Common Suicide Research Articles

Lethality-Associated Factors in Deliberate Self-Poisoning.

ObjectivesDeliberate self-poisoning (DSP) is the most common suicide method and can be life-threatening. The purpose of this study was to investigate the factors related to the lethality of DSP and the characteristics of the adolescent group.MethodsA retrospective study was conducted on patients who had visited an academic hospital’s regional emergency medical center between 2015 and 2018. The data reviewed through their medical records included sociodemographic factors, clinical variables, and psychiatric treatment. Four groups (Q1–Q4) were categorized by descriptive analysis using the risk-rescue rating scale.ResultsA total of 491 patients were enrolled in this study. This study showed that high lethality had statistically significant associa-tions with male sex, older age, admitting suicidal intentions, and the use of herbicides for suicide. Logistic regression analyses showed a significant association between high-lethality and female [odds ratio (OR)=0.50, 95% confidence interval (CI)=0.30–0.81, p=0.01], non-psychiatric drugs (over-the-counter drug: OR=2.49, 95% CI=1.08–5.74, p=0.03; herbicide: OR=8.65, 95% CI=3.91–19.13, p<0.01), and denial of suicide intent (OR=0.28, 95% CI=0.15–0.55, p<0.01).ConclusionThis study showed the clinical factors associated with the high lethality of DSP and suggested that efforts were needed to care for and thoroughly examine patients with DSP.

Gender differences in completed suicidal hangings from 2013 to 2018 in Muğla, Turkey.

BACKGROUND: Hanging is the most preferred among suicide methods. Although methods vary based on age groups and social and cultural conditions, many studies have reported it as the most common suicide method in Turkey.OBJECTIVE: Assess autopsy findings of suicidal hangings according to gender differences.DESIGN: Retrospective, cross-sectional.SETTING: Local morgue.SUBJECTS AND METHODS: The autopsy reports of hanging autopsies between 2013-2018. Data was retrospectively collected from autopsy reports. Sociodemographic features, reasons, suicide notes, the news media, and macroscopic autopsy findings were evaluated. Findings were statistically compared by gender.MAIN OUTCOME MEASURE: Gender differences in autopsy findings.SAMPLE SIZE AND CHARACTERISTICS: 175 autopsy reports of suicide by hanging.RESULTS: Among 2534 autopsies, 175 (6.9%) cases involved hanging. Most (76%, n=133) were males; the median (interquartile range) age was 42.0 (29.5), the male/female ratio was 3:1. Suicide notes were found in 42 cases; 81 (24%) were from men. The most common reason for suicide was a mental illness (n=51, 29.2%), followed by family problems (n=26, 14.9%), but the cause was unknown in 42 cases (24.0%). More than half of the events were covered in the news media (58.9%). Rope was most commonly used with women preferring a softer material. Men were more frequently single than women. Men were more frequently single and not actively working than women (P=.026 and P≤.001, respectively). The incidence of atypical hanging was higher for males than females (P<.05).CONCLUSION: The findings showed that there were some statistically significant differences in socioeconomic and mental health factors between men and women in hanging suicide. This study may serve as the basis for more comprehensive studies to investigate the causes of suicide.LIMITATIONS: Single-center, retrospective.CONFLICT OF INTEREST: None.

Trends and ecological results in suicides among Italian youth aged 10–25 years: A nationwide register study

BackgroundDocumenting current trends and sources of variation in youth suicide rates is critical to inform prevention strategies. We aimed to document suicide mortality trends among Italian youth from 1981 to 2016 and to describe age-, gender- and urbanization-specific suicide rates. MethodsWe used official mortality data for the period 1981–2016 for adolescents and young adults aged 10–25 years. We estimated standardized all-cause and suicide mortality rates per 100,000 individuals and used joinpoint regression analyses to determine annual mortality trends and significant changes in rate trends. Analyses were reported according to gender, age group (10–17 and 18–25 years), urbanization and suicide method. ResultsFrom 1981 to 2016, 1,752 suicides were identified among youth aged 10–17 years (boy/girl ratio of 5.80 in 2016) and 9,897 suicides among youth aged 18–25 years (boy/girl ratio of 3.97 in 2016). Overall suicide rates remained stable for boys and showed a small decrease for girls. Suicide was most common in rural areas for boys and in metropolitan areas for girls. We observed a significant decrease in the use of firearms and poisoning; the most common suicide method was hanging for boys and falls for girls. LimitationsWe did not control for regional-level sociodemographic, economic and health care system characteristics. ConclusionsYouth suicides were either stable (for boys) or slightly declining (for girls). We found differences according to urban versus rural areas, suggesting the need for a broader view of the phenomenon. Factors influencing these trends and gender differences in the geographical areas are important in delivering suicide prevention strategies.

