Lethal Methods Research Articles

111 Characterizing Physician Suicide in the U.S. (2003-2017)

OBJECTIVES/GOALS: Suicide is a growing public health problem with the rate of suicide increasing 33% since 1999. Physicians are not immune to this growing problem. Physicians represent a unique population that has been understudied with respect to suicide. The aim of the study is to investigate risk factors unique to physicians compared to the general population. METHODS/STUDY POPULATION: Using data from the National Violent Death Reporting System, a nationwide CDC database which aggregates information on violent deaths, we extracted demographic and circumstantial data on 172,135 suicide decedents ≥ 25 years old in participating states from 2003-2017. Of these, we found complete information regarding demographics, occupation, and circumstance for 160,159 suicide decedents. We separated suicide decedents by physician-status and compared 795 physicians to 159,364 non-physician decedents using chi-squared test. We then used multivariate logistic regression to examine differences in suicide method and circumstance by physician-status status, controlling for age, sex, and race. RESULTS/ANTICIPATED RESULTS: Compared to non-physicians, physicians were more likely to be male (84.5% vs 77.3%, p<0.001) and older (45.1% ≥65 vs. 17.8%, p<0.001). Controlling for demographics, physicians were less likely to complete suicide by firearm (aOR=0.60, 95%CI=0.51-0.71) but were more likely to suicide by overdose (aOR=1.41, 95%CI=1.13-1.77) or cutting (aOR=2.81, 95%CI=2.03-3.88). Physicians were more likely to have job related stressors (aOR=2.24, 95%Cl=1.83-2.74) and legal problems (aOR=2.34, 95%Cl=1.70-3.21). Physicians were also more likely to leave a suicide note (aOR=1.48, 95%Cl=1.26-1.73) but were less likely to be intoxicated on alcohol at time of death (aOR=0.76, 95%Cl=0.62-0.93). Physicians were no different than non-physicians in terms of financial or relational stressors. DISCUSSION/SIGNIFICANCE: Physicians are more likely to be male and older. Given their medical training, overdose and cutting may be more accessible and lethal methods for physicians. Physicians are more likely to leave a suicide note and less likely to be intoxicated, which may imply less impulsivity. Job stressors and legal problems may also contribute to physician suicide.

Comparative evaluation of lethal outcome prediction methods in severely burned patients

Background: Regarding burn injury there are many approaches to assessing the possibility of death in severely burned patients. Despite the ease of use and the maximum prevalence of existing models, the assessment of the outcome in each of them is questionable, since the emphasis in different indices is on different indicators, avoiding the overall clinical picture of the disease.Objective: Comparative analysis of the effectiveness of methods for predicting a lethal outcome in patients with extensive skin burns.Material and мethods: Calculated characteristics of known in the literature and widely used Baux rules, Frank index, probit analysis and a new method of logistic regression were obtained and applied to evaluate the results of treatment of 282 adult patients with extensive skin burns, hospitalized in the Department of Anesthesiology and Intensive Care of the Thermal Injuries Unit, Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine in the period 2015–2021.Results: During the study a descriptive characteristic of methods for predicting a lethal outcome was obtained. Based on the data obtained, four-field contingency tables were compiled and a comparative analysis of the effectiveness of the models was carried out.Conclusion: Despite the high frequency of use of such forecasting methods as the Baux score, the Frank index and probit analysis in the combustiology practice, the results of the calculation indicate that these methods have low efficiency: the Baux score method accuracy of a lethal outcome prediction is 49.7%, the Frank index method – 41.5%, probit analysis method – 60%. The logistic regression model developed by us showed high efficiency compared to those presented earlier (the accuracy of predicting a lethal outcome was 93%), which gives grounds for recommending it for practical application.

REFLECTIONS FROM DEATH FROM VOLUNTARY SELF-INJURY IN BRAZIL, 1996-2019.

