Suicide – A statistical analysis by age, sex and method

Relations of body dissatisfaction with self-injurious thoughts and behaviours in clinical and non-clinical samples: a meta-analysis of studies published between 1995 and 2022

Body dissatisfaction is a global public health concern. Self-injurious thoughts and behaviours (SITB), including suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI), have been documented as potentially significant correlates of body dissatisfaction. However, prior findings regarding associations between body dissatisfaction and SITB have been somewhat inconsistent. Therefore, this meta-analysis was conducted to determine the nature and strength of such associations in both clinical and non-clinical samples. A literature search identified 83 relevant articles and extracted 234 effect sizes. Using a three-level random-effects model, mean effect sizes (r values) for relationships between body dissatisfaction and suicidal ideation, suicide attempts, and NSSI in clinical samples were 0.29 (95% CI, 0.22-0.37), 0.16 (95% CI, 0.13-0.20) and 0.26 (95% CI, 0.19-0.34), respectively. In non-clinical samples, these values were 0.22 (95% CI, 0.16-0.28), 0.24 (95% CI, 0.17-0.30) and 0.22 (95% CI, 0.15-0.29), respectively. Several study features (e.g., participant age, geographic region and instrument validity) emerged as significant moderators. This meta-analysis provides robust support for body dissatisfaction as a significant correlate of SITB across clinical and non-clinical samples in addition to identifying study characteristics that contribute to effect size variability. Implications are discussed for SITB research, prevention and intervention.

Forensic analysis of suicide deaths: Comparing forensic information with public information and investigating factors contributing to psychiatric consultations

Aim

This study aimed to examine the usefulness of forensic information on suicide deaths in Japan for epidemiological studies on suicide and determine the factors that lead people with suicidal ideation to seek psychiatric care prior to attempting suicide.

Methods

We focused on forensic information of 514 suicide deaths that occurred in Osaka City in 2019. First, to examine whether the data used in this study can be generalized to these cases, we compared the information on suicide deaths officially published by Osaka City with that used in this study, utilizing Pearson's χ 2 test. Next, the forensic data were analyzed using multivariate logistic regression analysis to confirm the relationship between demographic factors and the likelihood of having a history of psychiatric consultation before suicide.

Results

Both the official information and the data used in this study showed a higher number of males than females who died by suicide, with no significant differences in values between the data sets. Multivariate logistic regression analysis showed significant correlations. More females were associated with seeking a psychiatric consultation. However, those with regular jobs or students were more likely to avoid a psychiatric consultation.

Conclusion

The findings of this study provide insights into the phenomenon of suicide deaths by using a forensic perspective. The results of this study suggest that psychiatric consultation may be effective in reducing deaths by suicide. Forensic data should be incorporated into the formulation of suicide-prevention policies in Japan to conduct a more multifaceted analysis and improve suicide-prevention measures.

Characterization of Psychiatric Inpatients: The Role of Gender Differences in Clinical and Pharmacological Patterns

BACKGROUND

Severe mental disorders that require hospitalization are disabling conditions that contribute to the burden of mental diseases. They pose increased clinical challenges and highlight the need to thoroughly explore variables emerging from daily clinical practice. In this study, we assessed to what extent gender differences may characterize a large population of psychiatric inpatients.

METHODS

We conducted a cross-sectional study in 2 Italian teaching medical centers, which included 2358 patients who were consecutively admitted to the psychiatric emergency units. We explored and characterized gender differences for variables such as prevalence of psychiatric diagnosis, presence of suicidal ideation, suicide attempts, age at onset of psychiatric illness, presence of substance or alcohol abuse, length of stay, number of hospitalizations, presence of involuntary admission, type of discharge from the hospital, and pharmacological treatment at discharge.

RESULTS

Female patients were primarily diagnosed with bipolar disorder or personality disorders. Female patients had a significantly higher prevalence of lifetime suicide attempts (23.1% vs. 16.5%, P<0.001) and a longer length of hospitalization (11.43±10.73 d vs. 10.52±10.37 d, t=-2.099, gl=2356, P=0.036) compared with male patients. Male patients had more involuntary admissions (25.1% vs. 19.7%, χ2=9.616, gl=1, P=0.002), more use of illicit substances (34.1% vs. 20.9%, χ2=51.084, gl=1, P<0.001), and higher rates of alcohol abuse (21.3% vs. 14.7%, χ2=17.182, gl=1, P<0.001) compared with female patients. Finally, antidepressants and lithium were prescribed more frequently to the female patients, whereas other mood stabilizers were more often prescribed to the male patients.

