Trends in Suicide Mortality in South Africa, 1997 to 2016

Child maltreatment and suicidal ideation among justice-and welfare-involved adolescents in Nigeria: Investigating the mediating role of social support and emotion regulation

BACKGROUND

Suicidal ideation is a global public health burden and justice and welfare-involved adolescents are more affected than the general population. Past studies have examined its risk and protective factors among adolescents. However, the association between child maltreatment and suicidal ideation remains an under-studied topic among at-risk adolescents in low- and middle-income countries. This study filled this gap by examing the association between child maltreatment and suicidal ideation among two high-risk adolescents in Nigeria METHODS: The purpose of this study was to examine the nexus between child maltreatment and suicidal ideation. A cross-sectional design was adopted through multi-stage sampling. Suicidal ideation was measured using a validated self-report Massachusetts Youth Screening Instrument (MAYSI-2). Child maltreatment was measured using a validated self-report intrusment (ICAST-C). The sample comprised 205 respondents: justice-involved adolescents (102 (49.8 %) and welfare-involved adolescents (103 (50.2 %). Among them, 151 (73.7 %) were males, while 54 (26.3 %) were females.

RESULTS

Half (51 %) of the adolescents in detention and 39 % of the adolescents in residential care reported suicidal ideation. Emotional abuse (OR = 0.072; 95CI% -412, 0.75, p < .001), no parent is alive (OR = 0.502; 95CI% 0.234-3.15; p < .001), one parent is alive (OR = 0.522; 95 %CI 0.207, 3.09; p < .025) and female gender (OR = -0.22; 95CI% -1.37- 207; p < .008) predicted suicidal ideation. Suicidal ideation was comorbid with depressed-anxious symptoms (OR = 1.46; 95 %CI 1.172, 1.83; p < .001) accounting for 31 % (Nagelkerke R2) of the variance. Social support had an indirect effect on suicidal ideation via emotional abuse (OR = 0.072; 95 % CI = -412-0.75).

CONCLUSION

The findings underscore the influence of child maltreatment and family background on suicidal ideation. Interventions should include emotional abuse in suicide screening. Children who have lost one or both parents should be the primary focus of interventions.

International trends in male youth suicide and suicidal behaviour

OBJECTIVE

Suicide and suicidal behaviour strongly contribute to overall male youth mortality. An understanding of worldwide data contextualises suicide and suicidal behaviour in young men within any given country.

METHOD

Members and colleagues of the World Federation of Societies of Biological Psychiatry's Task Force on Men's Mental Health review the relevant data from several regions of the world. The review identifies notable findings across regions of relevance to researchers, policymakers, and clinicians.

RESULTS

Male suicide and suicidal behaviour in adolescence and emerging adulthood within North America, Latin America and the Caribbean, Europe, the Mediterranean and the Middle East, Continental Africa, South Asia, East Asia, China, and Oceania share similarities as well as significant points of divergence.

CONCLUSIONS

International data provide an opportunity to obtain a superior understanding of suicide and suicidal behaviour amongst young men.

The Effect of the COVID-19 Pandemic on Suicide Trends in Pretoria, South Africa

ABSTRACT

Suicide is one of the worldwide leading causes of unnatural death. Pretoria is a capital city of South Africa and is the fourth most populated city in South Africa. Between 16 and 22 suicide cases are recorded daily in South Africa.Case files from the Pretoria Medico-Legal Laboratory were reviewed between 1 January 2015 to 31 December 2021, which spanned the COVID-19 pandemic. All cases of possible and probable suicides were included. One-way analysis of variance and Pearson chi 2 tests were conducted to determine statistical significance in the observed trends.A total of 1820 possible and probable suicide cases were identified. The year following the outbreak of the COVID-19 pandemic accounted for the largest number of suicides. White males were the most heavily represented population, followed by Black males. Hanging was the most common method for males, whereas poisoning via ingestion and/or overdose was more commonly used by females.Suicides in Pretoria have increased since previous studies from 9.74% and 10.2% to 13.32%. Methods used have changed among various population groups over the past two decades. This paper examined changes in suicide trends in Pretoria compared to previous studies and highlighted correlations between suicide trends and COVID-19 lockdown measures.

