Annual Suicide Research Articles

Seasonal variation of mortality from external causes in Hungary between 1995 and 2014.

ObjectiveTo analyze trends in external mortality in Hungary between 1995 and 2014 by sex.MethodsData on the numbers of deaths due to external causes were obtained from the published nationwide population register. Negative binomial regression was applied to investigate the yearly trends in external-cause mortality rates. Cyclic trends were investigated using the Walter-Elwood method.ResultsSuicide and accidents accounted for approximately 84% of the all-external-cause of deaths in Hungary. Annual suicide, unintentional falls and traffic accidents mortality declined significantly (p-value for annual trend: p < 0.001) from 30.5 (95% CI: 29.5–31.5) to 15.8 (15.1–16.5), from 31.2 (30.2–32.2) to 12.2 (11.7–12.8) and from 17.2 (16.4–18) to 5.4 (5–5.8) per 100 000 persons per year, respectively, during the study period. A significant declining trend in annual mortality was also found for assault, cold/heating-related accidents and accidents caused by electric current. However, the declining trend for drowning-related accidents was significant only for males. Significant winter-peak seasonality was found in the mortality rates from accidental falls, cold/heat-related accidents, other accidents caused by submersion/obstruction and other causes. Seasonal trends with a peak from June to July were observed in death rates from suicide/self-harm, accidental drowning/submersion and accidents caused by electric current. A significant seasonal variation with a peak in September was revealed in the mortality due to traffic accidents.ConclusionsThis Hungarian study suggests that there was a significant seasonal effect on almost all kinds of deaths from external causes between 1995 and 2014. Environmental effects are involved in the aetiology of suicide and accidents.

Endurance

You could be forgiven for thinking of every suicide as a lightning strike: an unpredictable flash of tragedy with shocking but isolated damage. In reality, however, suicides have more in common with earthquakes. Their effects reverberate far beyond an epicentre of devastation. Around 60 people are intimately affected by each of the 800 000 annual global suicides, bereaving an estimated 48 million to 500 million people a year. These survivors are exposed to an increased risk of suicide and mental illness themselves, and experience stigma, rejection, and shame. To maintain the analogy, most people will have their psychological foundations rocked again and again by suicide over the course of their lives.

The Impact of State Firearm Laws on Homicide and Suicide Deaths in the USA, 1991-2016: a Panel Study.

Firearm injuries are a major cause of mortality in the USA. Few recent studies have simultaneously examined the impact of multiple state gun laws to determine their independent association with homicide and suicide rates. To examine the relationship between state firearm laws and overall homicide and suicide rates at the state level across all 50 states over a 26-year period. Using a panel design, we analyzed the relationship between 10 state firearm laws and total, age-adjusted homicide and suicide rates from 1991 to 2016 in a difference-in-differences, fixed effects, multivariable regression model. There were 1222 observations for homicide analyses and 1300 observations for suicide analyses. Populations of all US states. The outcome measures were the annual age-adjusted rates of homicide and suicide in each state during the period 1991-2016. We controlled for a wide range of state-level factors. Universal background checks were associated with a 14.9% (95% CI, 5.2-23.6%) reduction in overall homicide rates, violent misdemeanor laws were associated with a 18.1% (95% CI, 8.1-27.1%) reduction in homicide, and "shall issue" laws were associated with a 9.0% (95% CI, 1.1-17.4%) increase in homicide. These laws were significantly associated only with firearm-related homicide rates, not non-firearm-related homicide rates. None of the other laws examined were consistently related to overall homicide or suicide rates. We found a relationship between the enactment of two types of state firearm laws and reductions in homicide over time. However, further research is necessary to determine whether these associations are causal ones.

Association Between State Minimum Wages and Suicide Rates in the U.S.

The suicide rate in the U.S. has been increasing in recent years. Previous studies have consistently identified financial stress as a contributing factor in suicides. Nevertheless, there has been little research on the effect of economic policies that can alleviate financial stress on suicide rates. The purpose of this study is to determine whether increases in state minimum wages have been associated with changes in state suicide rates. A retrospective panel data study was conducted. In 2018, linear regression models with state fixed effects were used to estimate the relationship between changes in state minimum wages and suicide rates for all 50U.S. states between 2006 and 2016. Models controlled for time-varying state characteristics that could be associated with changes in minimum wages and suicide rates. There were approximately 432,000 deaths by suicide in the study period. A one-dollar increase in the real minimum wage was associated on average with a 1.9% decrease in the annual state suicide rate in adjusted analyses. This negative association was most consistent in years since 2011. An annual decrease of 1.9% in the suicide rate during the study period would have resulted in roughly 8,000 fewer deaths by suicide. Analyses by race and sex did not reveal substantial variation in the association between minimum wages and suicides. Increases in real minimum wages have been associated with slower growth in state suicide rates in recent years. Increasing the minimum wage could represent a strategy for addressing increases in suicide rates.

