Incidence Rate Of Suicide Research Articles

Suicide mortality data from the Italian police during the COVID-19 pandemic

Suicide is a major public health issue worldwide, with about 880,000 dying annually for such a cause. The COVID-19 pandemic has led to severe social disruption both from health and economic standpoints. Law enforcement personnel have been significantly involved in helping to face the many difficulties due to the pandemic. Police officers have been subjected to further stress from managing social restrictions imposed by governments to contain the pandemic. The Italian State Police steadily approximate 100,000 people aged 25–65 years: 14 subjects (mean age 43.64 years) died by suicide in 2015, 7 (mean age 47.5 years) in 2016, 13 (mean age 45.62 years) in 2017, 10 (mean age 48.1 years) in 2018, 18 (mean age 46.78 years) in 2019, and 12 (mean age 52 years) in 2020. Our records excluded significant changes in suicide incidence rate within 2015–2020 (till December 2020). However, the COVID-19 pandemic spread faster in Italy than in other regions, meaning that the Italian State Police possibly faced prolonged, intense stress. Suicide prevention, therefore, remains a priority, especially during this difficult time.

The crude incidence rate of suicide and related factors in Turkey between 2009 and 2018

The crude incidence rate of suicide and related factors in Turkey between 2009 and 2018

Population-based Analysis for Risk of Suicide Death in Elderly Patients after Osteoporotic Fracture: a Nested Case-Control Study.

BackgroundThe purpose of study was to investigate the incidence rate of suicide in elderly patients with osteoporotic fractures in a nested case-control model and to analyze the change in the risk of suicide death over time after each osteoporotic fracture.MethodsWe used the National Health Insurance Service-Senior cohort of South Korea. Suicide cases and controls were matched based on sex and age at the index date. Controls were randomly selected at a 1:5 ratio from the set of individuals who were at risk of becoming a case at the time when suicide cases were selected. Conditional logistic regression analysis was performed to evaluate the association between each type of osteoporotic fracture and the risk of suicide death.ResultsThree thousand seventy suicide cases and 15,350 controls were identified. Patients with hip fracture showed an increased risk of suicide death within 1 year of fracture (adjusted odds ratio [aOR] = 2.64; 95% confidence interval [CI], 1.57–4.46; P < 0.001) compared to controls. However, the increased risk of suicide death in patients with hip fracture lasted up to 2 years (aOR = 1.59; 95% CI, 1.04–2.41; P = 0.031). Spine fracture increased the risk of suicide deaths for all observation periods. There was no evidence that humerus fracture increased the risk of suicide death during the observational period. Radius fracture increased only the risk of suicide death within 2 years of fracture (aOR = 1.43; 95% CI, 0.74–2.77; P = 0.282).ConclusionThere were noticeable differences in both degree and duration of increased suicide risks depending on the type of osteoporotic fracture. Mental stress and suicide risk in elderly patients after osteoporotic fracture should be assessed differently depending on the types of fracture.

Association between new-onset liver cirrhosis and suicide risk in South Korea: A nationwide cohort study.

Background/AimsCurrent evidence suggests that liver cirrhosis (LC) causes severe psychological stress and depression, which are risk factors for suicide. Although previous studies reported the association between LC and suicidal thoughts, little is known of its effect on suicidal deaths. Therefore, this study was undertaken to investigate the effect of new-onset LC on suicide.MethodsFrom the National Health Insurance Service-National Sample Cohort of South Korea, 5,809 incident LC patients and 11,618 risk-set controls matched by propensity score were selected for follow-up. The incidence rate of suicide was estimated using a generalized estimating equation with a Poisson distribution. Effect size was presented as a hazard ratio (HR) using Cox’s proportional hazards model.ResultsThe incidence rate of suicide was 143.3 cases per 100,000 person years (95% confidence interval [CI], 100.2–205.1) among the LC cohort. The LC patients were 2.37 times more likely to commit suicide compared with matched controls (HR, 2.37; 95% CI, 1.44–3.88). Increased suicide risk was evident within the first 2 years of the follow-up period (HR, 2.59; 95% CI, 1.20–5.60) and among the 18–49-year-old age group (HR, 3.72; 95% CI, 1.45–9.56).ConclusionsOur study found increased risk of suicide in patients with new onset LC, especially during the early period following diagnosis and in younger patients. To decrease this suicide risk, a regular and continuous social support system is required.

