Lethal Suicide Methods Research Articles

Conservative Beliefs, Male Gender, and Beliefs About Means Safety Among Firearm Owners

Reducing access to highly lethal methods for suicide (i.e., means safety) has been promoted as a way to reduce suicide risk. Research by Anestis et al. (J Affect Disord 227:530–535, 2018) has demonstrated that individuals who believe firearm ownership and storage are not associated with suicide risk and that those who are prevented from utilizing a specific method for suicide will find an alternative method (i.e., means substitution) are less willing to engage in firearms means safety. Sociopolitical beliefs and gender are two factors that are associated with beliefs about firearms and suicide. However, the extent to which these variables—in isolation and in combination—are associated with such beliefs has not been examined. This study examined how gender and social policy beliefs are associated with misconceptions about firearms and suicide. A total of 367 firearm owners took part in an anonymous online survey. Conservative firearm owners indicated firearm ownership and storage are less strongly related to suicide risk than did moderate or liberal individuals. Conservative males had significantly higher belief in means substitution than moderate and liberal males and liberal females. Liberal females had significantly lower belief in means substitution than moderate males and females and liberal males. Effective messaging regarding firearm means safety must consider the perspectives and potential motivations of individuals who are male and/or hold conservative beliefs to increase the reach and acceptability of means safety efforts.

Implementation and outcomes of suicide-prevention strategies by restricting access to lethal suicide methods in Korea.

For more than 10years, the suicide rate in South Korea has been the highest among members of the Organization for Economic Cooperation and Development. Suicide-prevention strategies, such as restricting access to lethal suicide methods, have been implemented in Korea. In this paper, we discuss suicide-prevention strategies that restrict access to the five leading methods for committing suicide: pesticide ingestion, inhalation of charcoal fumes, jumping from heights, placing oneself in front of moving subway trains, and hanging oneself by the neck. Of the five suicide-prevention strategies outlined in our study, prohibition of the herbicide paraquat and installation of screen doors were proven to be effective, while others need further assessments. Yet, the overall decline in suicide rate from 31.7 per 100,000 people in 2011 to 27.3 per 100,000 people in 2014 suggests that these suicide-prevention strategies have successfully decreased the suicide rate in Korea.

Duret haemorrhage: An unusual finding in compression of neck structures

Hanging is one of the most lethal methods of suicide, where survival is an obvious rarity. Those who survive the initial act of hanging mostly suffer from hypoxic ischemic encephalopathy, and show some form of neurological damage. Intracranial haemorrhages are rarely associated with hanging. We report the first case of Duret haemorrhages in a 58 years old victim who survived for 8 days after the attempted hanging. Duret haemorrhage is mostly associated with fatal outcome. It is thus implied that cerebral edema should be brought under control at the earliest to prevent transtentorial herniation and subsequent Duret haemorrhages.

Observations on self-incineration characteristics in 24 years (1993-2016) of autopsies in the city of Milan.

Self-incineration is one of the most dramatic and lethal suicide methods. It is rarely reported in Western countries and is more frequent in developing regions. We illustrate the forensic cases of self-immolation occurring over 24 years in the city of Milan, Italy, highlighting the main issues of such a complex and rare suicide. We selected 33 cases of self-incineration among 23,417 autopsies (4022 suicides) performed at the Department of Legal Medicine of the University of Milan over a period of 24 years (1993-2016). Several parameters were included and analysed: gender and age of the victims, pathological history, previous suicide intentions/attempts, duration of burning, place of death or discovery of the corpse, circumstantial data of fatal events and autopsy findings, with particular attention to thermal injuries. Self-incineration was found in 0.8% of total suicides and 0.14% of total autopsies. One of these cases involved a complex modality (association with plastic-bag suffocation). The typical characteristics of the victim were an Italian man with psychiatric illness, frequently moved by passion, existential discomfort and economic problems. During the 24-year period, the number of cases of self-incineration progressively reduced. This study provides a general overview in one of the biggest metropolitan Italian areas and is one of the few works performed on this topic. It may be helpful in understanding and studying such an unusual manner of suicide.

