Female Suicide Research Articles

Prevention of the Werther effect: compliance of the Italian newspapers to the ‘reporting on suicide’ recommendations

ObjectivesSuicide media coverage could lead to imitation, the so-called ‘Werther effect’. The World Health Organization (WHO) published specific recommendations for reporting suicide news. This study aimed to quantify the compliance of Italian newspapers with the WHO suicide reporting guidelines. Study designThis was a quantitative content analysis study. MethodsAll articles published by the three main Italian newspapers from June 2019 to May 2020 describing suicides or attempted suicides were included. The articles were analyzed using a checklist based on the WHO recommendations, which included 18 ‘negative’ items (e.g. ‘presence of the word ‘suicide’ in the title’) and nine ‘positive’ items (e.g. ‘the article reports the contacts of a suicide prevention hotline’). Each negative item was scored −1, and each positive item was scored +1. Multivariate linear regressions were performed to identify factors associated with lower adherence to WHO recommendations and higher social media engagement with the articles. ResultsA total of 3483 articles were screened, and 110 articles were included in the final analysis. The suicidal was male in 73.6% of cases. The median checklist score was −6 (interquartile range 3). Five percent of the articles had at least one positive item. The word ‘suicide’ was found in 90% of the titles. Female suicides were associated with a higher checklist score (coefficient 0.81, P = 0.039). No correlation was found between the checklist score and the social media engagement of the articles. ConclusionsItalian newspapers do not adhere completely to the WHO recommendations on reporting suicide, leading to a potential imitation effect. Public health professionals should make decision-makers and journalists aware of the importance of these recommendations.

Farmer Suicides Among States Reporting Violent Deaths, 2003 - 2017.

Research suggests that farmer suicide rates are at least two-fold higher than the general population. In estimating rates, prior research considered suicide events among farmers together with farmworkers, fishing, and forestry occupations and included non-farming populations in the defined at-risk populations (i.e., denominators). In this study, we sought to define and differentiate farmer suicide decedents from other agricultural occupations, estimate U.S. farmer suicide rates, and evaluate rate time trends. Farmer suicide decedents were ascertained from the 36 states in the National Violent Death Reporting System (NVDRS) from 2003-2017 using NVDRS occupation data. Farmers were defined as persons responsible for day-to-day farm decisions and operations. An expert panel was convened to classify farmer occupations. Rates were calculated using Census of Agriculture-identified farmers as the rate denominator, and time trends were evaluated using regression. Due to a low number of female decedents, female farmer suicide rates were not estimated. We identified1,575 male farmer suicide decedents and 77 female farmer decedents from the NVDRS during the study period. Aggregated age-specific male farmer suicide rates were highest among farmers ages 65 years and older (22.0/100,000). Estimated suicide rates for male farmers were highest during 2003 (31.8/100,000) and lowest during 2005 (19.2/100,000). Trend analysis revealed a statistically significant 2.4% annual percent change (APC) in rates over the 15-year study period. Suicide rates among male farmers showed evidence of an increase from 2003-2017. Farmer suicide rates parallel the rates of the U.S. population; thus, farmer suicide remains a public health concern.

The Association of Sex Ratio on Suicide Rates in United States Counties: An Exploration of Mechanisms

Researchers have long puzzled over suicidal behavior. In this paper, we posit that when people are unable to attract mates given unfavorable sex ratios, suicide rates increase. Sex ratio, the proportion of males in a population, is linked to a variety of behaviors, including marriage stability, violence, depression, and infidelity. We test whether suicide rates are associated with county-level sex ratios utilizing data from 1999 to 2018, controlling for a variety of factors known to be associated with suicide risk. We find that sex ratio is associated with suicide rates, where a greater proportion of males in a county (age 35–74) is associated with an increased rate of suicide for these males. Mediation analyses show that these effects are mediated by male marriage rates. Counter to predictions, male-biased sex ratios also tend to be associated with increased female suicide rates for women aged 35 to 74, and this effect is mediated by the unmarried sex ratio (i.e., when there are more unmarried men compared to unmarried women in a county, there is increased female suicide). Overall, these results suggest that male-biased sex ratios are associated with suicide rates for both men and women, but the mediators vary.