INTRODUCTION: Self-inflicted injuries may be classified suicidal behavior or self-harm. Regarding suicidal behavior, self-inflicted actions, which cause harm to the individual, involve ideation, attempt and suicide itself. Due to taboos related to suicide, public health problem and multifaceted psychosocial phenomenon, the perspectives of care and prevention are still limited in different health scenarios. This research aims to present a sociodemographic understanding of the phenomenon of suicide, promoting reflections that can improve therapeutic care, as well as subsidize preventive and health promotion proposals. METHODOLOGY: This is an ecological, descriptive and retrospective study whose methodology was the use of secondary data from the Mortality Information System (SIM). The sample consisted of all deaths secondary to voluntarily self-inflicted injuries, in Brazil, during the period 1996 to 2019, totaling 222,232 records. In the research, the following variables were used: Gender, Age, Color/Race, Marital Status and Education. RESULT AND DISCUSSION: men were the ones who died the most from self-harm and use more lethal methods to perform these injuries, although there are more suicide attempts among women. With regard to age group, most people who committed suicide were adults, aged between 20 and 59 years. However, it was noticed that the elderly and adolescents, in recent years, have become groups that are more vulnerable to suicide attempts. FINAL CONSIDERATIONS: there was an increase in the number of deaths from self-harm in Brazil among the years considered. It is noticeable that self-harm is a public health problem and requires adequate care and prevention interventions, in addition to structural changes related to risk factors.

A microwave energy meter to estimate energetic reserves in juvenile sturgeon

Energetic stores can be metrics of fish health but are determined using lethal methods. Validation of non-lethal alternatives to estimate energetic stores would facilitate monitoring of wild fish of conservation concern, such as sturgeons. The Distell Fatmeter, a microwave energy meter, has been validated to estimate energetic reserves in a range of fish taxa but has not been tested on sturgeon. Therefore, Fatmeter measurements were tested as a predictor of captive hatchery-origin juvenile pallid sturgeon (fork length: 240–415 mm) energetic reserves determined by lethal proximate analysis. Fatmeter measurements combined with size and condition metrics accounted for 40 to 45% of the variation in whole-body energetic reserves, which is notably lower than reported in previous studies on other fish taxa and a modest improvement on variation explained by size and condition metrics alone in the same sturgeon population. We suggest the low variation accounted for by the Fatmeter may be a result of small body size and low whole-body lipid content and recommend follow-up studies on sturgeon larger than 415 mm in fork length.

Evaluation of Gonad Reproductive Condition Using Non-invasive Ultrasonography in Red Abalone (Haliotis rufescens)

The reproductive status in abalone (Haliotis spp.) can be difficult to discern using traditional visual inspection methods and may therefore rely on lethal histological analyses for a definitive determination. With endangered species of abalone, lethal histological examinations are strictly prohibited due to their imperiled status. This research investigated the effectiveness of using non-invasive ultrasound technology as an alternate means of identifying the reproductive status of abalone rather than through invasive biopsies or lethal histological methods. Twelve abalone were randomly selected from cultured red abalone broodstock cohort (n = 200) produced at The Cultured Abalone Farm (Goleta, CA) to initially test these methods. Following initial gonad ultrasound determination, a subset of another cohort of 5 year-old (n = 62) red abalone produced at the UC Davis Bodega Marine Laboratory were monitored using ultrasonography to detect seasonal changes in gonad size for 7 weeks. Following the 7-week assessment period, the full cohort of 5-year old abalone (n = 122) were then spawned and gonads were also evaluated using ultrasound technology before and immediately after spawning. Ultrasound imaging technology accurately differentiated between digestive and reproductive tissues, allowing for the characterization of an ultrasound gonad index score for rapid assessment. Mean gonad thickness determined via ultrasound imaging was categorized on a scale of 1–5, with an index of 1 being the lowest (gonad tissue thin or absent) and an index of 5 being the highest (gonad margin has increased and is compressing the digestive gland) for red abalone. Ultrasound imaging technology was successful in rendering a gonad index score that can be used to track gonad maturation over time in cultured or captive species. Tracking ultrasound gonad scores over time is a useful tool for improving abalone culture production, and increasing animal welfare by reducing handling stress associated with gonad assessments. Individual abalone that are empirically determined ready to be spawned can then be selected for broodstock. Non-invasive ultrasound technology has the potential for broad applications within abalone aquaculture to enhance both food and conservation aquaculture breeding programs.