Impact of acute alcohol consumption on lethality of suicide methods

BackgroundThe influence of acute alcohol consumption on the factors related to suicide remains understudied. Thus, the present study investigated the relationship between blood alcohol content (BAC) and the lethality of suicide methods. MethodsAutopsy data on 315 South Korean suicide completers with a positive BAC were collected from a nationwide pool between May 2015 and November 2015, and the methods were dichotomised as suicide methods of low lethality (SMLL; drug/chemical overdose and sharp objects, n=67) and suicide methods of high lethality (SMHL; everything else, n=243). BAC at the time of autopsy and various suicide-related factors of these two groups were compared with logistic regression analyses. ResultsCompared to suicide completers with a BAC in the lowest range of 0.011–0.049%, suicide completers with a BAC in the range of 0.150–0.199% were more likely to use SMHL (odds ratio [OR]: 3.644, 95% confidence interval [CI]: 1.221–10.874). Additionally, the adoption of SMHL was significantly associated with the absence of a psychiatric illness (OR: 0.433, 95% CI: 0.222–0.843) and a younger age; the OR for high BAC among subjects in their 40s was 0.266 (95% CI: 0.083–0.856); in their 50s, 0.183 (95% CI: 0.055–0.615); and in their 60s, 0.057 (95% CI: 0.015–0.216). ConclusionsThe relationship between BAC and suicide method lethality was represented by a bell-shaped pattern in which suicide methods of high lethality were more likely to be used by suicide completers with mid-range BAC levels. The increased impulsivity and impairments in particular executive functions, including planning and organization, associated with acute alcohol use may influence the selection of a particular suicide method based on its lethality.

Changes in age patterns of suicide in Australia, the United States, Japan and Hong Kong

The patterns of association between age and suicide rate vary by country, subpopulation and gender, and over time. To shed light on factors associated with these differences, we analysed suicide data from four populations, two ‘Western’ (Australia, the United States [US]) and two Asian (Japan and Hong Kong). We computed suicide rates in five-year age-groups (between 10 and 14 years and 85+ years) for men and women separately, and present graphical representations of the age patterns during selected five-year periods. Rates and age patterns differed markedly, as did gender patterns except in Hong Kong. In 1964-8, male suicide rates in Australia and US were represented by upward-sloping graphs, whereas in Japan the pattern was bimodal. By 1979-83, male patterns in Australia and US were bimodal, but Japan's was trimodal, including a middle-age peak reached in 1994-98. In contrast, female age patterns in the Western countries were shallowly convex or uniform, while in Hong Kong and Japan the upward-sloping graphs became, over time, less steep; by 2009-13, the pattern in Japan was uniform (flat). In recent decades, suicide rates of older men in Australia, US and Japan, and older women in Japan and Hong Kong, have fallen considerably. Suicide rates of men aged 45–64 in Australia and US also fell, though by 2009-13 the US rate had risen again. The suicide rate of Australian men in their twenties halved between 1994-98 and 2009-13, while rates for younger men and women in Japan have risen since 1994-98. In Hong Kong, suicide rates of young men have increased. Age patterns of suicide likely reflect period and cohort effects shaped by socioeconomic stressors, availability of health and welfare services, access to lethal methods of suicide, and other factors. Greater understanding of their impact on age patterns of suicide can result in potential preventive solutions.

Identifying and Tracking Gas Suicides in the U.S. Using the National Violent Death Reporting System, 2005-2012.