Effect of Art Therapy on Changes in Psycho-Emotional State for Women Who Have Attempted Suicide

Background. Research is directed towards female suicides and the solution of the postvention problems in Lithuania. Suicidal behavior of women is conditioned by their psychological sensitivity to different psycho-social factors. The-psycho-emotional state of women who have attempted suicide is worsened, different negative emotions prevail, they lack self-esteem and are disappointed. The methods used in the research aim to answer the same question: does art therapy have an effect on the psycho-emotional state of women who have attempted suicide? It uses different methods of data analysis, i.e. quantitative and qualitative analysis of a small sample.
 Research aim. The aim of the research is to present effects of art therapy on changes in the psycho-emotional state of women who have attempted suicide. The aim of the research is supported by the following tasks and questions. Tasks: 1) to determine changes of depression symptoms; 2) to determine change of anxiety symptoms. Questions: 1) how do visually dominant iconographic motifs in patients’ drawings change during art therapy? 2) how do visually dominant formal motifs in patients’ drawings change during art therapy? 3) does the change of iconographic and formal motifs relate to changes of the emotional state of a selected group of women? 4) how interrelated are results of quantitative and qualitative research methods?
 Methods. Mixed research was conducted using the HADS scale, with analysis of visually dominant iconographic and formal elements.
 Results. The art therapy intervention significantly reduced the level of depression in the subjects. Art therapy had no significant effect on subjects’ anxiety levels. Selected iconographic motifs in the subjectsʼ drawings during the process of art therapy changed: from visually unindentifiable to recognizable objects; from an abstract symbolic meaning to a more concrete and clearly defined meaning; from a smaller to a larger number of iconographic elements; from an iconographically blurred to a more explicit plot. Selected formal motifs in the patients’ drawings during the process of art therapy changed: from incomplete to more detailed depiction of the object; from closed to more open silhouette type; from an isolated object opposed to the surrounding space to an object increasingly infiltrating into that space; from a closed to a progressively more open composition; from linearity to pictoriality; from darker to lighter color scale; from poorer to richer color palettes. The change of iconographic and formal motifs is related to the change of the emotional state of the subjects: the reduced isolation of the depicted objects and the strict separation from the surrounding space show a reduced opposition of the subjects, and the beginning of the social and psychological connection with the surrounding world. The shift from an incomplete to a more detailed depiction of an object shows that the former uncontrollability of the subjects’ self, their feelings, and their connection with the environment turns into clear and rational controllability; more concrete and realistic drawings show the increased awareness of the subjects and better connection with the surrounding world.
 Conclusions. The change in depression levels after art therapy intervention is statistically significant (p<0.05). The change in anxiety levels after art therapy intervention is not statistically significant (p>0.05). The shift of the drawings is from abstract to specific iconography. The formal motifs of the drawings become more detailed and their type of representation become more varied; the depiction of the objects have become more integrated in the composite space, and the composition become more open; the paintings became more artistic, and the color range became wider. The psycho-emotional state of the subjects in the sessions varied from detachment, withdrawal, hiding, fear of looking at oneself, to opening up, trying to notice and make sense of all one’s own negativity, to manage negative emotions and to project one’s future.
 Keywords: art therapy, woman suicide, anxiety, depression.

Studying Scripts of Women, Men and Suicide: Qualitative-Method Development and Findings from Nepal.

Information about suicidal behavior in Nepal is limited. According to official records, suicide rates were high until the year 2000 and declined thereafter. Official records are considered unreliable and a gross undercounting of suicide cases, particularly female cases. Suicide research in Nepal has been mostly epidemiologic and hospital-based. Little is known about how suicide is understood by Nepali people in general-including dominant suicide attitudes and beliefs in Nepal. Suicide attitudes and beliefs, which are elements of a culture's suicide scripts, predict actual suicidality. Drawing on suicide-script theory, we developed and used a semi-structured survey to explore Nepali beliefs about female and male suicide. The informants were adult (Mage = 28.4) university students (59% male). Female suicide was believed to be a response to the society-sanctioned oppression and abuse that women are subjected to, in their family and community. The prevention of female suicide was viewed as requiring dismantling ideologies, institutions, and customs (e.g., child marriage, dowry) that are oppressive to women, and ensuring that women are protected from violence and have equal social and economic rights and opportunities. Male suicide was believed to be a symptom of societal problems (e.g., unemployment) and of men's psychological problems (e.g., their difficulties in managing emotions). The prevention of male suicide was viewed as requiring both societal (e.g., employment opportunities) and individual remedies (e.g., psychological counseling). This study's findings suggest that a semi-structured survey can be a fruitful method to access the suicide scripts of cultures about which there is limited research.

