Seasonal fluctuation of suicide in Hungary between 1970-2000

Suicides in Turkey: 25-year trend (1995-2019)

The assessment of national suicide risks is considered critical in many countries for the establishment of suicide prevention initiatives aimed at considerably lowering suicide rates. The aim of this study is to identify at-risk suicide populations by reviewing the suicides in Turkey over a 25-year period. The Turkish Statistical Institute's suicide statistics for 1995-2019 in Turkey was retrospectively reviewed in current article. The data collected in the study was statistically analyzed using the MINITAB vn 14 software. Between 1995 and 2019, the total number of suicides in Turkey was 66,819, and suicide rates, especially in males, showed an increasing trend in this period. Males comprised 68.3% of the total cases, and most (27.2%) were aged 15-24 years. Suicides mostly occurred between May and July (27.7%), of individuals with a primary school level of education (51.7%) and who were married (6.0 per 100,000). Illness was most important risk factor for suicide (36.8%) and hanging (47.5%) was the leading suicide method in all age groups and in both genders. Despite the fact that Turkey's suicide rate is lower than many other countries, the growth in male suicide rates is concerning. Suicides are likely to become a severe problem in Turkey in the near future unless measures like education, psychiatric evaluations, the reactivation of psychological counseling service phone lines, and the establishment of youth counseling centers, as described in this paper, are taken.

Patterns of suicide deaths in Hungary between 1995 and 2017

Hungary has had one of the highest suicide mortality rates in the world for decades. Investigating seasonality of suicide deaths is essential as its findings could be key elements in the prevention. In our study we have analyzed the seasonal effect in suicide mortality in relation to possible risk factors in Hungary during 1995–2017.

Data on the numbers of suicide deaths were obtained from a published online database. Negative binomial regression was employed to investigate the effect of possible risk factors and seasonal and annual trends in suicide rates. The seasonal effect was further investigated, adding a significant risk factor from the “initial” negative binomial regression.

The suicide risk was significantly (p < 0.001) higher in men than in women (incidence rate ratio: 3.48), and it increased with age and decreased with education level. Marriage was a protective factor against suicide. Annual suicide mortality declined significantly (p < 0.001 for trend) from 36.7 (95% confidence interval: 35.5–37.9) to 16.5 (15.7–17.3) per 100,000 persons per year during the study period. Significant seasonality was found in suicide rates with a peak in late June. Similar peaks were observed at each level of each risk factor. There were differences in peaks by suicide method. The peak of non-violent suicides was in early June; suicides committed by violent methods peaked half a month later.

This study suggests that there was a significant seasonal effect on suicide deaths between 1995 and 2017, which remained significant even in the presence of each risk factor. To our knowledge, this has been the first study to investigate the seasonal pattern so extensively in Hungary. Our findings confirm that the environmental effects are involved in the etiology of suicide mortality.

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Significant seasonality was found in suicide rates with a peak in late June.

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Seasonal effect remained almost unchanged after adjusting sociodemographic factors.

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There were differences in seasonal peaks by suicide method.

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Environmental effects are involved in the etiology of suicide mortality.

Internal and external aspects of freedom of choice in mental health: cultural and linguistic adaptation of the Hungarian version of the Oxford CAPabilities questionnaire-Mental Health (OxCAP-MH)

Background

A link between mental health and freedom of choice has long been established, in fact, the loss of freedom of choice is one of the possible defining features of mental disorders. Freedom of choice has internal and external aspects explicitly identified within the capability approach, but received little explicit attention in capability instruments. This study aimed to develop a feasible and linguistically and culturally appropriate Hungarian version of the Oxford CAPabilities questionnaire—Mental Health (OxCAP-MH) for mental health outcome measurement.

Methods

Following forward and back translations, a reconciled Hungarian version of the OxCAP-MH was developed following professional consensus guidelines of the International Society for Pharmacoeconomics and Outcomes Research and the WHO. The wording of the questionnaire underwent cultural and linguistic validation through content analysis of cognitive debriefing interviews with 11 Hungarian speaking mental health patients in 2019. Results were compared with those from the development of the German version and the original English version with special focus on linguistic aspects.