The relationship between nightmares, depression and suicide

ObjectivePrevious studies investigating the association between nightmares and suicide have yielded different results. We aimed to investigate whether nightmares, directly or indirectly, influence the incidence of suicide. MethodsWe used a prospective cohort study, based on 40,902 participants with a mean follow-up duration of 19.0 years. Cox proportional hazards models with attained age as time-scale were fitted to estimate hazard ratios (HR) of suicide with 95% confidence intervals (CI) as a function of the presence or absence of depression and nightmares. Mediation analysis was used to asses to what extent the relationship between nightmares and the incidence rate of suicide could be mediated by depression. ResultsNo association was observed between nightmares and the incidence of suicide among participants without depression. Compared with non-depressed participants without nightmares, the incidence of suicide among participants with a diagnosis of depression was similar among those with and without nightmares (HR 12.3, 95% CI 5.55–27.2 versus HR 13.2, 95% CI 7.25–24.1). The mediation analysis revealed no significant effects of nightmares on suicide incidence. However, the incidence of depression during follow-up was higher among those who suffered from nightmares than among those who did not (p < 0.001). ConclusionsOur findings indicate that nightmares have no influence on the incidence rate of suicide, but may reflect pre-existing depression. This is supported by a recent discovery of a strong genetic correlation of nightmares with depressive disorders, with no evidence that nightmares would predispose to psychiatric illness or psychological problems. Interventions targeting both depression and nightmares, when these conditions co-occur, may provide additional therapeutic benefit.

Trend of Incidence Rate of Suicide and Associated Factors in 2011-2015 in Zarand-Iran

Background: Study of suicide and identify mental health problems, social, cultural and environmental communities are effective for preventive measures and reducing risk factors. Objectives: This study aimed to study epidemiology of suicide and its associated factors over 2011-2015 in Zarand. Methods: In this epidemiological study, all people who committed suicide in 2011-2015 were investigated. A standardized questionnaire was used to record the demogeraphic characteristics of the cases. Data was analyzed by SPSS software using descriptive statistics, chi-square tests, and logistic regression analysis. Results: During 2011-2015, 2401 persons (372 at 100000) committed suicide of which 33 cases (5.1 at 100000) died. The results showed that suicide attempt rate in people with middle school education was 15.7 times greater than educated ones. Similar results showed the rate of suicide of the people in age group 15-29 was 6.3 times higher than other age groups. Suicide attempt in retired and unemployed was 3.1 times more than employed and urban had suicide attempt rate of 1.6 times higher than rural. Conclusion: In Zarand, the incidence of suicide is much higher than the global, country, and province average (more than three to four times) and leading to death was much less than expected. However, there are significant differences in the cause and manner and demographic characteristics with other studies which require Creation SRCs (suicide registry centers) and qualitative studies with form layer analysis of causes in Zarand.

Geography of suicide in Japan: spatial patterning and rural\u2013urban differences

PurposeThere are notable geographic variations in incidence rates of suicide both in Japan and globally. Previous studies have found that rurality/urbanity shapes intra-regional differences in suicide mortality, and suicide risk associated with rurality can vary significantly by gender and age. This study aimed to examine spatial patterning of and rural–urban differences in suicide mortality by gender and age group across 1887 municipalities in Japan between 2009 and 2017.MethodsSuicide data were obtained from suicide statistics of the Ministry of Health, Labour and Welfare in Japan. We estimated smoothed standardized mortality ratios for suicide for each of the municipalities and investigated associations with level of rurality/urbanity using Bayesian hierarchical models before and after adjusting for socioeconomic characteristics.ResultsThe results of the multivariate analyses showed that, for males aged 0–39 and 40–59 years, rural residents tended to have a higher suicide risk compared to urban ones. For males aged 60+ years, a distinct rural–urban gradient in suicide risk was not observed. For females aged 0–39 years, a significant association between suicide risk and rurality was not observed, while for females aged 40–59 years and females aged 60 years or above, the association was a U-shaped curve.ConclusionOur results showed that geographical distribution of and rural–urban differences in suicide mortality in Japan differed substantially by gender and age. These findings suggest that it is important to take demographic factors into consideration when municipalities allocate resources for suicide prevention.