Assessment of a Risk Index for Suicide Attempts Among US Army Soldiers With Suicide Ideation

The Department of Veterans Affairs recently began requiring annual suicide ideation (SI) screening of all patients and additional structured questions for patients reporting SI. Related changes are under consideration at the Department of Defense. These changes will presumably lead to higher SI detection, which will require hiring additional clinical staff and/or developing a clinical decision support system to focus in-depth suicide risk assessments on patients considered high risk. To carry out a proof-of-concept study for whether a brief structured question battery from a survey of US Army soldiers can help target in-depth suicide risk assessments by identifying soldiers with self-reported lifetime SI who are at highest risk of subsequent administratively recorded nonfatal suicide attempts (SAs). Cohort study with prospective observational design. Data were collected from May 2011 to February 2013. Participants were followed up through December 2014. Analyses were conducted from March to November 2018. A logistic regression model was used to assess risk for subsequent administratively recorded nonfatal SAs. A total of 3649 Regular Army soldiers in 3 Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) surveys who reported lifetime SI were followed up for 18 to 45 months from baseline to assess administratively reported nonfatal SAs. Outcome was administratively recorded nonfatal SAs between survey response and December 2014. Predictors were survey variables. The 3649 survey respondents were 80.5% male and had a median (interquartile range) age of 29 (25-36) years (range, 18-55 years); 69.4% were white non-Hispanic, 14.6% were black, 9.0% were Hispanic, 7.0% were another racial/ethnic group. Sixty-five respondents had administratively recorded nonfatal SAs between survey response and December 2014. One additional respondent died by suicide without making a nonfatal SA but was excluded from analysis based on previous evidence that predictors are different for suicide death and nonfatal SAs. Significant risk factors were SI recency (odds ratio [OR], 7.2; 95% CI, 2.9-18.0) and persistence (OR, 2.6; 95% CI, 1.0-6.8), positive screens for mental disorders (OR, 26.2; 95% CI, 6.1-112.0), and Army career characteristics (OR for junior enlisted rank, 30.0; 95% CI, 3.3-272.5 and OR for senior enlisted rank, 6.7; 95% CI, 0.8-54.9). Cross-validated area under the curve was 0.78. The 10% of respondents with highest estimated risk accounted for 39.2% of subsequent SAs. Results suggest the feasibility of developing a clinically useful risk index for SA among soldiers with SI using a small number of self-report questions. If implemented, a continuous quality improvement approach should be taken to refine the structured question series.

Suicide among Italian police officers from 1995 to 2017.

Suicide rate in police officers is higher than in the general population worldwide. This paper assesses and analyzes the trends in suicide rates of Italian police officers from 1995 to 2017, comparing these with the trends of Italian general population. We reviewed all cases of active Italian police officers who died by suicide from 1995 through 2017 (N=271). We calculated age- and gender- specific suicide rates among police officers and the Italian general population. We carried out descriptive chi-squared analyses for categorical variables, and one-way ANOVA for continuous variables, performing a joinpoint regression to analize suicide trends. The mean police suicide rate was 11.78 per 100,000 individuals per year (95% CI=11.18-12.06). Joinpoint regression analyses of the period 1995-2017 showed that suicide rates of Italian police officers significantly decreased from 1995 to 2007 (annual percent change [APC]: -5.75%), followed by a period of a non-significant increase (APC: 3.9%). The period as a whole showed a non-significant decrease (APC: -1.7%). During 1995-2014, suicide rates were significantly higher among police officers vs. the age-adjusted general population (p<0.001), in male police vs. Italian male residents younger than 65 (p<0.001), and in female police vs. the female age-adjusted general population (p<0.05). Suicide rates among Italian police officers were significantly higher than those of the national resident population younger than 65 years. Annual suicide rate trends among Police showed a significant reduction in the period 1995-2007 followed by a stable trend until 2017. The entire period 1995-2017 showed a non-significant decreasing trend.

