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Tahmazov E, Blachier A, Nabbe P, Guillou-Landreat M, Walter M, Lemey C. Effect of early intervention for early-stage psychotic disorders on suicidal behaviours - a systematic review protocol. Front Psychiatry 2024; 15:1359764. [PMID: 38435977 PMCID: PMC10904604 DOI: 10.3389/fpsyt.2024.1359764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Background The early stages of psychotic disorders correspond to the early phases of the disease and include the prodromal phase and first-episode psychosis; they constitute a period at high risk of suicidal behaviour. A long duration of untreated psychosis (DUP) is among the risk factors of suicidal behaviour identified in this early period. Many studies have shown the effectiveness of early interventions on the overall prognosis of psychotic disorders in the early stages, and early intervention strategies have been developed and tested worldwide. Several authors reported an improvement in suicidal behaviours; however, all these data have not been systematically analysed yet. The main objective of this systematic review was to collect evidence on the effect on suicidal behaviour of early interventions for patients in the early stages of psychotic disorders. Methods We will carry out a systematic review of the literature according to the PRISMA criteria by searching articles in five databases (PubMed, Cochrane, PsycINFO, Scopus, EMBASE), without restriction on the publication date. The selection criteria are: articles (any type; e.g. prospective, retrospective, controlled or uncontrolled, and literature reviews) on early interventions for psychotic disorders in the early stages with data on suicide attempts, death by suicide, suicidal ideation; articles written in English or French. Exclusion criteria are: articles on suicidal behaviours in patients with psychotic disorders in the early stages, but without early intervention, and articles on early-stage psychotic disorders without data on suicidal behaviours. Discussion If this review confirms the effectiveness on suicidal behaviours of early interventions for young patients with psychotic disorders, the development/implementation of such intervention programmes should be better promoted. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021237833.
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Affiliation(s)
- Elkhan Tahmazov
- Unité de Recherche Clinique Intersectorielle (URCI), Service hospitalo-universitaire de psychiatrie adulte, Centre Hospitalo-Universitaire (CHU) de Brest, Hôpital de Bohars, Bohars, France
| | - Athéna Blachier
- Unité de Recherche Clinique Intersectorielle (URCI), Service hospitalo-universitaire de psychiatrie adulte, Centre Hospitalo-Universitaire (CHU) de Brest, Hôpital de Bohars, Bohars, France
| | - Patrice Nabbe
- ER 7479 SPURBO, University of Western Brittany, Brest, France
- Department of general practice – University of Western Brittany, Brest, France
| | | | - Michel Walter
- Unité de Recherche Clinique Intersectorielle (URCI), Service hospitalo-universitaire de psychiatrie adulte, Centre Hospitalo-Universitaire (CHU) de Brest, Hôpital de Bohars, Bohars, France
- ER 7479 SPURBO, University of Western Brittany, Brest, France
| | - Christophe Lemey
- Unité de Recherche Clinique Intersectorielle (URCI), Service hospitalo-universitaire de psychiatrie adulte, Centre Hospitalo-Universitaire (CHU) de Brest, Hôpital de Bohars, Bohars, France
- ER 7479 SPURBO, University of Western Brittany, Brest, France
- IMT Atlantique, Lab-STICC, Campus de Brest, Technopôle Brest-Iroise, Brest, France
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Benson R, Rigby J, Brunsdon C, Corcoran P, Dodd P, Ryan M, Cassidy E, Colchester D, Hawton K, Lascelles K, de Leo D, Crompton D, Kõlves K, Leske S, Dwyer J, Pirkis J, Shave R, Fortune S, Arensman E. Real-Time Suicide Surveillance: Comparison of International Surveillance Systems and Recommended Best Practice. Arch Suicide Res 2023; 27:1312-1338. [PMID: 36237124 DOI: 10.1080/13811118.2022.2131489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Some countries have implemented systems to monitor suicides in real-time. These systems differ because of the various ways in which suicides are identified and recorded. The main objective of this study was to conduct an international comparison of major real-time suicide mortality surveillance systems to identify joint strengths, challenges, and differences, and thereby inform best-practice criteria at local, national, and international levels. METHODS Five major real-time suicide mortality surveillance systems of various coverage levels were identified and selected for review via an internet-based scoping exercise and prior knowledge of existing systems. Key information including the system components and practices was collated from those organizations that developed and operate each system using a structured template. The information was narratively and critically synthesized to determine similarities and differences between the systems. RESULTS The comparative review of the five established real-time suicide surveillance systems revealed more commonalities than differences overall. Commonalities included rapid, routine surveillance based on minimal, provisional data to facilitate timely intervention and postvention efforts. Identified differences include the timeliness of case submission and system infrastructure. CONCLUSION The recommended criteria could promote replicable components and practices in real-time suicide surveillance while offering flexibility in adapting to regional/local circumstances and resource availability.HIGHLIGHTSEvidence-informed recommendations for current best practice in real-time suicide surveillance.Proposed comprehensive framework can be adapted based on available resources and capacity.Real-time suicide mortality data facilitates rapid data-driven decision-making in suicide prevention.
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van der Feltz-Cornelis CM, Hofstra E, Elfeddali I, Bakker M, Metz MJ, de Jong JJ, van Nieuwenhuizen C. Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands. Gen Hosp Psychiatry 2023; 84:73-81. [PMID: 37399647 DOI: 10.1016/j.genhosppsych.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE We evaluated the effect of a digitally supported systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands. METHOD Non-randomized stepped wedge trial design (SWTD). Stepwise implementation in the five subregions of the systems intervention. Pre-post analysis for the whole province (Exact Rate Ratio Test, Poisson count). SWTD Hazard Ratios of suicides per person-years for subregional analysis of control versus intervention conditions over five times three months. Sensitivity analysis. RESULTS Suicide rates dropped 17.8% (p = .013) from 14.4 suicides per 100,000 before the start of implementation of the systems intervention (2017), to 11.9 (2018) and 11.8 (2019) per 100, during implementation; a significant reduction (p = .043) compared to no changes in the rest of the Netherlands. Suicide rates dropped further by 21.5% (p = .002) to 11.3 suicides per 100,000 during sustained implementation in 2021. Sensitivity analysis confirmed the reduction (p = .02). The SWTD analysis over 15 months in 2018-2019 did not show a significant association of this reduction with implementation per subregional level, probably due to insufficient power given the short SWTD timeframe for implementation and low suicide rates per subregion. CONCLUSIONS During the SUPREMOCOL systems intervention, over four years, there was a sustained and significant reduction of suicides in Noord-Brabant.
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Affiliation(s)
- Christina M van der Feltz-Cornelis
- Mental Health and Addiction Research Group, Department of Health Sciences, Hull York Medical School, University of York, York, UK; Institute of Health Informatics, University College London, London, United Kingdom.
| | - Emma Hofstra
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Iman Elfeddali
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands; Specialized Mental Health Institution, GGz Breburg, Tilburg, Netherlands
| | - Marjan Bakker
- Department of Methodology and Statistics, Tilburg University, Tilburg, Netherlands
| | - Margot J Metz
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands; Specialized Mental Health Institution, GGz Breburg, Tilburg, Netherlands
| | - Jacobus J de Jong
- Specialized Mental Health Institution, GGz Breburg, Tilburg, Netherlands
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Moftakhar L, Mirahmadizadeh A, Amiri S, Rezaei F, Azarbakhsh H. Epidemiology of Suicide by Hanging in Fars Province, Iran (2011-2019): A Population-based Cross-sectional Study. J Prev Med Public Health 2023; 56:264-271. [PMID: 37287204 DOI: 10.3961/jpmph.22.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/06/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES Hanging is a common method of attempted suicide. This study investigated the epidemiological profile of attempted and completed suicides by hanging in southern Iran. METHODS This cross-sectional study was performed on 1167 suicide attempts by hanging between 2011 and 2019. All data related to suicide attempts by hanging were collected from the Fars Suicide Surveillance System. The trends in suicide cases and the mean age of attempted and completed suicides were plotted. The chi-square test was used to identify suicide-related factors. Crude rates of incidence, mortality, and standardized fatality during the study period were calculated. Finally, logistic regression was used to identify the predictors of death in individuals who attempted suicide. RESULTS The mean age of those who attempted suicide was 33.21±16.82 years; the majority were male (80.5%). The rate of attempted and completed suicide by hanging were 3.50 and 2.79 per 100 000 people, respectively. The case-fatality rate was calculated as 79.34%. The results of our study indicated an increasing trend in suicide attempts by hanging. The likelihood of death was 2.28 times higher in individuals with a previous history of suicide attempts and 1.85 times higher in those with a psychological disorder. CONCLUSIONS The findings of this study suggest an increasing trend in attempted and completed suicide by hanging, especially among individuals with a history of suicide attempts and psychological disorders. It is necessary to take action to reduce the rate of suicide attempts and identify the underlying causes of suicide attempts by hanging.
