Fatal Suicide Research Articles

Non-Opioid Substances Acute Poisonings with Suicidal Intent in Patients with Opioid Use Disorder.

Several epidemiological studies have evaluated the role of illicit drug use in suicide behaviour. To assess patients with opioid use disorder and suicidal intent related to behavior, severity of acute poisoning and the most commonly used non-opioid substances. This cross sectional study included 67 patients diagnosed with opioid use disorder. The study was conducted at the University Clinic of Toxicology in Skopje over a 5-year period (2013-2017). The following variables were examined: gender, age, duration and route of opioid administration, duration of hospitalization, and types of substances used in acute poisoning. Assessment of patients’ behavior and severity of poisoning was made by using the Suicide Behaviours Questionnaire-Revised and the Poison severity score. The majority of patients were male (88.1%). The mean age of patients was 30±6.1 years. The average duration of opioid use disorder was 8.5±3.9. A single poisoning was found in 62.7%, double poisoning in 25.4%, and triple poisoning in 11.9% of participants. Benzodiazepines were most commonly used by the patients (55.2%). The largest number of patients (32.8%) had minor Poison severity score (PSS), and only 17.9% had severe PSS. None of the patients had a fatal suicide attempt. 86.6% of patients had a score of ≥7 indicating a high risk of repeat suicide attempts. Benzodiazepines were most commonly used as a single or combined substance in patients with opioid use disorder. PSS indicated that most of the participants were with minor PSS and with high risk of a repeat suicide attempt.

Association between family history of suicide attempt and neurocognitive functioning in community youth.

Suicidal behavior is highly familial. Neurocognitive deficits have been proposed as an endophenotype for suicide risk that may contribute to the familial transmission of suicide. Yet, there is a lack of research on the neurocognitive functioning of first-degree biological relatives of suicide attempters. The aim of the present study is to conduct the largest investigation to date of neurocognitive functioning in community youth with a family history of a fatal or nonfatal suicide attempt (FH). Participants aged 8-21years from the Philadelphia Neurodevelopmental Cohort completed detailed clinical and neurocognitive evaluations. A subsample of 501 participants with a FH was matched to a comparison group of 3,006 participants without a family history of suicide attempt (no-FH) on age, sex, race, and lifetime depression. After adjusting for multiple comparisons and including relevant clinical and demographic covariates, youth with a FH had significantly lower executive function factor scores (F[1,3432]=6.63, p=.010) and performed worse on individual tests of attention (F[1,3382]=7.08, p=.008) and language reasoning (F[1,3387]=5.12, p=.024) than no-FH youth. Youth with a FH show small differences in executive function, attention, and language reasoning compared to youth without a FH. Further research is warranted to investigate neurocognitive functioning as an endophenotype for suicide risk. Implications for the prevention and treatment of suicidal behaviors are discussed.