Characteristics of and Circumstances Associated With Female Intimate Partner Problem-Included Suicides: Analysis of Data From the National Violent Death Reporting System (2003-2019).

Intimate partner problems (IPP)-which include divorce, breakups, arguments, jealousy, conflict, discord, and violence-have been robust precipitating factors associated with an increased risk for suicidal thoughts and behaviors. Although research on suicide related to IPP is growing, efforts to explore the circumstances surrounding suicidality among female victims struggling with IPP remain insufficient. To address this gap, this exploratory study sought to understand the circumstances surrounding female IPP-related suicide in the United States. We conducted a secondary analysis of data from the U.S. National Violent Death Reporting System (NVDRS, 2003-2019) which includes 43 states, the District of Columbia, and Puerto Rico. Of the final analytical sample of 58,545 female suicide cases in the United States, we delineated IPP-included suicide cases (13,496, 23.1%) and non-IPP-included suicide cases (45,049, 76.9%). Two-sided Pearson chi-square tests and standardized difference (SD) tests identified significant differences in the surrounding circumstances between IPP-included suicide and non-IPP-included suicide. IPP-included female suicide was more common among younger women, those involved in an intimate relationship, and women who were pregnant or postpartum (p < .001; SD > .10). IPP-included suicide victims were more likely to have experienced depression, substance abuse, and previous interpersonal trauma than non-IPP-included suicide victims (p < .001; SD > .10). Compared to non-IPP-included suicide, IPP-included suicide was more likely to occur at the victim's house or apartment during evening and nighttime by firearm or hanging (p < .001; SD > .10). Our findings also showed that IPP-included suicide victims had previous suicidal thoughts and were more likely to have disclosed their suicidal ideation with others before committing suicide than non-IPP-included suicide victims (p < .001; SD > .10). Findings identified unique circumstances and characteristics possibly associated with IPP-included female suicide. Our understanding of suicide may be enhanced by exploring the causal pathway behind these relationships.

Suicide and the economy: a regional analysis of italy

ABSTRACT This note investigates the empirical pattern of suicides across Italy over the last 15 years. Typically, a country shares similar basic cultural and social macro-features. Yet in Italy there are marked variations across the regions such that it provides a useful setting to examine the economic factors that influence suicidality. The results align with some earlier work positing an N-shaped Kuznets curve linking income and the suicide rate. Female participation in the labour market emerges as a robust explanatory factor for male and female suicide rates.

Indigenous suicide rates in the United States, Australia and New Zealand between 2006 and 2019.

Indigenous suicide prevention is an important focus for national health policies. Indigenous suicide rates in formerly colonial English-speaking countries such as the United States, Australia and New Zealand are considerably higher than the general population, particularly in young males. Given the similarities in their sociocultural history, a time series analysis was conducted to assess recent sex and age trends of suicide in the Indigenous and general populations in the United States, Australia and New Zealand. Using the number of deaths by intentional self-harm and estimated resident population, suicide incidence rates were calculated for the years 2006-2019 and stratified by Indigenous status, year, time period, sex and age group (above 15 years). Incidence rates were plotted. Using the Poisson regression model, calculated suicide incidence rate ratios were used to make comparisons for sex and age. Across all countries studied, Indigenous suicide rates have increased over time, with Indigenous males having higher suicide rates than Indigenous females. However, the increase in Indigenous female suicides was greater than that for Indigenous males in Australia and New Zealand. Indigenous males aged 15-44 years have the highest suicide rates across all countries. Indigenous suicide rates have remained consistently high in the United States, Australia and New Zealand, with Indigenous males aged 15-44 years showing the highest rate. However, suicide rates for Indigenous females in Australia and New Zealand are increasing more rapidly than males. Given this, it is critical that further research is dedicated to understanding and addressing the issues driving this problem, particularly in youth.

Pandemics and Suicide Rates in Spain: From the Spanish Flu to COVID-19.