What Is the Difference in the Risk of Suicide Death Between Spine Fracture in Patients Older Than 65 Years and Matched Controls? A Large-database Study from South Korea.

Pain and kyphotic deformity after spinal fractures can result in a decrease in a patient's physical function and quality of life. Furthermore, physical illness, such as respiratory compromise, or mental illness, including depression, may be exacerbated by a spinal fracture. Complications caused by spinal fractures and old age are risk factors for suicide, but studies on these patients are rare. (1) What is the incidence rate of death by suicide after a spinal fracture in patients older than 65 years? (2) How much does the risk of death by suicide increase in patients older than 65 years who have spine fractures compared with well-matched controls? (3) How does this risk change as a function of increasing time after injury? Spinal fractures in patients older than 65 years and matched controls were selected from the National Health Insurance Service-Senior cohort (NHIS-Senior) of South Korea. The NHIS-Senior consists of 558,147 people selected by 10% simple random sampling method from a total of 5.5 million people 60 and older in 2002; all people were followed through 2015. A total of 31,357 patients with spine fractures and their 62,714 matched controls remained in the study. The mean follow-up time was 4.3 ± 3.0 years (135,229 person-years) in the spine fracture group and 4.6 ± 3.0 years (290,096 person-years) in the matched control group. We matched the groups for demographic factors such as age, gender, Charlson Comorbidity Index score, medication history, medical history, preoperative disability, number of hospital admissions, as well as socioeconomic factors such as household income level, residential district, and type of national health insurance using a 1:2 risk set propensity score matching by a nearest-neighbor matching algorithm with a maximum caliber of 0.1 of the hazard components. The incidence rate of suicide and the 95% confidence interval were calculated based on a generalized linear model with a Poisson distribution. The effect size was presented as a hazard ratio (HR) using Cox's proportional hazard model with robust variance estimator that accounts for clustering within matched pairs. The overall risk of death by suicide throughout the surveillance period, expressed as an incidence rate, was 116 per 100,000 person-years in spinal fracture (157 deaths by suicide over 135,229 person-years). Throughout the entire surveillance period, the risk of death by suicide was greater among patients with spinal fractures than it was in the control group (HR 1.8 [95% CI 1.5 to 2.2]; p < 0.01). This difference was greatest in the first 365 days after the fracture (HR 2.5 [95% CI 1.6 to 3.8]; p < 0.01) (45 deaths by suicide, incidence rate: 156 per 100,000 person-years in spinal fracture). The risk of suicide death in patients with spine fracture from 365 days to the last follow-up was also higher than that of matched controls (HR 1.6 [95% CI 1.3 to 2.1]; p < 0.01). Considering the substantially increased risk of death by suicide in patients with spine fractures who are older than 65 years, surgeons should consider offering psychiatric evaluation and management more frequently, particularly in patients with chronic pain, functional disability, and depressive mood. Future studies should investigate the underlying causes of suicide, such as deteriorating socioeconomic support or depression, and whether early initiation of psychological support after injury can reduce the suicide rate. Level III, prognostic study.

Risk of suicidal ideation, suicide attempts, and suicide deaths in persons with sleep apnea: Protocol for a systematic review and meta-analysis.