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Affiliation(s)
- Leila Moftakhar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanaz Amiri
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariba Rezaei
- Mental Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Hofstra E, Bakker M, Diepstraten CAM, Elfeddali I, Lucas MS, van Nieuwenhuizen C, van der Feltz-Cornelis CM. The Association Between Suicide-Related Media Coverage and Suicide: A Cross-Sectional Observational Study. Arch Suicide Res 2022; 26:1094-1107. [PMID: 33275539 DOI: 10.1080/13811118.2020.1851833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the association between the publication and content of suicide-related media reports and actual suicide in Noord Brabant, a province of the Netherlands. METHOD Between April 2017 and March 2018, a retrospective cross-sectional observational study was conducted on suicide-related media reports and incident data regarding suicides. Linear regression, Mann-Whitney U and negative binomial regression analyses were conducted. RESULTS In Noord-Brabant, a total of 352 people died from suicide during the observation period and 440 reports were identified by using the search terms "suicide", "self-killing", and "self-murder". No associations between media reports and actual suicides were found for any of the analyses performed. CONCLUSIONS No indications were found for an association between media coverage of suicide and increases or decreases in actual suicides in Noord-Brabant. The descriptive statistics of this study reveal that the regional and national Dutch media are doing well with respect to not including elements in their reports that could encourage copycat behavior, such as simplifying, romanticizing or dramatizing. They could improve on including protective content, for example, providing supportive background information. A recommendation for further research is to evaluate causal relationships between media and actual suicide. A stepped wedge trial might be needed, as this provides an ethical research design to investigate this issue in a controlled setting. Also, in such a study, other variables influencing the decision to attempt suicide should be taken into account as much as possible.
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Benson R, Rigby J, Brunsdon C, Cully G, Too LS, Arensman E. Quantitative Methods to Detect Suicide and Self-Harm Clusters: A Systematic Review. Int J Environ Res Public Health 2022; 19:ijerph19095313. [PMID: 35564710 PMCID: PMC9099648 DOI: 10.3390/ijerph19095313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022]
Abstract
Suicide and self-harm clusters exist in various forms, including point, mass, and echo clusters. The early identification of clusters is important to mitigate contagion and allocate timely interventions. A systematic review was conducted to synthesize existing evidence of quantitative analyses of suicide and self-harm clusters. Electronic databases including Medline, Embase, Web of Science, and Scopus were searched from date of inception to December 2020 for studies that statistically analyzed the presence of suicide or self-harm clusters. Extracted data were narratively synthesized due to heterogeneity among the statistical methods applied. Of 7268 identified studies, 79 were eligible for narrative synthesis. Most studies quantitatively verified the presence of suicide and self-harm clusters based on the scale of the data and type of cluster. A Poisson-based scan statistical model was found to be effective in accurately detecting point and echo clusters. Mass clusters are typically detected by a time-series regression model, although limitations exist. Recently, the statistical analysis of suicide and self-harm clusters has progressed due to advances in quantitative methods and geospatial analytical techniques, most notably spatial scanning software. The application of such techniques to real-time surveillance data could effectively detect emerging clusters and provide timely intervention.
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Affiliation(s)
- Ruth Benson
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, T12 XF62 Cork, Ireland; (G.C.); (E.A.)
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, T12 XF62 Cork, Ireland
- Correspondence:
| | - Jan Rigby
- National Centre for Geocomputation, Maynooth University, W23 F2H6 Maynooth, Ireland; (J.R.); (C.B.)
| | - Christopher Brunsdon
- National Centre for Geocomputation, Maynooth University, W23 F2H6 Maynooth, Ireland; (J.R.); (C.B.)
| | - Grace Cully
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, T12 XF62 Cork, Ireland; (G.C.); (E.A.)
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, T12 XF62 Cork, Ireland
| | - Lay San Too
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia;
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, T12 XF62 Cork, Ireland; (G.C.); (E.A.)
- National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, T12 XF62 Cork, Ireland
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia
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Andersson AL, Sokolowski M. Accident or suicide? Improvement in the classification of suicides among road traffic fatalities in Sweden by extended psychosocial investigations, during the years 2010-2019. J Safety Res 2022; 80:39-45. [PMID: 35249619 DOI: 10.1016/j.jsr.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/17/2021] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Suicide is the second leading cause of death in the ages 15-29 worldwide, exceeded only by road injury. However, fatalities in road traffic may be either accidents or suicides. In 2010 Sweden began efforts to separately report deaths in road traffic as either accidents or suicides. METHOD Three alternative criteria defining what constitutes a fatality by suicide were introduced. After exclusion of natural deaths, fatalities were also classified on a five-level graded scale, which distinguished between accident, undetermined, and suicide. The investigations of fatalities were complemented by extended psychosocial investigations in 2012. The improvement in the classification of suicide deaths was evaluated by an intra-year 2012 comparison, as well as using the 2010-2012 period as a control to evaluate the continued use of extended psychosocial investigations during the 2013-2019 period. RESULTS The 2012 intra-year comparison showed a 63% increase in the number of identified suicides when using extended psychosocial investigations. The additional 14 suicides identified in 2012 were mainly attributed to a resolution of 12 "undetermined" causes of deaths. Suicides of all road fatalities increased from 5.7-6.8% in 2010-2011, to 11.2% in 2012. Over the subsequent period 2013-2019 with extended psychosocial investigations, suicides of all road fatalities averaged 10%, a 60% increase over prior years. An average of ∼9 additional suicides was identified each year during 2013-2019, which was accompanied by an annual reduction of ∼6 "undetermined" fatalities. CONCLUSION The use of extended psychosocial investigations is of major importance for our knowledge about the occurrence of suicides in road traffic. Practical applications: A standardized and in-depth classification of suicide deaths is a basic prerequisite needed for the cooperation, implementation, and effect-evaluations of suicide intervention and prevention efforts, with potential to include the entire Swedish transportation system.
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Affiliation(s)
- Anna-Lena Andersson
- Swedish Transport Administration (STA), Trollhättan, Sweden; Institute of Clinical Sciences at Sahlgrenska Academy, Department of Orthopedics, University of Gothenburg, Sweden.
| | - Marcus Sokolowski
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute (KI), Stockholm, Sweden
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Benson R, Brunsdon C, Rigby J, Corcoran P, Ryan M, Cassidy E, Dodd P, Hennebry D, Arensman E. Real-time suicide surveillance supporting policy and practice. Glob Ment Health (Camb) 2022; 9:384-8. [PMID: 36618746 DOI: 10.1017/gmh.2022.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023] Open
Abstract
Suicide mortality rates are a strong indicator of population mental-health and can be used to determine the efficacy of prevention measures. Monitoring suicide mortality rates in real-time provides an evidence-base to inform targeted interventions in a timely manner and accelerate suicide prevention responses. This paper outlines the importance of real-time suicide surveillance in the context of policy and practice, with a particular focus on public health and humanitarian crises.