Pattern of Suicidal Burn Deaths Autopsied at Central Delhi Tertiary Care Hospital

Introduction: Suicides have now been a growing problem around the world. India now accounts for over a third of the world's annual female suicides and nearly a fourth of male suicides. Long standing frustrations, depressions, failures, decreasing human contact with increasing digitalization make people poor handlers of emotions and urges. Self Immolation (7.2%) being the third commonly employed method of suicide after hanging (45.6%) and Poisoning(27.9 %).This increasing suicidal rate requires addressal and pondering over it to help these troubled suicides.

Higher Triglyceride and Normal HDL-C Concentrations, the Triglyceride/HDL-C Concentration Ratios ≥ 3.5, and Insulin Resistance as Potential Predictors of Developing Higher Paroxetine Concentrations and Suicide in the Early Months of Medication

Background: There are several reported results. Hazard ratios for suicide tended to increase with dose for selective serotonin reuptake inhibitors (SSRIs). The suicide rate in the first three months following initiation of paroxetine exposure was 799 per 100,000 person-years, while, annual suicide rates for depression and anxiety were 81.8 and 76.7, respectively. SSRIs serum concentrations were significantly associated with increases of triglyceride (TG) levels. SSRIs inhibited insulin signaling and beta cell function by a dose-dependent manner.Objective: Based on symptoms and blood lipid levels indicated by a young patient who committed suicide, my objective is to propose that higher TG concentrations above the normal range, normal high-density lipoprotein cholesterol (HDL-C) concentrations, and the TG/HDL-C concentration (mg/dL) ratios ≥ 3.5 to estimate insulin resistance are potentially useful in identifying individuals who are developing higher paroxetine concentrations.Methods: The glucose and lipid levels in the blood examination which was performed in an emergency hospital to where the patient was delivered by ambulance after his abnormal behaviors on the 14th day after the start of paroxetine treatment, were used for calculation and examination. Fasting TG levels were estimated by calculating TG values (TG-Cal) using the measured value of TG and a formula reported by Hitze et al., or the measured values of total cholesterol (TC), HDL-C, and low-density lipoprotein cholesterol (LDL-C), and nine formulas referred and reported by Dansethakul et al. Paroxetine levels in the patient’s serum were estimated by calculation using the regression coefficient of TG 46.49 mg/dL, with which the paroxetine serum concentration 75 ng/mL was associated in the results reported by Fjukstad et al.   Results: The 20-year-old patient free of recent suicidal ideation developed intense violent suicidal preoccupation, and exhibited abnormal behaviors in the first 41 days after the start of paroxetine treatment 10 mg twice daily. He sent emails with advanced notice of suicide to his friend on the 7th, 17th, and 18th days, drank alcohol alone and exhibited abnormal behaviors in a market place around noon, blacked out, and was ambulanced to the emergency hospital on the 14th day. Finally, he carried out suicide on the 41st day after three days of abrupt discontinuation of paroxetine. He never exhibited these abnormal behaviors before paroxetine exposure. The levels of glucose, TG, TC, HDL-C, and LDL-C measured in the blood examination at 15:56 on the 14th day after the start of paroxetine treatment were 111, 498, 185, 53, and 92 mg/dL, respectively. The levels of TC, HDL-C, and LDL-C were in the normal ranges, respectively, probably suggesting metabolic normality of the patient before paroxetine exposure. In order to estimate the fasting TG level, TG-Cal values were calculated to be 278, 200, 258, 240, 268, 272, 310, 308, 311, and 250 mg/dL in the range of 200 – 311 mg/dL beyond the normal range of TG 50 – 150 mg/dL. TG-Cal/HDL-C ratios were also calculated to be in the range of 3.8 – 5.9 (200/53 – 311/53), probably suggesting that the patient was in the stage of insulin resistance development. The paroxetine level in the patient’s serum was estimated to be in the range of 161 – 387 ng/mL by calculation using formulas 75(TG-Cal – 71)/46.49, 75(TG-Cal – 92.25)/46.49, and 75(TG-Cal – 100)/46.49, on the assumption that the patient’s TG levels before paroxetine exposure were 71, 92.25, and 100 mg/dL, respectively. The paroxetine concentrations in the range of 161 – 387 ng/mL were much higher than the therapeutic reference range 30 – 120 ng/mL.    Conclusions: The above results probably suggest that paroxetine exposure, higher TG concentration, higher paroxetine concentration, and suicide coincided in the patient. Follow-up measurements of TG and HDL-C concentrations and the TG/HDL-C ratios have a potential to predict and prevent suicides in the early months of paroxetine exposure.Â

A proposal for using the ratio of attempted to completed suicides across several countries worldwide.

