Crude Suicide Rates Research Articles

Suicides in the indigenous and non-indigenous populations in the Nenets Autonomous Okrug, Northwestern Russia, and associated socio-demographic characteristics

BackgroundTo describe suicide rates in the indigenous and non-indigenous populations of the Nenets Autonomous Okrug (NAO) in 2002–2012, as well as associated socio-demographic characteristics.Study designRetrospective population-based mortality study.MethodsData from autopsy reports were used to identify 252 cases of suicide in the NAO in 2002–2012. Data on socio-demographic characteristics of these cases were obtained from passports and medical records at local primary health care units, and were then linked to total population data from the Censuses in 2002 and 2010. Suicide rates for the indigenous Nenets population and the non-indigenous population were standardized to the European standard population. The rates were also estimated according to different socio-demographic characteristics and compared by calculating relative risks.ResultsThe crude suicide rates were 79.8 per 100,000 person-years (PYs) in the Nenets population and 49.2 per 100,000 PYs in the non-indigenous population. The corresponding standardized estimates were 72.7 per 100,000 PYs and 50.7 per 100,000 PYs. The highest suicide rates in the Nenets population were observed in the age group 20–29 years (391 per 100,000 PYs), and in females aged 30–39 years (191 per 100,000 PYs). Socio-demographic characteristics associated with high suicide rates in the Nenets population were age 20–39 years, male, urban residence, having secondary school or higher education, being an employee or employer, and being single or divorced. Males aged 20–29 years, and females aged 30–39 and aged 70 years and above had the highest suicide rates in the non-indigenous population (137.5, 21.6 and 29.9 per 100,000 PYs, respectively). The elevated suicide rates observed in the non-indigenous population were associated with male sex, rural residence, secondary school education, being an employee or employer, and being single or divorced.ConclusionsSuicide rates in the NAO were substantially higher among the indigenous Nenets population than the non-indigenous population, and were associated with different socio-demographic characteristics.

Gender differences in suicide in Serbia within the period 2006-2010

The complex multifactorial etiology of suicide suggests the need to consider gender differences when developing effective strategies for suicide prevention. The aim of this study was to examine the suicide rates and/or trends obtained for population as a whole, including gender differences in cases of committed suicide and to consider factors (age groups, education, employment, marital status, nationality and methods) associated with it in Serbia within the period 2006-2010. Data were obtained from the Statistical Office of the Republic of Serbia. Their classification related to the suicide method was carried out on the basis of ICD-X Code, WHO 1992 (Intemational Statistical Classification of Diseases and Related Health Problems 10th revision, World Health Organizaion). Statistical analysis was done by using the crude specific suicide rate. Within the period 2006-2010 the total number of suicides in Serbia was 6,673, of which 71.9% were males and 28.1% females (male to female suicide ratio 2.56 : 1). Their average rate was 18.15 per 100,000 persons, namely, 26.85 per 100,000 for males and 9.92 per 100,000 for females. Suicide was most often committed by married males and females with high school education, retired, by the Serbs. The suicide rate in Serbia increased paralelly with the age of suicide committers and it was the highest in subjects of both genders aged over 75 years. The most common suicide method in males (62.78%) and in females (58.38%) was hanging and strangling. The second most common method in males was by firearm (18.65%) and in females poisoning (19.26%). Suicide prevention Programme should be primarily oriented toward the male population because it is more exposed to stress in the period of social transition, but males are still less ready to ask for doctor's help when having some problems with mental health.

