Lower Suicide Rates Research Articles

Addressing the commercial determinants of mental health: an umbrella review of population-level interventions.

There is increasing evidence that commercial determinants impact mental health. Addressing the commercial determinants may therefore be a way of improving population-level mental health. This umbrella review aimed to provide an overview of evidence in this field and identify knowledge gaps. Five databases (MEDLINE, Embase, PsycINFO, Scopus and Cochrane Library) were searched on the 18/19 of July 2022. Eligible papers were systematic reviews published after 31 December 2011. No geographical limits were applied. Eligible interventions were those that targeted the behaviours or products of commercial actors. Ineligible interventions included individual behaviour change interventions, such as those seeking to educate consumers. Included mental health outcomes were anxiety, depression, self-harm and suicide, whilst surrogate outcomes included product consumption. Industry involvement and the quality of included reviews (critical components of A MeaSurementTool toAssess systematicReviews -AMSTAR 2) were assessed. A narrative synthesis was used to compare the findings by industry, and a typology of interventions was developed. Eight reviews with mental health outcomes were included, each with multiple methodological weaknesses. There is some evidence that reducing the availability of alcohol or pesticides may lower suicide rates. Despite the known links, no evidence on the mental health impacts of population-level interventions tackling the social media, tobacco, gambling and ultra-processed foods industries were located. All gambling reviews were identified as having links to industry. Future high-quality evaluations of commercial determinants interventions developed specifically with the aim of achieving positive mental health outcomes and/or that evaluate mental health outcomes and are free from industry links are needed. PROSPERO ref. number CRD42022346002.

The Hidden Toll: Investigating the influence of Corruption on Persistent Suicide in the Americas

Background Corruption, a multifaceted governance issue, impacts public well-being globally. The recent trends reveal a rise in suicide rates across the Americas, while all other regions show declines over twenty years of time. This study investigates corruption’s effect on suicide in 26 American countries, considering moderating factors of unemployment, inflation, and economic growth. Methods This study analysed latest two decades of available data, using stepwise panel regression method to investigate the effects of corruption and economic variables on suicide across income levels. Data were sourced from Transparency International, World Bank and the World Health Organization. Initially, unit root tests and CUSUM plots were used to ensure the stability and stationarity of the dataset, and model specification were validated through F test, LM test and Hausman test to select the ideal econometric model - POLS, REM, or FEM for the study. Results A strong suicide rate persistence revealed, particularly in high-income countries, where the lagged suicide variable showed a coefficient of 0.8063 (p < 0.001). Corruption significantly impacted suicide rates in upper-middle-income countries (coefficient = -0.0268, p < 0.05), with higher corruption perceptions scores correlating with lower suicide rates. Additionally, unemployment acted as a significant moderator, intensifying the corruption’s adverse impact on suicide with a coefficient of 0.0022 (p < 0.001) in upper-middle income nations. Economic growth demonstrated a minor protective effect, particularly in high-income regions, with an interaction coefficient of -0.0005 (p < 0.1), suggesting slight suicide reduction linked to economic stability. Conclusion This study found that corruption, unemployment, and economic growth significantly influence suicide rates across the Americas. Corruption exacerbates suicide risks in upper-middle-income countries, while unemployment amplifies this effect. Economic growth offers a slight protective effect, particularly in high-income regions, suggesting that economic stability may help mitigate suicide rates.

Trace Lithium for Suicide Prevention and Dementia Prevention: A Qualitative Review.

Background: Anti-manic effects of lithium and the nature of trace element in lithium were first observed in 1949. In this review, we explore the potential effects of trace lithium in the prevention of suicide and dementia. Methods: This is a qualitative and non-systematic review. Results: While most studies to date have been cross-sectional, limiting the establishment of causal relationships, the potential benefits of trace lithium for suicide prevention and dementia prevention are notable, especially in the absence of radical treatments for suicide and dementia. Furthermore, trace lithium appears to lack many of the adverse effects associated with so-called therapeutic lithium levels. Conclusions: The present findings suggest that trace lithium may be associated with lower suicide rates and reduced dementia rates. Probably, trace lithium may inhibit testosterone and thereby mitigate aggression and impulsivity and decrease suicide. Also, trace lithium may inhibit GSK-3β and thereby lower amyloid β and tau hyperphosphorylation and inhibit pro-inflammatory cytokines such as IL 6 and IL 8 and thereby mitigate inflammation, whereas trace lithium may promote BDNF and neurogenesis in the general population.

Can large language models be sensitive to culture suicide risk assessment?