Incidence and Lethality of Suicidal Overdoses by Drug Class

Prior lethality analyses of suicide means have historically treated drug poisoning other than alcohol poisoning as a lumped category. Assessing risk by drug class permits better assessment of prevention opportunities. To investigate the epidemiology of drug poisoning suicides. This cross-sectional study analyzed censuses of live emergency department and inpatient discharges for 11 US states from January 1, 2011, to December 31, 2012, as well as Healthcare Cost and Utilization Project national live discharge samples for January 1 to December 31, 2012, and January 1 to December 31, 2016, and corresponding Multiple Cause of Death census data. Censuses or national samples of all medically identified drug poisonings that were deliberately self-inflicted or of undetermined intent were identified using diagnosis and external cause codes. Data were analyzed from June 2019 to January 2020. Distribution of drug classes involved in suicidal overdoses. Logistic regressions on the state data were used to calculate the odds and relative risk (RR) of death for a suicide act that involved a drug class vs similar acts excluding that class. Among 421 466 drug poisoning suicidal acts resulting in 21 594 deaths, 19.6% to 22.5% of the suicidal drug overdoses involved benzodiazepines, and 15.4% to 17.3% involved opioids (46.2% men, 53.8% women, and <0.01% missing; mean age, 36.4 years). Opioids were most commonly identified in fatal suicide poisonings (33.3%-47.8%). The greatest RR for poisoning suicide completion was opioids (5.20 times the mean for suicide acts that did not involve opioids; 95% CI, 4.86-5.57; sensitivity analysis range, 3.99-6.86), followed by barbiturates (RR, 4.29; 95% CI, 3.35-5.45), antidepressants (RR, 3.22; 95% CI, 2.95-3.52), antidiabetics (RR, 2.57; 95% CI, 1.94-3.41), and alcohol (conservatively, because 30% of death certifiers do not test for alcohol; RR, 2.04; 95% CI, 1.84-2.26). The updated toxin diagnosis coding in International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, used to code the 2016 data revealed that calcium channel blockers also had a high RR of 2.24 (95% CI, 1.89-2.61). Translated to attributable fractions, approximately 81% of suicides involving opioids would not have been fatal absent opioids. Similarly, 34% of alcohol-involved suicide deaths were alcohol attributable. These findings suggest that preventing access to lethal means for patients at risk for suicide should extend to drugs with high case fatality rates. Blister packing and securely storing lethal drugs seems advisable.

Firearm Storage Maps: A Pragmatic Approach to Reduce Firearm Suicide During Times of Risk.

Preventing firearm-related injury and death requires pragmatic, community-based solutions. The authors describe their initial experiences developing a statewide map of locations where firearms may ...

Cases of asphyxia in children and adolescents: a retrospective analysis of fatal accidents, suicides, and homicides from 1998 to 2017 in Hamburg, Germany

PurposeInjury-related asphyxia is one of the most common causes of death in children in Germany. However, only a few systematic studies have analyzed the causes and circumstances of asphyxia in children and adolescents.MethodsAll cases of asphyxia in children and adolescents (0–21 years of age) among the Hamburg Legal Medical Department’s autopsy cases from 1998 to 2017 were retrospectively analyzed with special focus on how often external findings were completely absent.ResultsAmong 249 cases of fatal asphyxia, 68% were accidents, 14% were suicides, and 13% were homicides. Most of the cases involved boys. Adolescents and young adults aged 15–21 years represented the main age group. Drowning was the leading mechanism of asphyxia. Younger age was associated with less frequent detection of external signs of asphyxia in the postmortem external examination. Petechial hemorrhages were the most common visible external indication of asphyxia. No external findings indicative of asphyxia were present in 14% of the cases.ConclusionAsphyxia in children and adolescents often involves accidents. However, postmortem external examination alone is insufficient to identify asphyxia and the manner of death.

Impact of meteorological parameters on suicide mortality rates: A case-crossover analysis in Southern Germany (1990–2006)

BackgroundThere is evidence for a seasonal pattern of suicides with peaks in spring and early summer; however, only a limited number of studies has investigated whether daily changes in meteorological variables may trigger suicides. MethodsDaily fatal suicide (N = 10,595) and meteorological data were available for four Bavarian cities and ten counties (Germany) for 1990–2006. City/county-specific immediate, delayed and cumulative effects of air temperature, sunshine duration, and cloud cover on suicides were analyzed using a time-stratified case-crossover approach; city/county-specific effects were then combined using random effects meta-analysis. Potential effect modifiers were specific weather conditions, personal or regional characteristics, and season. ResultsA 5 °C increase in air temperature on the day before a suicide compared to the control days was associated with a 5.7% (95% confidence interval (CI): 0.6; 11.0) higher suicide risk. Further, the suicide risk was 6.5% (95% CI: 0.2; 13.3) higher on days with low/medium cloud cover (0–6 oktas) compared to days with high cloud cover (7–8 oktas). While daily changes in temperature were not associated with suicides in spring, we found a higher suicide risk in summer, autumn, and winter in association with temperature increases. The effects of cloud cover were strongest in summer and autumn and on days with temperature above the median (>8.8 °C). Sunshine duration was not associated with suicides. ConclusionWe found a higher risk for suicides in association with short-term increases in air temperature on the day before the event compared to the control days and on days with low to medium cloud cover. This may highlight times when people are more likely to commit suicide.

