Suicides in Northern India: comparison of trends and review of literature

Suicide Attempt by Hanging - A Study on Patients Admitted in Tertiary Care Hospital in Eastern India

Background

Suicide is defined as a fatal self-injurious act with some evidence of intent to die. Despite the evolution of sophisticated methods to commit suicide, hanging remains one of the commonest methods to commit suicide across the world. To evaluate the individuals using hanging as a method of suicide and identify the contributing factors for this behaviour.

Material and Methods

The study was carried out in a tertiary care hospital, over a period of 1 year on the suicide attempters using the method of hanging. Semi-structured in-depth interviews were conducted with all the 46 attempters. The questions focused on the precipitating events present before the attempt. After the in interview the risk factors of the conversations were identified, tabulated and categorized using descriptive analysis.

Results

Findings from descriptive analysis reveals that significant age group using this method was below 19 years followed by 20-29 age group, female attempters were more compared to male. Psychiatric diagnosis was present in 8 attempters and 4 attempters had alcohol/substance dependence. The most common personality component in attempters was impulsivity. The most common immediate stressor found were financial stress, conflict with family, spouse, humiliation, substance abuse, exam stress and domestic violence.

Conclusion

This study demonstrates that the reasons for suicide attempt by hanging is multifactorial. which includes, psychiatric diagnosis, personality factors, immediate stressors, ease of use, and accessibility, Overall, our study adds to understanding the intricates of this method and will help in developing effective suicide prevention strategies.

Sociodemography, pattern, and response inhibition in suicide survivors: A case-control study

Introduction

Suicide is a global phenomenon. Psychiatric disorders are estimated to contribute to a large proportion of suicides; however, impulsive suicide is also common. Among the ages of 15-29 years, suicide was the second leading cause of death worldwide and has been hypothesized to have reduced response inhibition and decision-making abilities as contributing factors, which directly relate to impaired executive functioning and suicidal behavior.

Aim

This study aimed to study sociodemography, method, and pattern of suicide, and response inhibition in suicide survivors.

Material and Methods

A case-control study was designed in a tertiary medical center in Madhya Pradesh using convenient sampling of suicide survivors and controls from the general population over 3 months. Data collection was semi-structured pro forma, and response inhibition was assessed using the Stroop test. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) Windows version 25.0. Independent-samples Student's t-test, Chi-square test, and Mann-Whitney U-test were used for analyzing means of continuous data, nominal data, and ordinal data, respectively. The level of significance was at P < 0.05.

Result

A total of 126 suicide survivors and 99 controls were assessed after the end of the study period. Age (mean age for cases 25.4 ± 9.16; controls 23 ± 7.9), gender (F ~ M), and socioeconomic status were used to match cases and controls. 85.7% of suicide survivors had no history of suicide, but the majority had precipitating factors. Anomic suicide was the most common type, and poisoning was the most common method of suicide. Response inhibition between cases and control was significantly different.

Conclusion

The majority of suicide attempts were impulsive in youth, with no gender discrimination. Response inhibition seemed to play a role in a suicide attempt.

Exploring the epidemiology of suicide attempts: Risk modeling in Kermanshah-Iran

Background

Suicide attempt is a serious global public health issue. The patterns of suicide may vary depending on the individual characteristics, methods, causes, and the geographical area-also socio-cultural context that determine it. This study identifies the spatial patterns of suicide attempts in Kermanshah province, Iran.

Method

The sample size of this cross-sectional study is 18,331 people (7234 males and 11097 females) who attempted suicide in Kermanshah province between 2006 and 2014. Data was collected from the records of patients referred to the emergency department of hospitals in Kermanshah and analyzed using tests of Mean Center, Standard Distance, and Average Nearest Neighbor.

Results

The results of the mean center and standard distance tests show that drug overdose, poisoning with toxins and pesticides, and chemicals mostly were used in the central areas of Kermanshah province. The mean center of suicide attempts by self-immolation, hanging and firearms was in the western parts of the province, while the suicide attempts with narcotic drug were concentrated in the eastern regions of the province. Out of the 18,331 cases, 74% attempted suicide with drug overdose, 13% with toxins and pesticides, 0.59% with chemicals, 4% with fire, 1% by self-immolation, 1% by hanging, 0.16% with firearms and 0.7% with cold weapons. The spatial pattern of all suicide attempts in Kermanshah was clustered (Z-score < -2.58).