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Gusmão R, Ramalheira C, Conceição V, Severo M, Mesquita E, Xavier M, Barros H. Suicide time-series structural change analysis in Portugal (1913-2018): Impact of register bias on suicide trends. J Affect Disord 2021; 291:65-75. [PMID: 34023749 DOI: 10.1016/j.jad.2021.04.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Suicide is a potentially preventable cause of death. Epidemiology might help to identify death determinants and to monitor prevention strategies. Few studies address secular trends in suicide deaths, and even fewer describe trend-changes in relation to data collection/registration bias. Moreover, suicide is admittedly underreported. It is crucial to validate results in the context of other external causes of death trends, such as unintentional and undetermined intent deaths. We aimed to explore trends in suicide and other external causes of death in Portugal from the inception of registries until 2018, considering breaks in series. METHODS We collected data from all available official primary sources. We calculated cause-specific age-standardized death rates (SDR) by sex for ages equal or higher than 15 years with reference to the European Standard Population. We considered suicide (S), undetermined intent deaths (UnD), accidents (Accs), and all causes of death (ttMty). A time-series structural analysis was executed. RESULTS Suicide and other external causes of death rates were consistently higher in males than females. A global decline of deaths by suicide, undetermined intention and unintentional is observable. Breakpoints in years 1930, 1954, 1982, 2000-2001 were associated with major changes in deaths registration procedures or methodology. CONCLUSIONS The epidemiology of suicide in Portugal has changed over 106 years. However, adjusted data and consideration of bias reduce trends fluctuation. Trend changes are akin to specific changes in methodology of death registry. Suicide surveillance will improve with more reliable and stable procedures.
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Affiliation(s)
- Ricardo Gusmão
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, Porto 4050-600, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, Porto 4050-600, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Portugal
| | - Carlos Ramalheira
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Portugal; Hospital de Cascais, Dr. José de Almeida, Portugal
| | - Virgínia Conceição
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, Porto 4050-600, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Portugal.
| | - Mílton Severo
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, Porto 4050-600, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, Porto 4050-600, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Portugal
| | - Edgar Mesquita
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, Porto 4050-600, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Portugal
| | - Miguel Xavier
- NOVA Medical School, New University of Lisbon, Portugal; Directorate-General of Health, Ministry of Health, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, Porto 4050-600, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Rua das Taipas 135, Porto 4050-600, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Portugal
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Li F, Yip PSF. How to make adjustments of underreporting of suicide by place, gender, and age in China? Soc Psychiatry Psychiatr Epidemiol 2020; 55:1133-1143. [PMID: 32221643 DOI: 10.1007/s00127-020-01856-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/28/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Underreporting of suicide is a worldwide problem. In particular, the national suicide rates published by the Chinese Ministry of Health ("MOH") could be severely underreported. Validity of the assumption of evenly underreported of suicide by place (city/rural), gender, and age in China has been evaluated and some possible adjustments to the underreporting have been suggested. METHODS Mortality rates from the MOH from 2002 to 2016 were extracted. Due to zero undetermined deaths, accidental deaths (weighted by causes of death) were used to evaluate underreported suicides. 53% of drownings, 11% of falls, 11% of poisonings, and 7% of other accidents were assumed as underreported suicides. Negative binomial regressions were used to calculate the rate ratios of the underreported suicides compared to suicides. Negative binomial regressions were also used to calculate the annual percentage changes of different mortality rates. RESULTS Suicides of rural males could most likely be underreported (49%; 95% CI 39-61%), but suicides of rural females would least likely (30%; 95% CI 24-38%). Suicides of people aged 15-24 years and 75 years and above could more likely to be underreported than other ages. After adding the underreported suicides, declining trends of the national suicide rates had been eased. CONCLUSIONS People who lack social connection could have a high possibility of underreporting suicide. However, when rural females died of unnatural causes, their parents or even the whole village tended to quest for their intents, thus rural females had a lower possibility of underreporting suicide.
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Affiliation(s)
- Feng Li
- Social Work and Social Administration Department, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Paul S F Yip
- Social Work and Social Administration Department, The University of Hong Kong, Pokfulam, Hong Kong SAR, China. .,Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Poorolajal J, Mohammadi Y, Soltanian AR, Ahmadpoor J. The top six risky behaviors among Iranian university students: a national survey. J Public Health (Oxf) 2020; 41:788-797. [PMID: 30452701 DOI: 10.1093/pubmed/fdy204] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/17/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multiple risk-taking behaviors are associated with increased risk of poor educational attainment, morbidity and premature mortality. This study involved a large representative sample of Iranian university students addressing multiple risk behaviors and associated factors. METHODS This cross-sectional study included 4261 participants, involving 13 medical universities throughout the country in 2017. The following six risky behaviors were addressed: (a) smoking cigarettes during the past month, (b) using some kinds of illicit drugs during the past month, (c) drinking alcohol during the past month, (d) engaging unprotected sex during the past year, (e) having suicidal ideation during the past month or attempting suicide in the past year, (f) and Internet addiction. The 20-item internet addiction test and the 28-item general health questionnaire were used. RESULTS Almost 37.3% of the participants engaged in at least one out of six risky behaviors. The prevalence of Internet addiction was 24.5%, cigarette smoking 13.5%, alcohol use 7.8%, illicit drug abuse 4.9%, unprotected sex 7.8%, suicidal ideation 7.4%, attempting suicide 1.7% and general health problems 38.9%. CONCLUSION A majority of the Iranian university students studied engaged in at least one risky behavior. Engaging in one risky behavior increases the risk of engaging in other risk-taking behaviors.
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Affiliation(s)
- Jalal Poorolajal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Younes Mohammadi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Social Determinants of Health Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Reza Soltanian
- Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jamal Ahmadpoor
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Abstract
This study seeks to establish whether medico-legal practitioners differ in their autopsy conclusions within and across medico-legal institutions. Data include 459 violent deaths (homicides, suicides, and accidents) autopsy reports written by more than 20 death certifiers from four medico-legal institutions in two countries (France and the United States). Multinomial models show that compared with accidental deaths, weapon use and decedents' characteristics both influence a homicide verdict, but not a suicide one. In addition, French practitioners are more likely than Americans to reach a conclusion of homicide or suicide compared with accident, and homicides are more likely to be certified by male practitioners.
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Affiliation(s)
- Ming-Li Hsieh
- University of Wisconsin-Eau Claire, Eau Claire, WI, USA
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Li F, Lu X, Ou Y, Yip PSF. The influence of undetermined deaths on suicides in Shanghai, China. Soc Psychiatry Psychiatr Epidemiol 2019; 54:111-119. [PMID: 30167734 DOI: 10.1007/s00127-018-1596-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE In global forensic practice, some suicides were misclassified as undetermined deaths, leading to suicide underreporting. In this study, we aimed to explore the influence of undetermined deaths on suicides in Shanghai, China. METHODS The police records on suicide verdicts and undetermined deaths in Pudong, Shanghai, from 2004 to 2016 were used. In this study, undetermined deaths have been classified into three levels of suicide possibilities namely, probable, possible, and highly unlikely. Probable suicides were presumed as misclassified suicides. Poisson regression was used to calculate the rate ratio ("RR") of probable suicides compared to suicide verdicts. Poisson regression was also used to calculate the annual percentage change ("APC") of the original suicide rates (crude suicide rates based on the suicide verdicts) and adjusted suicide rates (crude suicide rates based on the suicide verdicts and probable suicides). RESULTS Among the 1,318 underdetermine deaths, 560 (42.5%) were classified as probable suicides. The overall RR was 0.23 (95% CI 0.21-0.26): 0.15 (0.13-0.17) for the locals' RR and 0.22 (0.19-0.26) for the migrants' RR. The APCs of the original and adjusted suicide rates were - 2.0 (- 3.1 to - 0.9) and - 2.9 (- 3.8 to - 2.0), respectively, for the overall population. CONCLUSIONS The number of suicides could be 23% higher than the reported cases. Suicides were more likely to be underreported in migrants than in the locals. Thus, it is important to improve suicide monitoring and the surveillance systems in China.
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Affiliation(s)
- Feng Li
- Social Work and Social Administration Department, The University of Hong Kong, Pokfulam, China
| | - Xuesong Lu
- Criminal Science Institute, Pudong District of Shanghai Municipal Public Security Bureau, Shanghai, China
| | - Ying Ou
- Social Work and Social Administration Department, The University of Hong Kong, Pokfulam, China
| | - Paul S F Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Sisask M, Kõlves K. Towards a Greater Understanding of Suicidal Behaviour and Its Prevention. Int J Environ Res Public Health 2018; 15:ijerph15081629. [PMID: 30071699 PMCID: PMC6121881 DOI: 10.3390/ijerph15081629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/31/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Merike Sisask
- Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallinn 11615, Estonia.