From ALGOS to VigilanS: New perspectives in nurse skills for suicide prevention

There is growing evidence in the literature that brief contact interventions (BCIs) might be reliable suicide prevention strategies. Due to the human and societal burden of suicide in France, French government has supported the assessment of the effectiveness of combining BCIs to reduce suicide at a national level. Nurses play a central role in BCI suicide prevention strategies. To assess the effectiveness of a decision-making algorithm for suicide prevention (ALGOS) combining existing BCIs in reducing suicide reattempts in patients discharged after a suicide attempt. A randomized, multicenter, controlled, parallel trial was conducted in 23 hospitals. The study was conducted from January 26, 2010, to February 28, 2013. People who had made a suicide attempt were randomly assigned to either the intervention group (ALGOS) or the control group. The primary outcome was the rate of participants who reattempted suicide (fatal or not) within the 6-month study period. In total, 1040 patients were recruited. After 6 months, 58 participants in the intervention group (12.8%) reattempted suicide compared with 77 (17.2%) in the control group. We found an absolute reduction in global adverse events outcome (fatal and non fatal suicide reattempt and loss to follow-up) at 6 and 13 months. We are currently replicating the ALGOS experimentation in several French regions with different sociodemographic characteristics under the “VigilanS” project. Nurses play a critical role in such prevention approaches. The effect may also be reinforced by integrating effective TIC systems into work environment. Overall, we believe that the preventative effect of BCIs may be reinforced by integrating these systems into multimodal approaches and long-term follow-up strategies.

Comorbidity Profiles Identified in Older Primary Care Patients Who Attempt Suicide.

To identify comorbidity profiles of older patients last seen in primary care before a suicide attempt and assess attempt and clinical factors (eg, means and lethality of attempt) associated with these profiles. Cohort study and latent class analysis using Department of Veterans Affairs (VA) national data (2012-2014). All VA medical centers in the United States. A total of 2131 patients 65 years and older who were last seen by a primary care provider before a first documented suicide attempt. Fatal suicide attempt and means were identified using the National Suicide Data Repository. Nonfatal attempt was defined using the National Suicide Prevention Applications Network. Medical and psychiatric diagnoses and other variables were determined from electronic medical records. Patients (mean age = 74.4 y; 98.2% male) were clustered into five classes based on medical and psychiatric diagnoses: Minimal Comorbidity (23.2%); Chronic Pain-Osteoarthritis (30.1%); Depression-Chronic Pain (22.9%); Depression-Medical Comorbidity (16.5%); and High Comorbidity (7.3%). The patients in the Minimal Comorbidity and Chronic Pain-Osteoarthritis classes were most likely to attempt fatally compared with classes with a higher burden of comorbidities. Overall, 61% of the sample attempted fatally, and 82.5% of suicide decedents used firearms. This study provides evidence that most comorbidity profiles (>50%) in primary care patients attempting suicide were characterized by minimal depression diagnoses and fatal attempts, mostly with firearms. These findings suggest that more than a depression diagnosis contributes to risk and that conversations about firearm safety by medical providers may play an important role in suicide intervention and prevention. J Am Geriatr Soc 67:2553-2559, 2019.

