Seasonality of self-destructive behaviour: seasonal variations in demographic and suicidal characteristics in Van, Turkey

Analiza przypadków samobójstw w materiale sekcyjnym Katedry Medycyny Sądowej Collegium Medicum w Bydgoszczy Uniwersytetu Mikołaja Kopernika w Toruniu w latach 2011-2020

Cel pracy: Analiza samobójstw na podstawie sądowo-lekarskich sekcji zwłok przeprowadzonych w Katedrze Medycyny Sądowej w Bydgoszczy w porównaniu z danymi z lat wcześniejszych i innych ośrodków. Materiał i metody: Ocenie poddano 6564 opinii sądowo-lekarskich z przeprowadzonych badań pośmiertnych z lat 2011-2020, wśród których wyodrębniono 1073 przypadki samobójstw, uwzględniając płeć i wiek pokrzywdzonych, miejsce w którym dokonano czynu samobójczego, wpływ alkoholu lub innych środków odurzających, sposoby popełniania samobójstw oraz data (miesiąc i rok). Wyniki: Samobójstwa stanowiły 16,34% wszystkich badań pośmiertnych. Najczęstszą metodą samobójstwa było powieszenie – 73%. Drugim co do częstości sposobem odebrania sobie życia był upadek z wysokości –8%. Najliczniejszą grupą wiekową wśród popełniających samobójstwo stanowią osoby pomiędzy 51, a 60 rokiem życia. W większości przypadków samobójcy byli trzeźwi. Widoczna jest istotna różnica pomiędzy stanem trzeźwości, a płcią ofiary. Zdecydowanie częściej pod wpływem alkoholu w trakcie dokonania samobójstwa były ofiary płci męskiej. 14% ogółu samobójstw popełniły kobiety, zaś 86% mężczyźni. Nieco częściej zgon w wyniku samobójstwa miał miejsce w granicach dużych aglomeracji miejskich, niż na terenie miasteczek i wsi. Wnioski: Badania wykazały wzrost odsetka samobójstw w stosunku do lat poprzednich. Powieszenie nadal jest najczęstszym sposobem samobójstwa. Odnotowano wzrost liczby samobójstw osób w wieku podeszłym oraz zwiększenie liczby tzw. samobójstw kombinowanych. Słowa kluczowe: samobójstwa, sekcja zwłok Analysis of suicide cases in the autopsy material of the Department of Forensic Medicine Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus in Toruń in 2011-2020 Aim of the study: Analysis of suicides on the basis of forensic post mortem examinations conducted at the Department of Forensic Medicine in Bydgoszcz in comparison with data from previous years and other centers. Material and methods: The assessment included 6,564 forensic medical opinions from the post mortem examinations carried out in 2011–2020, including 1,073 cases of suicide, taking into account the sex and age of the victims, the place where the suicide was committed, the influence of alcohol or other intoxicants, methods of committing suicides and date (month and year). Results: Suicides accounted for 16.34% of all post mortem examinations. The most common method of suicide was hanging – 73%. The second most common way to take your own life was fall from height – 8%. The most numerous age group among those committing suicide are people between 51 and 60 years of age. In most cases, the suicide victims were sober. There is a significant difference between the state of sobriety and the gender of the victim. Male victims were much more often under the influence of alcohol during the suicide. 14% of all suicides were committed by women, and 86% by men. Death as a result of suicide took place somewhat more often within the boundaries of large urban agglomerations than in towns and villages. Conclusions: The research showed an increase in the suicide rate compared to the previous years. Hanging is still the most common form of suicide. There has been an increase in the number of suicides in the elderly and an increase in the number of so-called combined suicides.

Triggers for attempted suicide in Istanbul youth, with special reference to their socio-demographic background

OBJECTIVE

Suicidal behavior of young people is a topic of utmost importance because suicide is irreversible, and should be prevented. Knowing about the psychosocial background and the triggering events could help in preventing suicidal behavior. We therefore aimed at identifying psychosocial factors that may trigger suicidal behavior in youth.