Completed suicide (CS) is a leading cause of death worldwide and its rates are available for most developed countries. On the other hand, attempted suicide (AS) is a risk factor for CS but there are limited data on its rates in various countries. In constructing a ratio for AS/CS rates, most would agree that for CS, the denominator should be the annual suicide rate (per 100 000). As for the ratio's numerator (AS) per 100 000, there are three possible calculations: (1) annual prevalence from population surveys, (2) annual prevalence from national clinical registers or (3) lifetime prevalence from population surveys. We think that the first possibility would probably be the best choice but, unfortunately, surveys providing the annual prevalence of AS are lacking for most countries. Annual prevalence from national registers is also lacking for most countries and is contaminated by under-reporting. Therefore, in this editorial, we are left with only the last option, a ratio for lifetime prevalence of AS (per 100 000) divided by annual rate of CS (per 100 000). This ratio for AS/CS rates appears to differ substantially across countries worldwide but presents no big regional differences other than two remarkable exceptions, one per continent. In Europe, Spain and France had greater ratios (174.4 and 152.5, respectively) than Italy (64.1). In Asia/Pacific, New Zealand has a higher ratio (345.9) compared with China (75.8) and Japan (76.9). The ratio for AS/CS rates could be a good index for implementing evidence-informed decision-making regarding suicidal behaviour (SB) among health service managers, and for helping them in the allocation of health resources for the prevention of SB.

Report Shows Number of Hospital Suicides Lower Than Estimated

Back to table of contents Previous article Next article Professional NewsFull AccessReport Shows Number of Hospital Suicides Lower Than EstimatedMark MoranMark MoranSearch for more papers by this authorPublished Online:12 Oct 2018https://doi.org/10.1176/appi.pn.2018.10b10AbstractThe Joint Commission’s new, much lower estimate of annual inpatient suicides should have important implications for how resources are allocated to prevent suicide.Between 48.5 and 64.9 hospital inpatient suicides occur each year in the United States, according to a report in the September Joint Commission Journal on Quality and Patient Safety.iStock/gmast3rThat’s “far below the widely cited figure of 1,500 per year,” wrote lead author Scott Williams, Psy.D., director of the Department of Research at The Joint Commission, and colleagues.“The results from this study provide a more reliable benchmark of the national inpatient suicide rate for policymakers, regulators, accrediting organizations, health care providers, and researchers to use when making decisions regarding allocation of resources and implementation of specific requirements to prevent inpatient suicides,” they wrote.The authors analyzed data from 27 states reporting to the National Violent Death Reporting System (NVDRS) for 2014 to 2015 and from hospitals reporting to The Joint Commission’s Sentinel Event (SE) Database from 2010 to 2017. The Centers for Disease Control and Prevention established the NVDRS in 2002 as a population-based surveillance system to quantify deaths by violence and categorize them by cause.Deaths due to violence are defined by the World Health Organization as “the intentional use of physical force or power against oneself, another person, or against a group or community.”The sentinel event (SE) database includes data on the suicide of patients who received care in a setting that is staffed around the clock or who died by suicide within 72 hours of discharge, including from the hospital’s emergency department (ED).Reports to the SE database include coded information about the method of suicide (asphyxiation, hanging, gunshot, drug overdose, jumping from a height, jumping in front of a vehicle, laceration, other). Narrative descriptions from the NVDRS were reviewed and classified using the same categories, whenever the method was clearly indicated in the report.Here are the report’s main findings: From the states reporting to the NVDRS in 2014, there were 16 inpatient suicides, 11 of which were associated with psychiatric hospitalization. In 2015 there were 30 inpatient suicides reported, 23 of which were associated with psychiatric hospitalization.Extrapolating from the 18 states that reported to the NVDRS in 2014, representing 33 percent of all hospital admissions, the authors estimated that 48.5 inpatient suicides occurred in the United States. Based on the larger set of data available from 27 states in 2015, representing 46.2 percent of all hospital admissions, they estimated that 64.9 inpatient suicides occurred in the United States.A total of 174 inpatient suicides were reported to the SE Database from 2010 to 2016.Hanging was by far the most common method of inpatient suicide in the NVDRS and SE databases (71.7 percent and 70.3 percent, respectively).“This study provides the first data-driven estimate of the number of inpatient suicides per year in hospitals in the United States,” Williams and colleagues wrote. “The estimated range of 48.5 to 64.9 inpatient suicides per year is vastly lower than the most widely quoted figure of 1,500 per year, which appears to have been based on speculation. … This new, lower estimate of the rate of suicides in hospitals has important implications for the allocation of resources to address suicide prevention within health care and the broader population.“Because the vast majority of suicides continue to be by hanging, with the most common ligature fixation points being a door, door handle, or door hinge, hospitals should conduct careful environmental assessments to ensure that door handles and door hinges are ‘ligature resistant.’”Last year administrators at many hospitals expressed concern about increased monitoring and enforcement of citations by the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission around elimination of ligature risks that were costing facilities exorbitant amounts of money. At the July meeting of the APA Board of Trustees, APA CEO and Medical Director Saul Levin, M.D., M.P.A., reported that APA had surveyed 88 facilities in 34 states and the District of Columbia between April and June. Of the 55 that responded, 10 had closed inpatient beds due to the assessment of fines for ligature risks, and 14 had closed psychiatric beds. Twenty-three facilities reported paying fines between $100 and $6 million.Levin said that APA is continuing to work with CMS and The Joint Commission on the issue. ■“Incidence and Method of Suicide in Hos-pitals in the United States” can be accessed here. ISSUES NewArchived