Conclusion

The results of this study show that the methods of suicide attempt vary with geographical areas in the province. Therefore, it is suggested that planning tailored to the geographical location can reduce suicide attempts in Kermanshah.

Influence of the COVID-19 Pandemic on Parenting Stress Across Asian Countries: A Cross-National Study

Background: In a previous study, we demonstrated that the accumulation of parenting stress during prolonged school closures and restrictions on daily activities due to the COVID-19 pandemic in Japan indicates the need for mental health intervention for parents at higher risk of parenting stress. However, few studies have focused on parenting stress in other Asian countries, although they have experienced higher numbers of infections. The aim of the present study was to investigate whether parenting stress among caregivers increased across Asia due to school closures and restrictions on activities during the COVID-19 pandemic and to examine whether there were any country-specific, cross-country, or cross-regional risk factors for increased parenting stress. Methods: We conducted an online survey immediately after the number of new cases in India significantly increased (September-November 2020). We measured parenting stress, anxiety, and fear associated with the COVID-19 crisis, as evaluated by the Parenting Stress Index, Short-Form (PSI-SF), and the Coronavirus Anxiety Scale (CAS), across three Asian countries-India (n = 142), Malaysia (n = 69), and Japan (n = 182)-in addition to the United States (n = 203). We also investigated whether respondents had adverse childhood experiences (ACE) as a risk factor for parenting stress. Results: For all countries, we found significant increases in participants' current parenting stress levels, compared to what they recalled regarding their lives before COVID-19-related restrictions and school closures were enacted. Textual analysis qualitatively identified common terms related to parenting stress across all countries. We also found a statistical model that indicated ACE in parents was a critical risk factor for higher parenting stress via increasing anxiety and fear related to the pandemic. Conclusion: These results indicate the need to improve the mental health of caregivers who are at risk for higher levels of parenting stress during the COVID-19 pandemic in Asian countries as well as Western countries. These results indicate that there is a need to improve the mental health of caregivers who are at risk for higher levels of parenting stress during the COVID-19 pandemic globally.

Most Chinese Preschool Teachers Value Guided Play Over Free Play: Latent Profiles and Associated Predictors

Longitudinal research suggests that optimal long-term outcomes are achieved when early childhood education and care (ECEC) balance free with guided play. A prerequisite for this achievement is that ECEC teachers value both equally. This study examines preschool teachers' play beliefs profile and explores its association with teachers' backgrounds (e.g., teaching experience, education level) in a sample of 674 Chinese teachers in Fujian, China. Participants completed an adapted form of the Parent Play Belief Scale, the Chinese Teacher Play Beliefs Scale (CTPBS), to report their beliefs regarding young children's play and early academics. Latent profile analysis (LPA) revealed 91% of teachers exhibited high Academics over Guided Play (AGP) and low Free Play and Socio-Emotional Skills Support (FPSSS), whereas only 9% were high in both factors. Teachers with a decade or more teaching experience were more likely to belong to the high AGP and low FPSES profile. The findings indicate that the majority of Chinese ECEC teachers value guiding play to academic skills more than they do facilitating free play for socio-emotional skills. Professional development focused on balancing guided with free play may be necessary for the majority of Chinese ECEC teachers to catch up with the zeitgeist of contemporary international research and policy on intentional teaching in play.

Suicide methods in South Asia over two decades (2001-2020)

BACKGROUND

Suicide is a global preventable public health problem. About a quarter of all suicides in the world occur in South Asia. As means restriction is an important suicide prevention strategy, gaining knowledge of the common suicide methods and their changing trends in each country and region is crucial.

AIMS

We aimed to assess the suicide methods in South Asian countries over the last two decades.

METHODS

A search was performed in PubMed, PubMed Central, Scopus, and Google Scholar with the search terms. Original articles of quantitative studies, published in the English language, from 2001 to 2020, with full-accessible text, that rank different methods of suicide in eight South Asian countries, were included.

RESULTS

A total of 68 studies were found eligible for review. The Maximum number of studies were found from India (n = 38), followed by Bangladesh (n = 12), Pakistan (n = 9), Sri Lanka (n = 6), and Nepal (n = 3). Hanging (n = 40, 55.8%) and poisoning (n = 24, 35.3%) were the two most common suicide methods reported, in that order. Hanging followed by poisoning were the commonest suicide methods in Bangladesh, India, and Pakistan while in Sri Lanka, poisoning was the preferred method to hanging. There is a decline in suicide by poisoning and an increase in suicide by hanging in Sri Lanka, Bangladesh, and India. Although hanging is still the commonest method in Pakistan, the use of firearms is growing in recent years (2011-2020).

