587 58, Linköping, Sweden.
| | - Llia Rodushkin
- Division of Geosciences, Luleå University of Technology, 971 87, Luleå, Sweden.,ALS Scandinavia AB, 971 87, Luleå, Sweden
| | - Anna Johansson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Artillerigatan 12, 587 58, Linköping, Sweden
| | - Fredrik C Kugelberg
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Artillerigatan 12, 587 58, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linköping University, 581 83, Linköping, Sweden
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Rajapakse T, Silva T, Hettiarachchi NM, Gunnell D, Metcalfe C, Spittal MJ, Knipe D. The Impact of the COVID-19 Pandemic and Lockdowns on Self-Poisoning and Suicide in Sri Lanka: An Interrupted Time Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1833. [PMID: 36767200 PMCID: PMC9914278 DOI: 10.3390/ijerph20031833] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Evidence from high-income countries suggests that the impact of COVID-19 on suicide and self-harm has been limited, but evidence from low- and middle-income countries is lacking. Using data from a hospital-based self-poisoning register (January 2019-December 2021) and data from national records (2016-2021) of suicide in Sri Lanka, we aimed to assess the impact of the pandemic on both self-poisoning and suicide. We examined changes in admissions for self-poisoning and suicide using interrupted time series (ITS) analysis. For the self-poisoning hospital admission ITS models, we defined the lockdown periods as follows: (i) pre-lockdown: 01/01/2019-19/03/2020; (ii) first lockdown: 20/03/2020-27/06/2020; (iii) post-first lockdown: 28/06/2020-11/05/2021; (iv) second lockdown: 12/05/2021-21/06/2021; and (v) post-second lockdown: 22/06/2021-31/12/2021. For suicide, we defined the intervention according to the pandemic period. We found that during lockdown periods, there was a reduction in hospital admissions for self-poisoning, with evidence that admission following self-poisoning remained lower during the pandemic than would be expected based on pre-pandemic trends. In contrast, there was no evidence that the rate of suicide in the pandemic period differed from that which would be expected. As the long-term socioeconomic impacts of the pandemic are realised, it will be important to track rates of self-harm and suicide in LMICs to inform prevention.
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Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Tharuka Silva
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | | | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
- National Institute of Health Research Biomedical Research Centre, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Duleeka Knipe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
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26
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Rafati A, Janani L, Malakouti SK, Motevalian SA, Kabiri A, Pasebani Y, Shalbafan M. Evaluation of psychometric properties of the Persian version of the predicaments questionnaire, exploring social attitudes to suicide. Front Public Health 2023; 10:1061673. [PMID: 36703832 PMCID: PMC9872659 DOI: 10.3389/fpubh.2022.1061673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Background Due to the growing prevalence of suicide, assessing people's attitudes toward suicide is necessary. Therefore, this study aimed to examine the psychometric properties of the Persian version of the Predicaments Questionnaire (PQ), measuring social attitudes toward suicide. Methods This psychometrics study evaluated face validity, content validity, temporal stability, internal consistency, and construct validity. First, the questionnaire was translated into Persian by the translate-back-translate method. The Persian version was provided to 10 experts in psychiatry for further revision. Two indicators, CVR and CVI, were calculated to evaluate the content validity. To check the face validity, we prepared a form and gave it to 10 people outside the campus to submit their opinions. Temporal stability was investigated by the test-retest method, reporting Intraclass correlation (ICC). Internal consistency was assessed by reporting Cronbach's alpha and McDonald's Omega coefficients. Construct validity was assessed using the confirmatory factor analysis to determine the number of dimensions of the questionnaire. Results A total of 151 students were enrolled with a mean age of 25 (SD = 0.32). The Persian PQ was valid in terms of content validity and face validity. Furthermore, it was reliable as Cronbach's alpha, McDonald's Omega, and the ICC were 0.94, 0.943, and 0.998, respectively. In addition, the confirmatory factor analysis yielded one dimension. Finally, after reviewing the experts' comments, the final amendments were made, and only question 29 was removed from the final version. Conclusion Consequently, the Persian version of the PQ is acceptable in terms of content validity, face validity, temporal stability, and internal consistency.
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Affiliation(s)
- Ali Rafati
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Preventive Medicine and Public Health Research Centre, Psychosocial Health Research Institute (PHRI), Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- Mental Health Research Center, Tehran Institute of Psychiatry–School of Behavioural Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Abbas Motevalian
- Research Center for Addiction and Risky Behaviors (ReCARB), Psychosocial Health Research Institute (PHRI), Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kabiri
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Pasebani
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shalbafan
- Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran,*Correspondence: Mohammadreza Shalbafan ✉
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27
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Colbert SMC, Mullins N, Chan G, Meyers JL, Schulman J, Kuperman S, Lai D, Nurnberger J, Plawecki MH, Kamarajan C, Anokhin AP, Bucholz KK, Hesselbrock V, Edenberg HJ, Kramer J, Dick DM, Porjesz B, Agrawal A, Johnson EC. Polygenic Contributions to Suicidal Thoughts and Behaviors in a Sample Ascertained for Alcohol Use Disorders. Complex Psychiatry 2023; 9:11-23. [PMID: 38058956 PMCID: PMC10697665 DOI: 10.1159/000529164] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/03/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Suicidal thoughts and behaviors have partially distinct genetic etiologies. Methods We used PRS-CS to create polygenic risk scores (PRSs) from GWAS of non-suicidal self-injury, broad-sense self-harm ideation, nonfatal suicide attempt, death by suicide, and depression. Using mixed-effect models, we estimated whether these PRSs were associated with a range of suicidal thoughts and behaviors in the Collaborative Study on the Genetics of Alcoholism (N = 7,526). Results All PRSs were significantly associated with suicidal ideation and suicide attempt (betas = 0.08-0.44, false discovery rate [FDR] <0.023). All PRSs except non-suicidal self-injury PRS were associated with active suicidal ideation (betas = 0.14-0.22, FDR <0.003). Several associations remained significant in models where all significant PRSs were included as simultaneous predictors, and when all PRSs predicted suicide attempt, the PRS together explained 6.2% of the variance in suicide attempt. Significant associations were also observed between some PRSs and persistent suicidal ideation, non-suicidal self-injury, compounded suicide attempt, and desire to die. Conclusion Our findings suggest that PRS for depression does not explain the entirety of the variance in suicidal thoughts and behaviors, with PRS specifically for suicidal thoughts and behaviors making additional and sometimes unique contributions.