Sex-related inequalities in crude and age-standardized suicide rates: trends in Ghana from 2000 to 2019

BACKGROUND

Suicide represents a major public health concern, affecting a significant portion of individuals. However, there remains a gap in understanding the age and sex disparities in the occurrence of suicide. Therefore, this study aimed to investigate the sex-related inequalities in suicide rates in Ghana from 2000 to 2019.

METHODS

We utilized data from the WHO Health Equity Assessment Toolkit (HEAT) online software. We analysed sex differences in both crude and age-standardized suicide rates in Ghana spanning from 2000 to 2019. Crude and age-adjusted suicide rates were calculated based on the International Classification of Diseases (ICD) definition and coding of suicide mortality. We measured inequality in terms of sex. Two inequality indicators were used to examine the suicide rates: the difference (D) and the ratio (R).

RESULTS

Age-standardized and crude suicide rates in Ghana were higher among men from 2000 to 2019. Between 2000 and 2007, the age-standardized suicide rate for women rose steadily and declined slightly between 2008 and 2019. Age-standardized suicide rates for men increased consistently from 2000 to 2010, then declined steadily from 2011 to 2019. The crude suicide rates among men and women followed similar patterns. The widest absolute inequality in crude suicide rates (D) was recorded in 2013 (D=-11.91), while the smallest difference was observed in 2000 (D=-7.16). We also found the greatest disparity in age-standardized rates in 2011 (D=-21.46) and the least in 2000 (D=-14.32). The crude suicide rates increased with age for both men and women aged 15-54 years and 55-85+ years respectively. However, the increased rate was higher in men than in women across all age groups surveyed. A similar pattern was observed for relative inequality in both crude and age-standardized rates of suicide.

CONCLUSION

The suicide rate in Ghana has declined over time. Suicide is more common among older men. Inequalities in suicide rates, in both absolute and relative terms, are similar. There is a need to monitor suicide trends in Ghana, especially among older men. Moreover, the findings could serve as a basis for future studies on suicide in Ghana.

A systematic review of the epidemiology of suicide in Iraq and Kurdistan region

OBJECTIVES

The suicide rate has increased in Iraq in recent years, making it a major public health concern. This systematic review examines the prevalence of suicidal behaviours in the Iraq and Kurdistan region.

MATERIALS AND METHODS

This study adhered to the PRISMA guidelines, conducting searches on PubMed, MEDLINE, Web of Science, and Google Scholar. Out of 153 initially identified publications, only 18 full articles met the inclusion criteria, with 135 articles excluded due to reasons such as eligibility criteria, duplication, predatory publications and lack of relevance and lack of quality data.

RESULTS

The suicide crude rate in Iraq (excluding Kurdistan) rose from 1.09 to 1.31 per 100,000 between 2015 and 2016, while Kurdistan had an estimated rate of 3.83 per 100,000 during the same period. Limited data on reference group sizes and population figures make specific rate calculations challenging. Suicide is more prevalent among women, those aged 15-40, and individuals with mental disorders. Contributing factors include domestic violence, mental health issues, and traditional norms. Urban residents generally have higher suicide rates than rural residents. Common suicide behaviours include self-immolation, hanging, firearms, jumping from heights, and self-poisoning with pesticides.

CONCLUSION

The prevalence of suicide in Iraq, as indicated by this systematic review, requires urgent attention and effective public health initiatives. The interplay of social, economic, cultural, and psychological factors emphasizes the need for comprehensive prevention programs. Additionally, a crucial requirement is the implementation of a standardised method for collecting suicide data to improve epidemiological understanding.