Results

Twenty-nine phrases were translated. There were linguistic differences in each question and answer options due to the high number of inflected, affixed words and word fragments that characterize the Hungarian language in general. Major linguistic differences were also revealed between the internal and external aspects of capability freedom of choices which appear much more explicit in the Hungarian than in the English or German languages. A re-analysis of the capability freedom of choice concepts in the existing language versions exposed the need for minor amendments also in the English version in order to allow the development of future culturally, linguistically and conceptually valid translations.

Conclusion

The internal and external freedom of choice impacts of mental health conditions require different care/policy measures. Their explicit consideration is necessary for the conceptually harmonised operationalisation of the capability approach for (mental) health outcome measurement in diverse cultural and linguistic contexts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00660-0.

Exploring temporal suicidal behavior patterns on social media: Insight from Twitter analytics

A valid mechanism for suicide detection and intervention to a wider population online has not yet been fully established. With the increasing suicide rate, we proposed an approach that aims to examine temporal patterns of potential suicidal ideations and behaviors on Twitter to better understand their risk factors and time-varying features. It identifies latent suicide topics and then models the suicidal topic-related score time series to quantitatively represent behavior patterns on Twitter. After evaluated on a collection of suicide-related tweets in 2016, 13 key risk factors were discovered and the temporal patterns of suicide behavior on different days during 1 week were identified to highlight the distinct time-varying features related to different risk factors. This study is practical to help public health services and others to develop refined prevention strategies, to monitor and support a population of high-risk at right moments.

Moon/sun - suicide

INTRODUCTION

Findings concerning the effects of moon phases and sun activity on suicide are mixed in the international literature.

AIM

Our aim was to examine the hypothesised effects according to gender and age on Hungarian data covering more than 30 years.

METHODS

Time series ARIMA models and dynamic regression models were applied in our analysis.

RESULTS

Among women aged 20-49 years, a significant increase in the risk of suicide has been observed during proton solar events. At the same time, among women aged 50-59 years a slight but significant decrease has been identified in the risk of suicide during magnetic storms and full moons.

CONCLUSION

Proton solar events, geomagnetic storms and moon phases caused changes in the risk of suicide in certain age groups in the case of women only.

Springtime Peaks and Christmas Troughs: A National Longitudinal Population-Based Study into Suicide Incidence Time Trends in the Netherlands

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.

Association of weekly suicide rates with temperature anomalies in two different climate types

Annual suicide deaths outnumber the total deaths from homicide and war combined. Suicide is a complex behavioral endpoint, and a simple cause-and-effect model seems highly unlikely, but relationships with weather could yield important insight into the biopsychosocial mechanisms involved in suicide deaths. This study has been designed to test for a relationship between air temperature and suicide frequency that is consistent enough to offer some predictive abilities. Weekly suicide death totals and anomalies from Toronto, Ontario, Canada (1986-2009) and Jackson, Mississippi, USA (1980-2006) are analyzed for relationships by using temperature anomaly data and a distributed lag nonlinear model. For both analysis methods, anomalously cool weeks show low probabilities of experiencing high-end suicide totals while warmer weeks are more likely to experience high-end suicide totals. This result is consistent for Toronto and Jackson. Weekly suicide totals demonstrate a sufficient association with temperature anomalies to allow some prediction of weeks with or without increased suicide frequency. While this finding alone is unlikely to have immediate clinical implications, these results are an important step toward clarifying the biopsychosocial mechanisms of suicidal behavior through a more nuanced understanding of the relationship between temperature and suicide.

Local daily temperatures, thermal seasons, and suicide rates in Finland from 1974 to 2010

OBJECTIVES

Suicide peaks in late spring and October are still seen in Finland among many countries. Weather factors have been suggested as explanations for these peaks, although with inconsistent results. Since the exact timing of these peaks varies each year, the length of daylight and changes in it seem inadequate as an explanation. We hypothesized that ambient temperature and the timing of thermal seasons might associate with suicide rate.

METHODS

Suicide rates from three areas across Finland (N = 10,802) were analyzed with Poisson regression in six different models against variables calculated from the local ambient daily temperature, diurnal temperature range, and the duration from the onset of thermal seasons. Separate models for men and women were constructed.

RESULTS

The temperature change over 5 days associated with the suicide rate of men in Helsinki region, or in other words, the lower the suicide rate was, the higher the temperature decrease had been. For women, the results were more inconsistent.

CONCLUSIONS

Our study is in line with some earlier studies which imply that impairment of thermoregulation might exist among suicide victims.