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Affiliation(s)
- Sarah M C Colbert
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Niamh Mullins
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Grace Chan
- Mount Sinai Clinical Intelligence Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jacquelyn L Meyers
- Department of Psychiatry, University of Connecticut, Farmington, CT, USA
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jessica Schulman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel Kuperman
- Henri Begleiter Neurodynamics Lab, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Dongbing Lai
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - John Nurnberger
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Martin H Plawecki
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chella Kamarajan
- Department of Psychiatry, University of Connecticut, Farmington, CT, USA
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Andrey P Anokhin
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Victor Hesselbrock
- Mount Sinai Clinical Intelligence Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Howard J Edenberg
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Psychiatry and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John Kramer
- Henri Begleiter Neurodynamics Lab, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Danielle M Dick
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bernice Porjesz
- Department of Psychiatry, University of Connecticut, Farmington, CT, USA
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Arpana Agrawal
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Emma C Johnson
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Shoib S, Amanda TW, Saeed F, Ransing R, Bhandari SS, Armiya'u AY, Gürcan A, Chandradasa M. Association Between Loneliness and Suicidal Behaviour: A Scoping Review. TURK PSIKIYATRI DERGISI = TURKISH JOURNAL OF PSYCHIATRY 2023; 34:125-132. [PMID: 37357899 PMCID: PMC10468686 DOI: 10.5080/u27080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Suicide is a public health issue, and there are several factors leading to suicide, like mental illness and psychosocial stressors. Actual loneliness (living alone) and subjective loneliness (feeling of being alone) and different suicidal behaviors have been reported to have some link. This scoping review aimed to assess the association between loneliness and suicidal behaviour by exploring the existing literature. METHODS A scoping review was conducted implementing the appropriate framework and in accord with the PRISMA-ScR extension. A PubMed database search was made using a combination of terms to find publications in English from 2011 to 2021. Studies were included if they reported quantitative outcomes of the association between loneliness and suicidal experiences, including suicidal thoughts, plans, and/or attempts. Screening and data charting of the published literature was conducted by a panel of authors. The accuracy and clarity of extracted data was checked by three reviewers. RESULTS Among 421 articles found, 31 full texts were evaluated based on exclusion and inclusion criteria, out of which, 18 papers that reported quantitative outcomes of the association between loneliness and suicidal experiences were included. We found that association between loneliness and suicidal behaviour is determined by individual, social and cultural factors. Co-existing mental illness, substance use disorder and economic hardship play an important role for the completion of suicide. CONCLUSION Loneliness is correlated with suicide, and the knowledge about this association could assist in the identification of suicidal individuals or those at elevated risk of suicidal behaviour. Future studies should focus on loneliness and its relation to suicidal ideation in individuals with different mental health disorders and personalities.
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Lapo-Talledo GJ, Talledo-Delgado JA, Portalanza D, Rodrigues ALS, Siteneski A. Suicide rates in Ecuador: A nationwide study from 2011 until 2020. J Affect Disord 2023; 320:638-646. [PMID: 36208687 DOI: 10.1016/j.jad.2022.09.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
Suicide, suicide ideations, and psychiatric disorder rates tend to increase after natural disasters such as earthquake. In 2016 Ecuador experienced a 7.8Mw earthquake and, more recently, the Covid-19 confinement. Both events may have negatively affected the mental health of the Ecuadorian population. Therefore, the present study aimed to evaluate the suicide rates and choice of suicide method in the Ecuadorian population between January 2011 and December 2020. The dataset used is publicly available on the Ecuadorian National Institute of Statistics and Censuses. Multivariate logistic regression models were used to calculate adjusted odds ratios (OR) for potential sociodemographic factors associated with each suicide method compared to other reported suicide methods. There were 10,380 registered cases of suicide in Ecuador between 2011 and 2020. Significant suicide rates per provinces were seen in Napo with 12.63 and Azuay with 12.52, followed by Bolívar with 12.30, and Orellana with 11.36 suicides/100,000 habitants. Hanging accounted for 7082 cases (68.2 %). The mestizos (82 %) were the most prevalent ethnicity of all suicide cases. School-age children with 6-12 years (OR 8.83, 95 % CI 5.34-14.59) and adolescents with 13-19 years (OR 1.46, 95 % CI 1.29-1.66) were more likely to use hanging as method of suicide. In conclusion, we observed an increase of suicide rates from 8.15 per 100,000 in 2011 to 8.81 in 2020. The confinement of COVID-19 pandemic in the period evaluated did not significantly affect the suicide rates. An increased suicide rate was observed in the province hardest hit by the 2016 earthquake.
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Affiliation(s)
- German Josuet Lapo-Talledo
- School of Medicine, Faculty of Health Sciences, Universidad Técnica de Manabí, Portoviejo, Manabí, Ecuador
| | | | - Diego Portalanza
- Federal University of Santa Maria, Department of Physics, Climate Research group, Santa Maria, Rio Grande do Sul, Brazil
| | - Ana Lúcia S Rodrigues
- Department of Biochemistry, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Aline Siteneski
- School of Medicine, Faculty of Health Sciences, Universidad Técnica de Manabí, Portoviejo, Manabí, Ecuador; Research Institute, Universidad Técnica de Manabí, Portoviejo, Manabí, Ecuador.
