[Suicide notes and their importance to suicide research. The representativeness of suicide note writers]

Differences between suicide note leavers and other suicides: A German psychological autopsy study

INTRODUCTION

Suicide notes are not only the last personal message from the suicide victim to the bereaved, but are also a valuable source for research in preventing suicides. However, not all suicide victims leave a suicide note and it is unclear whether note leavers are representative of the general population of suicide victims.

METHODS

The aim of our study was to compare suicide victims who leave a suicide note compared to those who do not. Therefore, data from the Allgäu Suicide Study, which comprised detailed information on N = 626 suicides, were analysed using multiple regression analyses.

RESULTS

Of N = 612 cases with complete data, n = 255(42%) left a suicide note and n = 357 (58%) did not. Persons who wrote suicide notes before they killed themselves were more often female, less often married, found themselves more often in a financial or partnership crisis, and were more likely to suffer from a medical illness. They tended to poison themselves more often and were less likely to have a history of alcohol abuse disorder.

CONCLUSION

Suicide notes are one source to better understand the motives, which lie behind suicides and therefore may help to further develop and improve suicide prevention programs. Keeping in mind that suicide has heterogeneous reasons, the group of "note writers" might be one, which might especially have benefitted from psychosocial and psychotherapeutic interventions, as interpersonal relationships obviously played an important role even shortly before suicide.

Detecting Suicidal Ideation on Forums: Proof-of-Concept Study

BACKGROUND

In 2016, 44,965 people in the United States died by suicide. It is common to see people with suicidal ideation seek help or leave suicide notes on social media before attempting suicide. Many prefer to express their feelings with longer passages on forums such as Reddit and blogs. Because these expressive posts follow regular language patterns, potential suicide attempts can be prevented by detecting suicidal posts as they are written.

OBJECTIVE

This study aims to build a classifier that differentiates suicidal and nonsuicidal forum posts via text mining methods applied on post titles and bodies.

METHODS

A total of 508,398 Reddit posts longer than 100 characters and posted between 2008 and 2016 on SuicideWatch, Depression, Anxiety, and ShowerThoughts subreddits were downloaded from the publicly available Reddit dataset. Of these, 10,785 posts were randomly selected and 785 were manually annotated as suicidal or nonsuicidal. Features were extracted using term frequency-inverse document frequency, linguistic inquiry and word count, and sentiment analysis on post titles and bodies. Logistic regression, random forest, and support vector machine (SVM) classification algorithms were applied on resulting corpus and prediction performance is evaluated.

RESULTS

The logistic regression and SVM classifiers correctly identified suicidality of posts with 80% to 92% accuracy and F1 score, respectively, depending on different data compositions closely followed by random forest, compared to baseline ZeroR algorithm achieving 50% accuracy and 66% F1 score.

CONCLUSIONS

This study demonstrated that it is possible to detect people with suicidal ideation on online forums with high accuracy. The logistic regression classifier in this study can potentially be embedded on blogs and forums to make the decision to offer real-time online counseling in case a suicidal post is being written.

Method overtness, forensic autopsy, and the evidentiary suicide note: A multilevel National Violent Death Reporting System analysis

OBJECTIVE

Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by drug-intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note.

METHODS

This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States National Violent Death Reporting System throughout 2011-2013, the study population comprised registered suicides, aged 15 years and older. Decedents totaled 32,151. The outcome measure was relative odds of an authenticated suicide note.

RESULTS

An authenticated suicide note was documented in 31% of the suicide cases. Inspection of the full multivariable model showed a suicide note was more likely to manifest among drug intoxication (adjusted odds ratio [OR], 1.70; 95% CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm suicides, the referent. Respective excesses were larger when there was no autopsy or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95% CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62, 95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation suicides did not differ from the firearm referent given an autopsy.

CONCLUSIONS

Suicide requires substantial affirmative evidence to establish manner of death, and affirmation of drug intoxication suicides appears to demand an especially high burden of proof. Findings and their implications argue for more stringent investigative standards, better training, and more resources to support comprehensive and accurate case ascertainment, as the foundation for developing evidence-based suicide prevention initiatives.

Are suicide deaths under-reported? Nationwide re-evaluations of 1800 deaths in Scandinavia

OBJECTIVE

Valid mortality statistics are important for healthcare planning and research. Suicides and accidents often present a challenge in the classification of the manner of death. The aim of this study was to analyse the reliability of the national suicide statistics by comparing the classification of suicide in the Scandinavian cause of death registers with a reclassification by 8 persons with different medical expertise (psychiatry, forensic pathology and public health) from each of the 3 Scandinavian countries.