Emergency Medical Service responses as latent social capital toward Deliberate Self-Harm, Suicidality and Suicide

Escalation in Deliberate Self-Harm (DSH) is indicative of a rise in poor mental health and/or a failure of social and health services. The phenomenon of DSH exacerbates mental illness sequela, while being an essential indicator of suicide risk. Globally, about 800 000 people commit suicide yearly, averaging almost one suicide every 40 s. Based on a Retrospective Cross-Sectional Study, the aim sought to establish the scope of the DSH, suicidality and suicide case-load from a Western Cape Emergency Medical Services (EMS) prehospital perspective. A census of 3 years of EMS Incident Management Records (IMR) from a large rural district with seven local municipalities was undertaken using a novel data collection instrument. The 2976 (N) mental health-related incidents that met the inclusion criteria (from 413 712 cases) suggest a presentation rate of 7 per 1000 EMS calls. Sixty percent (n = 1776) were regarded to have deliberately self-harmed, attempted suicide or committed suicide. Overdose/deliberate self-poisoning accounted for 52% (n = 1550) of all the DSH caseload of the study. Attempted suicide accounted for 2.7% (n = 83) and Suicide for 3.4% (n = 102) of the suicidality case-load from the study, respectively. Suicide averaged 2.8. suicides per month in the Garden Route District over the 3-year period. Men were five times more likely to commit suicide than women, commonly using strangulation, while women mostly ingested household detergents and poison, and overdosed on chronic medication. Understandably, the EMS needs to assess its own capability to respond, treat, and transport health-care users with DSH and suicidality. This study demonstrates the EMS 'everyday' exposure to DSH, suicidality and suicide case-load. It represents a critical first step in the problem-space definition upon which a determination of the need for EMS responses can be based, to interrupt suicidality by removing methods of harm and strengthening the mental health economy through social capital investment.

Assessing the knot in a noose position by thyrohyoid and cervical spine fracture patterns in suicidal hangings using machine learning algorithms: A new insight into old dilemmas

Hanging is one of the most common suicide methods worldwide. Neck injuries that occur upon such neck compression - fractures of the thyrohyoid complex and cervical spine, occupy forensic pathologists for a long time. However, research failed to identify particular patterns of these injuries corresponding to the force distribution a ligature applies to the neck: the issue of reconstructing the knot in a noose position persists. So far, machine learning (ML) models were not utilized to classify knot positions and reconstruct this event. We conducted a single-institutional, retrospective study on 1235 autopsy cases of suicidal hanging, developed several ML models, and assessed their classification performance in a stepwise manner to discriminate between: 1. typical ('posterior) and atypical ('anterior' and 'lateral') hangings, 2. anterior and lateral hangings, and 3. left and right lateral hangings. The variable coding was based on the presence/absence of fractures of greater hyoid bone horns (GHH), superior thyroid cartilage horns (STH), and cervical spine. Subject age was considered. The models' parameters were optimized by the Genetic Algorithm. The accuracy of ML models in the first step was very modest (c. 60%) but increased subsequently: Multilayer Perceptron - Artificial Neural Network and k-Nearest Neighbors performed excellently discriminating between left and right lateral hangings (accuracy 91.8% and 90.6%, respectively). The latter is of great importance for clarifying probable hanging fracture biomechanics. Alongside the conventional inferential statistical analysis we performed, our results further indicate the association of the knot position with ipsilateral GHH and contralateral STH fractures in lateral hangings. Moreover, odds for unilateral GHH fracture, simultaneous GHH and STH fractures, and cervical spine fracture were significantly higher in atypical ('anterior' and 'lateral') hangings, compared to typical ('posterior') hangings.