AimTo estimate the pooled prevalence and incidence of suicidal ideation, attempts, and deaths in people with sleep apnea.MethodWe will identify epidemiological studies reporting the prevalence or incidence rate of suicide in people with sleep apnea. We will search the following databases: PubMed (MEDLINE), Scopus, Cochrane Library, OVID (HEALTH STAR), OVID (MEDLINE) and Joana Briggs Institute EBF Database. No age, geographical location, study-design or language limits will be applied. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Two reviewers (YY and YP) will independently screen citations, abstracts and will identify full-text articles for inclusion, extract data, and appraise the quality and bias of included studies. Discrepancies will be resolved by consulting with a third researcher (MC). Study quality will be assessed by the Newcastle-Ottawa Scale. The primary outcomes will be the overall prevalence or incidence of suicidal ideation, attempts and completion and the risk of suicide in people with sleep apnea. For pooling of the studies, we will use a random-effects model with a logit transformation. The DerSimonian and Laird (DL) random-effects method will be used to estimate the pooled inter-study variance. We will assess the between-study heterogeneity using I2 statistics, and Cochrane’s Q statistic (significance level < 0.05). If the I2 is high (>75%), we will perform subgroup meta-analyses and conduct a meta-regression analysis to explore sources of study heterogeneity using study level median age, study-level proportions of race, gender, depression and quality scores. We will report effect estimates as suicide risk per 1000 individuals. Egger’s test and funnel plots will be used to assess publication bias, and adjusted estimates using trim and fill methods will be reported if publication bias is suspected.Ethics and disseminationNo ethics clearance is required as no primary data will be collected. The results of this systematic review and meta-analysis will be presented at scientific conferences and published in a peer-review journal. The results may shed more light on the burden of suicide risk among individuals with sleep apnea and may guide future population-specific interventions.Trial registrationPROSPERO registration number: CRD42020165404.

Epidemiology of Suicide/Suicide Attempt and Its Association with Individual, Family, and Social Factors in Eastern Part of Iran: A Historical Cohort Study

Suicide/suicide attempt, as a major public health problem, has been included among anti-social behaviors. We aimed to investigate the epidemiology of suicide and some associated individual, family, and social factors. A historical cohort study was conducted among all cases (748 persons) reports related to suicide/suicide attempt that register in hospital reporting system and health care center in Gonabad and Bajestan, Iran, from 2009 to 2014. The required data were extracted through a checklist. Descriptive (mean and standard deviation) and analytic statistics (t-test, Chi-square, and logistic regression) applied to analyzed data. All data were analyzed using SPSS software. Of the 748 reported suicide attempters, 17 cases (2.3%) had completed suicide. The annual average incidence rate of suicide was 110.03 per 100,000 populations. The mean age of suicide attempt had significantly decreased during the time (P=0.007). Furthermore, a significant association was observed between outcome of suicide and place of residence (P=0.019), history of physical illnesses (P=0.002), and method of suicide (P=0.001). Due to trend of age among suicide attempters, considering intervention programs of suicide prevention for school pupils and university students especially individuals residing in rural areas, as well as individuals suffering from physical illness would be effective to reduce the rate of suicide.

WITHDRAWN: The relationship between nightmares, depression and suicide

ObjectivePrevious studies investigating the association between nightmares and suicide have yielded different results. We aimed to investigate whether nightmares, directly or indirectly, influence the incidence of suicide.MethodsWe used a prospective cohort study, based on 40,902 participants with a mean follow-up duration of 19.0 years. Cox proportional hazards models with attained age as time-scale were fitted to estimate hazard ratios (HR) of suicide with 95% confidence intervals (CI) as a function of the presence or absence of depression and nightmares. Mediation analysis was used to asses to what extent the relationship between nightmares and the incidence rate of suicide could be mediated by depression.ResultsNo association was observed between nightmares and the incidence of suicide among participants without depression. Compared with non-depressed participants without nightmares, the incidence of suicide among participants with a diagnosis of depression was similar among those with and without nightmares (HR 12.3, 95% CI 5.55–27.2 versus HR 13.2, 95% CI 7.25–24.1). The mediation analysis revealed no significant effects of nightmares on suicide incidence. However, the incidence of depression during follow-up was higher among those who suffered from nightmares than among those who did not (p < 0.001).ConclusionsOur findings indicate that nightmares have no influence on the incidence rate of suicide, but may reflect pre-existing depression. This is supported by a recent discovery of a strong genetic correlation of nightmares with depressive disorders, with no evidence that nightmares would predispose to psychiatric illness or psychological problems. Interventions targeting both depression and nightmares, when these conditions co-occur, may provide additional therapeutic benefit.