METHODS

The cause of death registers in Norway, Sweden and Denmark retrieved available information on a sample of 600 deaths in 2008 from each country. 200 were classified in the registers as suicides, 200 as accidents or undetermined and 200 as natural deaths. The reclassification comprised an assessment of the manner and cause of death as well as the level of certainty.

RESULTS

In total, 81%, 88% and 90% of deaths registered as suicide in the official mortality statistics were confirmed by experts using the Swedish, Norwegian and Danish data sets, respectively. About 3% of deaths classified as accidents or natural deaths in the cause of death registers were reclassified as suicides. However, after a second reclassification based on additional information, 9% of the natural deaths and accidents were reclassified as suicides in the Norwegian data set, and 21% of the undetermined deaths were reclassified as suicides in the Swedish data set. In total, the levels of certainty of the experts were 87% of suicides in the Norwegian data set, 77% in the Swedish data set and 92% in Danish data set; the uncertainty was highest in poisoning suicides.

CONCLUSIONS

A high percentage of reported suicides were confirmed as being suicides. Few accidents and natural deaths were reclassified as suicides. Hence, reclassification did not increase the overall official suicide statistics of the 3 Scandinavian countries.

Mysore study: A study of suicide notes

BACKGROUND

Suicide is one of the leading causes of preventable deaths. Recent data suggest South India as one of the regions with highest suicide rates in the world. In 2013, 134,799 people committed suicide in India according to the statistics released by the National Crime Records Bureau. Suicide note is one of the most important sources to understand suicide, which may be beneficial in suicide prevention. Studies on suicidal notes from this part of the world are sparse.

OBJECTIVE

The aim was to study the themes in suicide notes that might be useful in prevention strategies.

MATERIALS AND METHODS

A descriptive study of all suicide notes of those individuals who committed suicide between 2010 and 2013 available with Police Department, Mysore district was obtained and analyzed.

RESULTS

A total of 22 suicide note were available. A majority of suicide note was in age group of 16-40 years (86%) and most were men (59%). All suicide notes were handwritten, the majority (70%) in regional language Kannada. Length of notes varied from just few words to few pages. Contents of suicide notes included apology/shame/guilt (80%), love for those left behind (55%) and instruction regarding practical affairs (23%). Most have blamed none for the act (50%). 23% mentioned that they are committing suicide to prove their innocence. 32% mentioned a last wish.

CONCLUSION

The majority of suicidal note contained "guilt" which is a strong indicator of possible depression in deceased. Creating awareness about suicide among public and ensuring access to professionals trained in suicide prevention is need of the hour in this part of the world.

Analysis of Suicide Notes: An experience in Eskişehir City

INTRODUCTION

It is estimated that a million people around the world die by suicide each year. It has been reported that a note was left in 5%-43% of the suicides. In this study, it we aimed to evaluate and discuss suicide notes in our city which is situated in Western Anatolia and where several universities are located.

METHOD

All forensic deaths in Eskişehir in 10-year period between 2001 and 2011 were evaluated. Forensic investigation files were assessed. After investigation, Out of 399 cases, 168 (42.1%) cases, who were determined to have left a suicide letter, telephone message (sms) or message via social network sites, were included in the scope of the study.

RESULTS

It was found that 95 (56.5%) of all cases had left a suicide letter, 69 (41.1%) cases had sent a telephone message to a person or more than one person, 4 (2.4%) cases had written notes about suicide and death in social networking sites.

CONCLUSION

A suicide note is an important finding in suicide cases to clarify the case. However, the note should be confirmed by investigation to be accepted as evidence.

Suicide note on the palm: three case reports and discussion of medico-legal aspects

Suicide notes are usually written by the victim on paper or readily accessible things such as notebooks, walls or mirrors. Though writing may be found on the body of the deceased, suicide notes in a structured manner written on the palm have not been reported in forensic literature. In all the three cases presented here, we found a handwritten note on the palm of the deceased at the time of autopsy. The victims had written a brief note in their own handwriting, citing the reasons for ending their lives. The suicide note in one case also mentioned details regarding the custody of the victim's children to be given to her mother. Since we have not found similar cases in the literature, we present and discuss our three cases herein.

[Forensic aspects of gunshot suicides in Germany]

Suicidal gunshot wounds are a common appearance in forensic casework. The main task of the coroner lies in the detection of typical pathomorphological correlates, thus differentiating between homicide, suicide and accident. Apart from characteristic bloodstain patterns on the gun and shooting hand, the localisation of the entrance wound and the position of the weapon, additional details such as family background or medical history are important aspects of forensic investigation. An uncommon choice of weaponry and its unusual morphological manifestation often complicate the examination and reconstruction of such cases. Furthermore, due to social stigmatisation, the possibility of secondary changes by relatives at the crime scene should be considered. In addition to autopsy findings, a careful crime scene investigation and bloodstain pattern analysis, a ballistic reconstruction can be an essential tool to gain knowledge of the shooting distance and position of the gun.