Mental health implications of suicide rates in South Africa

Mental health challenges are a severe issue that could lead to suicide if not properly addressed. South Africa has a significant burden of mental health issues, which contributes to the soaring rate of suicide. Adequate mental health-care provision could reduce the high suicide rate in South Africa. Since the apartheid regime, the country has made a series of efforts to improve mental health. This study aimed to review and examine available literature on mental health and suicide issues in South Africa and demonstrate the policy implications. This study adopted a narrative review approach. Electronic databases (PubMed, Scilit, Google Scholar and Semantic Scholar) were used to identify published articles in the English language with crucial search terms that included mental health, South African mental health policy, South Africa, suicide and policy. Literature suggests that at the provincial level, there are no adequate mental health policies, and the implementation of the country's mental health policy is faced with many challenges, such as a shortage of professionals and finances. The review also showed that task sharing and counselling have been pilot-tested and shown to be effective methods for the prevention of mental illness and promotion of positive mental health. This study concludes that the mental health treatment gap still exists in South Africa, and this needs to be tackled using effective, multi-level counselling interventions and policy initiatives. Adequate mental health-care provision and effective implementation of mental health policy could reduce the high rate of suicide in South Africa.

Characteristics and risk factors of suicide among people who attempted self-harm in South Korea: A longitudinal National Cohort Study in South Korea

Although self-harm is known as a significant risk factor for suicide, there are insufficient studies on the characteristics of people who self-harmed and the factors affecting suicide using a national dataset in Asia. This study aimed to identify demographic, clinical, and socioeconomic factors of individuals who attempted self-harm concerning suicide mortality. By analyzing the Korean National Health Insurance Service data from 2002 to 2020, we compared the people who attempted self-harm to the general population and explored factors affecting suicide by using the Cox proportional hazards model. Older age, female sex, lower socioeconomic status, and psychiatric conditions were associated with higher self-harm attempts. Suicide was more prevalent among males with mild disabilities, using fatal self-harm methods, and higher Charlson Comorbidity Index (CCI) scores. Socioeconomic factors that were significantly related to self-harm attempt were relatively less significant in the suicide survival analysis, while male gender, older age, fatal self-harm methods, high CCI scores, psychiatric diagnosis, and drinking habits were significantly associated with lower suicide survival rates. These results showed that demographic, clinical and socioeconomic factors affecting self-harm differ from those affecting actual suicidal death after self-harm. These insights may assist in developing targeted prevention strategies for specific populations.

Impact of the lockdown by the COVID-19 pandemic on suicidal trend in the Colombian Coffee Region

Suicide is considered a Public Health issue. In 2019 the Colombian suicide rate was 5.8 per-100.000 inhabitant. Likewise, the Colombian Coffee Region has doubled the national average on these rates. On the other hand, the Pandemic COVID 19 socio-economic consequences are aggravating the risk factors that we've known about suicide.

Objective

To evaluate the suicidal trend in the population of the Colombian Coffee Region during the COVID-19 pandemic and compare it with a non-pandemic period.

Methods

The data were taken from the National Institute of Legal Medicine and Forensic Science for the suicidal events during the 2016-2020 period in the Colombian Coffee Region, and the Montecarlo Regression was applied using the JoinPoint Regression Program.

Results

We found 1022 cases, most of them were men. The mean age was 34 years. The most used method was hanging in both sexes. Half of them had at least a high school degree. Half of the suicides were committed by single people. One-third of the cases had a previous mental illness. There are significant differences in the suicidal trend between the lockdown period and the non-lockdown period with a P value < 0.05.

Conclusions

We found most suicidal cases between older men and an inversely proportional relationship between education and suicidal rate. Is interesting that the most applied method for suicide for both sexes was hanging. The suicidal trend was increasing until 2020, although in the lockdown we found a decrease. In the post-lockdown period for men was a posterior increase and for women the trend has a continued decrease.

Acute organophosphorus toxicity in a regional hospital in Johannesburg, South Africa: A retrospective chart review

Introduction

Intentional and accidental organophosphorus exposures pose a significant healthcare-related burden on South African communities. This study will review the demographics, characteristics and clinical course of patients presenting with features of acute organophosphorus toxicity to a regional Emergency Centre in Johannesburg, South Africa.

Methods

This was a retrospective chart review of all patients treated for possible acute organophosphorus toxicity from January 2020 to August 2021.