CONCLUSIONS

Our real-world results highlighted gender differences among patients with severe mental disorders admitted to psychiatric units, and suggest further investigations that may help in understanding trajectories accompanying disabling clinical conditions.

Is Lethality Different between Males and Females? Clinical and Gender Differences in Inpatient Suicide Attempters

According to the gender paradox in suicidology, an important sex difference has been reported with a preponderance of females in nonfatal suicidal behavior and a preponderance of males in completed suicide. Furthermore, females and males present different risk factors for suicide. The present study explored possible clinical differences between male and female psychiatric inpatients who had recently attempted suicide. The study included 177 adult inpatients hospitalized following a suicide attempt at the University Psychiatric Clinic, Sant'Andrea Hospital, Sapienza University of Rome. Clinical features assessed included psychiatric diagnosis, method and lethality of suicide attempts using the Risk/Rescue Rating Scale, the history of suicide attempts, age at onset of psychiatric illness, the presence of substance or alcohol use, and the length of stay. The results found that males and females differed in the method used for the suicide attempt, the scores for risk and rescue, and the length of hospitalization post-suicide attempt. In conclusion, identifying gender characteristics of patients at higher risk of suicide is important for implementing specific suicide prevention strategies and reducing the risk of future suicidal behavior in psychiatric inpatients.

Exploring the Impact of the COVID-19 Pandemic on Male Mental Health Emergencies Attended by Ambulances During the First National "Lockdown" in the East Midlands of the United Kingdom

The novel coronavirus disease 2019 (COVID-19) pandemic and associated mitigation strategies such as “lockdown” are having widespread adverse psychological effects, including increased levels of anxiety and depression. Most research using self-reported data highlights the pandemic’s impact on the psychological well-being of females, whereas data for mental health emergency presentations may reflect the impact on male mental health more accurately. We analyzed records of male mental health emergencies occurring in the East Midlands of the United Kingdom during the first national “lockdown.” We computed two binary logistic regression models to (a) compare male mental health emergencies occurring during “lockdown,” 2020 (5,779) with those occurring in the same period in 2019 (N = 4,744) and (b) compare male (N = 5,779) and female (N = 7,695) mental health emergencies occurring during “lockdown.” Comparisons considered the characteristics of mental health emergencies recorded by ambulance clinicians (Primary Impressions), and the socioeconomic characteristics of communities where emergencies use the Index of Multiple Deprivation. We found that during “lockdown,” male emergencies were more likely to involve acute anxiety (odds ratio [OR]: 1.42) and less likely to involve intentional drug overdose (OR: 0.86) or attempted suicide (OR: 0.71) compared with 2019. Compared with females, male emergencies were more likely to involve acute behavioral disturbance (OR: 1.99) and less likely to involve anxiety (OR: 0.67), attempted suicide (OR: 0.83), or intentional drug overdose (OR: 0.76). Compared with 2019, and compared with females, males experiencing mental health emergencies during “lockdown” were more likely to present in areas of high deprivation. Understanding the presentation of male mental health emergencies could inform improved patient care pathways.

Sensitivity is the dimension of temperament most associated with the progression from ideation to suicide attempts

BACKGROUND

To analyze the association between temperament (emotional and affective) and scrutinize the progression from suicide ideation to attempt, by using data from a large internet-based sample.

METHODS

It is a cross-sectional study, based on the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Temperament was assessed by the Affective and Emotional Composite Temperament Scale (AFECTS), and life-long suicidal behavior was determined by the adapted Suicidal Behaviors Questionnaire (SBQ-17). Odds ratios were obtained through multivariate logistic regression and a multiple linear regression were used in the analysis. According to the "ideation-to-action framework", we performed analyzes using two different reference groups: no suicidal ideation and suicidal ideation.

RESULTS

The affective temperaments that showed the greatest association with suicide attempts were depressive, cyclothymic, and volatile. The temperaments that reflected higher associations for progression from ideation to suicide attempt were cyclothymic, depressive, and euphoric. Sensitivity was manifested as the emotional temperament with the strongest positive association with the severity of suicidal behavior, followed by desire and control. Stability was estimated as the emotional trait with the strongest negative association with the severity of suicidal behavior.

LIMITATIONS

It is not a population based sample. BRAINSTEP is a self-selected sample whose participants are mostly women, who are highly educated and young.

CONCLUSIONS

Our results suggest that temperament assessment using AFECT model may be relevant to assess the risk for the progression from ideation to suicide attempts. These results strengthen the "ideation-to-action" framework that risk factors to suicide ideators can differ from suicide attempters.