A comprehensive analysis of attempted and fatal suicide cases involving frequently used psychotropic medications

ObjectivesSelf-poisoning is the most common suicide method in non-lethal suicide attempts and the third most frequent in fatal suicides. Psychoactive drugs are often used for intentional self-poisoning. While poisons centre data typically focus on survived suicide attempts and underrepresent fatal self-poisoning, medical examiner reports give insight into suicide deaths. To close this gap, we combined and compared data sets from both sources, assessing the mortality of psychotropic drugs used for self-poisoning. MethodsAnonymized cases of self-poisoning with suicidal intention from 2000 to 2010 were extracted from the national poisons centre case database and compared with cases of suicide documented in the project “Suicides, a national survey”. All cases with single substance exposure to a psychoactive drug (antidepressants, mood stabilizers, antipsychotics, sedatives) were included in the analyses. Opioids, over-the-counter- and illicit- drugs were excluded from the analysis. A mortality index was calculated by the ratio of the number of suicides and the sum of all (lethal and non-lethal) suicide attempts. ResultsTricyclics had a higher mortality rate than other antidepressants. Among the sedatives, zolpidem was found to have a higher mortality index compared to benzodiazepines. Clozapine and levomepromazine were found to be the most lethal antipsychotics. Non-lethal suicide cases with single substance exposure (n = 4697) diminished as age increased, while the rate of suicide cases (n = 165) was higher in elderly subjects (>65 years of age, p < 0.001). ConclusionIn summary, our findings confirm previous study results on the relative toxicity of distinct classes of psychotropic drugs. In this comprehensive analysis of a national cohort lorazepam had a lower mortality rate compared to other sedatives.

Improving pragmatic clinical trial design using real-world data.

Pragmatic clinical trials often use automated data sources such as electronic health records, claims, or registries to identify eligible individuals and collect outcome information. A specific advantage that this automated data collection often yields is having data on potential participants when design decisions are being made. We outline how this data can be used to inform trial design. Our work is motivated by a pragmatic clinical trial evaluating the impact of suicide-prevention outreach interventions on fatal and non-fatal suicide attempts in the 18 months after randomization. We illustrate our recommended approaches for designing pragmatic clinical trials using historical data from the health systems participating in this study. Specifically, we illustrate how electronic health record data can be used to inform the selection of trial eligibility requirements, to estimate the distribution of participant characteristics over the course of the trial, and to conduct power and sample size calculations. Data from 122,873 people with patient health questionnaire (PHQ) responses, recorded in their electronic health records between 1 July 2010 and 31 March 2012, were used to show that the suicide attempt rate in the 18 months following completion of the questionnaire varies by response to item nine of the PHQ. We estimated that the proportion of individuals with a prior recorded elevated PHQ (i.e. history of suicidal ideation) would decrease from approximately 50% at the beginning of a trial to about 5%, 50 weeks later. Using electronic health record data, we conducted simulations to estimate the power to detect a 25% reduction in suicide attempts. Simulation-based power calculations estimated that randomizing 8000 participants per randomization arm would allow 90% power to detect a 25% reduction in the suicide attempt rate in the intervention arm compared to usual care at an alpha rate of 0.05. Historical data can be used to inform the design of pragmatic clinical trials, a strength of trials that use automated data collection for randomizing participants and assessing outcomes. In particular, realistic sample size calculations can be conducted using real-world data from the health systems in which the trial will be conducted. Data-informed trial design should yield more realistic estimates of statistical power and maximize efficiency of trial recruitment.

Marriage Related Suicide Fatality Rates

Objective: The present study aimed at estimating the case fatality rates of suicide acts in different marital status subgroups and to find interrelation with a population living in Bushehr province along the coastal region of the Persian Gulf coast in southwest of Iran. Method : In this analytical and observational study, suicidal data were gathered in 5 successive years (2008-2012) in the population of Bushehr. Data were extracted from suicide registration forms provided by the Psychiatric Health Unit of Ministry of Health. Questions mainly focused on demographic characteristics, including age, sex, literacy, residency, marital status, birth rank, the number of previous suicide attempts, and probable reasons of suicide, such as family conflicts or/and psychiatric complications. Fatality rates in different subgroups (male/female; married/unmarried; etc.) were compared and odds ratios were computed. The main limitation of this study was the lack of a specific grouping for those who cohabited together (Those who live together and have a sexual relationship without being married). The logistic regression model was used in data analysis. Results: Case mortality rates of suicides were found to be 3.5% for both sexes, 5.2% in males and 2.7% in females. However, among the single population, either divorced or widowed, the probability of death due to suicide was 3.5 times higher (95% CI: 1.5-2.9) as compared to the unmarried. Age as a confounding factor in fatality rates made a significant difference between married and unmarried people, and differences disappeared after adjusting for age. However, fatality rate was still higher in the widowed /divorced group compared to other groups even after adjusting for age. Conclusion: Fatality rate was higher in married people compared to the unmarried, however, after adjusting for age as a determinant factor, no significant difference was observed between the 2 groups. The highest death rate belonged to the age-specific widowed /divorced individuals as compared to all other marital status subgroups.