Differences Between Suicide Victims Who Leave Notes and Those Who Do Not

Background: Whether differences exist between those who do leave a suicide note and those who do not has not yet been comprehensively answered. Leaving a suicide note is not a random phenomenon: A minority, varying between 3–42%, of all suicide victims leave a note. Aims: To compare the group of suicide victims who leave notes with the ones who do not, using data from the Athens Department of Forensic Medicine, the largest in Greece. Methods: We examined sex, age, nationality, religious beliefs, marital and residential status, history of prior psychiatric disorder and psychiatric attempt(s), suicide method, physical disease, recent hospitalization, and existence of suicide notes. We completed psychological autopsy questionnaires after phone interviews with relatives of the suicide victims of a 2-year period (November 2007–October 2009). Results: Note writers, 26.1% of our sample, differed in the following: they died by hanging or shooting (p = .007), had no history of psychiatric illness (p < .001) or recent (i.e., within 12 months of the suicide) psychiatric hospitalization (p = .005). Conclusions: Our study showed that there are indeed differences between suicide victims who leave a note and those who do not. We also suggest some explanations for these differences, which could represent a valuable starting point for future research on this topic.

[Suicide reporting in German print and online media for adolescents in Austria and possible effects on suicide prevalence]

OBJECTIVE

We analyzed the quality of suicide reporting in youth magazines and assessed potential copycat effects following media reports on suicide.

METHOD

We obtained suicide-related articles from five Austrian and German youth magazines published between 1996 and 2008. Reported sex, suicide (attempt) methods, suicide motives, the portrayal of suicide in a positive or negative light, accusations of blame and consistency with media recommendations for the reporting of suicide were analysed using qualitative content analysis. The suicide frequency among adolescents in Austria was compared 2 weeks before and after the publication of reports on suicide and suicide attempts.

RESULTS

59 articles were identified, most of which had been published in the magazine Bravo. There was an overrepresentation of suicide among girls and an underrepresentation of attempted suicide. The frequency of specific suicide and suicide attempt methods was consistent with epidemiological distributions of suicide methods. Fall from height was most frequently described for girls and hanging for boys. Regarding motives for suicide, factors like psychiatric diseases were underrepresented. Girls who died by suicide were often positively described in articles, but boys were more often negatively described. Parents were frequently blamed as being guilty of their child's suicidal behaviour, in particular when reporting on suicide attempts. Photos, suicide notes and details concerning method were frequently described. There was no indication of a Werther effect following reporting.

CONCLUSIONS

The identified discrepancies between epidemiologic data regarding suicidal behaviour in adolescents and media reporting in youth media constitutes an important basis for suicide prevention in the community.

Characteristics of police officer suicides in the Federal Austrian Police Corps

BACKGROUND

Suicide rates among police officers may be high because of strong occupational stressors.

AIMS

This study examined the suicide rate and suicide characteristics among police officers in the Federal Austrian Police Force.

METHODS

All suicides among policemen during the period 1996-2006 were analyzed retrospectively on the basis of personalized police record files from all Austrian police departments. Information on sex, age, marital status, children, region, method and place of suicide, suicide notes, position, and length of service was extracted from these files. The general Austrian population, adjusted for sex and age composition, served as the comparison group.

RESULTS

The suicide rate among male police officers was 30.2/100,000 (SD 11.0), which was comparable to the suicide rate in the adjusted general population (30.5/100,000; SD 2.9). The female police officer suicide rate was 1.8/100,000, while the corresponding suicide rate of the adjusted female general population was 12.5/100,000 (SD 1.7). Firearms were the most frequent suicide method (77.8%), and the incidence of suicide notes was 30.8%.

CONCLUSIONS

Suicide rates among police officers seem comparable to those of the age-adjusted general population. Given the healthy-worker effect, these results still suggest an increased risk of suicide among police officers. These findings should stimulate further research on stressors and risk factors for suicide among officers and should also encourage departments to increase awareness regarding suicidal signs among officers.

An uncommon case of failed suicide in a 94-year-old woman: "masked" depression or rational decision?

AIM

We report an unusual case of "failed suicide" in an oldest old woman who was apparently "aging successfully".

METHOD

This case was analysed in the light of a careful literature review.

RESULTS

This was an unusual case of failed suicide, attempted by a 94-year-old woman who had planned the suicide several days earlier.

CONCLUSIONS

The unusual features of this case relate to: 1) the person's female gender and very advanced age; 2) her apparently "successful aging" condition; 3) the violent method and unusual means she used; 4) the suicide note written several days beforehand.