- School of Governance, Law and Society (SOGOLAS), Tallinn University, Tallinn 10120, Estonia.
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention (AISRAP), WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt Campus, Mount Gravatt QLD 4122 Australia.
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Hsieh WH, Wang CH, Lu TH. Drowning mortality by intent: a population-based cross-sectional study of 32 OECD countries, 2012-2014. BMJ Open 2018; 8:e021501. [PMID: 30037871 PMCID: PMC6059339 DOI: 10.1136/bmjopen-2018-021501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 06/04/2018] [Accepted: 06/07/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare the drowning mortality rates and proportion of deaths of each intent among all drowning deaths in Organisation for Economic Co-operation and Development (OECD) countries in 2012-2014. DESIGN A population-based cross-sectional study. SETTING 32 OECD countries. PARTICIPANTS Individuals in OECD countries who died from drowning. MAIN OUTCOME MEASURES Drowning mortality rates (deaths per 100 000 population) and proportion (%) of deaths of each intent (ie, unintentional intent, intentional self-harm, assault, undetermined intent and all intents combined) among all drowning deaths. RESULTS Countries with the highest drowning mortality rates (deaths per 100 000 population) were Estonia (3.53), Japan (3.49) and Greece (2.40) for unintentional intent; Ireland (0.96), Belgium (0.96) and Korea (0.89) for intentional self-harm; Austria (0.57), Korea (0.56) and Hungary (0.44) for undetermined intent and Japan (4.35), Estonia (3.70) and Korea (2.73) for all intents combined. Korea ranked 12th and 3rd for unintentional intent and all intents combined, respectively. By contrast, Belgium ranked 2nd and 15th for intentional self-harm and all intents combined, respectively. The proportion of deaths of each intent among all drowning deaths in each country varied greatly: from 26.2% in Belgium to 96.8% in Chile for unintentional intent; 0.7% in Mexico to 57.4% in Belgium for intentional self-harm; 0.0% in nine countries to 4.9% in Mexico for assault and 0.0% in Israel and Turkey to 38.3% in Austria for undetermined intent. CONCLUSIONS A large variation in the practice of classifying undetermined intent in drowning deaths across countries was noted and this variation hinders valid international comparisons of intent-specific (unintentional and intentional self-harm) drowning mortality rates.
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Affiliation(s)
- Wan-Hua Hsieh
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Chien-Hsing Wang
- Division of Plastic Surgery, Department of Surgery and Trauma Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tsung-Hsueh Lu
- NCKU Research Center for Health Data and Department of Public Health, National Cheng Kung University, Tainan, Taiwan
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16
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Gatov E, Kurdyak P, Sinyor M, Holder L, Schaffer A. Comparison of Vital Statistics Definitions of Suicide against a Coroner Reference Standard: A Population-Based Linkage Study. Can J Psychiatry 2018; 63:152-160. [PMID: 29056088 PMCID: PMC5846963 DOI: 10.1177/0706743717737033] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to determine the utility of health administrative databases for population-based suicide surveillance, as these data are generally more accessible and more integrated with other data sources compared to coroners' records. METHOD In this retrospective validation study, we identified all coroner-confirmed suicides between 2003 and 2012 in Ontario residents aged 21 and over and linked this information to Statistics Canada's vital statistics data set. We examined the overlap between the underlying cause of death field and secondary causes of death using ICD-9 and ICD-10 codes for deliberate self-harm (i.e., suicide) and examined the sociodemographic and clinical characteristics of misclassified records. RESULTS Among 10,153 linked deaths, there was a very high degree of overlap between records coded as deliberate self-harm in the vital statistics data set and coroner-confirmed suicides using both ICD-9 and ICD-10 definitions (96.88% and 96.84% sensitivity, respectively). This alignment steadily increased throughout the study period (from 95.9% to 98.8%). Other vital statistics diagnoses in primary fields included uncategorised signs and symptoms. Vital statistics records that were misclassified did not differ from valid records in terms of sociodemographic characteristics but were more likely to have had an unspecified place of injury on the death certificate ( P < 0.001), more likely to have died at a health care facility ( P < 0.001), to have had an autopsy ( P = 0.002), and to have been admitted to a psychiatric hospital in the year preceding death ( P = 0.03). CONCLUSIONS A high degree of concordance between vital statistics and coroner classification of suicide deaths suggests that health administrative data can reliably be used to identify suicide deaths.
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Affiliation(s)
- Evgenia Gatov
- 1 Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Paul Kurdyak
- 1 Institute for Clinical Evaluative Sciences, Toronto, Ontario.,2 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario.,3 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Mark Sinyor
- 3 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,4 Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Laura Holder
- 1 Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Ayal Schaffer
- 3 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.,4 Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
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17
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Hofstra E, Elfeddali I, Bakker M, de Jong JJ, van Nieuwenhuizen C, van der Feltz-Cornelis CM. Springtime Peaks and Christmas Troughs: A National Longitudinal Population-Based Study into Suicide Incidence Time Trends in the Netherlands. Front Psychiatry 2018; 9:45. [PMID: 29535647 PMCID: PMC5834424 DOI: 10.3389/fpsyt.2018.00045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Time trends are one of the most studied phenomena in suicide research; however, evidence for time trends in the Dutch population remains understudied. Insight into time trends can contribute to the development of effective suicide prevention strategies. METHODS Time trends in national daily and monthly data of 33,224 suicide events that occurred in the Netherlands from 1995 to 2015 were examined, as well as the influence of age, gender, and province, in a longitudinal population-based design with Poisson regression analyses and Bayesian change point analyses. RESULTS Suicide incidence among Dutch residents increased from 2007 until 2015 by 38%. Suicide rates peak in spring, up to 8% higher than in summer (p < 0.001). Suicide incidence was 42% lower at Christmas, compared to the December-average (IRR = 0.580, p < 0.001). After Christmas, a substantial increase occurred on January 1, which remained high during the first weeks of the new year. Suicide occurred more than twice as often in men than in women. For both genders, the results indicated a spring time peak in suicide incidence and a trough at Christmas. Suicide rates were highest in the elderly (age group, 80+), and no evidence was found of a differential effect by season in the age groups with regard to suicide incidence. No interaction effect was found with regard to province of residence for both season and Christmas, indicating that no evidence was found that these time trends had differential effects in the Dutch provinces in terms of suicide incidence. CONCLUSION Evidence was found for time trends in suicide incidence in the Netherlands. It is recommended to plan (mental) health care services to be available especially at high-risk moments, at spring time, and in the beginning of January. Further research is needed to explore the protective effect of Christmas in suicide incidence.
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Affiliation(s)
- Emma Hofstra
- Academic Department of Specialised Mental Health Care, GGz Breburg, Tilburg, Netherlands.,Tranzo-Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
| | - Iman Elfeddali
- Academic Department of Specialised Mental Health Care, GGz Breburg, Tilburg, Netherlands.,Tranzo-Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
| | - Marjan Bakker
- Department of Methodology and Statistics, Tilburg University, Tilburg, Netherlands
| | - Jacobus J de Jong
- Academic Department of Specialised Mental Health Care, GGz Breburg, Tilburg, Netherlands.,Tranzo-Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
| | - Chijs van Nieuwenhuizen
- Tranzo-Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands.,Institute for Mental Health Care, GGzE, Eindhoven, Netherlands
| | - Christina M van der Feltz-Cornelis
- Academic Department of Specialised Mental Health Care, GGz Breburg, Tilburg, Netherlands.,Tranzo-Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
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18
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Abstract
Although sociological research in the Durkheimian tradition has generally accepted that religious involvement protects against suicide, few studies have examined this theoretical proposition outside Western industrialized settings. Using multilevel models to analyze data from the World Health Organization Mortality Database and the World Values Survey (1981-2007) across 42 countries in seven geographical-cultural regions, this study explores whether religious participation is more protective against suicide in some regions than others and, if so, why. Results indicate that while religious participation is protective in Latin America, eastern Europe, northern Europe, and English-speaking countries, it may aggravate the risk of suicide in East Asia, western Europe, and southern Europe. This regional variation is the result of differences in both the degree of integration/regulation of religious communities and suicide underreporting. Overall, the findings support the network perspective of Durkheim's classical theory and suggest that researchers should be more cautious about suicide underreporting in less industrialized settings.