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Liu RT. The epidemiology of non-suicidal self-injury: lifetime prevalence, sociodemographic and clinical correlates, and treatment use in a nationally representative sample of adults in England. Psychol Med 2023; 53:274-282. [PMID: 33960286 PMCID: PMC10324294 DOI: 10.1017/s003329172100146x] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although the clinical importance of non-suicidal self-injury (NSSI) has received increasing recognition, relatively little is known about its epidemiology. The objective of this study was to estimate the lifetime prevalence of NSSI in adults and its association with sociodemographic characteristics, psychiatric disorders, and lifetime treatment for NSSI. METHODS A nationally representative face-to-face survey was conducted with 7192 adults aged ≥18 years in England. Respondents were interviewed about engagement in NSSI, psychiatric illness, suicidal thoughts and behavior, and treatment history for this behavior. RESULTS The estimated lifetime prevalence rate of NSSI was 4.86%. Younger age, growing up without biological parents in the household, being unmarried, and impoverished backgrounds were associated with NSSI. The majority of respondents with lifetime NSSI (63.82%) had at least one current psychiatric disorder. Most psychiatric conditions were associated with greater odds of lifetime NSSI in multivariate models. NSSI was strongly associated with suicidal ideation and suicide attempts, respectively, even after accounting for psychiatric disorders and sociodemographic covariates. A substantial proportion of respondents with NSSI history (30.92%) have engaged in medically severe self-harm, as indexed by requiring medical attention for this behavior. The majority of respondents with NSSI (56.20%) had not received psychiatric care for this behavior. CONCLUSIONS NSSI is prevalent in the general population and associated with considerable psychiatric comorbidity. A high rate of unmet treatment needs is evident among those with this behavior. Those at the greatest lifetime risk for NSSI may also be particularly limited in their resources to cope with this behavior.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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31
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Karnecki K, Gos T, Steiner J, Mańkowski D, Kaliszan M. Epidemiology of suicide in the Tri-City metropolitan area in Poland in 2010-2019. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01548-9. [PMID: 36583739 DOI: 10.1007/s00406-022-01548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
The paper, which is a continuation of our previous epidemiological studies on the phenomenon of suicide in the Tri-City metropolitan area, presents the results of statistical analyses of suicides in the autopsy material of the Department of Forensic Medicine of the Medical University of Gdańsk in the years 2010-2019. The purpose of the study was to analyse in detail demographic data of suicides (age, sex, place of death), as well as to assess suicide methods and the impact of alcohol on suicides in the study area. During the 10-year study period, 8495 autopsies were performed, of which 1261 were suicides (14.8%). Statistical analyses were conducted using the statistical data analysis software system STATISTICA, version 13 (StatSoft, Tulsa, Oklahoma, USA). The results of the study indicate a continuing downward trend in the number of suicides since the beginning of the 21th century, with the number of suicides in rural areas increasing over the same period. In the analysed cohort, suicides were committed in particular by middle-aged men and the number of suicides among older people (65 +) increased at the same time. The increase in suicide occurred in late autumn and early spring. The most common method of suicide was hanging. There was a high percentage of inebriated victims (45%), and a comparison of the present studies with previous ones indicates the increasing impact of alcohol on suicide.
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Affiliation(s)
- Karol Karnecki
- Department of Forensic Medicine, Faculty of Medicine, Medical University of Gdańsk, 23 Dębowa St, 80-204, Gdańsk, Poland.
| | - Tomasz Gos
- Department of Forensic Medicine, Faculty of Medicine, Medical University of Gdańsk, 23 Dębowa St, 80-204, Gdańsk, Poland
| | - Johann Steiner
- Department of Psychiatry, Otto-Von-Guericke University, 44 Leipziger St, 39120, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Otto-Von-Guericke University, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Dobrosław Mańkowski
- Institute of Sociology, Faculty of Social Sciences, University of Gdańsk, Gdańsk, Poland
| | - Michał Kaliszan
- Department of Forensic Medicine, Faculty of Medicine, Medical University of Gdańsk, 23 Dębowa St, 80-204, Gdańsk, Poland
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Stulz N, Hepp U, Kupferschmid S, Raible-Destan N, Zwahlen M. Trends in suicide methods in Switzerland from 1969 to 2018: an observational study. Swiss Med Wkly 2022; 152:40007. [PMID: 36592392 DOI: 10.57187/smw.2022.40007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Suicide is a serious societal and health problem. We examined changes in rates of completed suicides in Switzerland between 1969-2018 with particular regard to different methods of suicide used in different subgroups of the resident population. METHODS We used data of the Swiss cause of death statistics and Poisson regression models to analyse annual incidence rates and calendar time trends of specific suicide methods used in population subgroups by sex (men vs women), age (10-29, 30-64, >64 years), and nationality (Swiss vs other citizenship). RESULTS There were 64,996 registered suicides between 1969 and 2018. Across these 5 decades, the overall suicide rate was higher in men than in women (incidence rate ratio [IRR] 2.62, 95% confidence interval [CI] 2.58-2.67), in Swiss citizens than in foreigners (IRR 2.02; 95% CI 1.97-2.07), and in older residents (>64 years) than in the age groups 30-64 years (IRR 1.35, 95% CI 1.32-1.37) and 10-29 years (IRR 2.37, 95% CI 2.32-2.43). After peaking in the 1980s, the overall suicide rate had declined in all of these population subgroups, with flattening trends over most recent years. The most common specific methods of suicide were hanging (accounting for 26.7% of all suicides) and firearms (23.6%). The rates of the specific suicide methods were usually higher in men, in Swiss citizens and in older residents, and they had typically declined over most recent decades in the population subgroups examined. However, some methods diverged from this general pattern, at least in some population subgroups. For instance, railway suicides most recently increased in younger and in male residents whereas suicides by gas and by drowning were only at a low level after rapid declines in the last millennium. CONCLUSIONS Restricting access to lethal means (e.g., detoxification of domestic gas), improvements in health care and media guidelines for responsible reporting of suicides are possible explanations for the generally declining suicide rates in Switzerland. Whereas some methods (e.g., poisoning by gases or drowning) had become rare, others continue to account for many suicides every year, at least in some population subgroups (e.g., firearms in older Swiss men or railway suicides in younger and in male residents). As different methods of suicide are chosen by different people or subgroups of the population, preventive efforts should include differentiated strategies and targeted measures to further reduce suicides in Switzerland and elsewhere.
