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Hollander AC, Pitman A, Sjöqvist H, Lewis G, Magnusson C, Kirkbride JB, Dalman C. Suicide risk among refugees compared with non-refugee migrants and the Swedish-born majority population. Br J Psychiatry 2020; 217:686-692. [PMID: 31608849 PMCID: PMC7705666 DOI: 10.1192/bjp.2019.220] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND It has been hypothesised that refugees have an increased risk of suicide. AIMS To investigate whether risk of suicide is higher among refugees compared with non-refugee migrants from the same areas of origin and with the Swedish-born population, and to examine whether suicide rates among migrants converge to the Swedish-born population over time. METHOD A population-based cohort design using linked national registers to follow 1 457 898 people born between 1 January 1970 and 31 December 1984, classified by migrant status as refugees, non-refugee migrants or Swedish-born. Participants were followed from their 16th birthday or date of arrival in Sweden until death, emigration or 31 December 2015, whichever came first. Cox regression models estimated adjusted hazard ratios for suicide by migrant status, controlling for age, gender, region of origin and income. RESULTS There were no significant differences in suicide risk between refugee and non-refugee migrants (hazard ratio 1.28, 95% CI 0.93-1.76) and both groups had a lower risk of suicide than Swedish born. During their first 5 years in Sweden no migrants died by suicide; however, after 21-31 years their suicide risk was equivalent to the Swedish-born population (hazard ratio 0.94, 95% CI 0.79-1.22). After adjustment for income this risk was significantly lower for migrants than the Swedish-born population. CONCLUSIONS Being a refugee was not an additional risk factor for suicide. Our findings regarding temporal changes in suicide risk suggest that acculturation and socioeconomic deprivation may account for a convergence of suicide risk between migrants and the host population over time. DECLARATION OF INTEREST None.
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Affiliation(s)
- Anna-Clara Hollander
- Research Coordinator, Department of Public Health Sciences, Karolinska Institutet, Sweden,Correspondence: Anna-Clara Hollander, Department of Public Health Sciences, Karolinska Institutet, Solnavägen 1E, SE-171 77 Stockholm, Sweden.
| | - Alexandra Pitman
- Associate Professor in Psychiatry, Division of Psychiatry, University College London, UK
| | - Hugo Sjöqvist
- Statistician, Department of Public Health Sciences, Karolinska Institutet, Sweden
| | - Glyn Lewis
- Professor, Division of Psychiatry, University College London, UK
| | - Cecilia Magnusson
- Professor, Department of Public Health Sciences, Karolinska Institutet; and Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden
| | - James B Kirkbride
- Reader in Epidemiology, Division of Psychiatry, University College London, UK
| | - Christina Dalman
- Professor, Department of Public Health Sciences, Karolinska Institutet; and Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden
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Bachmann S. Epidemiology of Suicide and the Psychiatric Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1425. [PMID: 29986446 PMCID: PMC6068947 DOI: 10.3390/ijerph15071425] [Citation(s) in RCA: 651] [Impact Index Per Article: 108.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 06/28/2018] [Accepted: 07/01/2018] [Indexed: 12/12/2022]
Abstract
Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.
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Affiliation(s)
- Silke Bachmann
- Clienia Littenheid AG, Hauptstrasse 130, 9573 Littenheid, Switzerland.
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University Halle (Saale), Julius-Kühn-Strasse 7, 6112 Halle (Saale), Germany.
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Cuerda-Galindo E, López-Muñoz F, Krischel M, Ley A. Study of deaths by suicide of homosexual prisoners in Nazi Sachsenhausen concentration camp. PLoS One 2017; 12:e0176007. [PMID: 28426734 PMCID: PMC5398659 DOI: 10.1371/journal.pone.0176007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/03/2017] [Indexed: 11/30/2022] Open
Abstract
Living conditions in Nazi concentration camps were harsh and inhumane, leading many prisoners to commit suicide. Sachsenhausen (Oranienburg, Germany) was a concentration camp that operated from 1936 to 1945. More than 200,000 people were detained there under Nazi rule. This study analyzes deaths classified as suicides by inmates in this camp, classified as homosexuals, both according to the surviving Nazi files. This collective was especially repressed by the Nazi authorities. Data was collected from the archives of Sachsenhausen Memorial and the International Tracing Service in Bad Arolsen. Original death certificates and autopsy reports were reviewed. Until the end of World War II, there are 14 death certificates which state “suicide” as cause of death of prisoners classified as homosexuals, all of them men aged between 23 and 59 years and of various religions and social strata. Based on a population of 1,200 prisoners classified as homosexuals, this allows us to calculate a suicide rate of 1,167/100,000 (over the period of eight years) for this population, a rate 10 times higher than for global inmates (111/100,000). However, our study has several limitations: not all suicides are registered; some murders were covered-up as suicides; most documents were lost during the war or destroyed by the Nazis when leaving the camps and not much data is available from other camps to compare. We conclude that committing suicides in Sachsenhausen was a common practice, although accurate data may be impossible to obtain.