Suicide in Parkinson’s disease

Persons with Parkinson’s disease (PwP) have many known risk factors for suicide and suicidal ideation (SI). Despite this, there is limited understanding of suicidality in this population. We conducted a...

Epidemiological trend of suicide in center of Iran from 2012 to 2016

ObjectivesSuicide is a conscious act in which the individual deliberately commit and unusual act with the intention of self-harm. The present study aims to examine some epidemiological factors affecting attempted and completed suicide rate during 2012–2016 in NajafAbad, a city in Isfahan province. MethodsThis is a cross-sectional study. The subjects are 2138 cases involved in suicide attempt during 2012–2016 that gone to Montazeri and Al-Zahra hospital. Chi-square, logistic regression and Cochran–Armitage test was used for data analysis. ResultTotally, 1385 (64.8%) patients were female and 47.8% were younger than 24 years of age. The most common method of suicide was medication overdose (91.1%). In multivariable analysis, male gender (OR: 2.67; CI 95% 1.53 to 4.64) was a risk factor for fatal suicide and application of chemical methods (OR: 0.018; CI 95% 0.010 to 0.032) was a protective factor. Results regarding completed suicide trend analysis shows that this trend has had a significant statistical difference in men (p = 0.019) but in women this trend doesn't statistically significant difference. (p = 0.209). ConclusionsAccording to the findings of the present study, attempted and completed suicide rate in Najafabad is relatively high compared to other regions in Islamic Republic of Iran. The completed suicide rate was significant in men which achieved its greatest value in 2015. Suicide attempt rate didn't show a significant statistical difference in both men and women.

Methomyl induced effect on fortilin and S100A1 in serum and cardiac tissue: Potential biomarkers of toxicity.

Methomyl toxicity has been reported as a cause of several accidental and suicidal fatalities. The study is evaluating the effect of lethal methomyl toxicity on fortilin and S100A1 in serum and cardiac tissues. Adult 96 female Sprague-Dawley rats were divided equally into a control (euthanized by cervical dislocation) and a study group (overdosed with methomyl). The levels of fortilin and S100A1 in serum were measured antemortem (to establish the basal levels in serum) and postmortem (to evaluate changes after methomyl exposure) using enzyme-linked immunoassay. S100A1 was immunostained in sections from cardiac tissues. Both proteins in the control were not significantly different (p > 0.05) compared with the antemortem levels. On the contrast, both biomarkers levels in the intoxicated group were remarkably higher (p < 0.001) than the control and the antemortem levels. Ventricular tissues from the intoxicated rats presented depleted S100A1 immunostain in cardiomyocytes localized mainly in the epicardium with deeply stained adjacent cardiac fibroblasts. The cardiomyocytes were damaged with a prominent loss of striations compared to normal cardiac tissues from the control. The present outcomes explain to a certain degree the potential toxic effect of methomyl poisoning on the cardiac tissue. Both proteins could be added to the currently available battery of markers for assessing methomyl toxicity.

Suicide Attempters, Suicide Ideators, and Non-Ideators.