Veterans and Suicide: A Reexamination of the National Death Index–Linked National Health Interview Survey

We assessed the risk of suicide among veterans compared with nonveterans. Cox proportional hazards models estimated the relative risk of suicide, by self-reported veteran status, among 500,822 adult male participants in the National Death Index (NDI)-linked National Health Interview Survey (NHIS), a nationally representative cohort study. A total of 482 male veterans died by suicide during 1,837,886 person-years of follow-up (76% by firearm); 835 male nonveterans died by suicide during 4,438,515 person-years of follow-up (62% by firearm). Crude suicide rates for veterans and nonveterans were, respectively, 26.2 and 18.8 per 100,000 person-years. The risk of suicide was not significantly higher among veterans, compared with nonveterans, after adjustment for differences in age, race, and survey year (hazard ratio = 1.11; 95% confidence interval = 0.96, 1.29). Consistent with most studies of suicide risk among veterans of conflicts before Operation Iraqi Freedom/Operation Enduring Freedom, but in contrast to a previous study using the NDI-linked NHIS data, we found that male veterans responding to the NHIS were modestly, but not significantly, at higher risk for suicide compared with male nonveterans.

Female Suicide Rates in Ghizer, Pakistan

Suicide is an understudied subject in Pakistan. There are many social, legal, and religious sanctions against it. National rates of suicides are not known. We calculated suicide rates of women in the Ghizer District of the remote Northern Areas of Pakistan. During years 2000 to 2004, 49 women committed suicide. Taking average mean population for women for 5 years as 65,783, we calculated annual crude suicide rates for women as 14.89/100,000/year. For women over the age of 15 years, rates were 33.22/100,000/year; age-specific rates for 15-24 years were 61.07/100,000 per year. These figures are considerably higher than suicide rates in other parts of Pakistan and may be related to high psychiatric morbidity in Pakistani women. This study underscores the need for a standardized system of registration of suicides in Pakistan. There is also urgent need to address high psychological distress in women in Pakistan.

P02-119 Smoker suicide rates and risks in the United States and Frankfurt, Germany

Background:Suicide and smoking are immense, growing, associated global problems. Recent general population suicide rates and ratios by smoking status are unknown though in past reports, smokers had near three-fold hazard ratios of suicide among health professionals. So we assessed recent suicide rates and rate ratios in the general population of the United States (US) and Frankfurt, Germany.Methods:US National Health Interview Survey interviewees from 1987, 1988, and 1990-94 with near complete follow up through 2002 (representing the US adult non-institutionalized population) and all suicides in 1999-2000 among adult residents of Frankfurt, their proxy respondents, control subjects, and census data were studied using survival time methods. Age was categorized in both samples as 18-30, 31-60 and 61+ years.Results:The respective US versus Frankfurt crude suicide rates per 100,000 were 13.8 (95% confidence interval (CI) 12.4-15.5) versus 17.7 (CI 15.0-20.5) overall, 7.9 (CI 6.4-9.9) versus 12.0 (CI 9.2-14.7) in never smokers, and 22.9 (CI 19.5-27.0) versus 32.0 (CI 24.5-39.6) in current smokers. Smoker suicide rate ratios relative to never smokers ranged from 2.1 (males) to 4.2 (females) in US groups and 1.5 (ages 61+ years) to 3.7 (ages 31-60 years) in Frankfurt groups (each p< 0.05).Discussion:In both the US and Frankfurt, Germany, large absolute and relative excesses of suicide are seen in smokers. Reducing the prevalence of smoking might greatly reduce suicide rates, especially in young and middle-aged adults and US females.Acknowledgements:This study was funded by Pfizer, Inc.

A Nonlinear Association of Fertility and Suicide Rates among Elderly Persons

A negative linear correlation for crude suicide rates of elderly persons with fertility rates was reported earlier but may mask a curvilinear relation. A re-analysis of those data from 81 countries as reported in the World Health Organization and United Nations data banks yielded a curvilinear (U-shaped curve) relation. Explanations require further study.

Correlates of Suicide in Building Industry Workers

Suicide within the construction industry in Queensland, Australia was reportedly high in a recent Royal Commission report. The current study examined the incidence and causes of suicide in this industry using psychological autopsy and focus group investigations. A total of 64 male suicides occurred over the seven-year period, representing a crude suicide rate of 40.3 per 100,000, significantly greater than the working age Australian male rate. Young employees were at excessive risk with separation/divorce, relationship problems, and untreated psychiatric conditions the major contributors. Focus groups emphasized the importance of work/home interface factors and industry-specific factors preceding suicide.