Profile of Fatal Suicide in Iran: A Report From the Iranian Forensic Medicine Between 2016 and 2018

The suicide rate among the Iranian population has increased over the past few decades. Descriptive information about this public health challenge could inform health policymakers to prioritize prevention strategies. We described the last updated data from the Iranian forensic medicine between 2016 and 2018. We obtained the data on the fatal suicide cases from the national suicide registry of the Iranian Forensic Medicine Organization (FMO), validated by death certificates and harmonized for epidemiologic studies. This study included 9,021 nationally registered suicide deaths from March 21, 2016, to March 20, 2018. A descriptive statistical approach was used to present the findings. Of 9,021 registered suicide deaths with age range between 10 to 94 years [median=31], 44.6% [n=4,015] was in the category of ≤ 29, 48.0% [n=4,328] between 30 to 59, and 7.4% (n=666) in the category of ≥ 60 years old. The percentage of fatal suicide was obviously higher in men (71.2%, n=6,424). Hanging was the most common method of suicide, both among men (57.7%, n=3706) and women (37.6%, n=976). The frequency of fatal suicide was significantly higher in married than single cases (52.6% vs. 42.9%). Overall, at the national level, the most common suicide method was hanging (51.9%), followed by self-poisoning (25.8%) and self-immolation (6.8%). We found evidence of age- and gender differences in suicide mortality across the country. Men, people in younger age groups, and married couples could be considered as the target population for preventive interventions in Iran.

Suicide rates in Fortaleza increased 157% in ten years

Objective: to analyze suicide rates between 2000-2009 in Fortaleza, Ceará, Brazil. Methodology: Data was obtained from Ceará’s Institute of Forensic Medicine (PEFOCE). Estimated population by year was obtained from the Unified Health System (DATASUS). Results: A total of 1903 suicide cases were registered in Fortaleza, between 2000 and 2009. The distribution of methods was analyzed using the variables gender, age and year. Around 80% of the cases were male, corresponding to 4.3 male to female suicide rate. The most common suicide method was hanging, followed by poisoning, firearms, and jumping from heights. Among males, hanging was the most prevalent suicide method, followed by poisoning; while in females poisoning was the most prevalent method, followed by hanging. Almost half of all suicides in the study were by hanging. Conclusions: The classification of death as suicide is subject to interpretation of the coroner. Local published literature about this problem is sparse. Understanding suicide methods may provide support to more effective suicide prevention programs.

A Descriptive Study on the Civil Lawsuits of Medical Malpractice Occurred during Psychiatric Ward Treatment.

ObjectiveMedical accidents have resulted in actual harm for patients, been costly for health care system, and diminished trust for both patients and practitioners. The present study analyzed malpractice claims related to accidents in psychiatric inpatient units. MethodsThis study analyzed defendants, cases and plaintiffs or patients characteristics, degrees of injury, and types of accidents in 85 civil malpractice suits filed from 2005 to 2015 with a focus on the methods and locations of suicides. ResultsMost defendants were psychiatrists (n=43). Of the 85 cases, 56 (65.9%) were decided in favor of the plaintiff, most commonly on the grounds of negligence and violation of sound facility management principles. The most common diagnosis of patients was schizophrenia (n=31). The damages were deaths in 52 cases and injuries or other damages in the remaining 33 cases. The most common accident was suicide (n=28), followed by escape attempts (n=15). The most common suicide method was hanging (n=21), which was usually committed in the private room using objects like door handles. ConclusionTo reduce medical accidents, medical staff should monitor high-risk patients closely and constantly. Sufficient numbers of well-trained personnel are required to meet this standard. Reducing environmental hazards such as removing anchor points and installing door locking systems will improve patient safety.