Identifying the source and specific type of gas used in suicides is difficult using most data systems owing to limitations in ICD-10 coding. The National Violent Death Reporting System (NVDRS), with its rich collection of both coded and free-text variables, has the potential to overcome these limitations. This study used a multipronged approach to identify gas-specific suicides in NVDRS and to track the incidence of these suicides over time. Using suicide cases from the 16 NVDRS states that participated throughout 2005-2012, free-text and code searches were conducted for four types of variables-incident narratives, coroner/medical examiner cause-of-death statements, cause-of-death codes, and substance names-to identify suicides by carbon monoxide, helium, hydrogen sulfide, and four other gases. All analyses were conducted in 2015. Approximately 4% (3,242 of 80,715) of suicides recorded in NVDRS over the study period were the result of gas inhalation. Of these, the majority (73%) were carbon monoxide suicides (almost exclusively from motor vehicle exhaust and charcoal burning). Other types of gas (most notably helium), once rare, are now more common: At the start of the study period non-carbon monoxide gas suicides represented 15% of all gas suicides; at the end of the study period, they represented 40%. Public health policies to reduce a suicidal person's access to more lethal suicide methods require a reliable source of surveillance data on specific methods used in suicide. Small changes to NVDRS could make it an efficient and nimble surveillance system for tracking these deaths.

Recent Advances in Means Safety as a Suicide Prevention Strategy.

Despite advances in theory and the development and implementation of evidence-based treatments, the United States suicide rate has been rising continuously for over a decade. Although this does not indicate that traditional treatment approaches should be abandoned, it does highlight the need to supplement such approaches with alternatives. One seemingly highly valuable option is means safety, defined as the reduced access to and/or increased safe storage of potentially lethal methods for suicide. This paper provides a review of the current literature on the prevalence of six methods for suicide and preventative efforts aimed to reduce suicide rates. The majority of means safety interventions seem promising given that these methods are common and highly lethal. However, cultural and practical barriers will need to be taken into consideration when implementing these plans. Overall, means safety efforts and preventative measures seem to be promising ways to reduce the national suicide rate if implemented.

From impulse to action among military personnel hospitalized for suicide risk: alcohol consumption and the reported transition from suicidal thought to behavior.

Alcohol use is associated with unplanned or impulsive suicide attempts. Although unplanned suicide attempts assume a rapid transition for suicidal impulse to action, many studies do not quantify the time elapsed from suicidal impulse to action. The current study was designed to clarify how alcohol use facilitates the transition from suicidal impulse to action among U.S. Army personnel. We hypothesized that alcohol consumption during the 24 h preceding a suicide attempt would be associated with significantly faster transition from suicidal impulse to action but would be unrelated to medical lethality. A total of 119 active duty U.S. Army Soldiers who made a total of 175 suicide attempts during military service, 121 of which occurred during the preceding year, completed clinician-administered structured interviews focused on psychiatric diagnosis and the contextual characteristics of their suicide attempts. Alcohol use during the 24 h prior to a suicide attempt was associated with significantly faster transition from suicidal impulse to action. Among suicide attempts in the past year, lethality significantly increased as the length of time since the last alcoholic drink increased. Drug use during the 24 h prior to a suicide attempt was unrelated to speed of transition or attempt lethality. Soldiers acted upon their suicidal impulses more quickly when they had been drinking on the day of their suicide attempts. This rapid transition may contribute to the selection of less lethal suicide methods during periods of active drinking as compared to methods selected after the discontinuation of alcohol consumption.

Trends in Suicide Methods and Rates among Older Adults in South Korea: A Comparison with Japan.

ObjectiveLethality of the chosen method during a suicide attempt is a strong risk factor for completion of suicide. We examined whether annual changes in the pattern of suicide methods is related to annual changes in suicide rates among older adults in South Korea and Japan.MethodsWe analyzed annual the World Health Organization data on rates and methods of suicide from 2000 to 2011 in South Korea and Japan.ResultsFor Korean older adults, there was a significant positive correlation between suicide rate and the rate of hanging or the rate of jumping, and a significant negative correlation between suicide rate and the rate of poisoning. Among older adults in Japan, annual changes in the suicide rate and the pattern of suicide methods were less conspicuous, and no correlation was found between them.ConclusionThe results of the present study suggest that the increasing use of lethal suicide methods has contributed to the rise in suicide rates among older adults in South Korea. Targeted efforts to reduce the social acceptability and accessibility of lethal suicide methods might lead to lower suicide rate among older adults in South Korea.