METHODS

We analyzed retrospectively the standardized records of 2232 youths aged ≤25 years, who were treated after a suicide attempt at emergency units of public hospitals in Istanbul, Turkey during a period of 1 year. We describe this population according to sex and socio-economic conditions, like educational, occupational, relationship status and link them with their reported reasons for suicide attempts.

RESULTS

The majority of patients were female (81.6%, N = 1822 females, 18.4%, N = 410 males). Independent of their educational and occupational background, patients indicated most frequently intra-familial problems (females 45.8%, males 30.5%), intrapersonal problems (females 19.9%, males 18.5%), and relationship problems (females 11.3%, males 23.9%) as triggering reasons.

CONCLUSIONS

Because intra-familial problems were the most frequently reported triggers of suicide attempts, preventive measures should focus on handling intra-familial conflicts. As sex differences were observed for the second-most common trigger-reasons, prevention should also focus on differentially handling intrapersonal and relationship conflicts better.

The effect of seasonal changes and climatic factors on suicide attempts of young people

BACKGROUND

Seasonal changes and climatic factors like ambient temperature, sunlight duration and rainfall can influence suicidal behavior.

METHODS

This study analyses the relationship between seasonal changes and climatic variations and suicide attempts in 2131 young patients in Istanbul, Turkey.

RESULTS

In our study sample, there was an association between suicide attempts in youths and seasonal changes, as suicide attempts occurred most frequently during summer in females as well as in males. Furthermore, there was a positive correlation between the mean temperature over the past 10 days and temperature at the index day and suicide attempts in females. After seasonality effects were mathematically removed, the mean temperature 10 days before a suicide attempt remained significant in males only, indicating a possible short-term influence of temperature on suicide attempts.

CONCLUSIONS

This study shows an association between suicide attempts of young people and climatic changes, in particular temperature changes as well as seasonal changes. Therefore, the influence of seasonal changes and climatic factors on young suicide attempters should get more attention in research to understand the biopsychosocial mechanisms playing a role in suicide attempts of young people. As suicide attempts most frequently occur in young people, further research is of considerable clinical importance.

The association of monthly, diurnal and circadian variations with suicide attempts by young people

BACKGROUND

Different psychosocial factors might have an impact on suicidal behaviour and evidence shows that there may be an association between monthly, diurnal and circadian changes and suicidal behaviours.

METHODS

In the present study we analysed retrospectively records of 2232 youth, who were treated in emergency units of state hospitals in Istanbul/Turkey after attempting suicide.

RESULTS

The majority of the suicide attempters were females (81.6%). In both sexes, suicide attempts most frequently occurred at the beginning of the calendar week and between evening and midnight.

CONCLUSIONS

This study shows that suicide attempts in youth follow diurnal and circadian changes. As suicide attempts of youth most frequently occurred at the beginning of the calendar week and between evening and midnight, health services such as specialized counselling for youth should especially be available during this time.

Adolescent Admissions to Emergency Departments for Self-Injurious Thoughts and Behaviors

The objective of the present study was to describe the incidence and the characteristics of Self-Injurious Thoughts and Behaviors (SITBs), among adolescents aged 11–18 admitted, over a two year period, to all the Emergency Departments of a Region of North-eastern Italy through a comprehensive analysis of medical records. A two-step search was performed in the regional ED electronic database. First, we identified the cases that had been clearly diagnosed as SITBs by an Emergency Department physician. Secondly, suspect cases were detected through a keyword search of the database, and the medical records of these cases were hand screened to identify SITBs. The mean annual incidence rate of SITBs was 90 per 100,000 adolescents aged 11–18 years. Events were more frequent in females. Drug poisoning was the most frequently adopted method (54%). In 42% of cases a diagnosis of SITB was not explicitly reported by the physician. In 65% of cases adolescents were discharged within hours of admission. Only 9% of patients started a psychiatric assessment and treatment program during hospital stay. This research confirms the high incidence of SITBs among adolescents and highlights the difficulty in their proper diagnosis and management. Such difficulty is confirmed by the fact that only a few patients, even among those with a clear diagnosis, were sent for psychiatric assessment. Correct identification and management of SITB patients needs to be improved, since SITBs are an important public health problem in adolescence and one of the main risk factors for suicide.

Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis

BACKGROUND

Seasonal variations in suicides have been reported worldwide, however, there may be a different seasonal pattern in suicide attempts. The aim of this study was to perform a systematic review on seasonality of suicide attempts considering potential interfering variables, and a statistical analysis for seasonality with the collected data.

METHOD

Observational epidemiological studies about seasonality in suicide attempts were searched in PubMed, Web of Science, LILACS and Cochrane Library databases with terms attempted suicide, attempt and season. Monthly or seasonal data available were evaluated by rhythmic analysis softwares.

RESULTS

Twenty-nine articles from 16 different countries were included in the final review. It was observed different patterns of seasonality, however, suicide attempts in spring and summer were the most frequent seasons reported. Eight studies indicated differences in sex and three in the method used for suicide attempts. Three articles did not find a seasonal pattern in suicide attempts. Cosinor analysis identified an overall pattern of seasonal variation with a suggested peak in spring, considering articles individually or grouped and independent of sex and method used. A restricted analysis with self-poisoning in hospital samples demonstrated the same profile.

LIMITATIONS

Grouping diverse populations and potential analytical bias due to lack of information are the main limitations.

CONCLUSIONS

The identification of a seasonal profile suggests the influence of an important environmental modulator that can reverberate to suicide prevention strategies. Further studies controlling interfering variables and investigating the biological substrate for this phenomenon would be helpful to confirm our conclusion.

Climate change but not unemployment explains the changing suicidality in Thessaloniki Greece (2000-2012)

INTRODUCTION

Recently there was a debate concerning the etiology behind attempts and completed suicides. The aim of the current study was to search for possible correlations between the rates of attempted and completed suicide and climate variables and regional unemployment per year in the county of Thessaloniki, Macedonia, northern Greece, for the years 2000-12.

MATERIAL AND METHODS

The regional rates of suicide and attempted suicide as well as regional unemployment were available from previous publications of the authors. The climate variables were calculated from the daily E-OBS gridded dataset which is based on observational data

RESULTS

Only the male suicide rates correlate significantly with high mean annual temperature but not with unemployment. The multiple linear regression analysis results suggest that temperature is the only variable that determines male suicides and explains 51% of their variance. Unemployment fails to contribute significantly to the model. There seems to be a seasonal distribution for attempts with mean rates being higher for the period from May to October and the rates clearly correlate with temperature. The highest mean rates were observed during May and August and the lowest during December and February. Multiple linear regression analysis suggests that temperature also determines the female attempts rate although the explained variable is significant but very low (3-5%)

CONCLUSION

Climate variables and specifically high temperature correlate both with suicide and attempted suicide rates but with a different way between males and females. The climate effect was stronger than the effect of unemployment.

Relationship of suicide rates with climate and economic variables in Europe during 2000-2012

BACKGROUND

It is well known that suicidal rates vary considerably among European countries and the reasons for this are unknown, although several theories have been proposed. The effect of economic variables has been extensively studied but not that of climate.

METHODS

Data from 29 European countries covering the years 2000-2012 and concerning male and female standardized suicidal rates (according to WHO), economic variables (according World Bank) and climate variables were gathered. The statistical analysis included cluster and principal component analysis and categorical regression.

RESULTS

The derived models explained 62.4 % of the variability of male suicidal rates. Economic variables alone explained 26.9 % and climate variables 37.6 %. For females, the respective figures were 41.7, 11.5 and 28.1 %. Male suicides correlated with high unemployment rate in the frame of high growth rate and high inflation and low GDP per capita, while female suicides correlated negatively with inflation. Both male and female suicides correlated with low temperature.