Distinct psychopathology of patients who attempted suicide with rodenticide in Taiwan: a comparative study with patients of suicide with paraquat

Objective

Rodenticide as a means of suicide has been documented for centuries. However, this method is often discussed in conjunction with other pesticides. Thus, we aimed to focus on patients who committed suicide with rodenticide and compared them with those who used paraquat for suicide, another frequently used yet lethal method, to highlight the different psychopathology of patients who choose rodenticide as their means of suicide.

Methods

A 12-year retrospective chart review was conducted on the medical records of all patients admitted to Chang Gung Memorial Hospital due to attempted suicide by either rodenticide or paraquat. Psychiatric consultation sheets were collected to ascertain the psychiatric comorbidity and the major stressor for suicide, measured by the Social Readjustment Rating Scale. A χ² test and logistic regression were used for group comparisons.

Results

Seventeen rodenticide and 157 paraquat suicide attempts were identified. Compared with suicides by paraquat, suicides by rodenticide had a more even distribution in the gender ratio but a lower Social Readjustment Rating Scale score (p<0.001). Depressive disorder was the most common diagnosis in suicides by rodenticide and paraquat. However, schizophrenia and psychotic disorder (29.4%) was the second most common diagnosis and a significant predictor of suicide by rodenticide (odds ratio =9.21, 95% confidence interval =1.2–66.07, p=0.027).

Conclusion

High comorbidity of psychosis in suicide by rodenticide warrants disease-specific suicide prevention and additional large-scale research to confirm this association.

Communities being well for family well-being: Exploring the socio-ecological determinants of well-being in an Inuit community of Northern Quebec

Inuit communities of Canada experience many disparities in health and psychosocial context. Research in community psychology has shown associations between such socio-ecological factors and individual well-being. The objective of the study was to explore how community-level determinants of well-being influence family well-being in a northern community of Nunavik, Quebec. A total of 14 participants were interviewed. A thematic inductive analysis was conducted to extract community determinants of family well-being from the data. A system science approach was used to explore the associations between determinants and larger psychosocial dynamics. A community workshop was held to discuss the results and their meaning. A total of 25 determinants were coded, 16 of which were community-level. Community-level stressors were highly interrelated, whereas community supports were generally disconnected and superimposed on narratives of stressors. Participants spoke of desired supports. In their narratives, these supports were connected to a variety of determinants of well-being, suggesting the need to connect, redefine and support existing resources rather than simply add on new ones. We discuss intricate links between family and community well-being in small and geographically isolated communities.

Amygdala functional connectivity in female patients with major depressive disorder with and without suicidal ideation

BACKGROUND

Major depressive disorder (MDD) is a known major risk factor for suicide and is one of the most common mental disorders. Meanwhile, gender differences in suicidal behavior have long been recognized including the finding that women have higher rates of suicidal ideation and/or suicidal behavior than men. The mechanism underlying suicide ideation in female patients with MDD remains poorly understood. The aim of the present study was to examine possible suicidal behavior-related neural circuitry in female MDD.

METHODS

In this study, 15 female participants with the first-episode MDD with suicidal ideation and 24 participants with the first-episode MDD without suicidal ideation as well as 39 female participants in a healthy control (HC) group, ranging in age from 18 to 50 years, underwent resting-state functional magnetic resonance imaging. The whole-brain amygdala resting-state functional connectivity (rsFC) was compared among these three groups.

RESULTS

Compared with female participants with the first-episode MDD without suicidal ideation and those in the HC group, female participants with the first-episode MDD with suicidal ideation showed a significant difference in rsFC between the amygdala and precuneus/cuneus (p < 0.05, corrected). No significant difference in amygdala-precuneus/cuneus rsFC was observed between female patients with the first-episode MDD without suicidal ideation and the HC group (p < 0.05, corrected).

CONCLUSIONS

Our findings suggest that suicidal ideation in female patients with the first-episode MDD may be related to an abnormality in amygdala neural circuitry. The abnormality in amygdala-precuneus/cuneus functional connectivity might present the trait feature for suicide in women with the first-episode MDD. The precuneus/cuneus may be an important region related to suicide and require future study.

Gender differences in exposure and vulnerability to psychosocial and behavioral factors of suicide attempt among Korean adolescents

INTRODUCTION

This study examined gender differences in suicide attempts and their association with exposure and vulnerability to psychosocial, behavioral, and structural factors among Korean adolescents.

METHODS

Data of 74 854 adolescents, taken from the 2010 Korea Youth Risk Behavior Survey, were used. Logistic regression analysis was used to assess the contribution of differential exposure to psychosocial, behavioral, and structural factors for gender differences of suicidal attempt.