Suicide by gassing in Hong Kong 2005–2013: Emerging trends and characteristics of suicide by helium inhalation

BackgroundIncreased use of lethal suicide methods can have a profound impact on overall suicide incidence; the epidemic of suicide by barbecue charcoal gas poisoning in some East Asian countries is a recent example. There have been concerns about recent rises in suicide using gases in some Western countries. MethodsWe investigated suicide by gassing in Hong Kong (2005–2013) using Coroner’s files data. The characteristics were compared between suicide by helium inhalation, charcoal gas poisoning, and other methods. ResultsAbout one sixth (1407/8445, 16.7%) of all suicides used gases. Charcoal-burning suicides constituted the majority (97.5%) of them but showed a reduction over the 9-year period (−33%). Helium suicide was not recorded in 2005–2010 but increased from one in 2011 to three in 2012 and 11 in 2013, accounting for 1.2% of all suicides in 2013. Similar to the profile of charcoal-burning suicides, helium suicides were younger and more likely to have debt problem and less likely to receive psychiatric treatment than other suicides. Internet involvement related to the method was found in one third of cases of helium suicide. LimitationsThe small number of helium suicides (n=15) limits the power to examine their characteristics. ConclusionSuicide by charcoal burning showed a downward trend whilst there was an alarming increase in helium suicide in Hong Kong. Public health measures to prevent an epidemic of helium suicide similar to that of charcoal-burning suicide may include close monitoring of trend, responsible media reporting, and restricting online information about and access to this method.

Impact of paraquat regulation on suicide in South Korea.

Ingestion of pesticides (mainly paraquat) accounted for one-fifth of suicides in South Korea in 2006-10. We investigated the effect on suicide mortality of regulatory action, culminating in a ban on paraquat in South Korea in 2011-12. We calculated age-standardized method-specific suicide mortality rates among people aged ≥15 in South Korea (1983-2013) using registered death data. Negative binomial regression was used to estimate changes in the rate and number of pesticide suicides in 2013, compared with those expected based on previous trends (2003-11). Pesticide suicide mortality halved from 5.26 to 2.67 per 100 000 population between 2011 and 2013. Compared with the number expected based on previous trends, the regulations were followed by an estimated 847 [95% confidence interval (CI) -1180 to -533] fewer pesticide suicides, a 37% reduction in rates (rate ratio = 0.63, 95% CI 0.55 to 0.73) in 2013. The decline in pesticide suicides after the regulations was seen in all age/sex/geographical groups. The absolute reduction in the number of suicides was greatest among men, the elderly and in rural areas. The reduction in pesticide suicides contributed to 56% of the decline in overall suicides that occurred between 2011 and 2013. There was no impact of the regulations on crop yield. The regulation of paraquat in South Korea in 2011-12 was associated with a reduction in pesticide suicide. Further legislative interventions to prevent the easy availability of highly lethal suicide methods are recommended for reducing the number of suicides worldwide.

Assessing the Efficacy of Restricting Access to Barbecue Charcoal for Suicide Prevention in Taiwan: A Community-Based Intervention Trial.

ObjectiveCharcoal-burning suicide has recently been spreading to many Asian countries. There have also been several cases involving this new method of suicide in Western countries. Restricting access to suicide means is one of the few suicide-prevention measures that have been supported by empirical evidence. The current study aims to assess the effectiveness of a community intervention program that restricts access to charcoal to prevent suicide in Taiwan.Methods and FindingsA quasi-experimental design is used to compare method-specific (charcoal-burning suicide, non-charcoal-burning suicide) and overall suicide rates in New Taipei City (the intervention site, with a population of 3.9 million) with two other cities (Taipei City and Kaohsiung City, the control sites, each with 2.7 million residents) before (Jan 1st 2009- April 30th 2012) and after (May 1st 2012-Dec. 31st 2013) the initiation of a charcoal-restriction program on May 1st 2012. The program mandates the removal of barbecue charcoal from open shelves to locked storage in major retail stores in New Taipei City. No such restriction measure was implemented in the two control sites. Generalized linear regression models incorporating secular trends were used to compare the changes in method-specific and overall suicide rates before and after the initiation of the restriction measure. A simulation approach was used to estimate the number of lives saved by the intervention. Compared with the pre-intervention period, the estimated rate reduction of charcoal-burning suicide in New Taipei City was 37% (95% CI: 17%, 50%) after the intervention. Taking secular trends into account, the reduction was 30% (95% CI: 14%, 44%). No compensatory rise in non-charcoal-burning suicide was observed in New Taipei City. No significant reduction in charcoal-burning suicide was observed in the other two control sites. The simulation approach estimated that 91 (95%CI [55, 128]) lives in New Taipei City were saved during the 20 months of the intervention.ConclusionOur results demonstrate that the charcoal-restriction program reduced method-specific and overall suicides. This study provides strong empirical evidence that restricting the accessibility of common lethal methods of suicide can effectively reduce suicide rates.