How to decrease suicide rates in both genders? An effectiveness study of a community-based intervention (EAAD)

Background

The suicide rate in Hungary is high in international comparison. The two-year community-based four-level intervention programme of the European Alliance Against Depression (EAAD) is designed to improve the care of depression and to prevent suicidal behaviour. Our aim was to evaluate the effectiveness of a regional community-based four-level suicide prevention programme on suicide rates.

Method

The EAAD programme was implemented in Szolnok (population 76,311), a town in a region of Hungary with an exceptionally high suicide rate. Effectiveness was assessed by comparing changes in suicide rates in the intervention region after the intervention started with changes in national suicide rates and those in a control region (Szeged) in the corresponding period.

Results

For the duration of the programme and the follow-up year, suicide rates in Szolnok were significantly lower than the average of the previous three years (p = .0076). The suicide rate thus went down from 30.1 per 100,000 in 2004 to 13.2 in 2005 (−56.1 %), 14.6 in 2006 (−51.4 %) and 12.0 in 2007 (−60.1 %). This decrease of annual suicide rates in Szolnok after the onset of the intervention was significantly stronger than that observed in the whole country (p = .017) and in the control region (p = .0015). Men had the same decrease in suicide rates as women. As secondary outcome, an increase of emergency calls to the hotline service (200%) and outpatient visits at the local psychiatry clinic (76%) was found.

Conclusions

These results seem to provide further support for the effectiveness of the EAAD concept. Whilst the majority of suicide prevention programs mainly affect female suicidal behaviour, this programme seems to be beneficial for both sexes. The sustainability and the role of the mediating factors (social service and health care utilization, community attitudes about suicide) should be key points in future research.

Suicide in Hungary-epidemiological and clinical perspectives

Annual suicide rates of Hungary were unexpectedly high in the previous century. In our narrative review, we try to depict, with presentation of the raw data, the main descriptive epidemiological features of the Hungarian suicide scene of the past decades. Accordingly, we present the annual suicide rates of the period mentioned and also data on how they varied by gender, age, urban vs. rural living, seasons, marital status, etc. Furthermore, the overview of trends of other factors that may have influenced suicidal behavior (e.g., alcohol and tobacco consumption, antidepressant prescription, unemployment rate) in the past decades is appended as well. Based on raw data and also on results of the relevant papers of Hungarian suicidology we tried to explain the observable trends of the Hungarian suicide rate. Eventually, we discuss the results, the possibilities, and the future tasks of suicide prevention in Hungary.

Seasonality of Chinese rural young suicide and its correlates

BACKGROUND

There had been few studies on seasonality of Chinese suicide especially for Chinese rural youths. In this research, we wanted to find the seasonal pattern and the relationship between personal and behavioral characteristics and seasonal variation of suicide.

METHOD

We examined Chinese rural young adults aged 15 to 34 years who died by suicide using Psychological Autopsy method to gather information from the informants of suicide victims. Altogether 330 suicide victims were collected among which 144 were female and 186 were male. The χ(2) test was used for comparison, and the multiple logistic regressions and Odds Ratios were adopted to analyze the seasonal preferences of suicide victims.

RESULT

Seasonal summer peak of suicide emerged in total population and in each subgroup. Four logistic regression models were constructed: in spring, six variables were included in the regression model, which were Gender (OR = 1.627), Pesticide Used (OR = 1.622), Life Events (OR = 2.764), Suicide Intent (OR = 1.641), Marital Status (OR = 0.574) and Family Conflicts (OR = 0.590); in summer, only Marital Status (OR = 1.927) was accepted; in autumn, four variables including Marital Problems (OR = 1.924), Trait Anxiety (OR = 1.758), Gender (OR = 0.518) and Religion (OR = 0.534) were retained; in winter, Pesticide Used (OR = 0.486) and Suicide Intent (OR = 0.614) were retained.

CONCLUSION

Seasonal variations of personal and behavioral characteristics, combined with social activities, might also play very important roles in suicide seasonality.

Relationship between daylength and suicide in Finland

Background

Many previous studies have documented seasonal variation in suicides globally. We re-assessed the seasonal variation of suicides in Finland and tried to relate it to the seasonal variation in daylength and ambient temperature and in the discrepancy between local time and solar time.