The black–white suicide paradox: Possible effects of misclassification

This research addresses the paradox that the crude and age-adjusted suicide rates of United States blacks are less than half those of whites despite similar risks. Upper and lower limits for true suicide rates are estimated to assess the potential for differential suicide misclassification by race. Construction of these two rate scenarios respectively incorporate one or all of the three cause-of-death categories identified in the literature as most prone to obscure suicides: injury of undetermined intent and unintentional poisonings and drownings. The data source is the US Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System, and the observation period is 1999–2002. We found that as in the official rates, the racial suicide gap persists within the lower and upper limit scenarios. However, there is marked shrinkage under the upper limit scenario. That scenario even generates rate crossovers for males ages 45–54 years and females ages 85 years and older. Suicide data appear relatively more deficient for black females than for black males. Racial data disparities are minimal for youth and young adults, and maximal for middle-aged males and the oldest and younger middle-aged females. Results strongly indicate greater susceptibility of medico-legal authorities to misclassify black suicides than white suicides. To demystify the racial suicide paradox, research is needed on medical histories and other biographical information that are accessible by the authorities in equivocal cases. To meet the standards of evidence-based medicine and public health, high-quality suicide data are an imperative for risk group delineation; risk factor identification; policy formulation; program planning, implementation, and evaluation; and ultimately, effective prevention.

Suicide in the United States End-Stage Renal Disease Program

Although depression and dialysis withdrawal are relatively common among individuals with ESRD, there have been few systematic studies of suicide in this population. The goals of this study were to compare the incidence of suicide with national rates and to contrast the factors associated with suicide with those associated with withdrawal in persons with ESRD. All individuals who were aged 15 yr and older and initiated dialysis between April 1, 1995, and November 30, 2000, composed the analytic cohort. Patients were censored at the time of death, transplantation, or October 31, 2001. Death as a result of suicide in the ESRD population and the general US population was ascertained from the Death Notification Form and the Centers for Disease Control and Prevention, respectively. Standardized incidence ratios for suicide among patient subgroups were computed using national data from the year 2000 as the reference population. The crude suicide rate from 1995 to 2001 was 24.2 suicides per 100,000 patient-years, and the overall standardized incidence ratio for suicide was 1.84 (95% confidence interval, 1.50 to 2.27). In multivariable models, age > or =75 yr, male gender, white or Asian race, geographic region, alcohol or drug dependence, and recent hospitalization with mental illness were significant independent predictors of death as a result of suicide. Persons with ESRD are significantly more likely to commit suicide than persons in the general population. Although relatively rare, risk assessment can be used to identify patients for whom counseling and other interventions might be beneficial.

Suicide in the French Armed Forces

Several states, of whom France, have been alarmed about suicide in the military. An observational longitudinal cohort study was conducted to check whether the suicide risk in the French army was higher than in the general population and to find out the more prone to self-harm destruction personnel categories. From 1997 to 2000 inclusive, 230 suicides occurred among 315,934 person.years; i.e., the overall annual crude suicide rate was 18.2 per 100,000 active-duty personnel. With the National data for 1999 as reference, army men had a lower suicide risk than men in the overall population of similar age categories (standardised mortality ratio = 67). A Poisson regression model showed that the incidence rate in the Gendarmerie was twice as high as in the Land Forces (incidence rate ratio = 2.15), that the incidence relative risk increased threefold over 4 years, and that the incidence rate ratio amongst under 25 and from 40 to 44-year-old personnel was almost twice as high as in the 25-29-year-old category. The main suicide methods were use of a firearm (51%) and hanging (28%). Despite a global lower risk than in the general population, certain army categories, i.e., Gendarmerie personnel and young men, deserve specific surveillance and preventive measures.