What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries.

BackgroundIn Europe, men have lower rates of attempted suicide compared to women and at the same time a higher rate of completed suicides, indicating major gender differences in lethality of suicidal behaviour. The aim of this study was to analyse the extent to which these gender differences in lethality can be explained by factors such as choice of more lethal methods or lethality differences within the same suicide method or age. In addition, we explored gender differences in the intentionality of suicide attempts.Methods and Findings Methods. Design: Epidemiological study using a combination of self-report and official data. Setting: Mental health care services in four European countries: Germany, Hungary, Ireland, and Portugal. Data basis: Completed suicides derived from official statistics for each country (767 acts, 74.4% male) and assessed suicide attempts excluding habitual intentional self-harm (8,175 acts, 43.2% male). Main Outcome Measures and Data Analysis. We collected data on suicidal acts in eight regions of four European countries participating in the EU-funded “OSPI-Europe”-project (www.ospi-europe.com). We calculated method-specific lethality using the number of completed suicides per method * 100 / (number of completed suicides per method + number of attempted suicides per method). We tested gender differences in the distribution of suicidal acts for significance by using the χ2-test for two-by-two tables. We assessed the effect sizes with phi coefficients (φ). We identified predictors of lethality with a binary logistic regression analysis. Poisson regression analysis examined the contribution of choice of methods and method-specific lethality to gender differences in the lethality of suicidal acts.Findings Main ResultsSuicidal acts (fatal and non-fatal) were 3.4 times more lethal in men than in women (lethality 13.91% (regarding 4106 suicidal acts) versus 4.05% (regarding 4836 suicidal acts)), the difference being significant for the methods hanging, jumping, moving objects, sharp objects and poisoning by substances other than drugs. Median age at time of suicidal behaviour (35–44 years) did not differ between males and females. The overall gender difference in lethality of suicidal behaviour was explained by males choosing more lethal suicide methods (odds ratio (OR) = 2.03; 95% CI = 1.65 to 2.50; p < 0.000001) and additionally, but to a lesser degree, by a higher lethality of suicidal acts for males even within the same method (OR = 1.64; 95% CI = 1.32 to 2.02; p = 0.000005). Results of a regression analysis revealed neither age nor country differences were significant predictors for gender differences in the lethality of suicidal acts. The proportion of serious suicide attempts among all non-fatal suicidal acts with known intentionality (NFSAi) was significantly higher in men (57.1%; 1,207 of 2,115 NFSAi) than in women (48.6%; 1,508 of 3,100 NFSAi) (χ2 = 35.74; p < 0.000001).Main limitations of the studyDue to restrictive data security regulations to ensure anonymity in Ireland, specific ages could not be provided because of the relatively low absolute numbers of suicide in the Irish intervention and control region. Therefore, analyses of the interaction between gender and age could only be conducted for three of the four countries. Attempted suicides were assessed for patients presenting to emergency departments or treated in hospitals. An unknown rate of attempted suicides remained undetected. This may have caused an overestimation of the lethality of certain methods. Moreover, the detection of attempted suicides and the registration of completed suicides might have differed across the four countries. Some suicides might be hidden and misclassified as undetermined deaths.ConclusionsMen more often used highly lethal methods in suicidal behaviour, but there was also a higher method-specific lethality which together explained the large gender differences in the lethality of suicidal acts. Gender differences in the lethality of suicidal acts were fairly consistent across all four European countries examined. Males and females did not differ in age at time of suicidal behaviour. Suicide attempts by males were rated as being more serious independent of the method used, with the exceptions of attempted hanging, suggesting gender differences in intentionality associated with suicidal behaviour. These findings contribute to understanding of the spectrum of reasons for gender differences in the lethality of suicidal behaviour and should inform the development of gender specific strategies for suicide prevention.