Results

A total of 205 patients were identified of which 134 patients were included in the study. The median age was 26 years with a male predominance (male= 56%, female=44%). 109 patients (81.3%) survived, 18 patients (13.4%) demised and the outcome of 7 patients (5.2%) was unknown. The median hospital length of stay was 8 days, (IQR= 5-13 days), and the longest hospital stay was 37 days in ICU. Atropinisation dose was significantly higher for intubated patients (median=140.0mg; IQR=90mg-219.5mg) compared to patients who were not intubated (median=60mg; IQR=20.5mg-120mg, p < 0.05). The length of stay was significantly higher for intubated patients (median=11 days; IQR=7-15 days) compared to patients who were not intubated (median=5 days; IQR=3-8 days, p < 0.00). There was a moderate positive correlation between atropinisation dose and length of stay (Correlation coefficient = 0.37, p < 0.00). There was a moderate negative correlation between atropinisation dose and cholinesterase level (Correlation coefficient= - 0.39, p < 0.00). Of those reported to have adverse effects 78.6%, were related to atropine toxicity.

Conclusion

Our study shows a high mortality rate secondary to organophosphorus toxicity. Significant exposures and thus higher doses of atropine were associated with increased length of stay and need for intubation. We found a high incidence of atropine-related adverse effects. More studies are needed to further establish the balance between the therapeutic and adverse effects of high-dose atropine as a treatment modality for organophosphorus toxicity.

Child and adolescent mortality associated with pesticide toxicity in Cape Town, South Africa, 2010-2019: a retrospective case review

BACKGROUND

Poisoning of children after exposure to pesticides is a major public health concern, particularly in countries with poorer urban populations, such as South Africa. This may stem from the illegal distribution and domestic use of street pesticides, which are highly hazardous agricultural pesticides. The aim of this study was to profile paediatric deaths due to acute pesticide poisoning in the west-metropole of Cape Town, South Africa; to identify whether the active ingredients were highly hazardous pesticides according to the FAO and WHO; and to inform policy and public health interventions to prevent future exposures and mortality.

METHODS

A retrospective and descriptive analysis of forensic post-mortem records (2010 to 2019) was conducted to identify cases of paediatric deaths (< 18 years old) in the west metropole of Cape Town, involving pesticide poisoning admitted to the Salt River mortuary (one out of 16 mortuaries in the Western Cape province). Demographic, circumstantial, autopsy, and toxicological information was captured. Descriptive statistics, together with chi-square tests, Fisher's probability tests, and Mann-Whitney U tests were used to analyse the data.

RESULTS

In total, 54 paediatric pesticide deaths were identified, including 22 (40.7%) males and 32 (59.3%) females, out of 5,181 paediatric unnatural deaths admitted over the 10-year period. The median age of the decedents was 8.3 years (range: 1 day to 17.9 years), with the majority under five years (42.6%) or between 15 and 18 years old (40.7%). All incidents occurred in peri-urban areas of Cape Town, with most individuals being admitted to hospital (88.9%) for a median survival time of 4.8 h. Toxicological analysis was requested in 50 cases (92.6%) with the organophosphate pesticides terbufos (n = 29), methamidophos (n = 2) and diazinon (n = 2) detected most frequently. Adolescent (15-18 years) suicides (29.6%) and accidental child deaths (< 4 years) (18.5%) were common.

CONCLUSIONS

Terbufos and methamidophos are highly hazardous pesticide (HHP) active ingredients registered in South Africa for agricultural uses, yet commonly sold as street pesticides for domestic use in lower socioeconomic areas. Reducing access and availability of toxic pesticides, especially through the illegal selling of street pesticides, and providing low toxic alternatives to poorer communities, may support mortality reduction initiatives. Mortality and toxicology data provide important, often overlooked, surveillance tools for informing policy and public health interventions to reduce toxic pesticide harm in local communities.