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Affiliation(s)
- Ning Hsieh
- 1 Michigan State University, East Lansing, MI, USA
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19
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Freeman A, Mergl R, Kohls E, Székely A, Gusmao R, Arensman E, Koburger N, Hegerl U, Rummel-Kluge C. A cross-national study on gender differences in suicide intent. BMC Psychiatry 2017; 17:234. [PMID: 28662694 PMCID: PMC5492308 DOI: 10.1186/s12888-017-1398-8] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/22/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Suicide accounts for over 58,000 deaths in Europe per annum, where suicide attempts are estimated to be 20 times higher. Males have been found to have a disproportionately lower rate of suicide attempts and an excessively higher rate of suicides compared to females. The gender difference in suicide intent is postulated to contribute towards this gender imbalance. The aim of this study is to explore gender differences in suicide intent in a cross-national study of suicide attempts. The secondary aims are to investigate the gender differences in suicide attempt across age and country. METHODS Data on suicide attempts (acquired from the EU-funded OSPI-Europe project) was obtained from eight regions in Germany, Hungary, Ireland and Portugal. Suicide intent data was categorized into 'Non-habitual Deliberate Self-Harm' (DSH), 'Parasuicidal Pause' (SP), 'Parasuicidal Gesture' (SG), and 'Serious Suicide Attempt' (SSA), applying the Feuerlein scale. Gender differences in intent were explored for significance by using χ2-tests, odds ratios, and regression analyses. RESULTS Suicide intent data from 5212 participants was included in the analysis. A significant association between suicide intent and gender was found, where 'Serious Suicide Attempts' (SSA) were rated significantly more frequently in males than females (p < .001). There was a statistically significant gender difference in intent and age groups (p < .001) and between countries (p < .001). Furthermore, within the most utilised method, intentional drug overdose, 'Serious Suicide Attempt' (SSA) was rated significantly more often for males than females (p < .005). CONCLUSIONS Considering the differences in suicidal intent between males and females highlighted by the current study, gender targeted prevention and intervention strategies would be recommended.
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Affiliation(s)
- Aislinné Freeman
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103, Leipzig, Germany.
| | - Roland Mergl
- 0000 0001 2230 9752grid.9647.cKlinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103 Leipzig, Germany ,Forschungszentrum Depression der Stiftung Deutsche Depressionshilfe, Leipzig, Germany
| | - Elisabeth Kohls
- 0000 0001 2230 9752grid.9647.cKlinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103 Leipzig, Germany
| | - András Székely
- 0000 0001 0942 9821grid.11804.3cSemmelweis University, Budapest, Hungary
| | - Ricardo Gusmao
- 0000000121511713grid.10772.33New University of Lisbon, Lisbon, Portugal
| | - Ella Arensman
- 0000000123318773grid.7872.aNational Suicide Research Foundation & Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Nicole Koburger
- 0000 0001 2230 9752grid.9647.cKlinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103 Leipzig, Germany ,Forschungszentrum Depression der Stiftung Deutsche Depressionshilfe, Leipzig, Germany
| | - Ulrich Hegerl
- 0000 0001 2230 9752grid.9647.cKlinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103 Leipzig, Germany ,Forschungszentrum Depression der Stiftung Deutsche Depressionshilfe, Leipzig, Germany
| | - Christine Rummel-Kluge
- 0000 0001 2230 9752grid.9647.cKlinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103 Leipzig, Germany ,Forschungszentrum Depression der Stiftung Deutsche Depressionshilfe, Leipzig, Germany
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20
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Gunnes MW, Lie RT, Bjørge T, Ghaderi S, Syse A, Ruud E, Wesenberg F, Moster D. Suicide and violent deaths in survivors of cancer in childhood, adolescence and young adulthood-A national cohort study. Int J Cancer 2016; 140:575-580. [DOI: 10.1002/ijc.30474] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/10/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Maria W. Gunnes
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Department of Pediatrics; Haukeland University Hospital; Bergen Norway
| | - Rolv T. Lie
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Norwegian Institute of Public Health; Bergen Norway
| | - Tone Bjørge
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Cancer Registry of Norway; Oslo Norway
| | - Sara Ghaderi
- Norwegian Institute of Public Health; Bergen Norway
| | - Astri Syse
- Department of Research, Statistics Norway; Oslo Norway
| | - Ellen Ruud
- Department of Pediatric Medicine; Oslo University Hospital; Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Norway
| | - Finn Wesenberg
- Cancer Registry of Norway; Oslo Norway
- Department of Pediatric Medicine; Oslo University Hospital; Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Norway
| | - Dag Moster
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Department of Pediatrics; Haukeland University Hospital; Bergen Norway
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Abstract
This article examines the cultural sources of underreported suicide deaths in South Korea. It analyzes two sets of suicide data compiled by two different government agencies. Noting the considerable undercounting of suicide deaths compiled by the National Statistical Office, it explores how the underreporting is linked to the Confucian norm of familism. Despite an effort to improve the quality of official suicide data, a reform in the death system is needed in order to gather accurate data for a better understanding of the increased suicides as well as for the development of more effective suicide prevention and intervention strategies.
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Affiliation(s)
- Jeong Soo Im
- Gachon University School of Medicine, Inchon, South Korea
| | - B. C. Ben Park
- Human Development and Family Studies, Pennsylvania State University—Brandywine, Media, PA, USA
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Abstract
BACKGROUND There may be various reasons for differences in suicide rates between countries and over time within a country. One reason can be different registration practices. AIMS The purpose of this study was to describe and compare the present procedures for mortality and suicide registration in the three Scandinavian countries and to illustrate potential sources of error in the registration of suicide. METHOD Information about registration practices and classification procedures was obtained from the cause of death registers in Norway, Sweden, and Denmark. In addition, we received information from experts in the field in each country. RESULTS Sweden uses event of undetermined intent more frequently than Denmark does, and Denmark more frequently than Norway. There seems to be somewhat more uncertainty among deaths classified as ill-defined and unknown cause of mortality in Norway, compared with the other two countries. Sweden performs more forensic autopsies than Norway, and Norway more than Denmark. In Denmark, in cases of a suspected unnatural manner of death, a thorough external examination of the deceased is performed. CONCLUSION Differences in the classification of causes of death and in postmortem examinations exist in Scandinavian countries. These differences might influence the suicide statistics in Scandinavia.