RESULTS

Gender differences were observed in the degree of exposure to the various factors. Females were more likely to report psychosocial problems, whereas males were more likely to report experience of smoking and drinking alcohol and to engage in vigorous physical activity. Stress and unhappiness were significantly associated with suicide attempts in both males and females, and gender differences in these variables were nonsignificant. Depressive symptoms were associated with a higher risk of suicide attempts, and this relationship was significantly stronger for males. The effects of cigarette smoking and risky drinking were significantly stronger in females.

DISCUSSION

Greater exposure to perceived stress, feelings of unhappiness, depression, and higher vulnerability of smoking and heavy drinking accounted for higher suicide attempts of female adolescents. Higher exposure to health-related behaviors and greater vulnerability to depressive symptoms in male were also noted. In conclusion, differences in exposure and vulnerability to psychosocial and behavioral factors may partly explain gender differences in suicide attempts among Korean adolescents.

Men and suicide prevention: a scoping review

BACKGROUND

Male suicide rates are higher than their female counterparts in almost every country around the world. Several developed countries have attempted to implement suicide prevention programmes, but few have specifically targeted men.

AIMS

To identify what is currently known about suicide prevention strategies, programmes, and interventions of relevance to men.

METHOD

A scoping review guided by Arksey and O'Malley's five-stage framework.

RESULTS

Twenty-two studies were included. Thematic analysis identified three categories: (i) male suicide prevention interventions; (ii) factors or coping strategies that interrupt the suicidal process in men; (iii) men's perspectives on service provision. Interventions included awareness campaigns; training of community "gatekeepers"; psychological support; and educational initiatives targeted to either GPs or depressed or suicidal men. Men emphasised the need to receive support from a trusted and respected individual, preferably in an informal setting. Connecting with others, reframing help-seeking as masculine, and the use of emotional regulation techniques were all identified as factors with potential to interrupt the suicidal process.

CONCLUSIONS

This review demonstrates the need for further research examining the perspectives of suicidal middle-aged men and their close family and friends.

Changing rates of suicide ideation and attempts among Inuit youth: a gender-based analysis of risk and protective factors

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15-24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross-sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long-term impacts on Inuit youth, as well as exposure to culturally meaningful activities.

Evaluation of suicide cases in Turkey, 2007-2012

Background

The aim of this study was to determine the demographic and sociocultural characteristics of suicide attempts by using data from the Turkish Statistical Institute. It is our intent that the work data may contribute to the national suicide data and the development of suicide prevention policies.

Material/Methods

We obtained our data, which cover the years 2007 to 2012, from the database accessible at the official website of the Turkish Statistical Institute, which permits the use of its data for research purposes. The data were evaluated by using the SPSS 10.0 program. The chi-square test was used for statistical analysis, and the percentage distribution and odds ratios were calculated.

Results

According to data from the Turkish Statistical Institute, the total number of suicide deaths in Turkey between 2007 and 2012 changed yearly (χ²=42,035–59,209; P<0.001). While suicide deaths in 2007 made up 0.00396% of the total deaths for that year, that figure increased to 0.00426% in 2013. According to the data from the Turkish Statistical Institute, over 1.9 million people died due to all causes between 2007 and 2012 in Turkey. Over 17,000 deaths (0.9%) were due to suicide.

Conclusions

Suicide is an important public health problem and is multidimensional in nature. Examining this subject from etiological, epidemiological, biological, psychological, sociological, and anthropological perspectives is important to improve the prevention of suicides.

Gender-specific differences among patients treated for suicide attempts in the emergency departments of four general hospitals in Shenyang, China

OBJECTIVE

We aimed to identify gender-specific characteristics of suicide attempters admitted to general hospital emergency departments in urban China.

METHODS

The Structured Clinical Interview for the DSM-IV, the Suicide Ideation Scale, the Hamilton Depression Rating Scale and a quality of life measure were administered to 239 suicide attempters who were treated consecutively in the emergency departments of four general hospitals randomly selected in Shenyang, China.

RESULTS

Among the 239 enrolled subjects, 53 (22.2%) were men, and 186 (77.8%) were women. Compared to women, men were more likely to be a minority, live with their families and/or suffer from substance-related disorders. Men were less likely to be living alone or cohabitating. Women were more likely to express suicide ideation compared with men. Thirty-seven (69.8%) men and 129 (69.4%) women had mental illness. The prevalence of psychiatric diagnosis was not significantly different between men and women (χ(2)=.004, df=1, P=.95).