Australia's 'Better Access' scheme: Has it had an impact on population mental health?

Australia introduced the Better Access scheme in late 2006, which resulted in a large increase in the provision of mental health services by general practitioners (GPs), clinical psychologists, other psychologists and allied health professionals. It is unknown whether this increase in services has had an effect on the mental health of the population. The following data were examined: per capita use of mental health services provided by GPs, clinical psychologists, other psychologists, allied health professionals and psychiatrists from 2006 to 2015 according to the Australian Government Department of Human Services; prevalence of psychological distress in adults (as measured by the K10) from National Health Surveys in 2001, 2004-2005, 2007-2008, 2011-2012 and 2014-2015; and the annual suicide rate from 2001 to 2015 according to the Australian Bureau of Statistics. The large increase in the use of mental health services after the introduction of the Better Access scheme had no detectable effect on the prevalence of very high psychological distress or the suicide rate. Better Access has not had a detectable effect on the mental health of the Australian population.

Human Emotion Surveillance Using Computer Vision

India, a land of marvels, is outstanding in many aspects, its culture, ecosystem, etc. Sadly, it also ranks among the top countries in the world to have an annual suicide rate. This project aims at the foundation of human emotion surveillance. This system assists in the facial recognition, feature extraction and the threshold detection of stress for emotions expressed through face using the viola-jones algorithms and weak classifiers. This focuses basically on segregation of positive and negative emotions, detecting stress based on a usual threshold value and possibly providing an alternate means to let loose the extra stress built up if possible.

Suicide in India: a complex public health tragedy in need of a plan

Suicide in India: a complex public health tragedy in need of a plan

Informing NCD control efforts in India on the eve of Ayushman Bharat

Informing NCD control efforts in India on the eve of Ayushman Bharat

Suicide in a rural area of coastal Kenya

BackgroundSuicide accounts for approximately 1.4% of deaths globally and is the 15th leading cause of death overall. There are no reliable data on the epidemiology of completed suicide in rural areas of many developing countries, yet suicide is an indicator of the sustainable development goals on health.MethodsUsing data collected between 2008 and 2016 from the Kilifi Health and Demographic Surveillance System in rural Kenya, we retrospectively determined the incidence rate and risk factors for completed suicide.ResultsDuring the period, 104 people died by suicide, contributing to 0.78% (95% CI = 0.74–1.10) of all deaths. The mean annual incidence rate of suicide was 4.61 (95% CI = 3.80–5.58) per 100,000 person years of observation (pyo). The annual incidence rate for men was higher than that of women (IRR = 3.05, 95% CI = 1.98–4.70, p < 0.001) and it increased with age (IRR = 2.73, 95% CI = 2.30–3.24, p < 0.001). People aged > 64 years had the highest mean incidence rate of 18.58 (95% CI = 11.99–28.80) per 100,000 pyo. Completed suicide was associated with age, being male, and living in a house whose wall is made of scrap material, which is a proxy marker of extreme poverty in this region (OR = 5.5, 95% CI = 4.0–7.0, p = 0.02). Most cases (76%) completed suicide by hanging themselves. Spatial heterogeneity of rates of suicides was observed across the enumeration zones of the KHDSS.ConclusionsSuicide is common in this area, but the incidence of completed suicide in rural Kenya may be an underestimate of the true burden. Like in other studies, suicide was associated with older age, being male and poverty, but other medical and neuropsychiatric risk factors should be investigated in future studies.

