Independent Predictors Of Suicide Research Articles

Sociodemographic inequalities of suicide: a population-based cohort study of adults in England and Wales 2011-21.

The risk of suicide is complex and often a result of multiple interacting factors. Understanding which groups of the population are most at risk of suicide is important to inform the development of targeted public health interventions. We used a novel linked dataset that combined the 2011 Census with the population-level mortality data in England and Wales. We fitted generalized linear models with a Poisson link function to estimate the rates of suicide across different sociodemographic groups and to identify which characteristics are independent predictors of suicide. Overall, the highest rates of suicide were among men aged 40-50 years, individuals who reported having a disability or long-term health problem, those who were unemployed long term or never had worked, and those who were single or separated. After adjusting for other characteristics such as employment status, having a disability or long-term health problem, was still found to increase the incidence of suicide relative to those without impairment [incidence rate ratio minimally adjusted (women) = 3.5, 95% confidence interval (CI) = 3.3-3.6; fully adjusted (women) 3.1, 95% CI = 3.0-3.3]. Additionally, while the absolute rate of suicide was lower in women compared with men, the relative risk in people reporting impairments compared with those who do not was higher in women compared with men. The findings of this work provide novel population-level insights into the risk of suicide by sociodemographic characteristics in England and Wales. Our results highlight several sociodemographic groups who may benefit from more targeted suicide prevention policies and practices.

A Systematic Review: Adolescent Cannabis Use and Suicide

Objective: We aim to review studies on the relationship between cannabis use and suicide risk among adolescents. Materials and Methods: Data were collected from a PubMed and Google Scholar search, resulting in a close examination of 12 papers from 1990 to 2019 concerning cannabis use and suicide in relation to adolescents. Key search words included “marijuana OR cannabis OR THC OR tetrahydrocannabinol, AND suicide, AND adolescents” and only published studies between 1990 and 2019 were included. Included are a single review, 3 longitudinal studies, 7 cross-sectional investigations, and 1 letter to the editor. We referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist and flowchart in the selection of our studies. Results: The review of the literature suggests that there is an association between cannabis use and suicidal behavior, as well as suicidal thoughts and attempts. Among cannabis users, adolescents were found to be most at risk for suicidal behavior. Our comprehensive examination of the literature suggests that cannabis is an independent predictor of suicide, with the frequency of use being associated with increased suicide attempts. Conclusions: Findings underscore the significance of the relationship between cannabis use and suicidal behavior in adolescents. Increased awareness of the detrimental outcomes due to adolescent cannabis use is necessary due to changing cannabis laws. The increasing legalization of cannabis use may change adolescents’ attitudes on using marijuana. Health care providers need to be increasingly aware of the potential effects that cannabis use has on adolescents.

Incidence of suicide among military police officers in South Brazil: An 11-year retrospective cohort study

BackgroundSuicide is known to be the leading cause of death among police officers (PO) worldwide. However, most studies were conducted in developed countries, with no data from Brazil. The present study aimed to evaluate the incidence and the sociodemographic profile of suicide among a military PO subpopulation in South Brazil. MethodsThis retrospective cohort evaluated 31,110 military PO with available data on cause of death from 2006 to 2016. Participants were monitored for an average of 18.8 ± 9.6 years following the date of entry into the military police. ResultsMean age at the end of the follow up time was 41.4 ± 9.1 years, with 90.7% males. A total of 650 participants died (2.1%), with 43 suicides (6.6% of all deaths) - cumulative incidence of 138/100,000. Bivariate analysis revealed a significant association (p < 0.05) between suicide and age (HR = 0.70, 95%CI = 0.66–0.74), females (HR = 1.67, 95%CI = 1.08–2.60) and enlisted military rank (HR = 14.9, 95%CI = 2.05–108.5). Multivariate models showed an independent association between suicide and age (HR = 0.71, 95%CI = 0.67–0.74) and enlisted military rank (HR = 9.96, 95%CI = 1.30–76.3). ConclusionsThe incidence of suicide among military PO in South Brazil was high, compared to the national suicide rate. Younger age and lower military rank were independent predictors of suicide in this subpopulation.