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Affiliation(s)
- Ingvild M Tøllefsen
- 1 Department of Acute Medicine, Oslo University Hospital Ullevaal, Oslo, Norway.,2 Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Erlend Hem
- 3 Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Øivind Ekeberg
- 2 Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway.,3 Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Oslo, Norway
| | | | - Karin Helweg-Larsen
- 5 Department of Social Medicine and Public Health Research, Copenhagen University, Denmark
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Dogan KH, Unaldi M, Demirci S. Evaluation of Postmortem Cerebrospinal Fluid S100B Protein and Serotonin Levels: Comparison of Suicidal Versus Nonsuicidal Deaths in Konya, Turkey. J Forensic Sci 2016; 61:1285-91. [DOI: 10.1111/1556-4029.13124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/16/2015] [Accepted: 11/27/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Kamil Hakan Dogan
- Department of Forensic Medicine; Faculty of Medicine; Selcuk University; 42075 Konya Turkey
| | - Mustafa Unaldi
- Department of Biochemistry; Private Ticaret Borsasi Hospital; Sukran Mh. Taskapu Medrese Sk. 42040 Konya Turkey
| | - Serafettin Demirci
- Department of Forensic Medicine; Meram Medical School; Necmettin Erbakan University; Akyokus 42080 Konya Turkey
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Dos Santos JP, Tavares M, Barros PP. More than just numbers: Suicide rates and the economic cycle in Portugal (1910-2013). SSM Popul Health 2016; 2:14-23. [PMID: 29349124 DOI: 10.1016/j.ssmph.2015.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 12/13/2022] Open
Abstract
Suicides are a major concern for public health first and foremost because they are an avoidable cause of death. Moreover, they can be an indicator of self-reported emotional satisfaction and a good marker of overall well-being. In this study we examine how different economic and social aspects affected Portuguese suicide rates for more than one hundred years (1910–2013). We place this exercise in the specific historical context of the XX and early XXI century in Portugal, emphasizing the role of economic recessions and expansions. Controlling for aspects like wars, health care availability, political instability, and demographic changes, we find a strong association between a decline in the growth rate of real output and an increase in suicide rates for the whole population. In this regard, while male suicide rates are non-negligibly influenced by economic downturns, female suicide rates are in general more responsive to a more open political and economic environment. Our results are robust if we consider the mid-term cyclical relationship. Our findings advocate that, during recessions, public health responses should be seen as a crucial component of suicide prevention. We study the relation between suicide rates and Portuguese output. Our dataset has more than a century where we analyze several economic, social and political events. Suicide rates tend to severely increase during times of recessions. In general, males are more sensitive to GDP fluctuations than females. Males react more, on average, to war events; while women are more affected by events related to social stability.
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25
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Bakst SS, Braun T, Zucker I, Amitai Z, Shohat T. The accuracy of suicide statistics: are true suicide deaths misclassified? Soc Psychiatry Psychiatr Epidemiol 2016; 51:115-23. [PMID: 26364837 DOI: 10.1007/s00127-015-1119-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 09/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Official suicide statistics often produce an inaccurate view of suicide populations, since some deaths endorsed as being of uncertain manner are in fact suicides; it is common, therefore, in suicide research, to account for these deaths. We aimed to test the hypothesis that non-suicide death categories contain a large potential reservoir of misclassified suicides. METHODS Data on undetermined intent and ill-defined death causes, and official suicide deaths recorded in the district of Tel Aviv for the years 2005 and 2008 were extracted. Based on supplementary data, cases regarded as probable suicides ("suicide probable") were then compared with official suicides ("suicide verdicts") on a number of socio-demographic variables, and also in relation to the mechanism of death. RESULTS Suicide rates were 42 % higher than those officially reported after accounting for 75 probable suicides (erroneously certified under other cause-of-death categories). Both death classifications ("suicide probable" and "suicide verdicts") had many similarities, significantly differing only with respect to method used. Logistic regression confirmed that the most powerful discriminator was whether the mechanism of death was considered "less active" or "more active" (p < 0.001). Indeed, deaths among the less active group were 4.9 times as likely to be classified as "suicide probable" than were deaths among the more active group. CONCLUSIONS Caution is needed when interpreting local area data on suicide rates, and undetermined and ill-defined deaths should be included in suicide research after excluding cases unlikely to be suicides. Improving suicide case ascertainment, using multiple sources of information, and uniform reporting practices, is advised.
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Affiliation(s)
- Shelly S Bakst
- Israel Center for Disease Control, Gertner Institute, Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, 52621, Ramat Gan, Israel.
| | - Tali Braun
- Israel Center for Disease Control, Gertner Institute, Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Inbar Zucker
- Israel Center for Disease Control, Gertner Institute, Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Ziva Amitai
- Israel Center for Disease Control, Gertner Institute, Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Tamy Shohat
- Israel Center for Disease Control, Gertner Institute, Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, 52621, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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26
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Branas CC, Kastanaki AE, Michalodimitrakis M, Tzougas J, Kranioti EF, Theodorakis PN, Carr BG, Wiebe DJ. The impact of economic austerity and prosperity events on suicide in Greece: a 30-year interrupted time-series analysis. BMJ Open 2015; 5:e005619. [PMID: 25643700 PMCID: PMC4316557 DOI: 10.1136/bmjopen-2014-005619] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 09/16/2014] [Accepted: 10/13/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To complete a 30-year interrupted time-series analysis of the impact of austerity-related and prosperity-related events on the occurrence of suicide across Greece. SETTING Greece from 1 January 1983 to 31 December 2012. PARTICIPANTS A total of 11 505 suicides, 9079 by men and 2426 by women, occurring in Greece over the study period. PRIMARY AND SECONDARY OUTCOMES National data from the Hellenic Statistical Authority assembled as 360 monthly counts of: all suicides, male suicides, female suicides and all suicides plus potentially misclassified suicides. RESULTS In 30 years, the highest months of suicide in Greece occurred in 2012. The passage of new austerity measures in June 2011 marked the beginning of significant, abrupt and sustained increases in total suicides (+35.7%, p<0.001) and male suicides (+18.5%, p<0.01). Sensitivity analyses that figured in undercounting of suicides also found a significant, abrupt and sustained increase in June 2011 (+20.5%, p<0.001). Suicides by men in Greece also underwent a significant, abrupt and sustained increase in October 2008 when the Greek recession began (+13.1%, p<0.01), and an abrupt but temporary increase in April 2012 following a public suicide committed in response to austerity conditions (+29.7%, p<0.05). Suicides by women in Greece also underwent an abrupt and sustained increase in May 2011 following austerity-related events (+35.8%, p<0.05). One prosperity-related event, the January 2002 launch of the Euro in Greece, marked an abrupt but temporary decrease in male suicides (-27.1%, p<0.05). CONCLUSIONS This is the first multidecade, national analysis of suicide in Greece using monthly data. Select austerity-related events in Greece corresponded to statistically significant increases for suicides overall, as well as for suicides among men and women. The consideration of future austerity measures should give greater weight to the unintended mental health consequences that may follow and the public messaging of these policies and related events.
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Affiliation(s)
| | | | | | | | - Elena F Kranioti
- Edinburgh Unit for Forensic Anthropology, SHCA, University of Edinburgh, UK
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Najafi F, Beiki O, Ahmadijouybari T, Amini S, Moradinazar M, Hatemi M, Moradi M. An assessment of suicide attempts by self-poisoning in the west of Iran. J Forensic Leg Med 2014; 27:1-5. [DOI: 10.1016/j.jflm.2014.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 06/06/2014] [Accepted: 07/07/2014] [Indexed: 11/20/2022]
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Hegerl U, Rummel-Kluge C, Värnik A, Arensman E, Koburger N. Alliances against depression – A community based approach to target depression and to prevent suicidal behaviour. Neurosci Biobehav Rev 2013; 37:2404-9. [DOI: 10.1016/j.neubiorev.2013.02.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 02/01/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
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Dias D, Mendonça MC, Real FC, Vieira DN, Teixeira HM. Suicides in the Centre of Portugal: seven years analysis. Forensic Sci Int 2014; 234:22-8. [PMID: 24378298 DOI: 10.1016/j.forsciint.2013.10.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 11/22/2022]
Abstract
As one of the more specific and distinctive problems of human beings, suicide has been investigated with increasing attention all over the world. Several risk factors have been described as well as limitations arising from their study. The World Health Organization estimates that this scourge affects one million people annually, which corresponds to one death every 40s worldwide. According to recent studies, Portugal, despite the good rates (10 suicide deaths per 100,000 inhabitants), had shown an increasing trend among younger people. This work aims to characterize the evolution of the suicidal profile autopsied at the Forensic Pathology Department of the Centre Branch of the National Institute of Legal Medicine and Forensic Sciences of Portugal, analyzing several variables: age, gender, marital status, employment status, suicidal methodology, toxicological analysis and some conditions/behaviors regarding personal history (alcoholism, suicidal ideation, suicide attempts, physical illness, psychiatric disorder). All the autopsies from the 1 January, 2003 to 31 December, 2009 were analyzed. The suicide profile achieved corresponded to a man (77%), aged between 65 and 74 years old (20.4%), married (54.5%), employed, who committed suicide by hanging, in September, May or February. Clinical records include an organic health problem or psychiatric one, in addition to risk behaviors such as alcoholism, suicidal thoughts or suicide attempts. The number of suicides autopsied at the Centre Branch has increased, resembling the profile to the result of many other authors. However, new medical and social developments place hanging as the favorite suicide method in our study. Many barriers remain to overthrow but several prevention programs begin to be designed and implemented. Future evaluations and interventions at the social and medical level, including the death certification process, will be fundamental to a better realistic understanding of this phenomenon.