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Affiliation(s)
- Esther Cuerda-Galindo
- Department of Human Anatomy and Embryology, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Francisco López-Muñoz
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
- Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain
- * E-mail: ,
| | - Matthis Krischel
- Institute of the History, Philosophy and Ethics of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Astrid Ley
- Memorial and Museum Sachsenhausen, Oranienburg, Germany
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Coêlho BM, Andrade LH, Borges G, Santana GL, Viana MC, Wang YP. Do Childhood Adversities Predict Suicidality? Findings from the General Population of the Metropolitan Area of São Paulo, Brazil. PLoS One 2016; 11:e0155639. [PMID: 27192171 PMCID: PMC4871559 DOI: 10.1371/journal.pone.0155639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 05/02/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Childhood adversities have been associated with a number of medical and psychiatric outcomes. However, the reported effects that specific childhood adversities have on suicidality vary across studies. METHOD This was a cross-sectional, stratified, multistage area probability investigation of a general population in Brazil, designated the São Paulo Megacity Mental Health Survey. The World Mental Health Composite International Diagnostic Interview was applied in 5037 individuals ≥ 18 years of age, in order to assess 12 different adversities occurring during childhood and/or adolescence, as well as to look for associations between those adversities and subsequent suicidality in different age strata. RESULTS Over half of the respondents reported at least one childhood adversity. Only physical abuse was consistently associated with suicide attempts in all subsequent life stages (OR = 2.1). Among adults 20-29 years of age, the likelihood of a suicide attempt was correlated with parental divorce, whereas suicidal ideation was associated with prior sexual abuse. Among adults over 30 years of age, physical illness and economic adversity emerged as relevant childhood adversities associated with suicide attempts, whereas sexual abuse, family violence, and economic adversity were associated with suicidal ideation. CONCLUSION Childhood adversities, especially physical abuse, are likely associated with unfavorable consequences in subsequent years. For suicidality across a lifespan, the role of different childhood adversities must be examined independently.
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Affiliation(s)
- Bruno Mendonça Coêlho
- Section of Psychiatric Epidemiology – LIM-23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil
- * E-mail:
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology – LIM-23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Guilherme Borges
- División de Investigaciones Epidemiológicas y Sociales, Instituto Mexicano de Psiquiatría (IMP), México, D.F., Mexico
| | - Geilson Lima Santana
- Section of Psychiatric Epidemiology – LIM-23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Maria Carmen Viana
- Department of Social Medicine Post-Graduate Program in Public Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Yuan-Pang Wang
- Section of Psychiatric Epidemiology – LIM-23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil
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Abstract
Data on the effect of the September 11, 2001 (9/11) terror attacks on suicide rates remain inconclusive. Reportedly, even people located far from the attack site have considerable potential for personalizing the events that occurred on 9/11. Durkheim's theory states that suicides decrease during wartime; thus, a decline in suicides might have been expected after 9/11. We conducted a time series analysis of 164,136 officially recorded suicides in Germany between 1995 and 2009 using the algorithm introduced by Box and Jenkins. Compared with the average death rate, we observed no relevant change in the suicide rate of either sex after 9/11. Our estimates of an excess of suicides approached the null effect value on and within a 7-day period after 9/11, which also held when subsamples of deaths in urban or rural settings were examined. No evidence of Durkheim's theory attributable to the 9/11attacks was found in this sample.
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Affiliation(s)
- Daniel Medenwald
- From the Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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López-Muñoz F, Cuerda-Galindo E. Suicide in Inmates in Nazis and Soviet Concentration Camps: Historical Overview and Critique. Front Psychiatry 2016; 7:88. [PMID: 27303312 PMCID: PMC4880554 DOI: 10.3389/fpsyt.2016.00088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/09/2016] [Indexed: 12/02/2022] Open
Abstract
Living conditions in concentration camps were harsh and often inhumane, leading many prisoners to commit suicide. We have reviewed this topic in Nazi concentration camps (KL), Soviet special camps, and gulags, providing some preliminary data for our research. Data show that the incidence of suicide in Nazi KL could be up to 30 times higher than the general population and was also much higher than in Soviet special camps (maybe due to more favorable conditions for prisoners and the abolishment of death penalty), while available data on Soviet gulags are contradictory. However, data interpretation is very controversial, because, for example, the Nazi KL authorities used to cover-up the murder victims as suicides. Most of the suicides were committed in the first years of imprisonment, and the method of suicide most commonly used was hanging, although other methods included cutting blood vessels, poisoning, contact with electrified wire, or starvation. It is possible to differentiate two behaviors when committing suicide; impulsive behavior (contact with electrified barbed wire fences) or premeditated suicide (hanging up or through poison). In Soviet special camps, possible motives for suicides could include feelings of guilt for crimes committed, fear of punishment, and a misguided understanding of honor on the eve of criminal trials. Self-destructive behaviors, such as self-mutilation in gulag camps or prisoners who let themselves die, have been widely reported. Committing suicide in concentration camps was a common practice, although precise data may be impossible to obtain.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain; Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain
| | - Esther Cuerda-Galindo
- Area of Human Anatomy and Embryology, Rey Juan Carlos University, Alcorcón , Madrid , Spain
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