Factors associated with increased risk of suicide among survivors of head and neck cancer: A population-based analysis

ObjectivesCancer diagnosis is considered an independent predictor of suicide. We aimed to determine whether gender and human papillomavirus (HPV)-relatedness are associated with increased risks of suicide in the head and neck cancer (HNC) population. Materials and methodsAdult patients ≥18 years with HNC were selected using the Surveillance, Epidemiology, and End Results (SEER) data from 1973 to 2014. Using anatomic sites as proxy, patients were grouped as HPV-related or not HPV-related. Standardized Mortality Ratios (SMRs) were calculated, and association between suicide, gender, HPV-relatedness were estimated as adjusted rate ratios (aRR) using multivariable Poisson regression model. ResultsThere were 1036 suicides among 287,901 HNC patients in the study period (63 suicides per 100,000 person-years). Male patients were six times more likely to commit suicide compared to female patients (aRR = 5.74, 95% CI 3.88, 8.50); however, HPV-relatedness did not increase risk of suicide (aRR = 0.87, 95% CI 0.58, 1.29). Compared with white patients, blacks (aRR = 0.20, 95% CI 0.12, 0.33) and Hispanics (aRR = 0.25, 95% CI 0.14, 0.43) were less likely to commit suicide. Additionally, increased risks of suicide were found among the widowed (aRR = 1.48, 95% CI 1.10, 1.99) and divorced/separated (aRR = 1.30, 95% CI 1.00, 1.69), compared with married patients. ConclusionGender, not HPV-relatedness, was associated with risk of suicide in our study. We identified HNC patients more likely to commit suicide as: previously married, white, male, widowed, divorced or separated, ≥70 years. Our findings may be useful clinically in planning personalized cancer care and lifelong surveillance of HNC patients with higher risks of suicide.

Implementation of the national register of suicide attempts as a preliminary strategy for the prevention of suicides in Poland

Studies show that suicide attempts are a major independent predictor of suicide. Only in some countries of the world, there are national registers of these behaviors. Poland is among the countries where suicide prevention is at the stage of implementation of these strategies. One is the initial diagnosis of the prevalence of suicidal behavior (SB) in selected populations. The aim of the study was to assess the prevalence of SB in Poland on the basis of available databases, including data such as age, sex and mental disorders and the analysis of differentiation of selected indicators of SB.Material and methodsWe analyzed available registers of completed suicides (CS) and suicide attempts (SA), carried out under reporting of the central statistical office (CSO, in the general population, based on death certificates), Police Headquarters (PH, the number of reported SB in the country) and the Institute of Psychiatry and Neurology in Warsaw (IPiN, the number of SB in all psychiatric institutions) and the department of adolescent psychiatry in Łódź (SB among hospitalized youth).Results and conclusionsReported data on dissemination of SB in Poland are incomplete, which may affect the reliability of the assessment of the effectiveness of implemented strategies for the prevention of suicides. The aim should be to create a central register of SB, which will not only gather a well-defined data but also monitor how it is obtained.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depressive symptoms and other risk factors predicting suicide in middle-aged men: a prospective cohort study among Korean Vietnam War veterans.