CONCLUSIONS

There is a steady decline in the incidence of suicides by poisoning following pesticide regulations in South Asian countries. However, there is heterogeneity of study methods, probable under-reporting of suicide, and lack of robust suicide data.

Evaluation of risk factors for Suicide Attempts in Turkey's East: A Five-Year Study

Objectives:

Suicide attempt has different risk factors for each community. In the study we aimed to reveal the causes of suicide attempt in Turkey’s Eastern part and to make suggestions to prevent suicide.

Methods:

For this study, 130 patients who were admitted to the Emergency Department of the University Hospital due to suicide attempt between January 2013 and December 2017 were included. Our University Hospital is the largest hospital in the East of Turkey. The data were obtained from hospital records and files of judicial investigations. Clinical progress records were obtained from the hospital archive. Investigation files were received from local judicial units.

Results:

Fifty six percent of the patients (n = 73) were female. 48% of female cases (n = 35) were married. There was major depressive disorder in 34% (n = 44) of the cases. Medicine taking was the most frequent suicide method with 63% (n = 82). The main reason for suicide was parental conflicts for female cases; and psychiatric and financial problems for males.

Conclusion:

Family therapy for married individuals would reduce suicide attempts in females. Psychiatric history is an important risk factor and it should be ensured that these patients are followed up regularly by the health institutions and their relatives. To prevent drug abuse, there should not be too much medicine in homes. If medicine is available at home, it should be kept in a safer environment.

Suicidal Ideation Among Adolescents-The Role of Sexual Abuse, Depression, and Impulsive Behavior

Suicide is the second leading cause of death among adolescents. With every fifth Indian to be an adolescent, the cost of an adolescent dying by suicide is enormous. This necessitates an understanding of the potential risk factors of suicidal ideation among adolescents. Secondary data analysis is performed on cross-sectional survey data obtained from Understanding the Lives of Adolescents and Young Adults. The survey was conducted in two Indian states of Bihar and Uttar Pradesh. Descriptive statistics, bivariate analysis and logistic regression are done to examine the results. Adolescent girls reported more suicidal ideation than boys. The odds of suicidal ideation are significantly higher among adolescents whose mother faced physical abuse and adolescents who themselves experienced sexual abuse. Adolescent boys and girls who have moderate depressive symptoms and impulsive behavior are significantly more likely to report suicidal ideation. The results help in identifying the adolescents who are at a particular risk for suicidal ideation while planning for intervention program for prevention of suicide.

Patterns of suicide in Kuwait from 2014 to 2018

OBJECTIVES

Suicide is a public health problem in many countries around the world and is one of the top ten causes of death internationally. We performed a retrospective study from 2014 to 2018 to study the patterns of suicide in Kuwait.

STUDY DESIGN

After reviewing files from the General department of Criminal Evidence, we collected a total of 297 in our study period that were signed out as suicide fatalities.

METHODS

The relationship between demographic factors (e.g. age, sex, residential area) and suicides were studied using various statistical methodologies.

RESULTS

The majority of the 297 samples were in the age range of 19-35 years (180; 60.6%) and 36-65 years (107; 36%). Males constituted the majority of cases (241; 81.1%). The sample consisted of 20 different nationalities. More than half of the 297 samples were Indian (179; 60.2%), whereas Kuwaitis were a minority (22; 7.4%). Hanging was the preferred method of suicide in our study population (269; 90.6%). The governorate of Ahmadi had the highest death toll (89; 30%), followed by Farwaniyah (77; 25.9%) and Jahra (64; 21.5%).

CONCLUSION

The government of the State of Kuwait needs to target the group that has the largest number of fatalities by increasing education and awareness of employers and employees to the danger of this condition and the driving factors that lead people to it.

A hospital-based cross-sectional study on suicidal poisoning in Western Uttar Pradesh

BACKGROUND AND AIMS

Poisoning is most common method of committing suicide in India. Objectives of this study to assess prevalence of suicidal poisoning among all poisoning cases, its socio-demographic profile and its reasons in all admitted cases of suicidal poisoning in hospital.