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Affiliation(s)
- Niklaus Stulz
- Integrated Psychiatric Services Winterthur - Zurcher Unterland, Switzerland
| | - Urs Hepp
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Switzerland.,Meilener Institute Zurich, Switzerland
| | | | | | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
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Tsellou M, Dona A, Antoniou A, Goutas N, Skliros E, Papadopoulos IN, Spiliopoulou C, Papadodima SA. A comparative autopsy study of the injury distribution and severity between suicidal and accidental high falls. Forensic Sci Med Pathol 2022; 18:407-414. [PMID: 35771377 DOI: 10.1007/s12024-022-00496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
Falls are the second cause of accidental deaths worldwide. Falls from height are also a common method of suicide. The aim of this study is to compare the characteristics of the victims, the circumstances of the fall and the severity and distribution of the injuries reported in an autopsy case series of falls from height. This study is a retrospective analysis of consecutive autopsy cases of suicidal and accidental falls from height which were investigated in the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens during the period 2011-2019. The recorded variables included demographic data of the victim, height of fall, length of hospital stay, toxicological results, the existence and location of injuries and Injury Severity Score (ISS). Victims of suicidal falls were younger (55.53 vs. 62.98, p = 0.001), they fell from higher heights (12.35 vs. 5.18 m, p < 0.001), and they sustained more severe injuries compared with victims of accidental falls (ISS 51.01 vs. 40.88, p < 0.001). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequently observed after a suicidal fall (93.6% vs. 67.3%, 72.1% vs. 21.4%, 72.1% vs. 27.6%, 42.9% vs. 15.3%, 45.7% vs. 13.3%, respectively-p < 0.001), probably due to the higher height of fall. Our study outlines the differences in the profile of the victims and in the severity of injuries caused by falls from height depending on the intention of the victim to fall. However, a distinctive injury pattern in victims of suicidal falls was not demonstrated.
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Affiliation(s)
- Maria Tsellou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | - Artemis Dona
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Antoniou
- 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Goutas
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Papadodima
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Athens, Greece.
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Albano GD, Malta G, La Spina C, Rifiorito A, Provenzano V, Triolo V, Vaiano F, Bertol E, Zerbo S, Argo A. Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries. TOXICS 2022; 10:toxics10110654. [PMID: 36355945 PMCID: PMC9698482 DOI: 10.3390/toxics10110654] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 05/15/2023]
Abstract
The use of illicit and non-illicit substances is widespread in suicides. The toxicological data may help in understanding the mechanism of death. This systematic review aimed to analyze autopsies related to suicides by consuming poison, focusing on the correlation between substance use and the country of origin to create an alarm bell to indicate that suicide maybe attempted and prevent it. The systematic review was conducted according to the PRISMA guidelines, with the primary objective of identifying autopsies conducted in cases of suicide by consuming poison in specific geographic areas. Significant differences in substances were observed between low-income and Western countries that confirm previous literature data. In rural areas and Asian countries, most suicides by consuming poison involve the use of pesticides, such as organophosphates and carbamates. In Western countries, illicit drugs and medically prescribed drugs are the leading cause of suicide by self-poisoning. Future research should shed light on the correlation between social, medical, and demographic characteristics and the autopsy findings in suicides by self-poisoning to highlight the risk factors and implement tailored prevention programs worldwide. Performing a complete autopsy on a suspected suicide by self-poisoning could be essential in supporting worldwide public health measures and policy makers. Therefore, complete autopsies in such cases must be vigorously promoted.
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Affiliation(s)
- Giuseppe Davide Albano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
- Correspondence: ; Tel.: +39-3312264328
| | - Ginevra Malta
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Corinne La Spina
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Arianna Rifiorito
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valeria Provenzano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valentina Triolo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Fabio Vaiano
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Elisabetta Bertol
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Stefania Zerbo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Antonina Argo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
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Zhu Y, Nam S, Quan L, Baek J, Jeon H, Tang B. Linking suicide and social determinants of health in South Korea: An investigation of structural determinants. Front Public Health 2022; 10:1022790. [PMID: 36388317 PMCID: PMC9641084 DOI: 10.3389/fpubh.2022.1022790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/10/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Studies have shown that suicide is closely related to various social factors. However, due to the restriction in the data scale, our understanding of these social factors is still limited. We propose a conceptual framework for understanding social determinants of suicide at the national level and investigate the relationships between structural determinants (i.e., gender, employment statuses, and occupation) and suicide outcomes (i.e., types of suicide, places of suicide, suicide methods, and warning signs) in South Korea. Methods We linked a national-level suicide registry from the Korea Psychological Autopsy Center with the Social Determinants of Health framework proposed by the World Health Organization's Commission on Social Determinants of Health. Results First, male and female suicide victims have clear differences in their typical suicide methods (fire vs. drug overdose), primary warning signs (verbal vs. mood), and places of death (suburb vs. home). Second, employees accounted for the largest proportion of murder-suicides (>30%). The proportion of students was much higher for joint suicides than for individual suicides and murder-suicides. Third, among individuals choosing pesticides as their suicide method, over 50% were primary workers. In terms of drug overdoses, professionals and laborers accounted for the largest percentage; the former also constituted the largest proportion in the method of jumping from heights. Conclusion A clear connection exists between the investigated structural factors and various suicide outcomes, with gender, social class, and occupation all impacting suicide.
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Affiliation(s)
- Yongjun Zhu
- Department of Library and Information Science, Yonsei University, Seoul, South Korea,*Correspondence: Yongjun Zhu
| | - Seojin Nam
- Department of Library and Information Science, Sungkyunkwan University, Seoul, South Korea
| | - Lihong Quan
- Department of Media and Communication, Sungkyunkwan University, Seoul, South Korea
| | - Jihyun Baek
- Department of Psychiatry, School of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, South Korea
| | - Hongjin Jeon
- Department of Psychiatry, School of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, South Korea,Depression Center, Samsung Medical Center, Seoul, South Korea
| | - Buzhou Tang
- Department of Computer Science, Harbin Institute of Technology (Shenzhen), Shenzhen, China
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Berardelli I, Rogante E, Sarubbi S, Erbuto D, Cifrodelli M, Concolato C, Pasquini M, Lester D, Innamorati M, Pompili M. Is Lethality Different between Males and Females? Clinical and Gender Differences in Inpatient Suicide Attempters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013309. [PMID: 36293891 PMCID: PMC9602518 DOI: 10.3390/ijerph192013309] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 05/09/2023]
Abstract
According to the gender paradox in suicidology, an important sex difference has been reported with a preponderance of females in nonfatal suicidal behavior and a preponderance of males in completed suicide. Furthermore, females and males present different risk factors for suicide. The present study explored possible clinical differences between male and female psychiatric inpatients who had recently attempted suicide. The study included 177 adult inpatients hospitalized following a suicide attempt at the University Psychiatric Clinic, Sant'Andrea Hospital, Sapienza University of Rome. Clinical features assessed included psychiatric diagnosis, method and lethality of suicide attempts using the Risk/Rescue Rating Scale, the history of suicide attempts, age at onset of psychiatric illness, the presence of substance or alcohol use, and the length of stay. The results found that males and females differed in the method used for the suicide attempt, the scores for risk and rescue, and the length of hospitalization post-suicide attempt. In conclusion, identifying gender characteristics of patients at higher risk of suicide is important for implementing specific suicide prevention strategies and reducing the risk of future suicidal behavior in psychiatric inpatients.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
- Correspondence: ; Tel.: +06-33-775-675
| | - Elena Rogante
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Mariarosaria Cifrodelli
- Psychiatry Residency Training Program, Psychiatry Unit, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Cristina Concolato
- Psychiatry Residency Training Program, Psychiatry Unit, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ 08205, USA
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
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Ilic M, Ilic I. Worldwide suicide mortality trends (2000-2019): A joinpoint regression analysis. World J Psychiatry 2022; 12:1044-1060. [PMID: 36158305 PMCID: PMC9476842 DOI: 10.5498/wjp.v12.i8.1044] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/16/2021] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies exploring suicide mortality on a global scale are sparse, and most evaluations were limited to certain populations.