Suicide among Health Care Professionals-An Indian Perspective.

Suicide is a global phenomenon that claims a person’s life every 40 s. The suicide-mortality rate in India is higher than the worldwide average for health care professionals (HCP). The treatment gap for mental health care is alarming, more than 80% in India which has improved compared to a decade. Among the methods chosen by HCPs for dying by suicide, violent suicide methods are more common. Hanging is the most common means, followed by lethal injection and jumping from a building. Among the medical students and professionals in India, academic stress is the leading cause of suicides, followed by mental illness and harassment. Stressfully long working hours, starvation for long hours, inadequate diet, sleep deprivation, inadequate rest, high levels of personal expectations, knowledge of lethal suicide methods, easy access to potentially fatal drugs, apathy, and fearlessness towards death are some of the contributing factors. Primary preventive measures to minimize suicides in HCPs would be to conduct stress-management workshops at an institutional level, routine mental health check-ups in healthcare institutions, mental-health screening for students enrolling into healthcare courses, and prompt referrals to mental healthcare facilities. In addition, telehealth services or mental health services for medical professionals of India are the need of the hour.

Complex suicides: 21 cases and a review of the literature

BackgroundThe use of more than one potentially lethal method together and sequentially to complete suicide is called “complex suicide.” Complex suicides are divided into two groups: planned and unplanned. This study aimed to discuss with literature 21 complex suicide cases identified after a 2-year retrospective study.ResultsThis study included 21 complex suicide cases. Eleven were classified as planned complex suicides, and 10 were labeled as unplanned complex suicides. The average age of all cases was 42.5 ± 17.7 (min: 19, max: 76) years. Suicide notes were present in six (28.5%) cases. Fifteen victims (71.4%) suffered from psychiatric diseases. Twelve victims ingested a toxic dose of medication, nine cases jumped from a height, eight cases used stabbing, six cases used hanging, two cases ingested a corrosive substance, two cases drowned, two cases inhaled a toxic gas, one case ingested cyanide, one case ingested insecticide, and one case used suffocation with a plastic bag. In two cases, three methods of suicide were used together. In the current study, “corrosive substance intake + cyanide intoxication” and “corrosive substance intake + jumping from a height” were defined for the first time and have not been previously described in the literature.ConclusionsComplex suicides are highly likely to be potentially mistaken for murder. The cause of death in these cases can be determined with a comprehensive autopsy along with a detailed examination of the scene, statements of relatives, and eyewitnesses.

Knowledge, attitude and practice of the local people towards human–carnivore coexistence in Faragosa–Fura Landscape, Gamo Zone, southern Ethiopia

Local people knowledge, attitudes and practices (KAP) have played an important role in human‐wildlife coexistence and have received increased attention in biodiversity conservation. However, studies on the KAP of local people towards human‐carnivore coexistence (HCC) are scarce, species‐specific or limited to the protected areas. Therefore, we investigated the local people KAP towards carnivore coexistence with humans, the problem of livestock and mitigation practices in a human‐dominated landscape of southern Ethiopia. We collected the data from 352 households interviews using a semi‐structured questionnaire and photographic sampling. The respondents mentioned 13 carnivores coexisting with local people belonging to six families. Eighty‐five percent of the respondents perceived carnivores as problematic species and expressed a negative attitude towards them, primarily due to the damage they caused to their livestock. Respondents who had better knowledge of carnivores also showed a positive attitude towards carnivores. The cluster analysis showed that the spotted hyena, serval, leopard, common genet and black‐backed jackal were grouped under a high‐threat cluster. Chickens and goats were the most threatened livestock reported by respondents. The main predation control methods reported were guarding and fencing for larger livestock and keeping chickens indoors during the night. The regression models predicted that males and literate respondents had better knowledge of carnivores than females and illiterates. The respondents who owned more livestock experienced more damage to livestock, and females showed a negative attitude towards carnivores. Although the study area is the critical conservation value of the 13 carnivore species, livestock predation by carnivores, the local people's negative attitude towards carnivores and lethal predation control methods practiced by local people were affecting HCC in the area. The findings call for conservation actions such as conservation education to raise awareness and develop a positive attitude and non‐lethal predation mitigation measures to promote HCC in consultation with the local community.