METHODS

A cross-sectional study was conducted on cases of poisoning of any age group admitted in the Chhatrapati Shivaji Subharti Hospital, Meerut. Poisoning cases with history or evidence of suicide were further interviewed. A semi-structured interview schedule in Hindi was used to collect data. Microsoft Excel 365 and R software version 3.6.0 were used for data entry and analysis respectively.

RESULTS

Among total 135 poisoning cases admitted in hospital, 126 provided consent and included in the study. Prevalence of suicidal poisoning was 77.7% (98). Most common age group involved was 11-20 years (36.7%) and 21-30 years (35.7%) and most of the participants were males (59.2%). Most suicidal poisoning cases took Aluminum Phosphide (31.6%), followed by Organophosphates (20.4%) as poison. Most frequent reasons for suicide as described by participants were 'Family quarrel or family unhappiness' (29.6%), 'failure in examination or interview or business' (23.5%), 'ill treatment by spouse or in laws' (16.3%) and 'unemployment' (9.2%).

CONCLUSION

Our study shows that consuming Agriculture poisons (Aluminum Phosphide and Organophosphates) are most common (52%) poisons consumed by suicidal poisoning cases. Agriculture poisons (Aluminum Phosphide and Organophosphates) are easily available in markets in India. There should be some restriction on their purchase to reduce suicidal incidences.

Suicides of Punjabi hawkers in 19th- and early 20th-century Australia

BACKGROUND

During the late nineteenth century, a considerable number of young Punjabi men sought their fortunes in the Australian colonies, working as hawkers and farm labor. While in Australia they experienced marginalization and high levels of racial vilification by the Anglo-Celtic settler community.

AIMS

To assess the frequency and nature of suicides of Punjabi workers in nineteenth century Australia.

MATERIALS AND METHODS

The paper draws on archival sources and contemporary newspaper reports.

RESULTS

A wide range of methods of suicides were observed, with drowning the preferred method.

CONCLUSIONS

This article is the first to collate the data on the suicides and suicide attempts by young Punjabi men working in an immigration country. It can be shown that the suicide rate among Punjabi was almost six times higher than that of the host community.

Phosphine Analysis in Postmortem Specimens Following Inhalation of Phosphine: Fatal Aluminum Phosphide Poisoning in Children

Phosphine is an insecticide for the fumigation of grains, animal feed, and leaf-stored tobacco, and it was used as a rodenticide in bulk grain stores. Phosphine poisoning may occur after accidental inhalation of phosphine, sometimes leading to death. Analysis of phosphine and its metabolites in postmortem specimens from seven fatal cases was conducted in this study, as well as postmortem specimens collected from rabbits exposed to phosphine. The total phosphine in postmortem specimens was analyzed by headspace gas chromatography coupled with mass spectrometry. Diagnosis of aluminum phosphide poisoning was made after postmortem toxicological analysis and confirmed by police investigation. The deaths of the children occurred after inhalation of phosphine generated from aluminum phosphide contacting moisture in the air in all seven fatal cases. The concentration of total phosphine in the biological fluids and tissues of victims ranged from 0.2 to 4.7 μg/mL (μg/g). Animal experiments demonstrated that the phosphine generated from aluminum phosphide could rapidly cause death. The toxicological analysis of postmortem specimens provides useful information in diagnosis of aluminum phosphide poisoning in forensic science. As an important fumigation pesticide, aluminum phosphide deserves special attention, especially since there is no specific antidote and there is a high fatality rate.

Comparing characteristics of suicide attempters with suicidal ideation and those without suicidal ideation treated in the emergency departments of general hospitals in China

Suicide attempts are more frequent than suicides, and suicidal ideation has been identified as an important precursor of both attempted and completed suicide. In this study, we compare the characteristics of suicide attempters with suicidal ideation and suicide attempters without suicidal ideation who were treated in the emergency departments of general hospitals in China. We identified 166 people as having suicidal ideation and 73 people who did not have suicidal ideation. The suicide attempters with suicidal ideation were more likely to be more depressed, older, have a lower score on life quality, female, divorced and unemployed, report having religious beliefs, have a suicide attempt history and a psychiatric diagnosis, and intend to reduce pain as motives. However, the suicide attempters without suicidal ideation were more likely to have a more self-rescue ideation and were more impulsive, and to threaten or intend revenge on others as motives. Multivariate logistic regression analysis identified the following independent predictors of suicidal ideation in the suicide attempters: a higher score on Hamilton Depression Rating Scale, religious beliefs, non-impulsive suicide attempts, and a psychiatric diagnosis. The results indicate the importance of developing different interventions for the two groups to prevent future suicide in China.