AIM To assess global, regional and national trends of suicide mortality.
METHODS Suicide mortality data for the period 2000-2019 were obtained from the mortality database of the World Health Organization and the Global Burden of Disease Study. Age-standardized rates (ASRs; expressed per 100000) were presented. To assess trends of suicide mortality, joinpoint regression analysis was used: The average annual percent change (AAPC) with the corresponding 95% confidence interval (95%CI) was calculated.
RESULTS A total of 759028 (523883 male and 235145 female) suicide deaths were reported worldwide in 2019. The global ASR of mortality of suicide was 9.0/100000 population in both sexes (12.6 in males vs 5.4 in females). In both sexes, the highest rates were found in the region of Africa (ASR = 11.2), while the lowest rates were reported in Eastern Mediterranean (ASR = 6.4). Globally, from 2000 to 2019, ASRs of mortality of suicide had a decreasing tendency in both sexes together [AAPC = -2.4% per year; 95%CI: (-2.6)-(-2.3)]. The region of the Americas experienced a significant increase in suicide mortality over 2000-2019 unlike other regions that had a declining trend. Out of all 133 countries with a decline in suicide mortality, Barbados (AAPC = -10.0%), Grenada (AAPC = -8.5%), Serbia (AAPC = -7.6%), and Venezuela (AAPC = -6.2%) showed the most marked reduction in mortality rates. Out of all 26 countries with a rise in suicide mortality, Lesotho (AAPC = +6.0%), Cyprus (AAPC = +5.1%), Paraguay (AAPC = +3.0%), Saudi Arabia (AAPC = +2.8%), Brunei (AAPC = +2.6%), Greece (AAPC = +2.6%), Georgia (AAPC = +2.1%), and Mexico (AAPC = +2.0%), are among those with the highest increase in mortality.
CONCLUSION Decreasing trends in suicide mortality were observed in most countries across the world. Unfortunately, the mortality of suicide showed an increasing trend in a number of populations. Further research should explore the reasons for these unfavorable trends, in order to consider and recommend more efforts for suicide prevention in these countries.
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Affiliation(s)
- Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
| | - Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
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Hernæs KH, Skyrud KD. The impact of daylight on suicide rates. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101151. [PMID: 35717823 DOI: 10.1016/j.ehb.2022.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Since Durkheim and Morselli found a spring peak in suicides in the late 19th century, researchers have presented possible explanations, including daylight variation, for this seasonal pattern. Our identification strategy exploits the idiosyncratic variation in daylight within Norwegian regions, arising from the country's substantial latitudinal range. We use full population data for a period of 45 years in a pre-registered research design. We find a small and non-significant relationship: One extra hour of daylight increases the suicide rate by merely 0.75 % (95 % CI: -0.4 % to 1.9 %).
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Affiliation(s)
- Kjersti Helene Hernæs
- Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway.
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Ali A, Broome J, Tatum D, Fleckman J, Theall K, Chaparro MP, Duchesne J, Taghavi S. The association between food insecurity and gun violence in a major metropolitan city. J Trauma Acute Care Surg 2022; 93:91-97. [PMID: 35234710 PMCID: PMC9233034 DOI: 10.1097/ta.0000000000003578] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Food insecurity (FI) is an important social determinant of health that is associated with many forms of violence. We hypothesized that FI would be associated with gun violence. METHODS Firearm injury data was collected from 2016 to 2020 (n = 3115) at a single institution that serves as the only Level I trauma center in a major southern US city. The data were linked with Map the Meal Gap data, a publicly available data set, which estimates rates of county-level FI based on state-level FI and social determinants, including unemployment, poverty, disability, and other factors. Regression analysis was utilized to examine the relationship between FI with rates of overall gun trauma and odds of gun-related violence. Food insecurity by county of patient residence was categorized by rates less than the national average of 11.5% (low), between the national and state average (16.5%) (moderate), and greater than the state average (high). Out of state residents were excluded from the analyses. RESULTS Of the 3,115 patients with firearm injuries identified, 138 (4.4%) resided in counties with low FI rates, 1048 (33.6%) in moderate FI, and 1929 (62.0%) in counties with high FI. Patients in regions of high FI were more likely to be a Level I trauma activation, a victim of assault, and have Medicaid or be self-pay. There was no significant difference in mortality by levels of FI. Food insecurity was significantly associated with firearm injury, with each percent increase in FI being related to approximately 56 additional gun-related injuries per 100,000 people (95% confidence interval, 54-59) and increased odds of the injury classified as assault (odds ratio, 1.13; 95% confidence interval, 1.07-1.19). CONCLUSION Violence prevention initiatives targeting food insecure communities may help alleviate the US gun violence epidemic. Further, trauma center screening for household FI and in-hospital interventions addressing FI may help reduce gun violence recidivism. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level IV.