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Gotsens M, Marí-Dell'Olmo M, Pérez K, Palència L, Martinez-Beneito MA, Rodríguez-Sanz M, Burström B, Costa G, Deboosere P, Domínguez-Berjón F, Dzúrová D, Gandarillas A, Hoffmann R, Kovacs K, Marinacci C, Martikainen P, Pikhart H, Rosicova K, Saez M, Santana P, Riegelnig J, Schwierz C, Tarkiainen L, Borrell C. Socioeconomic inequalities in injury mortality in small areas of 15 European cities. Health Place 2013; 24:165-72. [PMID: 24112963 DOI: 10.1016/j.healthplace.2013.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 08/30/2013] [Accepted: 09/10/2013] [Indexed: 11/26/2022]
Abstract
This study analysed socioeconomic inequalities in mortality due to injuries in small areas of 15 European cities, by sex, at the beginning of this century. A cross-sectional ecological study with units of analysis being small areas within 15 European cities was conducted. Relative risks of injury mortality associated with the socioeconomic deprivation index were estimated using hierarchical Bayesian model. The number of small areas varies from 17 in Bratislava to 2666 in Turin. The median population per small area varies by city (e.g. Turin had 274 inhabitants per area while Budapest had 76,970). Socioeconomic inequalities in all injury mortality are observed in the majority of cities and are more pronounced in men. In the cities of northern and western Europe, socioeconomic inequalities in injury mortality are found for most types of injuries. These inequalities are not significant in the majority of cities in southern Europe among women and in the majority of central eastern European cities for both sexes. The results confirm the existence of socioeconomic inequalities in injury related mortality and reveal variations in their magnitude between different European cities.
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Affiliation(s)
- Mercè Gotsens
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
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Gusmão R, Quintão S, McDaid D, Arensman E, Van Audenhove C, Coffey C, Värnik A, Värnik P, Coyne J, Hegerl U. Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study. PLoS One 2013; 8:e66455. [PMID: 23840475 PMCID: PMC3686718 DOI: 10.1371/journal.pone.0066455] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 04/29/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Research concerning the association between use of antidepressants and incidence of suicide has yielded inconsistent results and is the subject of considerable controversy. The first aim is to describe trends in the use of antidepressants and rates of suicide in Europe, adjusted for gross domestic product, alcohol consumption, unemployment, and divorce. The second aim is to explore if any observed reduction in the rate of suicide in different European countries preceded the trend for increased use of antidepressants. METHODS Data were obtained for 29 European countries between 1980 and 2009. Pearson correlations were used to explore the direction and magnitude of associations. Generalized linear mixed models and Poisson regression distribution were used to clarify the effects of antidepressants on suicide rates, while an autoregressive adjusted model was used to test the interaction between antidepressant utilization and suicide over two time periods: 1980-1994 and 1995-2009. FINDINGS An inverse correlation was observed in all countries between recorded Standardised Death Rate (SDR) for suicide and antidepressant Defined Daily Dosage (DDD), with the exception of Portugal. Variability was marked in the association between suicide and alcohol, unemployment and divorce, with countries depicting either a positive or a negative correlation with the SDR for suicide. Every unit increase in DDD of an antidepressant per 1000 people per day, adjusted for these confounding factors, reduces the SDR by 0.088. The correlation between DDD and suicide related SDR was negative in both time periods considered, albeit more pronounced between 1980 and 1994. CONCLUSIONS Suicide rates have tended to decrease more in European countries where there has been a greater increase in the use of antidepressants. These findings underline the importance of the appropriate use of antidepressants as part of routine care for people diagnosed with depression, therefore reducing the risk of suicide.
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Affiliation(s)
- Ricardo Gusmão
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal ; Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Hegerl U, Koburger N, Rummel-Kluge C, Gravert C, Walden M, Mergl R. One followed by many?-Long-term effects of a celebrity suicide on the number of suicidal acts on the German railway net. J Affect Disord 2013; 146:39-44. [PMID: 23040873 DOI: 10.1016/j.jad.2012.08.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/20/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Following the railway suicide of Robert Enke, a famous German football goal keeper, short-term copycat effects have been found. Main aims of the present study were to analyze long-term effects of this incidence and to compare them with overall national suicide data, as well as to investigate possible "anniversary effects". METHODS For long-term effects, the number of railway suicidal acts in the two years before and after Robert Enke's suicide (10th November 2009) were compared. For anniversary effects, the corresponding 2-week-periods in 2009, 2010 and 2011 were analyzed. Incidence ratios with 95% confidence intervals were computed. RESULTS Compared to the two years before Enke's suicide the incidence ratio of the number of railway suicidal acts in the 2-year-period following this event increased by 18.8% (95% confidence interval (CI)=11.0-27.1%; p<0.001). The median number of suicidal acts per day increased from 2 to 3 (p<0.001). This effect remains significant after excluding short-term 2-week effects of Enke's suicide. An anniversary effect was not present. The increase of fatal railway suicides between 2007 and 2010 (25%) was significantly different from that for the total number of suicides in Germany (6.6%) (p<0.0001). LIMITATIONS Due to missing data, analyses regarding gender were limited and regarding age not feasible. CONCLUSIONS Long-term effects of Enke's suicide on railway suicidal acts in Germany in the sense of copycat behavior are probable as this increase cannot be explained by corresponding changes of the total number of suicides in Germany.
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Affiliation(s)
- Ulrich Hegerl
- Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, D-04103 Leipzig, Germany.
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Abstract
OBJECTIVE Suicide rates in Quebec over the second half of the 20th century show a wide range of variation depending on age and time period. However, few studies have verified the presence of a cohort effect affecting trends in Quebec suicide rates. This study is designed to evaluate the potential effects of age, period and cohort (APC) on trends in suicide between 1950 and 2009 in Quebec. METHOD For these APC analyses, we used a multiphase approach combining a graphical inspection followed by an analysis that isolates the cohort effect from age and period effects (linear regression of the residuals from a median polish of the rates). RESULTS The graphical inspection of trends in rates points to combined effects of age, period and cohort among both men and women. However, the median polish analysis attributes primary importance to period effects, followed by age effects, but also shows weak cohort effects that are significant only among men born between 1950 and 1979. CONCLUSION The variation in Quebec suicide rates appears to be primarily a reflection of period, age and, to a lesser degree, birth cohort. Thus, in addition to sex, selection of risk groups should be based more on age and time period than on birth cohort.
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Affiliation(s)
- Gilles Légaré
- Institut national de santé publique du Québec and Université du Québec à Rimouski, Rimouski, QC.
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Abstract
The present article describes the process of developing a national suicide registry in Iran and evaluates the obstacles in this respect. We established a systematic and uniform portal data collection system in the country and evaluated it from March 2009 for a year. The quality of database and data registration challenges were assessed from different aspects. A total number of 41,109 suicide attempts and 1,338 completed suicides were reported from an area that covered 83.6% of Iran's population in 2009. The rate of suicide attempt was 65.8 per 100,000 people. This study revealed some of the obstacles and challenges of implementing a national registration system. Nationwide suicide registry can serve as a solid foundation for conceptual work, data collection, and preventive interventions. A concerted effort between various organizations is required to efficiently collect data on suicide behaviors.