Suicide in Elderly Patients with Hip Fracture: A South Korean Nationwide Cohort Study.

The purpose of the present study was to evaluate the incidence rate (IR) of suicide in elderly patients with hip fracture on the basis of a nationwide cohort and to analyze the change in the hazard ratio for suicide after hip fracture over time in comparison with a control group. Patients with hip fracture and their matched controls were selected from the National Health Insurance Service-Senior cohort (NHIS-Senior) of the Republic of Korea. The NHIS-Senior consists of 558,147 people selected by a 10% simple random-sampling method from a total of 5.5 million subjects ≥60 years of age in 2002. Risk-set matching (1:2) on the propensity score was performed with use of a nearest neighbor matching algorithm with a maximum caliper of 0.1 for the hazard components. The IR of suicide and 95% confidence interval (CI) were calculated on the basis of a generalized linear model with a Poisson distribution. The effect size was presented as a hazard ratio (HR) with use of the Cox proportional-hazard model with a robust variance estimator that accounts for clustering within matched pairs. A total of 11,477 patients with hip fracture and 22,954 matched controls were included. The mean duration of follow-up was 4.59 years, generating 158,139 person-years. During follow-up, a total of 170 suicides were identified. Comparisons at up to 180 days and 365 days showed that patients with hip fracture were at higher risk for suicide than matched controls (p = 0.009 and 0.004, respectively; stratified log-rank test). During the first 180 days of follow-up, 14 suicides were identified in patients with hip fracture during 11,152 person-years (IR, 266.1 per 100,000 person-years; 95% CI, 157.6 to 449.4). Patients with hip fracture were 2.97 times more likely to kill themselves than their matched controls during the same period (HR = 2.97; 95% CI, 1.32 to 6.69). Hip fracture in elderly patients increased suicide risk within a year. A new approach to psychiatric evaluation and management is needed in elderly patients with hip fracture. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Suicide risk in young people at Ultra-High Risk (UHR) of psychosis: Findings from a 2-year longitudinal study

BackgroundSuicide risk is high in first episode schizophrenia. Little data are available in young individuals at Ultra-High Risk (UHR) of psychosis. Purposes of the study were: (1) to assess prevalence and incidence rates of suicide attempts, suicidal ideation, and completed suicide in UHR individuals compared with First Episode Psychosis (FEP) and non-FEP/UHR help-seeking peers at baseline and over a 24-month follow-up time, and (2) to explore any association of suicidal ideation with other psychopathological parameters at baseline. Methods273 young people (13–35 years) were evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory – II Edition (BDI), and the World Health Organization Quality Of Life scale – Brief version (WHOQOL-BREF). The BDI item 9 cut-off score of ≥1 dichotomized the presence/absence of suicidal ideation. ResultsUHR individuals showed more severe suicidal ideation and a higher percentage of individuals with a history of attempted suicide than FEP and non-UHR/FEP samples, and a higher 2-year incidence rate of suicide attempts than non-UHR/FEP subjects. No inter-group differences in incidence rates of completed suicide were found. In the UHR group, suicidal ideation was associated with BDI-II and CAARMS “Anhedonia” scores, and showed a negative correlation with all WHOQOL-BREF scores. ConclusionsSuicidal ideation is frequent in UHR subjects, supporting the routine monitoring of suicide risk in people at risk of psychosis. Suicide risk is correlated with severity of depression and anhedonia, and with a poorer quality of life.

Self-harm in midlife: analysis using data from the Multicentre Study of Self-harm in England.