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Affiliation(s)
- Ayman Ali
- Department of Surgery, Tulane University School of Medicine
| | - Jacob Broome
- Department of Surgery, Tulane University School of Medicine
| | - Danielle Tatum
- Department of Surgery, Tulane University School of Medicine
| | - Julia Fleckman
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine
| | - Katherine Theall
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine
| | - M. Pia Chaparro
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine
| | - Juan Duchesne
- Department of Surgery, Tulane University School of Medicine
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Okada M, Matsumoto R, Motomura E, Shiroyama T, Murata M. Exploring characteristics of increased suicide during the COVID-19 pandemic in Japan using provisional governmental data. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 24:100481. [PMID: 35664440 PMCID: PMC9160839 DOI: 10.1016/j.lanwpc.2022.100481] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background The Japanese age-standardised death rate of suicide (SDR) had decreased during 2009-2019, but increased in 2020-2021, during the COVID-19 pandemic. Methods This study aimed to explain the trend change in the SDR during the pandemic, disaggregated by prefecture, gender, suicide method and household, as compared to predicted SDR derived from pre-pandemic data, using linear mixed-effect and hierarchical linear regression models with robust standard error analyses. Findings The SDR was lower during March-June 2020 (during the first wave of the pandemic), but higher during July-December 2020 than the predicted SDR. In 2021, males' SDR was nearly equal to the predicted SDR, whereas females' SDR in the metropolitan-region (17.5%: 95% confidence interval: 13.9-21.2%) and non-metropolitan-region (24.7%: 95% confidence interval: 22.8-26.7%) continued to be higher than the predicted SDR. These gender- and region-dependent temporal fluctuations of SDR were synchronised with those of SDRs caused by hanging, at home and single-person-households. Additionally, the rising number of infected patients with the SARS-CoV-2 and polymerase chain reaction (PCR) diagnostic examinations were positively (β = 0.024) and negatively (β =-0.002) related to the SDR during the pandemic, respectively. Interpretation Japanese suicide statistics have previously established that the predominant method and place of suicide were by hanging and at the individual's home, respectively. The present findings suggest that transformed lifestyles during the pandemic, increasing time spent at home, enhanced the suicide risk of Japanese people by hanging and at home. Funding Regional Suicide Countermeasures Emergency Enhancement Fund of Mie Prefecture (2021-40).
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Affiliation(s)
- Motohiro Okada
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan
| | - Ryusuke Matsumoto
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan
| | - Eishi Motomura
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan
| | - Takashi Shiroyama
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan
| | - Masahiko Murata
- Department of Psychiatry, National Hospital Organization Sakakibara Hospital, 777 Sakakibara, Tsu, Mie 514-1292, Japan
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Chiang MY, Shao SC, Liao SC. Validation of Diagnostic Codes to Identify Carbon Monoxide Poisoning in Taiwan’s Claims Data. Front Pharmacol 2022; 13:882632. [PMID: 35784736 PMCID: PMC9240270 DOI: 10.3389/fphar.2022.882632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose: Previous studies identified the study cohort or outcome of carbon monoxide poisoning (COP) by using the relevant disease diagnosis codes in secondary databases, but the validity of diagnosis codes of COP is unclear in such secondary databases. This study aimed to evaluate the accuracy of case definitions for COP using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes in Taiwan’s health insurance claims data. Methods: We selected a 10% simple random sample from an original cohort of patients newly undergoing carboxyhemoglobin (COHb) testing under any clinical diagnosis at four Chang Gung Memorial Hospitals in Taiwan during 2011–2020. Two clinical doctors independently ascertained the COP diagnosis by reviewing the medical records as the reference standard. We estimated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of various case definitions (e.g., ICD-9-CM code, ICD-10-CM code and the uses of hyperbaric oxygen therapy) in the claims data. Results: We randomly selected 557 cases from the original cohort of 5,571 cases newly receiving COHb test in the study hospitals. We found 90, 35, and 9 cases were true-positive, false-positive, and false-negative episodes of COP, respectively, among 278 cases with an ICD-9-CM code of 986. A further 111, 34, and 6 cases were true-positive, false-positive, and false-negative episodes of COP, respectively, among 279 cases with an ICD-10-CM code of T58. Using ICD-9-CM codes, the sensitivity, specificity, PPV and NPV for COP were 90.9, 80.4, 72, and 94.1%, respectively. Using ICD-10-CM codes they were 94.9, 79, 76.6, and 95.5%, respectively. PPV typically increased when COP was the primary diagnosis and could reach 100% if patients with ICD-CM code 986 or T58 also received hyperbaric oxygen therapy during hospitalization. Conclusion: The COP-related ICD-CM codes alone did not accurately identify COP patients, but accuracy improved after including oxygen therapy data with the ICD-CM codes in Taiwan’s claims data.
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Affiliation(s)
- Min-Ying Chiang
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Chen Liao
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Shu-Chen Liao,
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Lane TJ. Associations Between Firearm and Suicide Rates: A Replication of Kleck (2021). Arch Suicide Res 2022:1-16. [PMID: 35686601 DOI: 10.1080/13811118.2022.2083535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Using data from n = 194 nation-states, Kleck found that firearm availability was only associated with firearm suicide rates, but not total or non-firearm suicides. He thus concluded that while firearm availability influences how people commit suicide, it does not affect total numbers. However, the study contains numerous logical and methodological issues and is at odds with the evidence base. Therefore, I attempt to reproduce the original results. METHOD I reproduce the original study's methods: ordinary least squares regression, weighted by the square root of the population, with log-transformed suicide rates and three separate firearm availability measures: global estimates from the Small Arms Survey, proportion of suicides committed with firearms, and a European Union survey of firearm ownership. I also test several methodological variations and include U.S. suicide data. RESULTS In contrast to Kleck, global analyses with Small Arms Survey data found a significant and positive association between firearm availability and total suicides, as did U.S. analyses. Analyses with other firearm availability measures comported with the original study, finding no association. CONCLUSION The main result in Kleck failed to reproduce, finding instead a significant association between firearm availability and suicide rates, as did U.S. analyses. While reproductions of Kleck's other analyses continued to show no association, they were based on unreliable methods. I therefore reject Kleck's conclusion that that firearm availability does not influence suicide rates. HighlightsUsing data global data, I find firearm availability is positively associated with suicide rates.I identify serious flaws in the logic and methods of Kleck and an earlier review.For transparency, data and code have been archived on a public repository.