Objective: The aim of this study was to examine suicide rates in Spain during the COVID-19 pandemic and the influenza pandemic of 1918-1920.Methods: Data on deaths by cause for the periods 1910-1925 and 2016-2020 were obtained from the National Statistics Institute of Spain.Results: During the Spanish influenza pandemic, a peak of deaths in 1918 due to influenza, acute bronchitis, pneumonia, and other respiratory diseases coincided with an increase in suicides (from 5.9 in 1917 to 6.6 per 100,000 population in 1918). The pattern was repeated in the COVID-19 pandemic during 2020, with an increase in suicides from 7.8 in 2019 to 8.3 per 100,000 population in 2020. In both cases, the male:female suicide ratio was reduced in similar proportion, with a higher net increase in the number of suicides among males but a higher percentage increase among females.Conclusions: Albeit limited, there is evidence that the pandemics may have affected suicide rates. However, the effect was most likely due to precipitation of different diathesis-stressor factors in each setting, given the different historical contexts.

Palestinian female ‘suicide bombers’ and the masculinity of martyrdom: Comparing ‘scandalous subwomen’ reactions in British and American broadcast news media coverage of the Second Intifada

From grassroots activism to armed combatants, Palestinian females have been active in combating Israel’s occupation of Palestine since the early twentieth century. During the second Palestinian Intifada, however, western news media coverage of female-perpetrated ‘suicide bombings’ sensationalized these previously unseen acts. Utilizing Herjeet Marway’s ‘scandalous subwomen’ societal reaction as a framework, this article engages in a multimodal analysis of the largely unexplored UK and US broadcast news coverage of female-perpetrated Palestinian ‘suicide bombings’. Via a postcolonial perspective, it addresses this framework’s focus upon ‘exclusion’: the projection that Palestinian female suicide bombers’ political participation is subject to male influence. This article finds that exclusionary male figures, as well as Saudi Arabia, are framed by UK and US broadcast news media to afford Palestinian female suicide bombers a lack of political agency. Palestinian female ‘suicide bombers’, as a result, become victimized figures via the UK and US broadcast news media’s orientalist ‘perceived reality’ which fails to recognize these female actors’ agential will or their ability to freely participate in political acts.

Association Between Acute Alcohol Use and Firearm-Involved Suicide in the United States

Firearms are the method of suicide used most often in the US. Acute alcohol use is associated with an increased risk of suicide by firearm. However, the dose-response association between acute alcohol use and the probability of using a firearm as the method of suicide is unknown. To evaluate the association between the amount of alcohol consumed and the probability of using a firearm as the method of suicide. This cross-sectional study used mortality data from the US National Violent Death Reporting System on suicide decedents aged 18 years or older with a positive blood alcohol concentration (BAC; ie, ≥0.01 g/dL). Statistical analysis was performed from January 2003 to December 2020. Acute alcohol use, ascertained via postmortem toxicologic examination. Probability of using a firearm as the method of suicide compared with all other methods of suicide. The study included 45 959 male suicide decedents (mean [SD] age, 42.6 [14.8] years) and 12 136 female suicide decedents (mean [SD] age, 44.2 [13.8] years) with a positive BAC; of those, 24 720 male decedents (53.8%) and 3599 female decedents (29.7%) used a firearm as the method of suicide. The probability of using a firearm as the method of suicide when alcohol is consumed was higher for male decedents, with the probability starting at just below 0.50 and increasing to approximately 0.75. In contrast, for female decedents, the probability began at just above 0.30 and increased to approximately 0.55. For both male and female decedents, the dose-response curves were an inverted U shape; as BAC increased, the probability of firearm-involved suicide initially increased and then decreased at very high BACs (approximately 0.40 g/dL for male decedents and approximately 0.30 g/dL for female decedents; these BACs were present among only a small percentage of alcohol-involved suicides: male decedents, 589 [1.3%]; female decedents, 754 [6.2%]). This cross-sectional study of suicide decedents who had consumed alcohol prior to their death suggests that, as alcohol consumption increased, the probability of a firearm-involved suicide increased until a certain BAC, at which point the probability started to decrease.

Interpretable machine learning-based approaches for understanding suicide risk and protective factors among South Korean females using survey and social media data.