In England suicide rates are highest in midlife (defined as age 40-59). Despite a strong link with suicide there has been little focus on self-harm in this age group.AimTo describe characteristics and treatment needs of people in midlife who present to hospital following self-harm. Data from the Multicentre Study of Self-harm in England were used to examine rates over time and characteristics of men and women who self-harm in midlife. Data (2000-2013) were collected via specialist assessments or hospital records. Trends were assessed by negative binomial regression models. Comparative analysis used logistic regression models for binary outcomes. Repetition and suicide mortality were assessed by Cox proportional hazards models. A quarter of self-harm presentations were made by people in midlife (n = 24 599, 26%). Incidence rates increased over time in men, especially after 2008 (incidence rate ratio [IRR] 1.07, 95% CI 1.02-1.12, P &lt; 0.01), and were positively correlated with national suicide incidence rates (r = 0.52, P = 0.05). Rates in women remained relatively stable (IRR 1.00, 95% CI 1.00-1.02, P = 0.39) and were not correlated with suicide. Alcohol use, unemployment, housing and financial factors were more common in men; whereas indicators of poor mental health were more common in women. In men and women 12-month repetition was 25%, and during follow-up 2.8% of men and 1.2% of women died by suicide. Self-harm in midlife represents a key target for intervention. Addressing underlying issues, alcohol use and economic factors may help prevent further self-harm and suicide.Declaration of interestK.H. and N.K. are members of the Department of Health's National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group which developed the quality standards for self-harm services. N.K. also chairs the NICE guideline committee for the management of depression. All other authors declare no conflict of interest.

Risk of suicide attempts among colorectal cancer patients: A nationwide population-based matched cohort study.

Patients with colorectal cancer (CRC) have been found to have a higher risk of suicide in limited-number studies. However, data on the actual incidence rate of suicide remain scarce. Using Taiwan's National Health Insurance Research Database, we examined whether patients with CRC in Taiwan are at increased risk of suicide attempts. In this retrospective matched cohort study, data of 96470 cases of CRC during 1 January 2000 to 31 December 2010 were collected. The control group was derived from general population by frequency matching 2 individuals without CRC for each individual with CRC by year of CRC diagnosis, age, and sex. The suicide risk in the CRC group compared with the control group was determined through Cox proportional hazard regression. We also compared the Kaplan-Meier analyses to competing risk cumulative incidence curves using the Aalen-Johansen estimator. A statistically significant 103% higher risk of suicide was observed in the CRC group compared with the control group (adjusted hazard ratio: 2.03; 95% confidence ratio: 1.60-2.56). Additional stratified analyses revealed a significantly elevated risk across almost all demographic groups but limited to rectum location, short follow-up time (<5years), and without comorbidity. Our study suggested that patients with CRC in Taiwan have an elevated risk of suicide. Oncologists should pay attention to these patients and should consider referring them for psychological consultation to prevent suicide.

Suicide in a rural area of coastal Kenya

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

Does Compulsory Admission Prevent Inpatient Suicide Among Patients with Schizophrenia? A Nationwide Cohort Study in Taiwan

The aim of this study was to analyze the risk of inpatient suicide in patients with schizophrenia during 2007-2013 and to determine putative risk factors. We conducted a national population-based cohort study of 2,038 psychiatric inpatients in their first compulsory admission, matched with 8,152 controls who were voluntary inpatients. Only patients with schizophrenia were included in the study. We used data derived from the Taiwanese National Health Insurance Database 2005, comprising 1million beneficiaries randomly selected from the entire population of Taiwan. During the follow-up period, 23 and 75 inpatient suicides were observed in the compulsory and control groups, respectively. Kaplan-Meier curves showed that the cumulative incidence rate of inpatient suicide was not significantly different between compulsory and voluntary admissions (log-rank test, p=.206). Our results suggest that compulsory admission has no protective effects on risk reduction of inpatient suicide for patients with schizophrenia who are compulsorily admitted compared with voluntarily admitted controls. Clinicians should be more alert for the prevention of inpatient suicide among patients with schizophrenia and consider the close monitoring of inpatient suicide risk in the first week of admission.

Incidence of overwork-related mental disorders and suicide in Japan.