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Niraula SR, Manandhar N, Pandey S, Jha N. Stressors of Suicide Among the Residents of Ilam, Eastern Nepal: an Investigation Into a Neglected Burden. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ilic I, Zivanovic Macuzic I, Kocic S, Ilic M. Worldwide suicide mortality trends by firearm (1990–2019): A joinpoint regression analysis. PLoS One 2022; 17:e0267817. [PMID: 35613099 PMCID: PMC9132310 DOI: 10.1371/journal.pone.0267817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/15/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Suicide by firearm is a major public health problem in many countries. But, studies that investigated the mortality of suicide by firearm on a global scale are still limited. The aim of this study was to assess the global, regional and national trends in mortality of suicide by firearm from 1990 to 2019.
Method
Mortality data of suicide by firearm was presented using the age-standardized rates (ASRs, expressed per 100,000). Joinpoint regression analysis was used to assess trends of mortality of suicide by firearm: the average annual percent change (AAPC) with the corresponding 95% confidence interval (95%CI) was calculated.
Results
A total of 52,694 (45,110 male and 7584 female) deaths of suicide by firearm were reported worldwide in 2019. The global ASR of suicide by firearm was six-fold higher in males than in females (1.15 per 100,000 and 0.19 per 100,000, respectively), and varied greatly across countries: the highest rates were in Greenland (24.52 per 100,000 and 2.69 per 100,000, respectively) and the United States of America (10.13 per 100,000 and 1.66 per 100,000, respectively), while the lowest rates (0.05 per 100,000 or less) were observed in China, Japan and Singapore. Globally, the mortality of suicide by firearm had a decreasing tendency from 1990 to 2019 in both sexes together (AAPC = -2.0% per year; 95%CI = -2.1 to -1.9).
Conclusion
Decreasing trends in mortality of suicide by firearm were observed in majority of countries across the world, but not in all. Future research should determine more effective ways to further reduce mortality of suicide by firearm.
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Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Zivanovic Macuzic
- Faculty of Medical Sciences, Department of Anatomy, University of Kragujevac, Kragujevac, Serbia
| | - Sanja Kocic
- Faculty of Medical Sciences, Department of Social Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Milena Ilic
- Faculty of Medical Sciences, Department of Epidemiology, University of Kragujevac, Kragujevac, Serbia
- * E-mail:
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Ongeri L, Nyawira M, Kariuki SM, Theuri C, Bitta M, Penninx B, Newton CR, Tijdink J. Sociocultural perspectives on suicidal behaviour at the Coast Region of Kenya: an exploratory qualitative study. BMJ Open 2022; 12:e056640. [PMID: 35387823 PMCID: PMC8987750 DOI: 10.1136/bmjopen-2021-056640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To explore perceived sociocultural factors that may influence suicidality from key informants residing in coastal Kenya. DESIGN We used an exploratory qualitative study design. SETTING Mombasa and Kilifi Counties of Coastal Kenya. PARTICIPANTS 25 key informants including community leaders, professionals and community members directly and indirectly affected by suicidality. METHODS We conducted in-depth interviews with purposively selected key informants to collect data on sociocultural perspectives of suicide. Thematic analysis was used to identify key themes using both inductive and deductive processes. RESULTS Four key themes were identified from the inductive content analysis of 25 in-depth interviews as being important for understanding cultural perspectives related to suicidality: (1) the stigma of suicidal behaviour, with suicidal victims perceived as weak or crazy, and suicidal act as evil and illegal; (2) the attribution of supernatural causality to suicide, for example, due to sorcery or inherited curses; (3) the convoluted pathway to care, specifically, delayed access to biomedical care and preference for informal healers; and (4) gender and age differences influencing suicide motivation, method of suicide and care seeking behaviour for suicidality. CONCLUSIONS This study provides an in depth understanding of cultural factors attributed to suicide in this rural community that may engender stigma, discrimination and poor access to mental healthcare in this community. We recommend multipronged and multilevel suicide prevention interventions targeted at changing stigmatising attitudes, beliefs and behaviours, and improving access to mental healthcare in the community.
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Affiliation(s)
- Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Miriam Nyawira
- Neuroscience Unit, Kenya Medical Research Institute, Wellcome Trust Research Program, Kilifi, Kenya
| | - Symon M Kariuki
- Neuroscience Unit, Kenya Medical Research Institute, Wellcome Trust Research Program, Kilifi, Kenya
| | - Cyrus Theuri
- Neuroscience Unit, Kenya Medical Research Institute, Wellcome Trust Research Program, Kilifi, Kenya
| | - Mary Bitta
- Neuroscience Unit, Kenya Medical Research Institute, Wellcome Trust Research Program, Kilifi, Kenya
| | - Brenda Penninx
- Department of Psychiatry, Amsterdam UMC VUMC Site, Amsterdam, Netherlands
| | - Charles Rjc Newton
- Psychiatry, Oxford University, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Joeri Tijdink
- Department of Humanities, Amsterdam UMC VUMC Site, Amsterdam, Netherlands
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Clark KA, Mays VM, Arah OA, Kheifets LI, Cochran SD. Sexual Orientation Differences in Lethal Methods Used in Suicide: Findings From the National Violent Death Reporting System. Arch Suicide Res 2022; 26:548-564. [PMID: 32897837 PMCID: PMC7937759 DOI: 10.1080/13811118.2020.1811181] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We examined sexual orientation and sex differences in seven methods of suicide among adult suicides reported in the United States National Violent Death Reporting System (2012-2015; N = 59,075). Overall, most sexual minorities (i.e., lesbians, gay men, bisexuals) identified in the dataset used hanging (38%) followed by firearm (30%) and drug or poison ingestion (20%). Sexual minorities were more likely than heterosexuals to be younger, female, and Black/African American. Multivariate sex-stratified analyses in the overall sample showed that strong sexual orientation differences in lethal methods existed among men but not among women. However, when we compared sex differences in lethal methods among sexual minorities only, we found that lesbian/bisexual women, as compared to gay/bisexual men, were more likely to use a firearm or drug or poison ingestion than hanging. Findings suggest that the higher rate of suicide mortality among sexual minorities is likely driven by hanging, a method of suicide that is not particularly amenable to lethal method restricted-access prevention approaches. Future research directions, clinical training recommendations, and intervention opportunities are discussed.