DISCUSSION

The current study reports that the climatic effect (cold climate) is stronger than the economic one, but both are present. It seems that in Europe suicidality follows the climate/temperature cline which interestingly is not from south to north but from south to north-east. This raises concerns that climate change could lead to an increase in suicide rates. The current study is essentially the first successful attempt to explain the differences across countries in Europe; however, it is an observational analysis based on aggregate data and thus there is a lack of control for confounders.

Impact of religious feast days on youth suicide attempts in Istanbul, Turkey

BACKGROUND

Suicidal behaviour is related to psychosocial and biological factors. Although suicide is strictly forbidden by the Islamic faith, there are non-confirmed observations of increased suicidality on religious feast days. The objective of the present study was to find out if suicide attempts of youths living in Istanbul increase on religious feast days compared to ordinary and non-religious holidays.

METHODS

We retrospectively analyzed all suicide attempts (N = 2,232) of young people up to 25 years of age seeking support at various hospitals in Istanbul in 2010. The main hypothesis was that the number of suicide attempts would increase during religious feast days.

RESULTS

The number of suicide attempts was higher on religious feast days and non-religious holidays except for New Year's Day and International Labour Day than the daily average number of the actual months. Like on ordinary days, more female than male youth (84.9% vs. 15.1%) attempted suicide on feast days.

CONCLUSION

We speculate that changes of the daily rhythm and increased family interaction on feast days and non-religious holidays could lead to unexpected confrontations and disputes instead of the expected positive family climate. This "Broken-Promise Effect" and changes of the daily rhythm could contribute to the observed increased suicidal behaviour.

Biological rhythm differences and suicidal ideation in patients with major depressive disorder

BACKGROUND

Suicidal behavior has been reported to be associated with seasonality and chronotype. However, no study has reported the suicidality according to chronotype and seasonality in patients with major depressive disorder (MDD). This study evaluated the relationship of suicidality and biological rhythm in patients with MDD.

METHODS

A total of 120 patients with MDD participated. We evaluated their seasonal patterns, chronotypes (morningness, wake up early and are at their best during the first part of the day; eveningness, feel best and most alert during late hours), suicidal ideations, and other clinical variables including symptom severity.

RESULTS

Patients with seasonality showed significantly higher suicidal ideation than patients without seasonality. Compared to morning-type participants, the evening-type participants showed higher suicidality. Suicidal ideation was positively correlated with eveningness tendencies and hypomanic personality traits.

LIMITATIONS

First, we did not analyze the causal relationship between biological rhythm and suicidality. Secondly, suicidal ideation does not in most cases reflect an actual attempt. Lastly, we did not categorize seasonal pattern into summer or winter type.

CONCLUSIONS

Our findings suggest that biological rhythm is significantly associated with suicidal ideation in patients with MDD.

Nothing like Christmas--suicides during Christmas and other holidays in Austria

BACKGROUND

Contrary to the myth that suicides increase around Christmas, multiple studies reveal that suicide rates decrease towards Christmas and return back to normal or even peak in the beginning of the new year. We aimed to replicate this effect for Austria.

METHODS

The analyses were based on the official suicide statistics 2000-13 using Poission regression and Bayesian changepoint analysis. We also investigated changes of suicide rates during other major holidays and weekends. Seasonal effects were controlled for by using restricted control periods.

RESULTS

Suicide rates declined before Christmas and were minimal on December 24th, remained low until the end of the year, peaked on New Year's day, but remained at average level in New Year's week. In contrast, suicide rates increased in the week after Easter and on Mondays/Tuesdays after weekends. No significant effects were found in the week after Whitsun and summer holidays.

CONCLUSION

Compared with other holidays, Christmas time is clearly associated with fewer suicides in Austria, too, and may even counteract the 'broken promise' effect. This finding may help clarifying common myths in suicide prevention and may enhance the proper timing of preventive efforts.