Suicidal attempt with intracranial sewing needle in a female adult with major depressive disorder, case report

BackgroundMajor depressive disorder is one of the most common psychiatric illnesses. It is counted as an important suicide-attempting factor. Beside common and known suicide methods such as pesticide poisoning and hanging, some unusual methods (adapted by major depressive disorder patients) are reported in the literature. One of these methods is intracranial swing needle insertion.Case presentationHereby, we detail a 44-year-old woman who was admitted to our hospital due to a sewing needle in her brain tissue. The first sign suggesting the existence of a metal foreign body in her brain was the rejection of magnetic resonance imaging ordered (follow-up of a previous admission). Later, a sewing needle was observed in her skull inserted in a suicidal attempt. Her denial of the attempt has aroused the medical team attention to make further study of the patient from a psychiatric point of view. The psychiatric study expressed major depressive disorder in the patient which can justify her suicide intention in the needle insertion.ConclusionsTreating such patients should be tackled in two fronts. From neurosurgical point of view, it should be decided whether to extract the foreign body or conduct a follow-up in order to determine the necessary time for operation. On the other hand, from a psychiatric point of view, rigorous consult sessions with patient and family members are required to prevent recurrence of such attempts.

Belief in suicide prevention myths and its effect on helping: a nationally representative survey of Australian adults

BackgroundDebunking suicide myths, such as ‘asking someone about suicide could make them start thinking about it’ is a common strategy in suicide prevention education. However, there has been little research investigating the relationship between suicide myths and helping behavior toward people at risk of suicide. We aimed to identify sociodemographic characteristics associated with belief in eight common suicide myths and the associations between beliefs in these myths and helping intentions and behaviors toward a family member or friend in severe distress or at risk of suicide.MethodsWe conducted a random digit dial (mobile and landline) survey of 3002 Australian adults. We asked respondents about their beliefs in suicide myths, intentions to help a person in severe distress or at risk of suicide presented in a vignette, and helping actions taken toward such a person in the last 12 months. We weighted this data to be representative of the Australian population. Regression analyses were undertaken to determine associations between sociodemographic and exposure characteristics and beliefs in suicide myths, and between beliefs in myths and helping intentions and behaviors.ResultsBeing male, speaking a language other than English at home and being over 60 years were associated with the strongest beliefs in suicide myths. The strongest and most consistent associations were found between belief in the myth ‘asking someone about suicide could make them start thinking about it’, risk assessment intentions and behaviours and intentions to undertaken actions not recommended for suicide prevention.ConclusionsIdentifying those sociodemographic groups most likely to believe in suicide myths allows targeted intervention for suicide prevention education ‘debunking’ suicide myths. By isolating those myths that are most commonly believed, and their specific effects on helping intentions and behaviors, suicide prevention educators can target these specific myths to have the most effect on helping behavior. Our findings suggest that targeting the myth ‘asking someone about suicide could make them start thinking about it’ may have the greatest effects on helping behavior, and that men, those aged over 60 years and those speaking a language other than English at home could most benefit from myth ‘debunking’.

The characteristics of older people suicides by sex and age subgroups.

As the older population steadily grows, a corresponding increase in elderly suicides is also expected. In addition, due to differences in the physical and psychosocial characteristics of this age group, the characteristics of elderly suicides are predicted to be different to those of other groups. In this study, we aimed to report the characteristics of suicides 60years and older according to sex and age subgroups. We retrospectively reviewed the autopsy reports of individuals aged 60 and older who committed suicide in Turkey during the 10-year period between 2005 and 2014. Their age, sex, cause of death, and year, month, season, place, and method of suicide were analyzed. Comparisons were made based on sex, age subgroup, demographic variables, and descriptive characteristics of the suicides. Of 17,942 forensic autopsies, 525 were elderly suicides. Of these, 77.3% were men and the mean age was 71.26±8.16 (range, 60-94) years. There were statistically significant differences in suicide method according to sex (p<0.001, X=43.984) and age subgroups (p=0.001, X=51.457). For both sexes, hanging was the most common suicide method (59.4%) and the majority of suicides occurred at home (73.1%). The suicides occurred more frequently in the 65-74 age subgroup, in the summer, and in the months of June and July. Identifying the characteristics of elderly suicides, especially by sex and age subgroups, may be beneficial for suicide risk assessment and the development of prediction and prevention programs.

The effect of meteorological variables on suicide.