Elevated Suicide Risk among Patients with Multiple Sclerosis in Sweden

Results from previous studies of suicide risk among patients with multiple sclerosis (MS) are inconsistent. This may be explained partly by differences in methodology and study populations. The purpose of our study was to investigate suicide risk among hospital patients with MS in Sweden. During the period 1969–1996, 12,834 cases were recorded in the Swedish Hospital Inpatient Register, with 77,377 hospital admissions, in which MS was a primary or secondary diagnosis at discharge. The mean follow-up time for the whole cohort was 9.9 (SD 7.3) years. When the data for these MS patients were linked to the Swedish Causes of Death Register for the same period, 5,052 (39.4%) were found to have died. Among the 5,052 deaths, suicide was an underlying cause of death in 90 cases (1.8%). The mean period between the initial admission date with an MS diagnosis at discharge and the date of death for the 90 MS suicide cases was 5.8 (SD 5.1) years. This was significantly shorter (p = 0.002) than the mean of 7.9 (SD 6.4) years for MS cases who died due to other causes. Suicide risk, calculated as the standardized mortality ratio (SMR), was significantly elevated (SMR = 2.3) among both male and female MS cases compared with the general population. Suicide risk was particularly high in the first year after initial admission with an MS diagnosis, and among younger male MS cases. The mean age at the time of suicide was 44.5 (SD 12.4) years, and 58% of the suicides were committed within 5 years after the first admission with an MS diagnosis. The crude suicide rate among MS patients during the study period was 71 per 100,000 person-years. The rate was significantly higher (p < 0.001) in males (114) than in females (47), with an odds ratio of 2.4 (95% CI: 1.6–3.8). These findings have implications for suicide preventive measures in neurological practice.

Suicide rates from 1960 to 1989 in Norwegian physicians compared with other educational groups

The aim of the present study is to compare suicide rates between 1960 and 1989 for Norwegian physicians with corresponding rates for other Norwegians with and without university education, by age, gender, and five-year period, based on death certificates for all Norwegians who died in the period 1960–1989. There were 82 registered physician suicides, of which 9 were female, 265 suicides by persons with other university education, and 11, 165 by persons with no university education. Suicide rate is measured in number of deaths per 100,000 person years. Crude suicide rates were 47.7 (95% CI 37.7–60.4) for male physicians, 20.1 (17.7–22.9) for other male university graduates, and 22.7 (22.2–23.2) for men with no university education. The corresponding figures for females were 32.3 (15.8–63.7), 13.0 (8.4–19.8) and 7.7 (7.5–8.0). Both for males and females, suicide rates, controlled for age and period, were significantly higher for physicians than for persons with other or no university education. Poisson modelling showed that the risk of suicide for male physicians has the same age pattern as for other males with higher education. In 1985–89 the suicide rate for male physicians increased nearly linearly from about 35 at the age 35–40 to about 100 at the age 75–79, which was almost three times higher than for the other male university graduates. For the age group 50–54 the estimated rate increases from about 50 in 1960–64 to about 90 in 1985–89. For the female physicians, the low number of cases prevents reliable estimation of trends. For male physicians, the trend from 1960 to 1989 is increasing. The estimated risk for a single physician to commit suicide was almost 5 times that of a married or co-habitant colleague. For 52% of the male and 85% of the female physicians the suicide method was poisoning. This is about twice the rates in the general population.

Gender equality and the sex differential in suicide rates using gender-age standardized data

Using crude suicide rates, Lester (1994) reports that occupational segregation and gender egalitarianism are not significantly related to the sex differential in suicide rates, male suicide rates, and female suicide rates in 24 countries. Using a gender-age standardized version of Lester's data, occupational segregation is significantly related to all four dependent variables, and gender egalitarianism is significantly related to two of the four dependent variables.

Gender equality and the sex differential in suicide rates using gender-age standardized data

Using crude suicide rates, Lester (1994) reports that occupational segregation and gender egalitarianism are not significantly related to the sex differential in suicide rates, male suicide rates, and female suicide rates in 24 countries. Using a gender-age standardized version of Lester's data, occupational segregation is significantly related to all four dependent variables, and gender egalitarianism is significantly related to two of the four dependent variables.