An assessment of animal welfare impacts in wild Norway rat (Rattus norvegicus) management

AbstractNorway rats (Rattus norvegicus) are considered one of the most significant vertebrate pests globally, because of their impacts on human and animal health. There are legal and moral obligations to minimise the impacts of wildlife management on animal welfare, yet there are few data on the relative welfare impacts of rat trapping and baiting methods used in the UK with which to inform management decisions. Two stakeholder workshops were facilitated to assess the relative welfare impacts of six lethal rat management methods using a welfare assessment model. Fifteen stakeholders including experts in wildlife management, rodent management, rodent biology, animal welfare science, and veterinary science and medicine, participated. The greatest welfare impacts were associated with three baiting methods, anticoagulants, cholecalciferol and non-toxic cellulose baits (severe to extreme impact for days), and with capture on a glue trap (extreme for hours) with concussive killing (mild to moderate for seconds to minutes); these methods should be considered last resorts from a welfare perspective. Lower impacts were associated with cage trapping (moderate to severe for hours) with concussive killing (moderate for minutes). The impact of snap trapping was highly variable (no impact to extreme for seconds to minutes). Snap traps should be regulated and tested to identify those that cause rapid unconsciousness; such traps might represent the most welfare-friendly option assessed for killing rats. Our results can be used to integrate consideration of rat welfare alongside other factors, including cost, efficacy, safety, non-target animal welfare and public acceptability when selecting management methods. We also highlight ways of reducing welfare impacts and areas where more data are needed.

Perceptions towards charcoal-burning suicide and the surge of this lethal method in Taiwan.

ObjectiveWhether sociocultural perceptions of charcoal-burning suicide have influenced its rapid increase in prevalence is unclear. We aimed to explore perceptions of Taiwan’s general population regarding charcoal-burning suicide, their personal belief in life after death, and related feelings of thoughts associated with those who attempt charcoal-burning suicide.MethodsAn online web-based survey, focussing on sociocultural attitudes towards death, as well as perceptions towards charcoal-burning suicide, and those who attempt charcoal-burning suicide, was conducted from 14 January to 14 June 2016.ResultsIn total, 1343 adults completed the online survey (mean age of 33.46; 66.6% women). Notably, 90.3% of participants considered charcoal burning to be an easily accessible suicide method. Multivariable analyses revealed that among the examined factors, the perceived ‘painlessness’ of charcoal-burning suicide was associated with an over seven-fold increased risk of choosing charcoal-burning suicide (OR = 7.394; p < 0.001; 95% CI: 2.614–20.912).ConclusionAs reflected in this study, charcoal-burning suicide is perceived as easily accessible and painless. The perceived ‘painlessness’ may be the factor that distinguishes the choice of charcoal-burning suicide from that of other suicide methods. Future efforts to target these perceptions regarding charcoal-burning suicide may be warranted in both media reporting and suicide prevention programmes.

Management of Psychiatric Disorders during the Perinatal Period.

Management of Psychiatric Disorders during the Perinatal Period.

Comparison of South Korean men and women admitted to emergency departments after attempting suicide: a retrospective study

Background: Suicide is a major health concern, especially in South Korea. The probability of dying by suicide and the fatality rate differ between men and women. The present study compared the suicide characteristics of women and men and analyzed the choice of suicide methods. Methods: This study retrospectively analyzed patients who visited the emergency department after a suicide attempt in the period from 2016 to 2018, which had been obtained from the National Emergency Department Information System. Variables included suicide methods, Korean Triage and Acuity Scale level, vital signs, and disposition following emergency care. Results: A total of 88,495 (54.7% women vs. 45.3% men) cases were investigated. Significant gender differences were observed in clinical outcomes. In total, 10.3% of the men (n = 3811) and 4.0% of the women (n = 1852) died in the hospital. Women were proportionately more likely to use poisoning (62.3% vs. 51.0% in men) and piercing and cutting (24.9% vs. 22.9% in men) compared with men, whereas men were more likely to use hanging (9.5% vs. 4.6% in women) and being struck (7.9% vs. 1.1% in women). Conclusions: Women chose less lethal suicide methods, whereas men chose more violent methods. The fatalities among men were higher, even when the same method was used. In establishing a suicide prevention policy, it is important to consider gender differences.