Background. Few studies have prospectively examined whether depressive symptoms and other risk factors are associated with a higher risk of suicide death in individuals other than high-risk populations such as psychiatric patients and individuals with self-harm histories. The purpose of the study is to prospectively examine whether depressive symptoms assessed by the Beck Depression Inventory (BDI) are associated with greater risk of suicide death and whether depressive symptoms and other risk factors are independent predictors of suicide in general-risk populations. Another aim is to evaluate the sensitivity of the BDI for predicting suicide death.Methods. 10,238 Korean Vietnam War veterans (mean age: 56.3 years) who participated in two surveys in 2001 were followed up for suicide mortality over 7.5 years.Results. 41 men died by suicide. Severely depressed participants had a higher adjusted hazard ratio (aHR = 3.4; 95% CI [1.5–7.7]) of suicide than non-to-moderately depressed ones. Higher suicide risk was associated with more severe depressive symptoms (p for trend = 0.009). After adjustment for depressive symptoms and other factors, very poor health, low education, and past drinking were associated with higher suicide risk, while good health, body mass index, and marital status were not associated with suicide. The sensitivity at the cut-off score of 31 for detecting suicide was higher during the earlier 3.5 years of the follow-up (75%; 95% CI [50–90]) than during the latter 4 years (60%; 95% CI [41–76]).Conclusions. Depressive symptoms are a strong independent predictor and very poor health, low education, and drinking status may be independent predictors of future suicide. The BDI may have acceptable diagnostic properties as a risk assessment tool for identifying people with depression and suicidal potential among middle-aged men.

Risk and predictors of suicide in colorectal cancer patients: A SEER analysis.

9596 Background: Colorectal cancer (CRC) patients have a higher risk of suicide as compared with the general population. Due to differences in the sites/morbidity of recurrences as well as ostomy rates, we sought to evaluate the distribution and predictors of suicide among patients with colon and rectal cancer. Methods: A retrospective analysis was undertaken using the Surveillance, Epidemiology, and End Results (SEER) database from 1973-2009. Patients included were &gt;18yrs and had confirmed adenocarcinoma of the colon or rectum. Results: Included in this analysis were 187,996 rectal cancer and 443,368 colon cancer patients. Colon cancer patients were older (median age 71 vs. 67 yrs, p &lt;0.001) and included more females (51 vs. 43%, p &lt;0.001) as compared to rectal cancer patients. Suicide rates were similar (611 [0.14%] vs. 337 [0.18%], p &lt;0.001), as was the median time to suicide for colon vs. rectal cancer patients respectively (37 vs.32 months, p = 0.13). On univariate analysis, having rectal cancer was a predictor of suicide (HR 1.26; 95% CI: 1.10-1.43). However after adjustment for age, sex, race, marital, primary site surgery, stage and one primary, rectal cancer was not a predictor of suicide (HR 1.05; CI: 0.83- 1.33). In the combined CRC cohort, independent predictors of suicide included age &gt;70 (HR 1.55; CI: 1.23-1.94), male gender (HR 7.56; CI: 5.34-10.70), being single (HR 1.56; CI: 1.14- 2.13), distant metastases at diagnosis (HR 1.58; CI: 1.13- 2.21), and white race (HR 3.21; CI: 1.75- 5.88). Also, lack of resection of primary tumor was associated with increased risk of suicide (HR 2.83; CI: 1.97- 4.05). Among colon cancer cohort, older age, male gender, and white race as well as lack of primary resection were independent predictors of suicide. Similarly, the aforementioned predictors as well as metastatic disease on presentation were the independent predictors of suicide in the rectal cohort. Conclusions: The suicide risk in CRC patients is low (&lt; 0.2%) and no difference was found based on location of primary tumor. Gender, age, distant spread of disease, intact primary tumour and race are the main predictors of suicide among colorectal patients. Future studies and interventions are needed to target these high risk groups.

Family history of suicide and exposure to interpersonal violence in childhood predict suicide in male suicide attempters

BackgroundFamily studies, including twin and adoption designs, have shown familial transmission of suicidal behaviors. Early environmental risk factors have an important role in the etiology of suicidal behavior. The aim of the present study was to assess the impact of family history of suicide and childhood trauma on suicide risk and on severity of suicide attempt in suicide attempters. MethodsA total of 181 suicide attempters were included. Family history of suicide was assessed with the Karolinska Suicide History Interview or through patient records. Childhood trauma was assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to violence and expressed violent behavior in childhood (between 6 and 14 years of age) and during adult life (15 years or older). Suicide intent was measured with the Freeman scale. ResultsMale suicide attempters with a positive family history of suicide made more serious and well planned suicide attempts and had a significantly higher suicide risk. In logistic regression, family history of suicide and exposure to interpersonal violence as a child were independent predictors of suicide in male suicide attempters. LimitationsThe information about family history of suicide and exposure to interpersonal violence as a child derives from the patients only. In the first part of the inclusion period the information was collected from patient records. ConclusionsThe results of this study imply that suicides among those at biological risk might be prevented with the early recognition of environmental risks.