Alcohol use by suicide victims in the city of Sao Paulo, Brazil, 2011-2015

Excessive alcohol consumption is a serious public health issue, because drunkenness affects critical judgment and self-control which could trigger violent and self-harm behavior, with thus a potential association between alcohol consumption and suicide deaths. The objective of the present study was to assess the association between alcohol consumption and suicide deaths in the city of Sao Paulo, Brazil, from 2011 to 2015, and its relationship with socio-demographic characteristics of the victims and the circumstances of the suicide. A cross-sectional retrospective study was conducted by collection of data from 1,700 suicide victims subjected to examination of blood alcohol concentration (BAC) from toxicology reports from the Institute of Legal Medicine of the State of Sao Paulo, Brazil. Alcohol was detected in blood samples of 30.2% of the victims and mean BAC levels were 1.73 ± 0.08 g/L. The mean age of the victims was 39.90 ± 0.75 years. The majority of the victims were male (74.6%) and the prevalence of positive BAC was higher amongst men (34.7%) than women (17.1%), p<0.05. The majority of the victims were white skinned (64.7%), but there was a higher proportion of victims with positive BAC among mulatto and black individuals, p<0.05. Hanging was the most prevalent suicide method in the sample (48.7%) and amongst men (55.4%), but amongst women it was jumping from a height (35%), p < 0.05.

Epidemiological study of suicide by physical methods between 1993 and 2013 in Ilam province, Iran

BACKGROUND

Suicide by aggressive physical methods such as firearms, hanging, and jumping is well known; however, different factors may influence a person while selecting a particular method. The aim of this study was to investigate the epidemiological factors involved in the selection and use of different physical methods for suicide over a long-term period in Ilam province, Iran.

METHODS

The present study was conducted retrospectively between 1993 and 2013 using recorded data from a comprehensive system for registration of suicide attempts in Ilam University of Medical Sciences. The epidemiological characteristics included person, time and place variables, and the outcomes of the suicide attempts. The chi square, univariate and multivariate logistic regression models were used for data analysis.

RESULTS

Totally, 1516 suicide attempts were evaluated (the annual incidence rate: 19/100,000 individuals). The most commonly used suicide method in females (88.4%) and males (38.9%) was self-immolation. Furthermore, the annual incidence rate among males and females was within the age group of 15-24 years (24.6 and 47.8/100,000 individuals). The risk of death by suicide in the age group of 55-64 years was 2.93 compared with the age group of 10-14 years (OR = 2.93; 95% CI = 0.64-13.54, P = 0.168).

CONCLUSION

This study revealed that self-immolation was the most selected physical method of suicide and had the highest incidence rate, and inflicted the survivors with severe physical and mental complications. In order to reduce the use of physical methods, especially self-immolation, life skills training becomes more important than ever.

Comparison of the characteristics of suicide attempters with major depressive disorder and those with no psychiatric diagnosis in emergency departments of general hospitals in China

BACKGROUND

Major depressive disorder (MDD) is a known major risk factor for suicide due to the high suicide mortality. However, studies comparing the characteristics of suicide attempters with major depressive disorder and those with no psychiatric diagnosis in China are very limited. This study examined and compared the sociodemographic and psychological characteristics of suicide attempters with MDD and those with no psychiatric diagnosis in emergency departments of general hospitals to better understand the risk factors for suicide attempts in China.

METHODS

All subjects were enrolled in the study between June 2007 and January 2008. A total of 127 suicide attempters-54 with MDD and 73 with no psychiatric diagnosis-were enrolled. The sociodemographic and clinical characteristics were compared between two groups using the statistical analysis performed using frequency distribution, Student's t test, Chi-square test, and Fisher's exact test and a logistic regression model.

RESULTS

Suicide attempters with MDD were more likely to be more depressive, older, divorced or separated, unemployed, and living alone, and more likely to write a suicide note, have suicide ideation, and be motivated by reducing pain and burden. Suicide attempters with no psychiatric diagnosis were more likely to be younger and more impulsive, have self-rescue, and be motivated by threatening or taking revenge on others. Multivariate logistic regression analysis identified the following independent predictors of suicide attempts in individuals with MDD: a lower score on the quality of life scale, more years of education, and suicide ideation.