CONCLUSION

The rate of attempted suicide is higher among women than among men in the emergency departments of urban China. Except for race, living situation and suicide ideation, there are few gender differences regarding socio-demographic and clinical characteristics in the current study that are not consistent with reports from other countries. However, similar to other studies, men are more likely to suffer from substance-related disorders than are women. The unique, gender-specific characteristics pertaining to suicide attempters in urban China emphasizes the need for gender-specific interventions in future clinical treatment.

The gender paradox in suicidal behavior and its impact on the suicidal process

BACKGROUND

An important gender difference has been reported regarding suicidal behavior with an overrepresentation of females in nonfatal suicidal behavior and a preponderance of males in completed suicide, also known as the 'gender paradox of suicidal behavior'. The concept of a 'suicidal process' classifies suicidal behavior chronologically; this process starts with suicidal ideation and then implies a progression of suicidality ranging from suicidal ideation over plans to suicide attempts and finally fatal suicide.

AIMS/METHODS

The current paper aims to deepen the knowledge on the gender paradox by collecting and discussing the recent literature on this topic: the most relevant, impacting gender-related factors will be discussed within the suicidal process concept.

RESULTS

Several factors had a gender-dependent impact on suicidal behavior: psychosocial life stressors such as stressful life events but also sociodemographical or socio-economical factors, and sexual abuse. The gender differences in psychiatric (co)morbidity and in response to or attitude towards antidepressant treatment also appear to have an impact. Furthermore, not only suicide methods but also the gender-dependent variation in reporting suicide has an influence. Finally, the gender differences in help seeking behavior as well as region-dependent cultural beliefs and societal attitudes are discussed.

CONCLUSIONS

Especially life-events seem to exert an important influence at the beginning of a suicidal process, whereas the other factors occur at a further stage in the process, however without a fixed chronology. Also, the duration of the suicidal process is much shorter in male than in females. Finally, some implications with regard to clinical practice and suicide prevention are suggested.

Konya’da 2000-2005 Yılları Arasında Gerçekleşen İntihar Orijinli Ölüm Olgularının Retrospektif Değerlendirilmesi

İntihar; tüm yaş, ırk ve sınıftaki insanları etkileyen, ölüm nedeni olarak erişkin ve adolesan yaş grubunda daha sık karşımıza çıkan adli bir olaydır. Bu çalışmada, Konya ilinde intihara bağlı ölüm olgularının sosyodemografik özelliklerinin ve adli tıp açısından öneminin belirlenmesi, elde edilen verilerin literatür bilgileri ışığında değerlendirilmesi amaçlanmıştır. Konya Adli Tıp Şube Müdürlüğü’nce 01.01.2000 ve 31.12.2005 tarihleri arasında ölü muayene ve otopsisi yapılan 2698 olgu içinden orijini intihar olarak bildirilen 220 (%8.2) olgu, retrospektif şekilde değerlendirildi. Bu olgular; yaş, cinsiyet, kullanılan intihar yöntemi, aylara ve günlere göre dağılımı, tanısı konmuş psikiyatrik bir hastalık ve daha önceden intihar girişimi mevcut olup olmadığı yönünden incelendi. 220 intihara bağlı ölüm olgusundan 157’si (%71.4) erkek, 63’ü (%29.6) kadın idi. Olgularımızın yaşları 10 ile 94 arasında değişmekte olup, ortalama yaş 38.7 + 18.7 bulundu. İntiharlara bağlı ölüm, 54 (%24.5) olgu ile en sık 20-29 yaş grubunda meydana gelmişti. Olguların kullandığı intihar yöntemi değerlendirildiğinde, 105 (%47.8) olguda ası ilk sırada olup, bunu 51 (%23.2) olgu ile ateşli silah yaralanmaları (30 Av Silah Mermi Çekirdeği (ASMÇ), 21 Av Tüfeği Saçma Taneleri (ATST)), 39 (%17.7) olgu ile zehirlenmeler, 15 (%6.8) olgu ile yüksekten atlamalar izlemekteydi. Çocuk ve gençlerimize okullardaki psikolojik danışma ve rehberlik servisinin aktif ve etkili olarak hizmet vermesinin, daha önceden intihar girişimi öyküsü bulunan, başta depresyon olmak üzere psikiyatrik rahatsızlığı olan ve intihar eğilimi bulunan bireylerin ülkemiz çapında örgün, kolay erişilebilir psikolojik danışma hizmetlerinden yararlanmasmm sağlanmasının, intihar girişim oranmda ve intihara bağlı ölümlerin sayısında azalma sağlayacağını düşünmekteyiz.Anahtar kelimeler: İntihar, adli tıp, ölüm.