Use of age-adjusted suicide rates in time series studies in Canada.

For 1950–1985 age adjusted suicide rates were associated with marriage, birth, and divorce rates in Canada in the same way as were crude suicide rates.

The two study groups may not be comparable

EDITOR,--Susan S Jick and colleagues conclude their detailed study of suicide and prescribing of antidepressants by stating that their data are consistent with the hypothesis that those who are determined to commit suicide will do so even if one particular means (drug overdose) is made less available.1 Such a view is also supported by J Guy Edwards in his accompanying editorial.2 The data presented do not support these assertions. In Jick and colleagues' study overall crude suicide rates were twice as high in the group who took other antidepressants (14.9/10000 person years) as in those taking tricyclic antidepressants (7.4/10000). This suggests that there may be differences between …

Suicide and undetermined violent deaths in Malaysia, 1966-1990: evidence for the misclassification of suicide statistics.

Suicide statistics are generally recognised to be unreliable. This study of the reported rates of suicide in West Malaysia between 1966-1990 shows that the mean crude suicide rate between 1966-1974 was 6.1 per 100,000, but had dropped drastically between 1975-1990 to a mean of 1.6 per 100,000. Three lines of evidence are presented to show that this reduction in the suicide rate is due to a systematic misclassification of medically certified suicides as deaths due to undetermined violent deaths (which refers to violent deaths not known to be accidentally or deliberately inflicted). Firstly, the large drop in reported suicide rates corresponds closely to an increase in the rate of deaths due to undetermined violent deaths. There is a highly positive negative correlation between the two rates (coefficient of correlation, r = -0.9). Secondly, the misclassification appears to be mainly a problem with the medically certified deaths which follow the ICD classification. The mean ratio of uncertified to certified suicides before 1975 was 0.8, but from 1975 onwards the mean was 3.1. This is in contrast to the corresponding ratio for deaths due to all accidents which has remained fairly constant throughout these years. Thirdly, the race and sex differences for the rates of undetermined violent deaths are identical to those of suicide. Taking the misclassification into account the corrected suicide rate for West Malaysia is estimated to be between 8-13 per 100,000 since 1982.

Mortality and suicide rates of involuntarily committed patients

The mortality and suicide rates for involuntarily committed patients in Denmark are presented. Two cohorts of psychiatric patients committed to a mental hospital from January 1, 1971 to December 31, 1975 (8322 people) and January 1, 1981 to December 31, 1985 (5253 people) have been followed. The standard mortality rate (SMR) in relation to the total Danish population were 4.9 (4.5-5.4) and 5.2 (4.7-5.8), respectively, for the two cohorts, during the first year after involuntarily commitment to a mental hospital. During the same period, the SMR for suicide among the committed patients were 44.9 (37.1-53.9) and 30.9 (24.2-38.9), respectively. The crude suicide rates among the committed patients during the first year after the commitment were 14.3 and 14.0, respectively, per 1000 years, unchanged between the cohorts. Short length of stay in hospital (< 14 days), a nonpsychotic main diagnosis, male sex, and age 35 years or more were equally related to high risk of suicide in the 1971 cohort as evaluated to proportional hazard methods (Cox regression), and short length of stay and commitment on the danger indication provided the most information in relation to high suicidal risk in the 1981 cohort. Methodological problems and the reasons for the results are discussed.

Effect of using age-adjusted suicide rates on time-series studies of the American suicide rate.

Divorce rates were significantly associated with crude suicide rates in a time-series study of the USA from 1950–1985 but not with age-adjusted suicide rates.

Effect of using age-adjusted suicide rates on the results of time-series analyses of the suicide rate.

Using data from Motohashi, differences in results of time-series analyses of crude and age-adjusted suicide rates in Japan were observed.