The Effective Factors on Survival in Near-Hanging

Aim: Neck hanging is one of the most lethal suicide methods. The morbidity and mortality due to hanging is usually associated with neck's structure injury attached to a fall from height, venous obstruction and cerebral hypoxia time. Mortality is usually caused by respiratory failure in patients who recovered from hanging. In this study, we aimed to investigate effective factors on mortality in cases of neck hanging. Materials and Methods: Socio-demographic data of 43 out of 2006-2013 patients brought to our hospital because of neck hanging were analyzed retrospectively. The first arrival time of clinical signs of the patient, laboratory findings and complications due to hanging were recorded. The effects of these findings on mortality are examined. Results: 35% of the 43 patients were included in the study were female gender. The mean age of the patients was 21.4±6.8 minutes. The estimated time was found to be 25±12 (minimum-maximum 3-60) minutes. 26 patients (68.4%) were lost their life. The Glasgow coma score of the majority of patients who died was less than 7. Among the most common complications associated with hanging, laryngeal edema(60%) was observed. Among the most common complications during the intensive care, pulmonary infection (18.5%) was developed. Conclusion: The most important factor in terms of effectiveness over mortality for hanging were observed to be time increment of hanging and low Glasgow coma score. We recommended that the cases of near hanging should be aggressively resuscitated and treated regardless of their bad initial findings.

Comparison of Trends in Suicide Methods and Rates Among Older Adults in South Korea and United States

Lethality of the chosen method during a suicide attempt is a strong risk factor for completion of suicide. We examined whether annual changes in the pattern of suicide methods is related to annual changes in suicide rates among older adults in South Korea and the United States. We analyzed annual the World Health Organization data on rates and methods of suicide from 2000 to 2011 in South Korea, and from 2000 to 2010 in the United States. We found that. for both Korean male and female older adults, there was a significant positive correlation between suicide rate and the rate of hanging, and a significant negative correlation between suicide rate and the rate of poisoning. Among older adults in the U.S., annual changes in the suicide rate and the pattern of suicide methods were less conspicuous, and no correlation was found between them. The results of the present study suggest that the increasing use of lethal suicide methods has contributed to the rise in suicide rates among older adults in South Korea. Targeted efforts to reduce the social acceptability and accessibility of lethal suicide methods might lead to lower suicide rate among older adults in South Korea.

The rate of fatality and demographic characteristics associated with various suicide methods: a community-based study in Northern Taiwan.

Understanding lethality and risk factors of suicide methods is an initial step in suicide prevention. To investigate the fatality rate and demographic characteristics of various suicide methods. This study enrolled consecutive individuals with episodes of suicide attempts registered in a surveillance database in a city with a high rate of suicide mortality in Taiwan, from January 1, 2006, to December 31, 2010. In total, 3,089 suicide attempt events (including 2,583 nonfatal suicides and 506 completed suicides) occurred during the study period. Overall, the fatality rate of suicides was 16.4%. Charcoal burning accounted for the most suicide deaths (37.6%), with a fatality rate of 50.1%. Suicide by hanging carried the highest fatality rate (81.2%). Males tended to choose more lethal methods and had higher fatality rates compared with females. Elders and married persons were less likely to attempt suicide by charcoal burning. The case fatality ratio increased along with age among suicide attempts, but not in those using charcoal burning. The choice of suicide methods and lethality might be influenced by one's demographic characteristics. RESULTS from this study may provide clues for establishing suicide prevention strategies such as restricting access to common lethal suicide methods in the high-risk group.