Redefining feral dogs in biodiversity conservation

Unlike most feral domestic animals, ranging behavior, diet dependence, and human socialization have been used as criteria to define feral dogs. These criteria can obstruct wildlife conservation if decisions depend on identifying ferality in dogs. We argue that diet dependence and human socialization are unnecessary to define ferality in situations where dogs constitute a threat to wildlife. Human-dependent diet and sociability are not exclusive to house dogs; thus, they do not differentiate ferality with certainty, and they have no established testing methods or thresholds. Most notably, they obstruct management by complicating feral dog identification. As a case study, legislation in Chile surrounding dog management does not recognize the existence of feral dogs and bans the application of lethal methods on dogs. This impairs conservation because the current definition makes it impossible to distinguish if a dog is feral at first sight. This is a problem in the small-scale livestock industry, where goat and sheep losses are mainly caused by dogs. Stakeholders could kill attacking dogs to defend their livestock, risking a lawsuit if those dogs were owned, or continue to lose their livelihood. Neither option benefits livestock owners. To not hinder conservation, we propose feral dogs be defined based only on ownership status, ranging behavior, and location in the context of management, and offer a classification based on these criteria. However, we contend that whether a dog is feral is not important for decision-making. Instead, dogs should be controlled if they are found on any public space unaccompanied by humans.

Is the Felixer cat control device safe for marsupial carnivores?

Context The Felixer grooming device (‘Felixer’) is a lethal method of feral cat control designed to be cost-effective and target specific. Aims This study aims to test the target specificity of the Felixer in Tasmania, with a particular focus on Tasmanian devil and quoll species due to the overlap in size, habitats and behaviour between these native carnivores and feral cats. Methods Our study deployed Felixer devices set in a non-lethal mode in nine field sites in Tasmania, one field site in New South Wales and two Tasmanian wildlife sanctuaries. Key results Our study recorded 4376 passes by identifiable vertebrate species including 528 Tasmanian devil passes, 507 spotted-tailed quoll passes and 154 eastern quoll passes. Our data showed that the Felixer can successfully differentiate quoll species from feral cats with spotted-tailed quolls and eastern quolls targeted in 0.19% and 0% of passes, respectively. However, Tasmanian devils and common wombats were targeted in 23.10% and 12% of passes, respectively, although sample size was low for common wombats (n = 25). Conclusions The Felixer could not reliably identify Tasmanian devils and possibly common wombats as non-target species. Further data is needed to confirm the potential for impacts on the common wombat and other potential non-target species in Tasmania, and the likelihood of the toxin being ingested by falsely targeted individuals. Implications Our study suggest that the Felixer device is safe for use in the presence of two species of conservation concern, the eastern and spotted-tailed quoll. It also supports evidence from previous studies that the Felixer is unlikely to impact bettongs and potoroos. Use of Felixer devices across much of Tasmania would have to balance the conservation or economic benefits of cat control against potential impacts on Tasmanian devils. We suggest that active Felixer deployments be preceded by surveys to establish the range of species present at the control site, and the season of control considered carefully to minimise potential impacts on more susceptible juvenile animals. In addition, modifications to the Felixer device such as the proposed incorporation of AI technology should be tested against the Tasmanian devil and other non-target species.

Diet of the southern ravine salamander Plethodon richmondi

The diets of many small North American Plethodon species are poorly studied despite their important roles in forest ecosystems. Using a non lethal gastric lavage method, we examined the spring-season diet of 31 southern ravine salamanders (Plethodon richmondi) from a second-growth forest in south-eastern Kentucky (USA). We recovered and identified a total of 452 prey items from 14 different prey groups. The three most important prey groups were Formicidae (ants), Acari (mites and ticks), and Collembola (springtails). Together, these groups accounted for more than 80 % of all prey items. Examining the diets of terrestrial salamanders may help us better understand their roles in the regulation of invertebrate communities and the transfer of accessible nutrients back to the soil.