A 17-Year National Study of Prison Suicides in Belgium.

Suicide is a leading cause of mortality in prisoners worldwide, yet empirical data on this matter are lacking in Belgium. This study sought to describe characteristics associated with a consecutive series of suicides in Belgian prisons from 2000 to 2016 inclusive, in order to inform suicide prevention strategies. All documented cases of suicide ( N = 262) were reviewed using a standardized assessment checklist. Official records were abstracted for prisoners' sociodemographic, criminological, and clinical information, as well as for suicide-related characteristics. Over the 17-year study period, suicides accounted for one third of all deaths in Belgian prisons. The average annual suicide rate in Belgium from 2000 to 2016 was 156.2 per 100,000 prisoners. Examination of all cases highlights both individual (psychiatric disorders and a history of suicide attempt) and situational (the early period of incarceration, interfacility transfers, and placement in solitary confinement) factors common in many prison suicides; some of them amenable to (clinical) management, which presents several potential avenues for suicide prevention. Given the absence of a matched control group, no conclusions could be ascertained regarding risk factors. Suicide is a common, preventable cause of death among prisoners in Belgium. The results underscore the timely need for national standards and guidelines for suicide prevention in Belgian prisons.

Age, Period, and Cohort Effects on Suicide Mortality in South Korea, 1992⁻2015.

Although the effects of age, period, and cohort (APC) on suicide are important, previous work in this area may have been invalid because of an identification problem. We analyzed these effects under three different scenarios to identify vulnerable groups and thus overcame the identification problem. We extracted the annual numbers of suicides from the National Death Register of Korea (1992–2015) and estimated the APC effects. The annual average suicide rates in 1992–2015 were 31.5 and 14.7 per 100,000 males and females, respectively. The APC effects on suicide were similar in both sexes. The age effect was clearly higher in older subjects, in contrast to the minimal changes apparent during earlier adulthood. The birth cohort effect showed an inverted U shape; a higher cohort effect was evident in females born in the early 1980s when period drift was larger than 3.7%/year. Period effect increased sharply during the early 1990s and 2000s. We found that elderly and young females may be at a particularly high risk of suicide in Korea.

Psychiatric comorbidity increases mortality in immune-mediated inflammatory diseases.

We determined the association between any common mental disorder (CMD: depression, anxiety disorder, bipolar disorder) and mortality and suicide in three immune-mediated inflammatory diseases (IMID), inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA), versus age-, sex- and geographically-matched controls. Using administrative data, we identified 28,384 IMID cases (IBD: 8695; MS: 5496; RA: 14,503) and 141,672 matched controls. We determined annual rates of mortality, suicide and suicide attempts. We evaluated the association of any CMD with all-cause mortality and suicide using multivariable Cox regression models. In the IMID cohort, any CMD was associated with increased mortality. We observed a greater than additive interaction between depression and IMID status (attributable proportion 5.2%), but a less than additive interaction with anxiety (attributable proportion -13%). Findings were similar for MS and RA. In IBD, a less than additive interaction existed with depression and anxiety on mortality risk. The IMID cohort with any CMD had an increased suicide risk versus the matched cohort without CMD. CMD are associated with increased mortality and suicide risk in IMID. In MS and RA, the effects of depression on mortality risk are greater than associations of these IMID and depression alone.

Adjusting Suicide Rates in a Military Population: Methods to Determine the Appropriate Standard Population.

The choice of the standard population is important when calculating adjusted rates for a military population: results can influence policies and funding allocations for programs and initiatives for suicide prevention. We describe the methodological considerations and decision-making process used in choosing a standard population for adjusting rates to compare suicide among US Army soldiers and the general US population. We examined 5 different standard populations, using the direct method to adjust annual suicide rates for the Army and the US population, 2004 to 2015, for age and for age and sex. The pattern of the Army and US population age- and sex-adjusted rates remained consistent with crude rates when adjusted to any of the Army standard population distributions. Using an Army distribution as the standard population produces suicide rates consistent with routine messaging about suicide trends among Army soldiers.

Most campuses don't track student suicides, despite increase in resources

Most large public research institutions in the United States do not track student suicides, according to a research report issued by The Associated Press. The AP asked the 100 largest public research institutions in the country for their annual statistics on student suicide. Of those 100 institutions, only 46 reported tracking annual student suicides. Of the remaining 54 institutions, 43 did not track student suicides at all, nine were able to provide limited or incomplete data, and two did not respond to the survey.