Background: Suicide ideation is a prerequisite for suicide attempts. However, the majority of ideators will never act on their thoughts. It is therefore crucial to understand factors that differentiate those who consider suicide from those who make suicide attempts. Aim: Our aim was to investigate the role of protective factors in differentiating non-ideators, suicide ideators, and suicide attempters. Method: Inpatients without suicide ideation (n = 32) were compared with inpatients with current suicide ideation (n = 37) and with inpatients with current suicide ideation and a lifetime history of suicide attempts (n = 26) regarding positive mental health, self-esteem, trust in higher guidance, social support, and reasons for living. Results: Non-ideators reported more positive mental health, social support, reasons for living, and self-esteem than suicide ideators and suicide attempters did. No group differences were found regarding trust in higher guidance. Suicide ideators and suicide attempters did not differ regarding any of the study variables. Limitations: Results stem from a cross-sectional study of suicide attempts; thus, neither directionality nor generalizability to fatal suicide attempts can be determined. Conclusion: Various protective factors are best characterized to distinguish ideators from nonsuicidal inpatients. However, the same variables seem to offer no information about the difference between ideators and attempters.

Pattern of suicide by self-poisoning in Northern Tunisia: An eleven-year study (2005–2015)

ObjectiveThe aim of our study was to discuss the epidemiological features of self-poisoning suicide in Northern Tunisia. MethodsWe conducted a retrospective, descriptive and cross-sectional study, including all the cases of fatal self-poisoning suicide occurring between January 2005 and December 2015. ResultsIn the study period, 204 cases of self-poisoning suicide occurred in northern Tunisia, with a prevalence of 0.44 cases/100 000 inhabitants/year. Among these cases, 59% were females (the sex ratio was 0.69). The mean age was 34 ± 15.3 years-old. The most common age group of the victims (28.4%) was between 20 and 29 years old. Victims were unemployed in 45% of cases and single at the time of suicide in 52%. None of the victims left a suicide note. Self-poisonings were due to the ingestion of drugs (52.5%), pesticides (42.6%), caustic products (5.5%) and Butane gas (1 case). ConclusionsFatal casualties of self-poisoning in Tunisia are frequently young, single, unemployed women. This pattern would allow planning of targeted preventive measures.

Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm

BackgroundThe Columbia-Suicide Severity Rating Scale (C-SSRS) is a relatively new instrument for the assessment of suicidal ideation and behaviour that is widely used in clinical and research settings. The predictive properties of the C-SSRS have mainly been evaluated in young US populations. We wanted to examine the instrument’s predictive validity in a Swedish cohort of adults seeking psychiatric emergency services after an episode of self-harm.MethodsProspective cohort study of patients (n = 804) presenting for psychiatric emergency assessment after an episode of self-harm with or without suicidal intent. Suicidal ideation and behaviours at baseline were rated with the C-SSRS and subsequent non-fatal and fatal suicide attempts within 6 months were identified by record review. Logistic regression was used to evaluate separate ideation items and total scores as predictors of non-fatal and fatal suicide attempts. Receiver operating characteristics (ROC) curves were constructed for the suicidal ideation (SI) intensity score and the C-SSRS total score.ResultsIn this cohort, the median age at baseline was 33 years, 67% were women and 68% had made at least one suicide attempt prior to the index attempt. At least one non-fatal or fatal suicide attempt was recorded during follow-up for 165 persons (20.5%). The single C-SSRS items frequency, duration and deterrents were associated with this composite outcome; controllability and reasons were not. In a logistic regression model adjusted for previous history of suicide attempt, SI intensity score was a significant predictor of a non-fatal or fatal suicide attempt (OR 1.08; 95% CI 1.03–1.12). ROC analysis showed that the SI intensity score was somewhat better than chance in correctly classifying the outcome (AUC 0.62, 95% CI 0.57–0.66). The corresponding figures for the C-SSRS total score were 0.65, 95% CI 0.60–0.69.ConclusionsThe C-SSRS items frequency, duration and deterrents were associated with elevated short term risk in this adult psychiatric cohort, as were both the SI intensity score and the C-SSRS total score. However, the ability to correctly predict future suicidal behaviour was limited for both scores.