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Ilic M, Ilic I. Trends in suicide by hanging, strangulation, and suffocation in Serbia, 1991-2020: A joinpoint regression and age-period-cohort analysis. World J Psychiatry 2022; 12:505-520. [PMID: 35433320 PMCID: PMC8968500 DOI: 10.5498/wjp.v12.i3.505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/18/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hanging is one of the most commonly used methods for suicide in both sexes worldwide. In a number of countries, hanging mortality has increased over the last decades. Nevertheless, there is a scarcity of studies that have explored the patterns and trends for mortality of suicide by hanging on global, regional and national levels, as most evaluations are limited to certain populations.
AIM To assess the trends of suicide mortality by hanging, strangulation, and suffocation in Serbia, from 1991 to 2020.
METHODS This nationwide study, with epidemiological descriptive study design, was carried out based on official data. The age-standardized rates (ASRs, expressed per 100000 persons) were calculated by direct standardization, using the World Standard Population. Mortality trends from suicide by hanging were assessed using the joinpoint regression analysis: The average annual percent change (AAPC) with the corresponding 95% confidence interval (95%CI) was calculated. Age-period-cohort analysis was performed to address the possible underlying reasons for the observed suicide trends.
RESULTS Over the 30-year period studied, there were 24340 deaths by hanging (17750 males and 6590 females) in Serbia. In 2020, the ASR of deaths by hanging was 4.5 per 100000 persons in both sexes together (7.6 in males vs 1.7 in females). The trends of suicide mortality by hanging decreased significantly between 1991 and 2020 in both males (AAPC = -1.7% per year; 95%CI: -2.0 to -1.4) and females (AAPC = - 3.5% per year; 95%CI: -3.9 to -3.1). Mortality rates of suicide by hanging had a continuously decreasing tendency in both sexes together in all age groups: The only exception was among males in 40-49 age group, with an increasing trend of suicide by hanging from 1991 to 2011 (by +0.3% per year).
CONCLUSION The trends in suicide mortality by hanging have been decreasing in Serbia in the last three decades in both sexes, but this was more pronounced in women than in men. Despite the decreasing trends observed in mortality of suicide by hanging, further research is needed for better clarification of trends and help in suicide prevention in the future.
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Affiliation(s)
- Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
| | - Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
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Sivaraman JJC, Greene SB, Naumann RB, Proescholdbell S, Ranapurwala SI, Marshall SW. Association Between Medical Diagnoses and Suicide in a Medicaid Beneficiary Population, North Carolina 2014-2017. Epidemiology 2022; 33:237-245. [PMID: 34799475 PMCID: PMC10281339 DOI: 10.1097/ede.0000000000001439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Firearms are used in about half of U.S. suicides. This study investigated how various medical diagnoses are associated with firearm and nonfirearm suicide. METHODS We used a case-control design including n = 691 North Carolina Medicaid beneficiaries who died from suicide between 1 January 2014 and 31 December 2017 as cases. We selected a total of n = 68,682 controls (~1:100 case-control ratio from North Carolina Medicaid member files using incidence density sampling methods). We linked Medicaid claims to the North Carolina Violent Death Reporting System to ascertain suicide and means (firearm or nonfirearm). We matched cases and controls on number of months covered by Medicaid over the past 36 months. Analyses adjusted for sex, race, age, Supplemental Security Income status, the Charlson Comorbidity Index, and frequency of health care encounters. RESULTS The case-control odds ratios for any mental health disorder were 4.2 (95% confidence interval [CI]: 3.3, 5.2) for nonfirearm suicide and 2.2 (95% CI: 1.7, 2.9) for firearm suicide. There was effect measure modification by sex and race. Behavioral health diagnoses were more strongly associated with nonfirearm suicides than firearm suicide in men but did not differ substantially in women. The association of mental health and substance use diagnoses with suicides appeared to be weaker in Blacks (vs. non-Blacks), but the estimates were imprecise. CONCLUSION Behavioral health diagnoses are important indicators of risk of suicide. However, these associations differ by means of suicide and sex, and associations for firearm-related suicide are weaker in men than women.
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Affiliation(s)
- Josie J. Caves Sivaraman
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Sandra B. Greene
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Rebecca B. Naumann
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Scott Proescholdbell
- North Carolina Department of Health and Human Services, Division of Public Health, Injury and Violence Prevention Branch
| | - Shabbar I. Ranapurwala
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Stephen W. Marshall
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
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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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Bierens J, Hoogenboezem J. Fatal drowning statistics from the Netherlands - an example of an aggregated demographic profile. BMC Public Health 2022; 22:339. [PMID: 35177025 PMCID: PMC8851711 DOI: 10.1186/s12889-022-12620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Incompleteness of fatal drowning statistics is a familiar problem impeding public health measures. Part of the problem may be that only data on accidental drowning are used and not the full potential of accessible data. Methods This study combines cause-of-death certificates and public prosecutor’s court documents between 1998 and 2017 to obtain an aggregated profile. Data are also used as a basis for a trend analysis. Results The dataset includes 5571 drowned persons (1.69 per 100,000). The highest risk group are persons above the age of 50. Demographic differences are observed between suicide by drowning, accidental drowning, and drowning due to transportation (0.72, 0.64, 0.28 per 100.000) and between native Dutch, and Dutch with western and non-western background (1.46, 1.43, 1.76 per 100.000). Non-residents account for another 12.2%. When comparing the periods 1998–2007 with 2008–2017, the Standard Mortality declines for suicide drowning and accidental drowning among persons with a native Dutch and non-western background. Single regression analysis confirms a decrease of drowning over the full period, breakpoint analysis shows an increase in the incidence of the total number of drowning, suicide by drowning and accidental drowning starting in 2007, 2008 resp. 2012. Discussion Compared to the formal number of fatal accidental drowning in the Netherlands (n = 1718; incidence 0.52 per 100,000), the study identifies 350% more drowning. Differences in demographic data and the recent increase needs to be explored for public health interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12620-3.
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Affiliation(s)
- Joost Bierens
- Research Group Emergency and Disaster Medicine, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Jan Hoogenboezem
- Centraal Bureau voor de Statistiek (Statistics Netherlands), Department of Causes of Death Statistics, Henri Faasdreef 312, 2492, JP, Den Haag, the Netherlands
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