Inpatient Suicide in a Chinese Psychiatric Hospital

Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.

Risk Factors for Suicide Completion in Major Depression: A Case-Control Study of Impulsive and Aggressive Behaviors in Men

Major depression is a major risk factor for suicide. However, not all individuals with major depression commit suicide. Impulsive and aggressive behaviors have been proposed as risk factors for suicide, but it remains unclear whether their effect on the risk of suicide is at least partly explained by axis I disorders commonly associated with suicide, such as major depression. With a case-control design, a comparison of the level of impulsive and aggressive behaviors and the prevalence of associated psychopathology was carried out with control for the presence of primary psychopathology. One hundred and four male suicide completers who died during an episode of major depression and 74 living depressed male comparison subjects were investigated with proxy-based interviews by using structured diagnostic instruments and personality trait assessments. The authors found that current (6-month prevalence) alcohol abuse/dependence, current drug abuse/dependence, and cluster B personality disorders increased the risk of suicide in individuals with major depression. Also, higher levels of impulsivity and aggression were associated with suicide. An analysis by age showed that these risk factors were more specific to younger suicide victims (ages 18-40). A multivariate analysis indicated that current alcohol abuse/dependence and cluster B personality disorder were two independent predictors of suicide. Impulsive-aggressive personality disorders and alcohol abuse/dependence were two independent predictors of suicide in major depression, and impulsive and aggressive behaviors seem to underlie these risk factors. A developmental hypothesis of suicidal behavior, with impulsive and aggressive behaviors as the starting point, is discussed.

Access to Firearms and Risk for Suicide in Middle-Aged and Older Adults

Elderly white men are at the highest risk for suicide. Firearms are the most common method of suicide used by both men and women in later life, and a greater proportion of older than younger suicide victims use a gun. This psychological autopsy study aimed to test hypotheses concerning the risk for suicide associated with access to and storage of firearms. Subjects included 86 suicide victims age 50 years of age and over and 86 community control subjects individually matched on age, sex, race, and county of residence. Presence of a firearm in the home was associated with increased risk for suicide, even after controlling for psychiatric illness. Elevated risk was accounted for by access to handguns rather than long guns and was more pronounced in men than women. Among subjects who kept a gun in the home, storing the weapon loaded and unlocked were independent predictors of suicide. Findings support the potential benefit for suicide prevention of restricting access to handguns. Education programs for older persons, their families, and healthcare providers concerning the risks of having a gun in the home and reinforcement of rules for safe storage may contribute to reducing the rate of suicide in older people.

Physical illness and suicide in the elderly

Of all the age groups, seniors aged 75 and older have the highest rates of suicide in most industrialized countries. Due to the aging of the world’s populations, suicide is predicted to become the tenth leading cause of death by the year 2020.1 Seniors who commit suicide often consult their doctors a short time before they take their lives,2,3 but few communicate their suicide intent. Rather, suicidal seniors may focus on somatic complaints. How are physical illness and suicide connected? While the associations between depression and suicidal feelings,4 attempts5 and completed suicide6-9 are well established, our understanding of the link between physical illness and suicidality is more limited. Snowdon and Baume analysed coroners’ data, and noted that physical ill-health or disability was a major precipitant in one-third of all senior suicides.10 Yet physical illness also is widespread among older people who do not commit suicide. Can physical illness be considered an independent predictor of suicide? This paper will review what is known about the connection between physical illness and suicide, with special focus on the elderly.