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Affiliation(s)
- Ahmad Hajebi
- a Mental Health Research Centre , Tehran Psychiatric Institute, Iran University of Medical Sciences , Tehran , Iran
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Solano P, Pizzorno E, Gallina AM, Mattei C, Gabrielli F, Kayman J. Employment status, inflation and suicidal behaviour: an analysis of a stratified sample in Italy. Int J Soc Psychiatry 2012; 58:477-84. [PMID: 21813481 DOI: 10.1177/0020764011408651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is abundant empirical evidence of a surplus risk of suicide among the unemployed, although few studies have investigated the influence of economic downturns on suicidal behaviours in an employment status-stratified sample. AIMS We investigated how economic inflation affected suicidal behaviours according to employment status in Italy from 2001 to 2008. METHODS Data concerning economically active people were provided by the Italian Institute for Statistical Analysis and by the International Monetary Fund. The association between inflation and completed versus attempted suicide with respect to employment status was investigated in every year and quarter-year of the study time frame. We considered three occupational categories: employed, unemployed who were previously employed and unemployed who had never worked. RESULTS The unemployed are at higher suicide risk than the employed. Among the PE, a significant association between inflation and suicide attempt was found, whereas no association was reported concerning completed suicides. No association was found between completed and attempted suicides among the employed, the NE and inflation. Completed suicide in females is significantly associated with unemployment in every quarter-year. CONCLUSION The reported vulnerability to suicidal behaviours among the PE as inflation rises underlines the need of effective support strategies for both genders in times of economic downturns.
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Affiliation(s)
- Paola Solano
- Department of Neurosciences, Ophtalmology and Genetics, Section of Psychiatry, San Martino Hospital, University of Genova, Italy
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Höfer P, Rockett IRH, Värnik P, Etzersdorfer E, Kapusta ND. Forty years of increasing suicide mortality in Poland: undercounting amidst a hanging epidemic? BMC Public Health 2012; 12:644. [PMID: 22883342 PMCID: PMC3543353 DOI: 10.1186/1471-2458-12-644] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/01/2012] [Indexed: 01/09/2023] Open
Abstract
Background Suicide rate trends for Poland, one of the most populous countries in Europe, are not well documented. Moreover, the quality of the official Polish suicide statistics is unknown and requires in-depth investigation. Methods Population and mortality data disaggregated by sex, age, manner, and cause were obtained from the Polish Central Statistics Office for the period 1970-2009. Suicides and deaths categorized as ‘undetermined injury intent,’ ‘unknown causes,’ and ‘unintentional poisonings’ were analyzed to estimate the reliability and sensitivity of suicide certification in Poland over three periods covered by ICD-8, ICD-9 and ICD-10, respectively. Time trends were assessed by the Spearman test for trend. Results The official suicide rate increased by 51.3% in Poland between 1970 and 2009. There was an increasing excess suicide rate for males, culminating in a male-to-female ratio of 7:1. The dominant method, hanging, comprised 90% of all suicides by 2009. Factoring in deaths of undetermined intent only, estimated sensitivity of suicide certification was 77% overall, but lower for females than males. Not increasing linearly with age, the suicide rate peaked at ages 40-54 years. Conclusion The suicide rate is increasing in Poland, which calls for a national prevention initiative. Hangings are the predominant suicide method based on official registration. However, suicide among females appears grossly underestimated given their lower estimated sensitivity of suicide certification, greater use of “soft” suicide methods, and the very high 7:1 male-to-female rate ratio. Changes in the ICD classification system resulted in a temporary suicide data blackout in 1980-1982, and significant modifications of the death categories of senility and unknown causes, after 1997, suggest the need for data quality surveillance.
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Affiliation(s)
- Peter Höfer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna,Vienna, Austria
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Abstract
Background: As in several other countries, inquiries after a suspected suicide in England and Wales now routinely seek to include both medico-legal and family perspectives on the character and motivations of the person who died. Little research attention, however, has been paid to the reactions of the bereaved to the coroner’s verdict. Aims: To explore people’s accounts of their acceptance or resistance to the verdict and the resources they draw upon in explaining their perspectives, especially when these contraindicate the coroner’s verdict. Methods: Indepth interviews with 40 people who had been bereaved by suicide, followed by qualitative analysis, combining thematic analysis with constant comparison. Results: Bereaved relatives who saw the suicide verdict as a correct reflection of events drew on the conventional constructions of suicide used by coroners, and (thus) the media. Relatives who resisted a suicide verdict referred to their privileged knowledge and beliefs about the person who had died, producing claims about their character, relationships, and motivations which often contradicted the conventional cues, such as a diagnosis of mental illness, previous attempts at suicide, method used, and suicide notes. For some relatives an open verdict was acceptable, even desirable, while for others it left too much uncertainty. Conclusions: The findings have implications for coroner’s practice, understanding varied responses of people bereaved by suicide, and for future research.
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Affiliation(s)
- Alison Chapple
- Department of Primary Health Care, University of Oxford, UK
| | - Sue Ziebland
- Department of Primary Health Care, University of Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, UK
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Reynders A, Scheerder G, Van Audenhove C. The reliability of suicide rates: an analysis of railway suicides from two sources in fifteen European countries. J Affect Disord 2011; 131:120-7. [PMID: 21129779 DOI: 10.1016/j.jad.2010.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 11/09/2010] [Accepted: 11/09/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND National suicide data are an underestimation of the actual number of suicides but are often assumed to be reliable and useful for scientific research. The aim of this study is to contribute to the discussion of the reliability of suicide mortality data by comparing railway suicides from two data sources. METHODS Data for the railway suicides and the concurrent causes of death of fifteen European countries were collected from the European Detailed Mortality Database and the European Railway Agency (ERA). Suicide rates, odds ratios and confidence intervals were calculated. RESULTS The suicide data from the ERA were significantly higher than the national data for six out of fifteen countries. In three countries, the ERA registered significantly more railway suicides compared to the sum of the national suicides and undetermined deaths. In Italy and France, the ERA statistics recorded significantly more railway related fatalities than the national statistical offices. In total the ERA statistics registered 34% more suicides and 9% more railway fatalities compared with the national statistics. LIMITATIONS The findings of this study concern railway suicides and they cannot be extrapolated to all types of suicides. Further, the national suicide statistics and the ERA data are not perfectly comparable, due to the different categorisations of the causes of death. CONCLUSIONS Based on the data for railway suicides, it seems that the underestimation of suicide rates is significant for some countries, and that the degree of underestimation differs substantially among countries. Caution is needed when comparing national suicide rates. There is a need for standardisation of national death registration procedures at the European level.
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Petik D, Czeizel B, Banhidy F, Czeizel AE. A study of the risk of mental retardation among children of pregnant women who have attempted suicide by means of a drug overdose. J Inj Violence Res 2011; 4:10-9. [PMID: 21502792 PMCID: PMC3291287 DOI: 10.5249/jivr.v4i1.85] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 07/15/2010] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND The aim of the study was to estimate the effect on the fetal development of high doses of prescription drugs taken as a suicide attempt during pregnancy. METHODS Pregnant women were identified among self-poisoned females in the toxicological inpatient clinic in Budapest between 1960 and 1993. Congenital abnormalities, intrauterine development based on birth weight and post-conceptional age, mental retardation, cognitive-behavioral status were compared in exposed children born to mothers who had attempted suicide by means of a drug overdose during pregnancy with their siblings, born either before or after the affected pregnancy, as sib controls. RESULTS Of a total of 1 044 pregnant women, 74 used the combination of amobarbital, glutethimide and promethazine (Tardyl®, one of the most popular drugs for treatment of insomnia in Hungary) for suicide attempt. Of these 74 women, 27 delivered live-born babies. The mean dose of Tardyl® used for suicide attempts was 24 times the usually prescribed clinical dose. The rate of congenital abnormalities and intrauterine retardation was not higher in exposed children than in their sib controls. However, of the 27 exposed children, eight (29.6%) were mentally retarded (X²₁=79.7, p= Sig) while mental retardation did not occur among 46 sib controls. These exposed children were born to mothers who attempted suicide with Tardyl® between the 14th and 20th post-conceptional weeks. The components of Tardyl® used separately for a suicide attempt during pregnancy were not associated with a higher risk of mental retardation. Therefore the high doses of Tardyl® associated with the high risk for mental retardation may be due to the interaction of its three drug components. CONCLUSIONS The findings of the study showed that the high doses of a drug containing three components may be associated with a significantly increased risk for mental retardation without any structural defects, whereas each of these three component drugs taken alone was not associated with this adverse effect.
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Affiliation(s)
- Dora Petik
- Foundation for the Community Control of Hereditary Diseases, Budapest, Hungary
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