We aimed to identify and understand risk and protective factors for suicide among South Korean females by linking survey and social media data and using interpretable machine learning approaches. We collected a wide range of potential factors including the material, psychosocial, and behavioral data from a detailed survey, which we then linked to data from social media. In addition, we adopted interpretable machine learning approaches to (1) predict the suicide risk, (2) explain the relative importance of factors and their interactions regarding suicide, and (3) understand individual differences affecting suicide risk. The best-performing machine learning model achieved an AUC of 0.737. Adverse childhood experiences, social connectedness, and mean positive sentiment score of social media posts were the three risk factors that had a monotonic or unimodal relationship with suicide, and satisfaction with life, narcissistic self-presentation, and number of close friends on social media were the three protective factors that had a monotonic or unimodal relationship with suicide. We also found several meaningful interactions between specific psychiatric symptoms and narcissistic self-presentation. Our findings can help governmental organizations to better assess female suicide risk in South Korea and develop more informed and customized suicide prevention strategies.

Long-term development of assisted suicide in Switzerland: analysis of a 20-year experience (1999–2018)

The legalisation of assisted suicide is one of the most debated topics in the field of medical ethics worldwide. In countries in which assisted suicide is not legal, public discussions about its approval also encompass considerations of the long-term consequences that such legalisation would bring, for example, how many people will use this option, from what conditions would they be suffering, would there be differences between male and female assisted suicide and which developments and trends could be expected if there were to be a marked increase of cases of assisted suicide over time? In order to answer these questions, we present the development of assisted suicide in Switzerland over a 20-year period (1999-2018; 8738 cases) using data from the Swiss Federal Statistical Office. During the observation period, the number of assisted suicides rose significantly: when four 5-year periods (1999-2003, 2004-2008, 2009-2013, 2014-2018) were analysed, the number of assisted suicide cases doubled over each period compared with the preceding one (Χ = 206.7, 270.4 and 897.4; p <0.001). The percentage of assisted suicides among all deaths rose from 0.2% (1999-2003; n = 582) to 1.5% (2014-2018: n = 4820). The majority of people who chose assisted suicide were elderly, with increasing age over time (median age in 1999-2003: 74.5 years vs 2014-2018: 80 years), and with a predominance of women (57.2% vs 42.8%). The most common underlying condition for assisted suicide was cancer (n= 3580, 41.0% of all assisted suicides). Over time, assisted suicide increased similarly for all underlying conditions; however, the proportion in each disease group remained unchanged. It is a matter of one's viewpoint whether the rise of assisted suicide cases should be considered alarming or not. These figures reflect an interesting social development but still do not appear to represent a mass phenomenon.

Characterizing Female Firearm Suicide Circumstances: A Natural Language Processing and Machine Learning Approach

Since 2005, female firearm suicide rates increased by 34%, outpacing the rise in male firearm suicide rates over the same period. The objective of this study was to develop and evaluate a natural language processing pipeline to identify a select set of common and important circumstances preceding female firearm suicide from coroner/medical examiner and law enforcement narratives. Unstructured information from coroner/medical examiner and law enforcement narratives were manually coded for 1,462 randomly selected cases from the National Violent Death Reporting System. Decedents were included from 40 states and Puerto Rico from 2014 to 2018. Naive Bayes, Random Forest, Support Vector Machine, and Gradient Boosting classifier models were tuned using 5-fold cross-validation. Model performance was assessed using sensitivity, specificity, positive predictive value, F1, and other metrics. Analyses were conducted from February to November 2022. The natural language processing pipeline performed well in identifying recent interpersonal disputes, problems with intimate partners, acute/chronic pain, and intimate partners and immediate family at the scene. For example, the Support Vector Machine model had a mean of 98.1% specificity and 90.5% positive predictive value in classifying a recent interpersonal dispute before suicide. The Gradient Boosting model had a mean of 98.7% specificity and 93.2% positive predictive value in classifying a recent interpersonal dispute before suicide. This study developed a natural language processing pipeline to classify 5 female firearm suicide antecedents using narrative reports from the National Violent Death Reporting System, which may improve the examination of these circumstances. Practitioners and researchers should weigh the efficiency of natural language processing pipeline development against conventional text mining and manual review.