Suicide remains a pressing global public health issue. Previous studies have shown the promise of Generative Intelligent (GenAI) Large Language Models (LLMs) in assessing suicide risk in relation to professionals. But the considerations and risk factors that the models use to assess the risk remain as a black box. This study investigates if ChatGPT-3.5 and ChatGPT-4 integrate cultural factors in assessing suicide risks (probability of suicidal ideation, potential for suicide attempt, likelihood of severe suicide attempt, and risk of mortality from a suicidal act) by vignette methodology. The vignettes examined were of individuals from Greece and South Korea, representing countries with low and high suicide rates, respectively. The contribution of this research is to examine risk assessment from an international perspective, as large language models are expected to provide culturally-tailored responses. However, there is a concern regarding cultural biases and racism, making this study crucial. In the evaluation conducted via ChatGPT-4, only the risks associated with a severe suicide attempt and potential mortality from a suicidal act were rated higher for the South Korean characters than for their Greek counterparts. Furthermore, only within the ChatGPT-4 framework was male gender identified as a significant risk factor, leading to a heightened risk evaluation across all variables. ChatGPT models exhibit significant sensitivity to cultural nuances. ChatGPT-4, in particular, offers increased sensitivity and reduced bias, highlighting the importance of gender differences in suicide risk assessment. The findings suggest that, while ChatGPT-4 demonstrates an improved ability to account for cultural and gender-related factors in suicide risk assessment, there remain areas for enhancement, particularly in ensuring comprehensive and unbiased risk evaluations across diverse populations. These results underscore the potential of GenAI models to aid culturally sensitive mental health assessments, yet they also emphasize the need for ongoing refinement to mitigate inherent biases and enhance their clinical utility.

Correlation between lithium concentrations in drinking water and suicide attempt in the southeast of Iran.

Suicide, as an avoidable cause of death in public health systems, currently lacks effective global strategies to prevent it. However, several epidemiological studies found a correlation between the concentration of lithium (Li) in drinking water and lower suicide rates in the general population. Our ecologicalstudy investigated this hypothesis in the Rafsanjan districtof Iran. Samples from the public water supply in 16 areas in the district were analyzed using the graphite furnace atomic absorption. The resulting data were examined in relation to the suicide attempt from March 2019 to March 2020 obtained from Iran's Ministry of Health's registration system. During that period, 239 suicide attempts were recorded, resulting in an average of 69 individuals (85 women and 54 men) per 100,000 residents of the area. The average Li concentration in the drinking water was 47.30 µg/L (ranging from 9.4 to 141 µg/L). A negative significantcorrelation (r = -0.551, p = 0.027) between Li concentration in water and the rate of suicide attempt were observed in the studied population. Notably, these findings indicate an inverse significantrelationship between Li levels and suicide attempt rate in women (r = -0.725, p = 0.001). This is the first study in Iran that examines the relationship between Li levels in drinking water and suicide attempt rate. The findings of this study support an inverse relationship between the level of Li in public drinking water and the rate of womensuicide attempt.

Suicide among post-Arabellion refugees in Germany.

Although immigrants are considered to be vulnerable to mental illness, there is limited knowledge regarding their suicide mortality. To investigate standardised mortality ratios (SMR) for suicide among the largest immigrant populations in Germany before and after the refugee movement of 2015. Data on immigrants and the general population in Germany between 2000 and 2020 were provided by the scientific section of the Federal Statistical Office. SMR with 95% confidence intervals were calculated by indirect standardisation for gender, age and calendar year for the pre-2015 and post-2015 time interval, first for all the immigrant populations studied and second for the Syrian, Afghan and Iraqi populations separately. Immigrants from the countries studied showed a lower suicide risk compared with the German reference population (SMR = 0.38, 95% CI = 0.35-0.41). No differences in SMR were found between pre- and post-2015 time intervals, in either the aggregate data for all populations or the data for Syrian, Afghan and Iraqi populations. Post-2015, Afghan immigrants (SMR = 0.68, 95% CI = 0.54-0.83) showed a higher SMR than Syrians (SMR = 0.30, 95% CI = 0.25-0.36) or Iraqis (SMR = 0.37, 95% CI = 0.26-0.48). Despite the many and varied stresses associated with flight, comparison of the pre- and post-2015 time intervals showed that the suicide risk of the populations studied did not change and was considerably lower than that of the German reference population. We attribute this to lower suicide rates in the countries of origin but also to flight-related selection processes that favour more resilient individuals.

Suicide variations between English neighbourhoods over 2017-21: The role of spatial scale

Geographic studies of suicide variation typically focus on predictors at the same level as the event rates, and the possible interplay between different spatial scales does not generally figure. In this paper we focus on suicide variations between 6856 small area census units in England, but against a background provided by nine regions, broad urban-rural categories, and 155 local labour markets. Suicide death totals vary considerably between the small areas, with more areas than expected having no deaths, so we apply zero inflated regression. With this framework, we consider the relative contribution of factors at higher and lower spatial scales in explaining small area suicide contrasts, and why some areas have unduly elevated or unduly low suicide rates. We find significantly lower suicide levels in English metropolitan regions, after allowing for neighbourhood influences, but considerable heterogeneity in risks within broader spatial units. Varying incidence in general is associated significantly with all observed neighbourhood risk factors (social fragmentation, socioeconomic status, mental ill-health, ethnic mix), but low fragmentation and low psychiatric morbidity are the only significant influences on unduly low incidence.