We aimed to reveal the relationship between the meteorological variables and suicide rates (completed suicides and suicide attempts) independently of the seasonal cycle and holiday effects. This is an observational retrospective study. We collected the data on age, gender, and suicide method of all suicide cases transferred to hospitals from the scene by emergency medical services as well as those cases in which the victim died on the scene between January 1, 2017 and June 30, 2019. We also collected data on maximum, minimum, and average temperatures (°C), average humidity (%), and average actual pressure (hPa) measured daily in Ankara. The total number of cases due to suicide between the given dates was 6777. The suicide method in 60.1% of the cases was drug poisoning, which was the most common suicide method. Investigating the effect of meteorological variables on suicide cases (suicide attempts and completed suicides), the present study found that after smoothing the effect of the day of the week and seasonality, an increase in the minimum temperature on the day of the application by 1 unit (1°C degree)leads to an increase in the number of suicides by 0.01 point (0.01 ± 0.005, p= 0.046). There was no significant change in the variables other than the minimum temperature. We believe that the results of the present study will contribute to growing body literature about the epidemiology of suicide. We also believe that there is a need for large-scale studies that include individual data to reveal causality.

Sex-specific and age-specific suicide mortality by method in 58 countries between 2000 and 2015

ObjectiveTo examine recent changes in sex-specific and age-specific suicide mortality by method across countries.MethodsUsing mortality data from the WHO mortality database, we compared sex-specific, age-specific and country-specific suicide mortality by...

Epidemiology of Self-poisoning with Drug in the Central Anatolian Region in Turkey.

Aim: Deliberate self-poisoning (DSP) is a common cause of intensive care hospitalization among young adults and a serious health problem worldwide. Demographic data vary according to geographical and sociocultural characteristics of the regions. In recent years, studies investigating epidemiological features and prognosis of these patients have increased. In our study, we retrospectively examined patients who committed suicide with drugs and were treated in the ICU of our hospital.Materials and Methods: The files of 148 patients who took drugs or substances for committing suicide and who were hospitalized in the ICU of Aksaray Training and Research Hospital between 2015 and 2019 were examined. Demographic data of the patients, type of the agent used in the suicide, time to reach hospital, treatment methods applied, length of hospital stay, vital signs, complications, need for intubation, and mortality rates were recorded.Results: Mean age of the 148 patients who took drugs for suicide was 26.7. Female rate was 73%. The most frequently used drug for suicide was paracetamol (34.4%). Antidepressants took the second place and were followed by drugs in the NSAID group. The duration of admission in the hospital after taking the medicine ranged from 1 to 6 h, while it was less than 3 h in 68.2% of the patients. In most suicide patients, the treatment method was in the form of intravenous fluid and supportive therapy (95%). N-acetyl cysteine (paracetamol intoxication) was used in 7% of the patients, an intubation requirement developed in 2.7%, and three patients taking organophosphate died.Conclusion: In studies conducted in developing countries such as Turkey, female sex (63%-71%) and 25 years of age have been found to be the proportion of the patients (56%-63%), whereas our study found even higher ratios compared to those (73%-66%). In studies conducted in developed countries, most commonly used agents for suicide were benzodiazepines and tricyclic antidepressants, while the most common suicide agent was paracetamol in our study. We believe that the reason for this could be the possibility of accessing the agent without a prescription.

The rate, trends and lethality of common violent suicide attempt methods in Iran, a systematic review and meta-analysis

The rate, trends and lethality of common violent suicide attempt methods in Iran, a systematic review and meta-analysis

Age patterns of suicide with different methods for US Whites: APC modelling analysis of the 1999-2017 national data.

Suicide emerges as a threat to national health of USA with Whites being at extra risk. More information is needed regarding the increased suicide among Whites to improve national suicide prevention strategies. This study aims to characterise the age pattern of suicide among Whites by suicide methods adjusting for time period and birth cohort. Suicide mortality data by age of 15-84 years during 1999-2017 were derived from the Wide-Ranging Online Data for Epidemiological Research, prepared by US Center for Disease Control and Prevention. Mortality data for three common suicide methods, firearms, suffocation and poisoning were analysed using the age-period-cohort (APC) model. Period-cohort adjusted mortality rates by age were estimated based on results from APC modelling. Period-cohort adjusted rates indicated that the overall age pattern for males contained five phases, including three increasing phases (ages 15-20, 30-50 and 65+), connected by two declining phases (ages 20-30 and 50-65); and the age pattern for females was a parabolic with an increasing phase from 15 years of age up to 50, followed by a declining phase after age 50. Furthermore, the age pattern for different suicide methods differed substantially for males, but did not for females. Among males, suicide by firearms contained two rapid increasing phases, one during adolescence and another in older ages; suicide by suffocation showed a high plateau across an age span from 20 to 55 years; and suicide by poisoning followed a parabolic, increasing by age up to 45 before it declined. Age patterns revealed by the unadjusted crude rates were biased because of significant linear period effect and W-shaped cohort effect. This study is the first to quantify the age patterns of suicide by different methods for US Whites using period-cohort adjusted rates. Study findings provide valid evidence supporting precision interventions to reduce the extra suicide mortality among Whites by targeting specific age ranges with different suicide methods.