Emotionally Unstable Personality Disorder and Severity of Suicide Attempt are related to Epigenetic Hypermethylation of Brain-Derived Neurotrophic Factor in Women

IntroductionBrain-derived neurotrophic factor (BDNF) has been associated with both emotionally unstable personality disorder (EUPD) and suicidal behavior. No study has yet investigated BDNF-associated epigenetic alterations in severely impaired EUPD and suicidal patients.ObjectivesThe main goal of the present study was to investigate whether epigenetic dysregulation in BDNF, CRP, IL-1, IL-2 and IL-6 were associated with EUPD and severity of suicidal behavior.MethodsThe discovery cohort consisted of 97 women with emotionally unstable personality disorder (EUPD) with at least two serious suicide attempts (SA) and 32 healthy women. The genome-wide methylation pattern was measured by the Illumina EPIC BeadChip and analyzed by robust linear regression models to investigate mean BDNF methylation levels in a targeted analysis conditioned upon severity of suicide attempt. The validation cohort consisted of 60 female suicide attempters, stratified into low- (n=45)and high-risk groups (n=15) based on degree of intent-to-die and lethality of suicide attempt method, and occurrence of death-by-suicide at follow-up.ResultsMean BDNF methylation levels exhibited hypermethylation in relation to EUPD(p=0.0343, percentage mean group difference ~3.8%). Similarly, this locus was confirmed as hypermethylated in an independent cohort of women with severe suicidal behavior (p=0.0469). Results were independent of age and BMI.ConclusionsThis study elicits emerging evidence of epigenetic dysregulation of BDNF in relation to phenotypes known to increase risk of suicide (lethality of suicide-attempt method and presence of EUPD diagnosis with history of recent SA). Further studies investigating epigenetic and genetic effects of BDNF on severe suicidal behavior and EUPD are needed to elucidate the role of epigenetic regulatory mechanisms and neurotrophic factors in relation to suicide risk.Disclosure of InterestNone Declared

Epigenetic changes in the CYP2D6 gene are related to severity of suicide attempt: A cross-sectional study of suicide attempters

BackgroundThe ability to accurately estimate risk of suicide deaths on an individual level remains elusive. MethodsThis study reports on a case-control study set-up from a well-characterized cohort of 88 predominantly female suicide attempters (SA), stratified into low- (n = 57) and high-risk groups (n = 31) based on reports of later death by suicide, as well as degree of intent-to-die and lethality of SA method. We perform an unbiased analysis of 12,930 whole-blood derived CpG-sites (Illumina Infinium EPIC BeadChip) previously demonstrated to be more conciliable with brain-derived variations. The candidate site was validated by pyrosequencing. External replication was performed in (1) relation to age at index suicide attempt in 97 women with emotionally unstable personality disorder (whole-blood) and (2) death by suicide in a mixed group of 183 prefrontal-cortex (PFC) derived samples who died by suicide or from non-psychiatric etiologies. ResultsCYP2D6-coupled CpG-site cg07016288 was hypomethylated in severe suicidal behavior (p < 10E-06). Results were validated by pyrosequencing (p < 0.01). Replication analyses demonstrate hypomethylation of cg07016288 in relation to age at index SA in females (p < 0.05) and hypermethylation in PFC of male suicide completers (p < 0.05). LimitationsGenotyping of CYP2D6 was not performed and CpG-site associations to gene expression were not explored. ConclusionsCYP2D6-coupled epigenetic markers are hypomethylated in females in dependency of features known to confer increased risk of suicide deaths and hypermethylated in PFC of male suicide completers. Further elucidating the role of CYP2D6 in severe suicidality or suicide deaths hold promise to deduce clinically meaningful results.

Increased Methylation of Brain-Derived Neurotrophic Factor (BDNF) Is Related to Emotionally Unstable Personality Disorder and Severity of Suicide Attempt in Women.

Brain-derived neurotrophic factor (BDNF) has previously been associated with the pathogenesis of both emotionally unstable personality disorder (EUPD) and suicidal behavior. No study has yet investigated BDNF-associated epigenetic alterations in a group of severely impaired EUPD and suicidal patients. The discovery cohort consisted of 97 women with emotionally unstable personality disorder (EUPD) with at least two serious suicide attempts (SAs) and 32 healthy female controls. The genome-wide methylation pattern was measured by the Illumina EPIC BeadChip and analyzed by robust linear regression models to investigate mean BDNF methylation levels in a targeted analysis conditioned upon severity of suicide attempt. The validation cohort encompassed 60 female suicide attempters, stratified into low- (n = 45) and high-risk groups (n = 15) based on degree of intent-to-die and lethality of SA method, and occurrence of death-by-suicide at follow-up. Mean BDNF methylation levels exhibited increased methylation in relation to EUPD (p = 0.0159, percentage mean group difference ~3.8%). Similarly, this locus was confirmed as higher-methylated in an independent cohort of females with severe suicidal behavior (p = 0.0300). Results were independent of age and BMI. This is the first study to reveal emerging evidence of epigenetic dysregulation of BDNF with dependence on features known to confer increased risk of suicide deaths (lethality of suicide-attempt method and presence of EUPD diagnosis with history of recent SAs). Further studies investigating epigenetic and genetic effects of BDNF on severe suicidal behavior and EUPD are needed to further elucidate the role of epigenetic regulatory mechanisms and neurotrophic factors in relation to suicide and EUPD, and hold potential to result in novel treatment methods.