Methods

The daily data of all suicides from 1969 to 2003 in Finland (N = 43,393) were available. The calendar year was divided into twelve periods according to the length of daylight and the routinely changing time difference between sun time and official time. The daily mean of suicide mortality was calculated for each of these periods and the 95% confidence intervals of the daily means were used to evaluate the statistical significance of the means. In addition, daily changes in sunshine hours and mean temperature were compared to the daily means of suicide mortality in two locations during these afore mentioned periods.

Results

A significant peak of the daily mean value of suicide mortality occurred in Finland between May 15th and July 25th, a period that lies symmetrically around the solstice. Concerning the suicide mortality among men in the northern location (Oulu), the peak was postponed as compared with the southern location (Helsinki). The daily variation in temperature or in sunshine did not have significant association with suicide mortality in these two locations.

Conclusions

The period with the longest length of the day associated with the increased suicide mortality. Furthermore, since the peak of suicide mortality seems to manifest later during the year in the north, some other physical or biological signals, besides the variation in daylight, may be involved. In order to have novel means for suicide prevention, the assessment of susceptibility to the circadian misalignment might help.

Seasonality in suicide--a review and search of new concepts for explaining the heterogeneous phenomena

Seasonality is one of the oldest and most resistant-to-elucidation issues in suicide research. However, in recent years epidemiological research has yielded new results, which provide new perspectives on the matter. This qualitative review summarizes research published since the 1990 s. In particular, the focus is on studies dealing with the historical change of seasonality, cross-sectional comparisons including method-specific diversity, and the association with weather variables and other putative covariates. Recent research has shown that in Western countries the seasonality of suicide is tending to diminish and may, eventually, disappear. It can no longer be considered a universal and homogeneous phenomenon. In addition, different major seasonal cycles have now been determined which mainly depend on different suicide methods. Just as in the epidemiology of suicide methods, the (seasonal) availability and perceived adequacy of methods emerge as the major driving force beyond the seasonal phenomena in suicide.

[Temporal dimensions of suicide: hypothesis]

In this article, the author examines the temporal dimensions of suicide by taking into account the multiple existing approaches-circadian physiology, psychiatric or sociological epidemiology of suicide-however promoting a socio-anthropological perspective. From this perspective, suicide is examined as a social phenomenon inscribed in time. By beginning with a concern that is characteristic of anthropology of time, knowingly the relation between time of nature and time of society, the author addresses a key issue of the study of suicide already elaborated by Durkheim, in the relation between change that is a basic expression of the passage of time and suicide. After presenting different scientific contributions on the subject, the author proposes an hypothesis allowing integration of the influence of time related to natural phenomenon (cosmobiological rhythms) and the relation of time to social phenomenon (politico-economic rhythms) in relation with suicide and this, according to Gabennesch's theory of "failed promises."

Climate impact on suicide rates in Finland from 1971 to 2003

Seasonal patterns of death from suicide are well-documented and have been attributed to climatic factors such as solar radiation and ambient temperature. However, studies on the impact of weather and climate on suicide are not consistent, and conflicting data have been reported. In this study, we performed a correlation analysis between nationwide suicide rates and weather variables in Finland during the period 1971-2003. The weather parameters studied were global solar radiation, temperature and precipitation, and a range of time spans from 1 month to 1 year were used in order to elucidate the dose-response relationship, if any, between weather variables and suicide. Single and multiple linear regression models show weak associations using 1-month and 3-month time spans, but robust associations using a 12-month time span. Cumulative global solar radiation had the best explanatory power, while average temperature and cumulative precipitation had only a minor impact on suicide rates. Our results demonstrate that winters with low global radiation may increase the risk of suicide. The best correlation found was for the 5-month period from November to March; the inter-annual variability in the cumulative global radiation for that period explained 40 % of the variation in the male suicide rate and 14 % of the variation in the female suicide rate, both at a statistically significant level. Long-term variations in global radiation may also explain, in part, the observed increasing trend in the suicide rate until 1990 and the decreasing trend since then in Finland.

The impact of holidays on suicide in Hungary

The suicide rate on religious and public holidays was examined for 133,699 suicides for Hungary for the period 1970-2002. For both men and women, more suicides were committed on Monday, while fewer were committed on the weekends. More suicides occurred on New Year's Day than expected. On Christmas Day and on Easter Sunday and Monday, suicides were less frequent only for men, a result consistent with Durkheim's theory. There was less evidence for Gabennesch's broken promise effect on the days after the holidays. National holidays had no impact on the frequency of suicide.