Longevity of an immunocontraceptive vaccine effect on fecundity in rats

•Increases in human-wildlife conflicts alongside cultural shifts against lethal control methods are driving the need for alternative wildlife management tools such as fertility control. Contraceptive formulations suitable for oral delivery would permit broader remote application in wildlife species.•This study evaluated the contraceptive effect and immune response to two novel injectable immunocontraceptive formulations targeting the Gonadotropin Releasing Hormone (GnRH): MAF-IMX294 and MAF-IMX294P conjugates, both identified as having potential as oral contraceptives. The study also explored whether in multiparous species immunocontraceptives may either totally prevent reproduction or also affect litter size.•Female rats, chosen as a model species, were given three doses of either MAF-IMX294 or MAF-IMX294P to compare anti-GnRH immune response and reproductive output up to 310 days post-treatment.•Both formulations induced anti-GnRH antibody titres in 100% of rats and significantly impaired fertility compared to control animals. Following treatment with MAF-IMX294 and MAF-IMX294P 0 of 9 and 1 of 10 females respectively produced litters following the first mating challenge 45 days post-treatment, compared to 9 of 9 control animals.•Across the whole 310 day study period 7 of 9 females from the MAF-IMX294 group and 10 of 10 females in the MAF-IMX294P group became fertile, producing at least one litter throughout six mating challenges.•No significant differences were found between the two formulations in antibody titre response or duration of contraceptive effect, with an average time to first pregnancy of 166 days for MAF-IMX294 and 177 days for MAF-IMX294P for all females that became fertile.•Following treatment with MAF-IMX294 and MAF-IMX294P the first litter produced post-infertility in treated females was significantly smaller than in control animals. This indicates treatment with immunocontraceptives may induce an overall suppression of fecundity extending past an initial infertility effect. This increases the potential long-term impact of these immunocontraceptives in multiparous species such as commensal rodents.

Rapid Molecular Determination of Sex for Western North American Chub (Gila spp.)

AbstractGathering sex data is frequently a complicated matter for fish species that lack sexually dimorphic traits. Secondary sexual characteristics are cryptic or nonexistent in many minnows (Cyprinidae) during early life stages or outside of the breeding season, which may require lethal methods for determining sex. This complicates many conservation actions and population genetic studies, including (1) the development of hatchery broodstocks for threatened and endangered species, (2) sex ratio determination in wild populations, (3) the influence of sex ratio on the effective population size estimates, and (4) limitations on the implementation of genetic tagging and parentage assignment in wild populations. Here, we remedy this issue for four western North American chub species (Gila spp.) through restriction‐site‐associated DNA sequencing of Bonytail G. elegans, which identified a single locus indicating an XY sex determination system and no candidate loci consistent with a WZ system. This locus cross‐amplified in three additional Gila species (Chihuahua Chub G. nigrescens, Virgin Chub G. seminuda, and White River Chub G. jordani), although species‐specific differences necessitated the development of three novel primer/probe sets. Real‐time PCR with hydrolysis probe assays was used to genotype sex‐linked single‐nucleotide polymorphisms for each species. The measurement of endpoint fluorescence in a real‐time PCR thermal cycler allowed for rapid and accurate sex genotyping of these species, with accuracy &gt;97% relative to phenotypic sex identification when three PCR replicates were employed. These assays provided high precision, with unanimous results across &gt;87% of the replicates and a majority consensus genotype for 98.6% of the samples. The locus identified herein was conserved across all of the Gila species that we tested (n = 6) and other western North American cyprinids; however, sex‐linked polymorphisms were found only in the four species that are named above. Consequently, this locus has promise for the identification and development of sex‐linked assays for other Gila and closely related cyprinids.