Associations between changes in the pattern of suicide methods and rates in Korea, the US, and Finland

BackgroundThe lethality of the suicide method employed is a strong risk factor for the completion of suicide. We examined whether annual changes in the pattern of suicide methods is related to annual changes in suicide rates in South Korea, the United States (US), and Finland.MethodsWe analyzed annual data from 2000–2011 for South Korea and Finland, and 2000–2010 for the US in order to examine trends in the rates and methods of suicide. Data on suicide methods were obtained from the World Health Organization (WHO) mortality database.ResultsAlong with an annual rapid increase in suicide rates, the incidence of hanging increased steadily while suicide by self-poisoning steadily decreased in South Korea. In the US, along with an annual increase in suicide rates, the proportion of suicides committed by hanging increased while those committed with the use of firearms steadily decreased. In Finland, annual changes in the suicide rate and suicide method were not statistically significant during the study period.ConclusionsOur present findings suggest that the increased use of specific lethal methods for suicide, namely hanging, is reflected in the increased suicide rates in the Korean and the US populations. The most effective approach for reducing overall suicide rates may be the implementation of population-based initiatives that reduce both the accessibility (e.g., access to firearms) and the social acceptability (e.g., effective and responsible regulations for reporting suicide) of lethal methods of suicide.

Psychosocial and medical aspects of older suicide completers in Israel: a 10-year survey.

The rate of completed suicide among the elderly continues to be the highest of any age group worldwide. The aim of the present study was to investigate the sociodemographic data, mental and physical health characteristics, and suicide methods of the elderly population who completed suicide in Israel. A national retrospective record-based case series study of consecutive elder (50 years or older) suicide completers who had undergone autopsy over a 10-year period was conducted. Three hundred and fourteen consecutive records of suicide completers, 69.6% males, and mean age 64.7 were analyzed. The largest group (38%) emigrated from the Former Soviet Union and 19% emigrated from East Europe. Immigrants from East Europe committed suicide at an older age. Hanging was the predominant suicide method. Jumping from height increased more than threefold in the ‘old-old’(older than 75 years) group. Hanging and firearms were more frequently used by males. Females were more likely to employ poisoning and suffocation. A significant minority (30%) had been diagnosed as suffering from psychiatric morbidity. Most common diagnoses were depression and alcohol abuse or dependence. Physical disorders (mainly cardiovascular disease and malignancy) were present in 27% of cases. Subjects with psychiatric illness were more likely to complete suicide at a younger age compared with subjects with physical illness. Findings of male predominance, psychiatric morbidity, and physical illness are consistent with previously published studies. Immigrants from East Europe completed suicide at an older age and the older victims had used more lethal methods of suicide.

Increased use of lethal methods and annual increase of suicide rates in Korean adolescents: comparison with adolescents in the United States

The lethality of the suicide method is a strong risk factor for completed suicide. We examined whether the annual change in the pattern of suicide methods was related to the annual change in suicide rates among adolescents in South Korea and the United States. We analyzed annual data for the 2000-2009 period for South Korea and the 2000-2008 period for the United States to examine time trends in the suicide rates and suicide methods of adolescents aged 10-19years in two countries. Data on suicide methods were obtained from the World Health Organization (WHO) mortality database. Suicide rates among adolescents in the United States have remained relatively steady since 2000, whereas the suicide among Korean adolescents has increased. Between 2000 and 2009, the most common suicide method among Korean adolescents was jumping for boys and girls, whereas it was hanging for girls and firearms for boys in the United States. Along with the annual increase in suicide rates in South Korea, the incidences of jumping among males and hanging (and recently jumping) among females have increased steadily, whereas suicide by self-poisoning steadily decreased. In the United States, between 2000 and 2008, the proportion of suicides committed by hanging increased, whereas those committed using firearms steadily decreased, particularly among adolescent females. These findings suggest that the increased use of lethal suicide methods is reflected in the increase in suicide rates in Korean adolescents. The most fruitful approach to addressing the rises in jumping suicides among Korean adolescents and hanging suicides among adolescents in the United States may be through population-based initiatives to reduce the physical availability (e.g., limiting access to or fencing off tall structures) and the social acceptability (e.g., effective and responsible regulations for reporting suicide) of these methods.