Psychiatric presentations and admissions during the first wave of Covid-19 compared to 2019 in a psychiatric emergency department in Berlin, Germany: a retrospective chart review

BackgroundMost studies agree that the Covid-19 pandemic and the subsequent lockdown had a negative impact on mental health. On the other hand, international studies have shown that psychiatric emergency departments (pED) experienced a decrease in presentations and admissions.MethodsRetrospective chart review of all pED presentations and admissions during the first wave of Covid-19 pandemic in Germany (Covid-19 period: 3/2/20 to 05/24/20) in a psychiatric hospital in Berlin compared to 1 year earlier (pre-Covid-19 period). Descriptive statistics and logistic regression were performed.ResultsWe observed no statistical significant changes in overall pED presentations and overall hospital admissions during the Covid-19 period compared to the pre-Covid-19 period (813 vs. 894, − 9.1%, p = 0.064 and (363 vs. 437, − 16.9%, p = 0.080 respectively). In the subgroup analysis, less patients with depressive disorders (p = 0.035) and with personality disorders (p = 0.002) presented to the pED, a larger number of presentations with schizophrenia was observed (p = 0.020). In the Covid-19 period, less patients with substance use disorder and paranoid schizophrenia were admitted to the hospital via the pED than in the pre-Covid-19 period (p = 0.035 and p = 0.006, respectively). Bed capacity was reduced in the Covid-19 period by − 32.8% (p < 0.001).Presentations in police custody were 13.7% (p = 0.029) higher during the Covid-19 compared to pre-Covid-19 period, with higher rates in female presentations (p = 0.008) and suicide attempts (p = 0.012) and less hospital admissions (p = 0.048). Logistic regression analyses revealed that positive predictors for pED presentation during Covid-19 period were police custody (p < 0.001), being redirected from another hospital (p < 0.001), suicide attempt (p = 0.038), suicidal thoughts (p = 0.004), presentation with paranoid schizophrenia (p = 0.001) and bipolar and manic disorders (p = 0.004), negative predictors were hospital admission (p < 0.001), depressive disorders (p = 0.021) and personality disorders (p < 0.001).ConclusionsA larger number of presentations in police custody during the Covid-19 period may represent untreated medical needs. This was seen predominantly in female patients, suggesting this subgroup might have suffered particularly under lockdown measures. Patients with paranoid schizophrenia were the only subgroup, which increased in absolute numbers, also suggesting a particular lockdown effect. Reduced bed capacity due to infection curbing measures is suggestive to have played an important role in augmenting the threshold for hospital admissions.

Suicide in Switzerland: why gun ownership can be deadly

There is a great deal of empirical evidence that owning a firearm increases the risk of dying from suicide. Most suicides are impulsive. Nearly 50% of survivors of suicide attempts report that they took less than 10 minutes between the decision to die and their suicide attempt. The great majority of these suicide survivors never make another attempt and die of natural causes. Because nearly 90% of firearm suicide attempts have a deadly outcome, gun owners are unlikely to have such a second chance. These impulsive suicide attempts are typically carried out with the means at hand. Swiss men have much higher firearm suicide rates than men in other European countries and this excess is likely to be due to their easy access to guns, because army conscripts have to keep their guns at home. When the number of conscripts was nearly halved in 2003/4 as a result of the Swiss Army Reform XXI, the number of army-issued firearms was reduced by an estimated 20%. An analysis of suicide rates before and after the reform indicated that male (but not female) suicide rates decreased by 8%, with no evidence of substitution with other means of suicide. If the army would require that the remaining half of conscripts had to keep their weapons at their barracks rather than at home, a further decrease in male suicide rates could be expected.

The male-female suicide ratio in Denmark plateaus at 2.7: an opportunity for targeted intervention?

The male-female suicide ratio in Denmark plateaus at 2.7: an opportunity for targeted intervention?