Impulsive suicide attempts among young people–A prospective multicentre cohort study in Sweden

BackgroundWe aimed to compare the prevalence of impulsive suicide attempts (ISA) among young adults and those over 25 who present at hospital in connection with attempted suicide. We also aimed to identify factors associated with ISA in young adults and to assess medical severity as well as the probability of repeated suicide attempts in this age group. MethodA prospective multicentre cohort study included hospital known cases of suicide attempt (N = 666). The prevalence of ISA was compared between young adults (18–25) and adults aged > 26. We used logistic regression models to identify factors associated with ISA, associations of ISA with high medical severity and prediction of new fatal or non-fatal suicide attempts within 6 months. Results43.7% of the young patients had made an ISA, and 30.2% among those aged > 26 (p = 0.001). Among the young, substance use disorder was associated with ISA; crude odds ratio (OR) 2.0 (1.0–4.2), and adjusted OR 2.1 (0.99–4.4). Affective disorder and unemployment/ sickness absence implied lower odds of ISA. ISA resulted in injuries of high medical severity as often as more planned attempts and non-fatal or fatal repetition within 6 months was equally common (30%) in both groups. LimitationsThe study was set in psychiatric emergency services, which limits the generalizability. ConclusionsClinicians should acknowledge that suicide attempts among youth often occur without previous planning and may result in medically severe injuries. The probability of new fatal or non-fatal suicide attempts should be kept in mind also after an impulsive suicide attempt.

Firearm deaths in Sweden.

Sweden's firearm legislation obligates physicians to report patients that are deemed unsuitable to possess a firearm. This study aimed to explore the involvement of firearm use in firearm fatalities and to evaluate physician reporting concerning cases of firearm deaths. Fatal firearm suicides and homicides in Sweden were studied for the years 2012-2013, accidental deaths and undetermined manner of deaths for the period 1987-2013. Police reports and autopsy protocols were collected from the National Board of Forensic Medicine, health care data in 1 year before the fatality from the National Board of Health, and information about physician reports and firearm licences from the Swedish Police. A total of 291 firearm deaths (213 suicides, 52 accidental deaths, 23 solved homicides and 3 cases with undetermined manner of death) were identified. Firearm suicides were positively correlated with the number of licensed firearm owners. Legal firearm use predominated in firearm suicides and accidental deaths, illegal in homicides. No suicide victim or shooter in an accidental death was previously reported by a physician to the police according to the firearm law. The majority of the shooters in accidental deaths and suicides had no registered health care visits. Less than half (42%) of all suicide victims had a previous health care contact due to mental health problems. Not one single suicide victim nor any shooter in accidental deaths in the present study had been reported according to the firearm law, bringing the evidence of a suboptimal framework.

Analysis of 124 Suicide Cases in Wuhua District in Kunming

To analyze the relationship between the suicide method and the sex, age, education background and cause of suicide to provide reference for the forensic identification of suicide. After scene investigation, external body examination, autopsy and case investigation, 124 identified suicide cases which happened in recent three years in Wuhua district in Kunming were collected. Analytical methods as chi-square test and descriptive statistics were performed by SPSS 22.0. In all the suicide cases, male to female ratio was 1.53∶1. The suicide methods were mainly fatal fall, hanging and drowning. The ratio of local to non-native residents was 1∶1. The suicide rate in the people with primary school or junior middle school education level was highest. The group of >10-50 years tended to choose fatal fall suicide and people over 60 years were more likely to choose hanging. People with different academic background tended to choose fatal fall suicide. The suicide methods as fatal fall and hanging were chosen because of mental and physical diseases and economic problems, while the suicides with emotional problems were more likely to choose fatal fall and poisoning. Suicide belongs to a kind of complex cases. For the cases of suspected suicide, complete exploration and overall consideration should be done to determine the nature of cases based on comprehensive analysis of all the influence factors.