CONCLUSIONS

The present study found both similarities and differences in the sociodemographic and clinical characteristics of suicide attempters with MDD and those with no psychiatric diagnosis in the emergency departments of general hospitals in China. These findings will help us to recognize the characteristics of suicide attempters in both groups and develop specific interventions for the two types of suicide attempters to prevent future suicide in China. For example, the suicide attempters with MDD in the emergency departments must be advised to the psychological clinic.

Epidemiological survey of intentional poisoning suicide during 1993-2013 in Ilam Province, Iran

BACKGROUND

Suicide is an important social tragic phenomenon which occurs by different tools or methods in different communities. Considering deliberate poisoning as a common and important method in Ilam province for suicide, the present study was launched to epidemiologically assess committing suicide in Ilam province, Iran, based on intentional poisoning.

METHODS

By a retrospective study, all the recorded data associated with intentional poisoning suicide in Ilam Province during 1993-2013 were analyzed. All the demographic variables and the suicides' outcomes were analyzed using the Chi-Square test, and the univariate and multivariate logistic regression models.

RESULTS

Totally, 6794 cases of suicide (annual incidence rate of 87.28/ 100, 000) associated with poisoning were evaluated. The incidence rate of suicide attempts was 84.63/ 100, 000 (94.51 in female and 74.98 in male) and the incidence rate of completed suicide was 2.17/ 100, 000 (1.94 in female and 2.40 in male). Also, the highest rates of attempted and completed suicide (annual incidence rate of 172.42 and 4.14, respectively) were attributed to the age group of 15-24 year.

CONCLUSION

Females had a greater tendency to commit suicide by poisoning, and the lower level of education, the age group of 15-24 years and single individuals were more associated with suicide using poisonings. The incidence of attempted suicide in females and completed suicide in males was higher in this method. Considering the high rate of suicide by poisoning, further attention and supervision on the sale and reserve of drugs and poisons is necessary. Meanwhile, it seems that due to momentary emotions during the pubertal stage, the risk of committing suicide is increased especially among unemployed individuals; therefore, performing an extensive psychotherapy intervention is needed in the societies with younger populations.

Characteristic Risk Factors Associated with Planned versus Impulsive Suicide Attempters

OBJECTIVE

The present study aimed to investigate predictors for planned suicide attempters.

METHODS

This study included 1,003 patients who attempted suicide and visited emergency department. They were divided into two groups, planned suicide attempters (SAs; n=133 [13.3%]) and impulsive SAs (n=870, [86.7%]), and the demographic variables, clinical characteristics, factors related to suicide, and psychiatric resources of the groups were compared.

RESULTS

Major depressive disorder and substance use disorders were more common among planned SAs than among impulsive SAs. Additionally, the planned SAs were older, more likely to be divorced, separated or widowed, and more likely to have comorbid medical illnesses, severe depression, higher suicidality, and self-blaming tendencies than the impulsive SAs. Financial problems and physical illnesses were more common in planned SAs but interpersonal conflicts were more frequent in impulsive SAs. Planned SAs had fewer previous suicide attempts but these were more serious suicide attempts. The presence of the hope to die, a written will, and suicidal ideation of a repetitive, intense, and continuous nature were predictive of planned SAs.

CONCLUSION

The present findings demonstrated that planned SAs had more severe psychopathology and medical illnesses than impulsive SAs. Therefore, screening for depression, substance use disorders, and suicidal plans among old and medically ill patients may be important for preventing suicide attempts.

Her life ended jumping from the fifth floor: the importance of scene investigation and the need for restrictive means to prevent jumping suicide

In January 2014, a dead woman was found lying near the back entrance of a building belonging to Bari University Hospital compound. After the external examination and identification of the corpse, through history, circumstances, and postmortem findings, it was supposed that the woman probably committed suicide, by jumping from the nearby building. But only after additional investigation of the scene was it possible to locate the window through which the victim had jumped, by assessing the height from which she leapt. We underline the importance of the examination of the scene. It has to be done with circumspection, even in cases that could be considered routine, paying attention to details, not excluding things that, at first glance, seem to be unnecessary. Inspection needs time, patience and accuracy, knowledge, competence, and intuition and must be the result of an efficient team action. Furthermore the occurrence of suicides, particularly jumping from a height, among immediate postdischarge psychiatric patients, stresses the importance of immediate follow-up treatment and alternative preventive strategies, considering, of course, the feasibility of structural means.