Does population density moderate suicide risk? An Italian population study over the last 30years.

The relationship between population density and suicide risk remains unclear. While urbanization is associated with greater risk for psychopathology, higher suicide rates have been reported in rural areas. We examined population density and suicide in the Italian population in the last 30years. The Italian National Institute of Statistics databases of the Italian population aged 15years and older (52.4 million in 2016) were used to compute age-adjusted annual total mortality and suicide rates for the years 1985-2016. According to the European Union statistical office (EUROSTAT) criteria, municipalities were classified into densely populated areas, intermediate density areas, or thinly populated areas. Rate ratios (RRs) were computed by sex, age, and geographical area, using densely populated areas as reference. Total mortality was not associated with population density. In males, suicide rate increased with decreasing population density (RR=1.17, 95% confidence interval [CI]:1.08-1.28, in intermediate population areas, and RR=1.32, 95% CI: 1.20-1.45, in thinly populated areas, in 2016). This inverse relationship was found across age, geographical areas, and consecutively over 22years (1994-2016). In females, no significant difference was detected (RR=0.96, 95% CI: 0.82-1.13 in intermediate density areas and RR=1.02, 95% CI: 0.85-1.22 in thinly populated areas). Hanging was the most common suicide method among males, more frequent in thinly (58.8%) than intermediate (53.2%) or densely (41.4%) populated areas. A consistent and temporally stable inverse relationship between population density and suicide was found in the male, but not female, population. Men may be more vulnerable to adverse social and economic factors associated with lower population density.

Advances in the application of narcotic drugs in electro shock therapy for patients with depression

Depression is a clinical common high suicide rates of mental illness, electro-convulsive therapy with the introduction of anesthetics and muscle relaxants is called modified electroconvulsive therapy(MECT). MECT can be quickly alleviate symptoms of depression, reduce the risk of suicide in patients with, at the same time for treatment-resistant depression has obvious curative effect. By summarizing the application of anesthetic drugs in the treatment of MECT in patients with depression, advances in the application of narcotic drugs in electroshock therapy for patients with depression were reviewed, to achieve a more reasonable anesthesia management, improve the treatment of depression patients. Key words: Anesthetic; Depression; Modified electro-convulsive therapy

Addiction counselors and suicide: Education and experience do not improve suicide knowledge, beliefs, or confidence in treating suicidal clients

Substance use disorders (SUDs) are strongly associated with suicide deaths. However, SUD treatment is associated with lower suicide risk. To this date, we know little about whether SUD counselors are sufficiently knowledgeable about suicide and feel prepared and comfortable with treating and assessing their suicidal clients. This study was designed to characterize SUD counselors' general knowledge and confidence in treating suicidal clients, which was measured by their self-report of general knowledge of suicide prevention and belief in common myths about suicide as well as their self-reported confidence in treating suicidal clients. We hypothesized that confidence would be greater for counselors with more years of education and experience, that degree of education would predict greater knowledge and fewer beliefs in suicide myths, and finally that those counselors with greater knowledge and fewer beliefs in myths would have more confidence when treating suicidal clients. A total of 118 SUD counselors from 15 sites in Western Washington State agreed to participate in the study and completed baseline assessments. They were consented in group setting, usually during a staff meeting, and they were administered surveys on tablet computers. On average, the SUD counselors answered more than half the knowledge questions correctly and disagreed or strongly disagreed with common suicide myths. Their confidence in treating suicidal clients scored across the entire range. Our hypotheses were not supported: Confidence was not greater for those with more education or with more years of experience; degree of education and experience did not predict fewer beliefs in suicide myths; degree of education and experience did not predict greater knowledge; and greater knowledge and fewer beliefs in myths did not predict more confidence. The surprising finding that neither general suicide knowledge nor confidence were associated with the years of their work experience as a SUD counselor nor the level of their education and neither was associated with the other suggests that SUD treatment leadership should not depend on experience, education, general suicide knowledge to assure counselors are confidently able to treat suicidal clients. New or more precise training methods should be considered and evaluated.