A meta-analytic review of the frequency and patterning of laryngohyoid and cervical fractures in cases of suicide by hanging

The frequency and distribution of fractures are commonly utilized to assist in interpreting the manner of death. In cases of alleged suicide by hanging, however, the evidence base for the frequency and patterning of laryngohyoid and cervical vertebrae fractures resulting from such blunt force traumatic events is limited and so fractures cannot be reliably used to assist in interpreting the manner. Using meta-analytic techniques, this study aimed to estimate frequency and distribution of fractures in the context of relevant intrinsic and extrinsic variables. A systematic review of the literature identified 20 studies with relevant data (8523 cases of suicide by hanging). Meta-analyses identified the frequency and distribution of fractures present and how fracture frequency was affected by the subgroups of age, sex, completeness of suspension, ligature knot position and study design. Results indicated that fracture frequency was variable, there was no unique patterning, and high levels of heterogeneity were present in all variable sub-groups. Age was the only subgroup to show differences. Findings suggest that neck fracture frequency is inconsistent and cannot be predicted by the chosen variables. Subsequently, neck fractures in isolation should not be given weight in medico-legal interpretations of a hanging death as suicidal.

Suicide attempts among students of higher education, Nelson Mandela Bay Municipality, South Africa

BACKGROUND

Worldwide, death by suicide is a leading cause of death among young people, and students of higher educational institutions constitute a vulnerable group. This study aimed to determine the lifetime prevalence and associated factors of suicide attempt among students of a higher education institution in Nelson Mandela Municipality.

METHODS

A cross sectional study was conducted among students of East Cape Midland College in Nelson Mandela Municipality. The participants were selected by stratified random sampling and a standardised self-administered questionnaire was used to collect data.

RESULTS

The prevalence of lifetime suicide attempts was 16.0% among the participants. Multivariate logistic regression analysis revealed higher odds of suicide attempts among participants who: experienced bullying (OR: 1.66, CI: 1.05-2.61; p  0.001), had underlying medical conditions (OR: 3.27, CI: 2.08-5.14; p  0.001), had abnormal body weight perceptions (OR: 1.64, CI: 1.03-2.62; p  0.05), had experienced sexual abuse (OR: 5.72, CI: 2.86-11.45; p  0.001), or had someone very close who had experienced sexual abuse (OR: 1.77, CI: 1.02-3.05; p  0.05).

CONCLUSION

This study identified history of sexual abuse, bullying, perceptions of abnormal body weight and underlying medical conditions as associated risk factors of suicide attempts among the participants. The high prevalence of suicide attempts among the participants (16%) demonstrates the urgent need for campus-based interventions and prevention strategies aimed at addressing the identified associated factors.

Current pesticide suicide surveillance methods used across the African continent: a scoping review protocol

INTRODUCTION

Every year, more than 800 000 people die from suicides of which an estimated 20% are from pesticide ingestion. Multiple studies have estimated that around 77%-80% of these pesticide suicides occur in low/middle-income countries. The full burden of pesticide suicides in African countries remains poorly documented, one reason being the lack of systematic data collection. It is essential to know the number of pesticide suicide cases to guide prevention of further cases occurring. This can be done by informing policy and legislation, and the implementation of targeted bans, as well as raising community awareness around the use of these pesticides, training of healthcare personnel, and influencing the type and level of clinical facility investments into this area of healthcare. The scoping review aims to investigate how pesticide suicide deaths in Africa are recorded by exploring the various surveillance systems in place, as well as highlighting key limitations and data collection barriers.

METHODS AND ANALYSIS

A scoping review will be carried out with the five-stage methodological frameworks set out by Arksey and O'Malley and the Joanna Briggs Institute. Studies in English that looked at pesticide suicide in African countries will be extracted and screened independently by two reviewers against the inclusion and exclusion criteria of this review. Studies' data will be extracted, and a descriptive synthesis developed of their main findings, as guided by the approach of Levac and colleagues.

ETHICS AND DISSEMINATION

Ethics approval is not required for this review as no human participants will be involved. The study findings will be distributed in a peer-reviewed publication.

REGISTRATION DETAILS

This protocol has been submitted for publication to BMJ Open.