Factors associated with choice of high lethality methods in suicide attempters: a cross-sectional study

Background

Most attempted suicides have a low lethality, but hanging, drowning, and jumping from a great height have a high risk of completed suicide. The aim of this study was to assess the sociodemographic profiles of patients who attempted suicide using high lethality methods relative to all other methods of attempted suicide.

Methods

We retrospectively investigated all attempted suicides treated at a tertiary university hospital in Seoul between January 2008 and February 2012. The following variables were considered: the patients’ attempted suicide methods, age, sex, history of attempted suicides, previous psychiatric history, occupation, and living conditions. The suicide methods were categorized into two groups: high lethality (e.g., hanging, falling, and drowning) and low lethality methods (e.g., self-poisoning and cutting). We investigated risk factors related to the choice of high lethality methods.

Results

A total of 560 patients were enrolled in this study. Deliberate self-poisoning was the most common method of attempted suicide (61.6%), followed by cutting (22.5%), hanging (10.4%), falling (4.1%), and drowning (1.4%). In logistic regression analyses, odds ratios for the choice of high lethality methods were 1.02 (95% CI = 1.01 to 1.03, p < .01), 7.22 (95% CI = 3.06 to 17.04, P < .01), and 0.59 (95% CI = 0.35 to 0.99, p = .04) for age, previous attempted suicide with a high lethality method, and alcohol co-ingestion, respectively.

Conclusions

Our findings indicated that age and past attempted suicide using a high lethality method are associated with the use of high lethality methods for attempting suicide.

Suicide: An Indian perspective

Suicide is the third leading cause of death among young adults worldwide. There is a growing recognition that prevention strategies need to be tailored to the region-specific demographics of a country and to be implemented in a culturally-sensitive manner. This review explores the historical, epidemiological and demographic factors of suicide in India and examines the strategies aimed at the prevention of suicide. There has been an increase in the rates of suicide in India over the years, although trends of both increases and decline in suicide rates have been present. Distinct from global demographic risk factors, In India, marital status is not necessarily protective and the female: male ratio in the rate of suicide is higher. The motives and modes of suicide are also distinct from western countries. Preventive strategies implemented at a community level and identifying vulnerable individuals maybe more effective than global strategies.

Spatial clusters of suicide in the municipality of São Paulo 1996-2005: an ecological study

BACKGROUND

In a classical study, Durkheim mapped suicide rates, wealth, and low family density and realized that they clustered in northern France. Assessing others variables, such as religious society, he constructed a framework for the analysis of the suicide, which still allows international comparisons using the same basic methodology. The present study aims to identify possible significantly clusters of suicide in the city of São Paulo, and then, verify their statistical associations with socio-economic and cultural characteristics.

METHODS

A spatial scan statistical test was performed to analyze the geographical pattern of suicide deaths of residents in the city of São Paulo by Administrative District, from 1996 to 2005. Relative risks and high and/or low clusters were calculated accounting for gender and age as co-variates, were analyzed using spatial scan statistics to identify geographical patterns. Logistic regression was used to estimate associations with socioeconomic variables, considering, the spatial cluster of high suicide rates as the response variable. Drawing from Durkheim's original work, current World Health Organization (WHO) reports and recent reviews, the following independent variables were considered: marital status, income, education, religion, and migration.

RESULTS

The mean suicide rate was 4.1/100,000 inhabitant-years. Against this baseline, two clusters were identified: the first, of increased risk (RR=1.66), comprising 18 districts in the central region; the second, of decreased risk (RR=0.78), including 14 districts in the southern region. The downtown area toward the southwestern region of the city displayed the highest risk for suicide, and though the overall risk may be considered low, the rate climbs up to an intermediate level in this region. One logistic regression analysis contrasted the risk cluster (18 districts) against the other remaining 78 districts, testing the effects of socioeconomic-cultural variables. The following categories of proportion of persons within the clusters were identified as risk factors: singles (OR=2.36), migrants (OR=1.50), Catholics (OR=1.37) and higher income (OR=1.06). In a second logistic model, likewise conceived, the following categories of proportion of persons were identified as protective factors: married (OR=0.49) and Evangelical (OR=0.60).