B- and N-doped carbon dots by one-step microwave hydrothermal synthesis: tracking yeast status and imaging mechanism

BackgroundCarbon dots (CDs) are widely used in cell imaging due to their excellent optical properties, biocompatibility and low toxicity. At present, most of the research on CDs focuses on biomedical application, while there are few studies on the application of microbial imaging.ResultsIn this study, B- and N-doped carbon dots (BN-CDs) were prepared from citric acid, ethylenediamine, and boric acid by microwave hydrothermal method. Based on BN-CDs labeling yeast, the dead or living of yeast cell could be quickly identified, and their growth status could also be clearly observed. In order to further observe the morphology of yeast cell under different lethal methods, six methods were used to kill the cells and then used BN-CDs to label the cells for imaging. More remarkably, imaging of yeast cell with ultrasound and antibiotics was significantly different from other imaging due to the overflow of cell contents. In addition, the endocytosis mechanism of BN-CDs was investigated. The cellular uptake of BN-CDs is dose, time and partially energy-dependent along with the involvement of passive diffusion. The main mechanism of endocytosis is caveolae-mediated.ConclusionBN-CDs can be used for long-term stable imaging of yeast, and the study provides basic research for applying CDs to microbiol imaging.Graphical

Handgun purchasing characteristics and firearm suicide risk: a nested case\u2013control study

BackgroundFirearms are the most lethal method of suicide and account for approximately half of all suicide deaths nationwide. We describe associations between firearm purchasing characteristics and firearm suicide.MethodsData on all legal handgun transactions in California from 1996 to 2015 were obtained from the California Department of Justice Dealer’s Record of Sale database. Handgun purchasers were linked to mortality data to identify those who died between 1996 and 2015. To account for variation in timing and duration of observation time, analyses were stratified by birth cohort. The primary analysis focused on those aged 21–25 in 1996. A secondary analysis tested associations among those aged 50–54 in 1996. Using incidence density sampling, purchasers who died by firearm suicide (cases) were each gender-matched to 5 purchasers (controls) who remained at risk at the case’s time of death. We examined the characteristics of purchasers and transactions, focusing on the transaction closest in time to the case’s death. Data were analyzed with conditional logistic regression.ResultsThere were 390 firearm suicides among the younger cohort and 512 firearm suicides among the older cohort. Across both cohorts, older age at first purchase and the purchase of a revolver were associated with greater risk of firearm suicide. For example, among the younger cohort, those who purchased a revolver versus semiautomatic pistol had 1.78 times the risk of firearm suicide (95% CI 1.32, 2.40) in multivariable models. Other associations varied across cohorts, suggesting cohort or age effects in purchasing patterns.ConclusionsFindings add to the evidence on firearm suicide risk and may help inform prevention strategies and future research.

Hangings attended by ambulance clinicians in the North East of England

Suicide rates have risen in England over the last decade and hanging, a highly lethal method of suicide, has been the most common method. Previous work in this area identified a lack of literature discussing emergency medical services (EMS) attendance at hangings. This article aims to describe hangings attended by EMS in the North East of England in order to inform future work in this area. A retrospective service evaluation was conducted using existing data from a comprehensive pre-hospital trauma audit database to describe patients with hanging documented in their records who were attended by ambulance clinicians between 1 December 2018 and 31 November 2020. Hanging was recorded in 604 incidents. Most cases (n = 579/604) involved adults (aged 18 years or older) with a median age of 35 years (IQR 27-45 years), who were male (n = 410/579, 71%). Just over half (n = 341/579, 59%) of adult hangings resulted in cardiac arrest and of these, 10% (n = 33/341) were resuscitated and survived to hospital admission. Threatened and non-fatal hangings appear to have increased dramatically in the latter half of 2020. Previous suicide attempts and mental health issues were frequently reported across this population. Hangings are a method of suicide which frequently result in a cardiac arrest. In the North East of England the ambulance service attends approximately one hanging per day and one fatal hanging every two days. When fatal hangings were resuscitated, pre-hospital outcomes were similar to other causes of cardiac arrest, highlighting that despite the traumatic nature of these cases resuscitation is not futile. In order to better understand this patient group and improve care, pre-hospital data need to be linked to data from other services such as mental health services and acute hospitals.