Mental disorders and suicide resulting from overwork or work-related stress have become major occupational health issues worldwide, particularly in Asian countries. However, no studies have reported incidence rates of mental disorders and suicide by sex, age group and industry, using a national database containing all cases involving compensation in Asian countries. The present study examined incidence rates of occupational mental disorders and suicide by sex, age group and industry using a database containing all cases involving compensation for mental disorders and suicide in Japan over a 5-year period. Cases involving compensation for mental disorders and suicide in Japan between January 2010 and March 2015 were analysed. Incidence rates over the 5-year study period were calculated by sex, age group and industry. In total, 1990 cases involving compensation for mental disorders and suicide (619 women and 1371 men) between January 2010 and March 2015 were analysed. The incidence rate involving compensation was higher in employees aged between 30 and 39 years. In men, incidence rates were higher in 'accommodation/eating/drinking services', 'information/communication' and 'scientific research, professional and technical services'. In these industries, incidence rates were particularly high for those aged 29 years or younger. Our findings highlight the importance of promoting mental health support for younger employees and increasing awareness of their working conditions. Differences in incidence rates by sex, age and industry should be taken into consideration in the development of a national policy and industry- and age-specific preventive measures for overwork-related mental disorders and suicide.

Income-related inequality in completed suicide across the provinces of Iran.

OBJECTIVESThe aim of this study was to measure income-related inequality in completed suicide across the provinces of Iran.METHODSThis ecological study was performed using data from the Urban and Rural Household Income and Expenditure Survey-2010 conducted by the Iranian Center of Statistics, along with data on completed suicide from the Iranian Legal Medicine Organization in 2012. We calculated the Gini coefficient of per capita income and the completed suicide rate, as well as the concentration index for per capita income inequality in completed suicide, across the provinces of Iran.RESULTSThe Gini coefficients of per capita income and the completed suicide rate in the provinces of Iran were 0.10 (95% confidence interval [CI], 0.06 to 0.13) and 0.34 (95% CI, 0.21 to 0.46), respectively. We found a trivial decreasing trend in the completed suicide incidence rate according to income quintile. The poorest-to-richest ratio in the completed suicide rate was 2.01 (95% CI, 1.26 to 3.22). The concentration index of completed suicide in the provinces of Iran was -0.12 (95% CI, -0.30 to 0.06).CONCLUSIONSThis study found that lower income might be considered as a risk factor for completed suicide. Nonetheless, further individual studies incorporating multivariable analysis and repeated cross-sectional data would allow a more fine-grained analysis of this phenomenon.

MANAGEMENT OF ENDOCRINE DISEASE: Suicide risk in patients with diabetes: a systematic review and meta-analysis

Previous studies investigating the risk of suicide in diabetes patients reported controversial findings. We did a systematic review and meta-analysis to comprehensively estimate the risk and incidence rate of suicide in diabetic patients. PubMed, EMBASE and PsycINFO were searched for eligible studies. Random-effects meta-analysis was used to calculate the relative risk (RR) and the incidence rate of suicide in diabetes patients. We also calculated the proportion of deaths attributable to suicide among diabetes patients. 54 studies were finally included, including 28 studies on the suicide risk associated with diabetes, 47 studies on the incidence rate of suicide and 45 studies on the proportion of deaths attributable to suicide. Meta-analysis showed that diabetes could significantly increase the risk of suicide (RR = 1.56; 95% CI: 1.29-1.89; P < 0.001). Subgroup analysis showed that the RR of suicide associated with type 1 diabetes was 2.25 (95% CI: 1.50-3.38; P < 0.001). The pooled incidence rate of suicide in patients with diabetes was 2.35 per 10 000 person-years (95% CI: 1.51-3.64). The pooled proportions of long-term deaths attributable to suicide in type 1 diabetes patients and type 2 diabetes patients were 7.7% (95% CI: 6.0-9.8) and 1.3% (95% CI: 0.6-2.6), respectively. This meta-analysis suggests that diabetes can significantly increase the risk of suicide. Suicide has an obvious contribution to mortality in diabetic patients, especially among type 1 diabetes patients. Effective strategies to decrease suicide risk and improve mental health outcomes in diabetes patients are needed.