CONCLUSIONS

This risk/ protection profile is in accordance with the interpretation that, as a social phenomenon, suicide is related to social isolation. Thus, the classical framework put forward by Durkheim seems to still hold, even though its categorical expression requires re-interpretation.

Suicide methods in Asia: implications in suicide prevention

As the largest continent in the World, Asia accounts for about 60% of World suicides. Preventing suicide by restricting access to suicide methods is one of the few evidence-based suicide prevention strategies. However, there has been a lack of systematic exploration of suicide methods in Asian countries. To amend this shortage, the current review examines the leading suicide methods in different Asian countries, their trend, their age- and sex- specific characteristics, and their implications for suicide prevention. In total, 42 articles with leading suicide methods data in 17 Asian countries/regions were retrieved. The epidemiologic characteristics and recent trends of common suicide methods reflect specific socio-cultural, economic, and religious situations in the region. Common suicide methods shift with the introduction of technologies and constructions, and have specific age- or sex-characteristics that may render the restriction of suicide methods not equally effective for all sex and age sub-groups. Charcoal burning, pesticide poisoning, native plant poisoning, self-immolation, and jumping are all prominent examples. In the information society, suicide prevention that focuses on suicide methods must monitor and control the innovation and spread of knowledge and practices of suicide "technologies". It may be more cost-effective to design safety into technologies as a way of suicide prevention while there is no rash of suicides yet by the new technologies. Further research on suicide methods is important for public health approaches to suicide prevention with sensitivity to socio-cultural, economic, and religious factors in different countries.

Blood alcohol levels in suicide by hanging cases in the state of Sao Paulo, Brazil

Suicide is one of the main causes of violent death worldwide, and has become a public health issue. Since alcohol consumption is associated with the increase in the number of suicides and hanging is one of the main methods used worldwide, the present study consists of an epidemiological analysis of BACs in victims of suicide by hanging autopsied in the State of Sao Paulo, Brazil. The objective of the present work was to establish an epidemiological profile and evaluate blood alcohol concentrations in victims of suicide by hanging in the State of São Paulo, Brazil, in the year of 2007. A cross-sectional retrospective study was conducted by collection of secondary data from autopsy reports of victims of hanging. According to the present study, positive results for alcohol were higher in male victims, but the mean BAC was higher in women.

Proximal risk factors and suicide methods among suicide completers from national suicide mortality data 2004-2006 in Korea

This study was conducted to examine differences in proximal risk factors and suicide methods by sex and age in the national suicide mortality data in Korea. Data were collected from the National Police Agency and the National Statistical Office of Korea on suicide completers from 2004 to 2006. The 31,711 suicide case records were used to analyze suicide rates, methods, and proximal risk factors by sex and age. Suicide rate increased with age, especially in men. The most common proximal risk factor for suicide was medical illness in both sexes. The most common proximal risk factor for subjects younger than 30 years was found to be a conflict in relationships with family members, partner, or friends. Medical illness was found to increase in prevalence as a risk factor with age. Hanging/Suffocation was the most common suicide method used by both sexes. The use of drug/pesticide poisoning to suicide increased with age. A fall from height or hanging/suffocation was more popular in the younger age groups. Because proximal risk factors and suicide methods varied with sex and age, different suicide prevention measures are required after consideration of both of these parameters.

Suicides in Turkey between 1996 and 2005: general perspective

Suicide is a significant problem in the world. Sharing the information about the national suicide rates in the international scientific area is an important issue for not only the solution of the problem, but also improving the efforts for decreasing the suicidal deaths. We aimed to add the statistical information about the rates, the risk factors, and the methods of suicides in Turkey to the literature. The suicide rates in Turkey increased in the period between 1996 and 2005 years; it was 3.8 per 100,000 populations in 2005. The average ratio of male to female was 1.58/1 between 1996 and 2005 years. The suicidal deaths increased above the age of 75, especially in male population. In females, the most dangerous period was 15 to 24 age group. The major risk factor for suicides was found to be illness (29.6%) for both genders and especially for above middle ages. Hanging was the most preferred method for both genders and for most of the age groups in Turkey. Suicides increased in the spring and summer.

The global distribution of fatal pesticide self-poisoning: systematic review

BACKGROUND

Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown.

METHODS

We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990-2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning.

RESULTS

We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm.

CONCLUSION

Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.