Suicide by psychiatric patients: Nature of risk, risk categorisation and preventability.

This study considers risk factors associated with suicide by psychiatric patients, the perceived risk at last contact and risk categorisation and reflects upon the potential for prevention. Information regarding 63 consecutive suicides known to mental health services in Wolverhampton, UK, over a 15-year period was collected as part of an audit using a semi-structured questionnaire covering sociodemographic and clinical risk factors, along with information about preventability. A complex mixture of historical, enduring and current risk factors was observed. In addition to common risk factors, a considerable proportion had histories of multiple co-morbid psychiatric (52.5%) and physical diagnoses (27.6%) and psychiatric admission (70.5%). Common suicide methods included hanging (36.5%) and poisoning (36.5%). Most suicides occurred in the post-discharge months up to around two years (75.8%). Although a range of psychopathologies and suicidal cognitions were observed at the last clinical contact, the immediate suicide risk was considered low (46.2%) or not present (38.5%) in the majority of cases. Clinicians suggested various factors that could have made suicides less likely. Clinical assessment can identify risk factors, but categorisation may not be indicative of the outcome. A focus on modifiable factors, with support for psychosocial and clinical issues, may assist with prevention.

Investigating the psychometric properties of the Suicide Stroop Task.

Behavioral measures are increasingly used to assess suicidal thoughts and behaviors. Some measures, such as the Suicide Stroop Task, have yielded mixed findings in the literature. An understudied feature of these behavioral measures has been their psychometric properties, which may affect the probability of detecting significant effects and reproducibility. In the largest investigation of its kind, we tested the internal consistency and concurrent validity of the Suicide Stroop Task in its current form, drawing from seven separate studies (N = 875 participants, 64% female, aged 12 to 81 years). Results indicated that the most common Suicide Stroop scoring approach, interference scores, yielded unacceptably low internal consistency (rs = -.09-.13) and failed to demonstrate concurrent validity. Internal consistency coefficients for mean reaction times (RTs) to each stimulus type ranged from rs = .93-.94. All scoring approaches for suicide-related interference demonstrated poor classification accuracy (AUCs = .52-.56) indicating that scores performed near chance in their ability to classify suicide attempters from nonattempters. In the case of mean RTs, we did not find evidence for concurrent validity despite our excellent reliability findings, highlighting that reliability does not guarantee a measure is clinically useful. These results are discussed in the context of the wider implications for testing and reporting psychometric properties of behavioral measures in mental health research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Annual Research Review: A meta-analytic review of worldwide suicide rates in adolescents.

Suicide is a leading cause of death among youth worldwide. The purpose of the current review was to examine recent cross-national trends in suicide mortality rates among 10- to 19-year-olds. This study extracted suicide mortality data from the World Health Organization's (WHO) Mortality Database for the most recent year (since 2010) from any country with available high-quality data (as defined by the WHO's guidelines). Data on access to lethal means (firearms, railways) and measures of economic quality (World Bank Income Group) and inequality (Gini coefficients) were obtained from publicly available data sources. Cross-national suicide mortality rates in youth were heterogeneous. The pooled estimate across all ages, sexes, and countries was 3.77/100,000 people. The highest suicide rates were found in Estonia, New Zealand, and Uzbekistan. Suicide rates were higher among older compared with younger adolescents and higher among males than females. The most common suicide methods were hanging/suffocation and jumping/lying in front of a moving object or jumping from a height. Firearm and railway access were related to suicide deaths by firearms and jumping/lying, respectively. Economic quality and inequality were not related to overall suicide mortality rates. However, economic inequality was correlated with a higher ratio of male:female suicides. This study provides a recent update of cross-national suicide trends in adolescents. Findings replicate prior patterns related to age, sex, geographic region, and common suicide methods. New to this review are findings relating suicide method accessibility to suicide mortality rates and the significant association between income inequality and the ratio of male:female suicide. Future research directions include expanding the worldwide coverage to more low- and middle-income countries, examining demographic groupings beyond binary sex and to race/ethnicity within countries, and clarifying factors that account for cross-national differences in suicide trends.