Management of self-harm, suicidal ideation and suicide attempts

The strategic location of primary care providers (PCPs) in clinics, private general practices and emergency departments is critical to the detection and appropriate management of patients with suicidal behaviour. Their position within the primary care setting and responsibility for preventive and promotive care require PCPs to possess good clinical skills and evidence-based knowledge to assist patients presenting with suicidal ideation and behaviour. The objective of this article is to provide guidelines for the management of suicidal behaviour within the primary care setting, with the goal of reducing deaths from suicide, and the frequency and intensity of suicide attempts. The priority in the management of patients presenting at health facilities following suicide attempts is medical resuscitation and stabilisation. As soon as the patient is medically stable, a thorough suicide risk assessment, which evaluates suicidal ideation/intent, preceding circumstances, predisposing and protective factors, should be conducted. An assessment of current and ongoing suicide risk will assist in determining the safest place to manage the patient. For those with a low level of suicide risk, outpatient management may be considered in the presence of a good social support system at home and a well-documented safety plan. Measures should be put in place to address the modifiable psychosocial risk factors for suicide, whilst appropriate pharmacotherapy is instituted for co-existing mental illness. Post-discharge care such as referral to psychologist, psychiatrist or social worker should be initiated by the primary care practitioner to ensure continuity of care. Support and psycho-education should also be extended to immediate family members of patients with suicidal behaviour for their own well-being and their ability to support the patient.

Trends in suicide by hanging, strangulation, and suffocation in Serbia, 1991-2020: A joinpoint regression and age-period-cohort analysis

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.

Dying in a foreign land: A study of completed suicides among foreign workers in Singapore

Suicide is a public health issue that impacts a nation's resident and non-resident populations alike. Singapore has one of the largest non-resident (work permit holder) populations in the world, yet very little attention has been given to examining suicide in this population. The current study examined the case materials of all 303 non-resident completed suicides in Singapore in the period January 2011 to December 2014. Their basic profiles were compared with that of the 1,507 resident cases in the same period. A sample of 30 death notes written by non-residents were randomly selected and thematically analyzed to supplement the descriptive findings and discussion. Results showed that suicides were highest among males, those aged 21-35 years old, and South Asians. Most non-resident suicide cases did not have known physical or mental health issues, prior suicide attempts, or suicide notes. Suicide decedents from South Asia and Europe most frequently used hanging, while jumping was most common among decedents from other regions. Relationship and health problems emerged as the top two suspected triggers for suicide based on our analysis of the suicide notes. The unique situation of working abroad may increase non-residents' vulnerability in general, while adverse life events such as relationship and health issues may be too overwhelming to bear, especially when support services are not readily available and accessible. The results have implications for suicide prevention among this neglected group of people who choose to work in foreign lands.

Male-Female Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: A State-by-State Analysis

Males are at higher risk relative to females of severe outcomes following COVID-19 infection. Focusing on COVID-19-attributable mortality in the United States (U.S.), we quantify and contrast years of potential life lost (YPLL) attributable to COVID-19 by sex based on data from the U.S. National Center for Health Statistics as of 31 March 2021, specifically by contrasting male and female percentages of total YPLL with their respective percent population shares and calculating age-adjusted male-to-female YPLL rate ratios both nationally and for each of the 50 states and the District of Columbia. Using YPLL before age 75 to anchor comparisons between males and females and a novel Monte Carlo simulation procedure to perform estimation and uncertainty quantification, our results reveal a near-universal pattern across states of higher COVID-19-attributable YPLL among males compared to females. Furthermore, the disproportionately high COVID-19 mortality burden among males is generally more pronounced when measuring mortality in terms of YPLL compared to age-irrespective death counts, reflecting dual phenomena of males dying from COVID-19 at higher rates and at systematically younger ages relative to females. The U.S. COVID-19 epidemic also offers lessons underscoring the importance of a public health environment that recognizes sex-specific needs as well as different patterns in risk factors, health behaviors, and responses to interventions between men and women. Public health strategies incorporating focused efforts to increase COVID-19 vaccinations among men are particularly urged.