Civil Society Participation and Suicide Rates: A Cross-National Analysis

Previous valuable research has examined the effect individual-level social and psychological factors have on suicidality. However, scholarship has yet to investigate the role civil society participation plays in suicide rates cross-nationally. Thus, this study examines the effect civil society participation has on suicide rates in 156 countries from varying levels of development from 2000 – 2019 from Africa, Asia, Europe, Latin America, the Middle East, and North America. When including standard controls and controlling for potential endogeneity, the findings indicate that civil society participation, both political and non-political, has a negative and statistically significant effect on suicide rates. The results suggest that both political and non-political forms of civil society participation may produce positive social and psychological benefits that are associated with lower suicide rates.

Firearm Purchaser Licensing Laws and Firearm Deaths Among Adolescents and Emerging Adults

Research on firearm purchaser licensing laws has found population level reductions in firearm-related mortality. Limited research has been conducted specifically examining the impact of these laws among adolescents and emerging adults. We obtained death data from the National Center for Health Statistics from 1990 to 2019. We generated state-year rates of homicide and suicide, stratified by firearm involvement, for decedents aged 15 to 24. We stratified by race and ethnicity (white, Black, and Hispanic) to assess for differential policy effects. We used stacked difference-in-difference and augmented synthetic control modeling to estimate law repeal or adoption. Repeal of firearm purchaser licensing laws was associated with significantly higher rates of firearm homicide and suicide among those age 15 to 24. The adoption of these laws was associated with significantly lower rates of firearm homicide and suicide among this group. These laws are a promising supply-side intervention to reduce firearm mortality among those with elevated violence vulnerability.

Ethnicity and suicide in England and Wales: a national linked cohort study

Understanding of ethnic disparities in suicide in England and Wales is poor as ethnicity is not recorded on death certificates. Using linked data, we examined variations, by sex, in suicide rates in England and Wales by ethnicity and migrant and descendant status. Using the Office for National Statistics 2012-19 mortality data linked to the 2011 census from the Public Health Research Database, we calculated the age-standardised suicide rates by sex for each of the 18 self-identified ethnicity groups in England and Wales. We present rates by age, sex, and methods used for suicide by ethnic group. We estimated age-adjusted and sex-adjusted incidence rate ratios (IRRs) using Poisson regression models for each minority ethnic group compared with the majority population. We involved people with lived experience in the research. Overall, 31 644 suicide deaths occurred over the study period, including 3602 (11%) in people from minority ethnic backgrounds, with a mean age of death of 43·3 years (SD 17·0, range 13-96). Almost all minority ethnic groups had a lower rate of suicide than the White British majority, apart from individuals who identified as being from a Mixed heritage background or White Gypsy or Irish Travellers. In females who identified as Mixed White and Caribbean, the suicide IRR was 1·79 (95% CI 1·45-2·21) compared with the White British majority; in those who identified as White Gypsy or Irish Travellers, the IRR was 2·26 (1·42-3·58). Rates in males identifying as from these two groups and those identifying as White Irish were similar to the White British majority. Compared with the non-migrant population, migrants had a lower rate of suicide regardless of ethnicity, but in the descendant population, people from a Mixed ethnicity background had a higher risk of suicide than the White British majority. There are ethnic disparities in suicide mortality in England and Wales, but the reasons for this are unclear. The higher rate in previously overlooked minority ethnic groups warrants further attention. Wellcome Trust.

Lithium in Drinking Water and its Potential Impact on Mental Health: A Review.

This review explores the relationship between lithium in drinking water and mental health, a subject that has garnered increasing attention in investigations. Lithium, a metal with a well-established role in psychiatric medications, is found in trace amounts in drinking water, and studies suggest its potential correlations with lower rates of suicide and certain psychiatric disorders. However, these correlations do not imply causation, necessitating an examination of the underlying mechanisms. Lithium concentrations in drinking water vary globally, presenting challenges in establishing a universal threshold for "high" or "low" levels. Additionally, the optimal dosage for potential mental health benefits remains uncertain. Lithium is not considered an essential nutrient, and supplementation should be approached with caution due to possible toxicity risks, emphasizing the importance of medical supervision. The lack of causation and ongoing need for further investigation underscores the importance of cautious interpretation and transparent communication in navigating this evolving field.

Faith, policy, and suicide: A Machine learning and spatial analysis approach of religious affiliation and suicide rates in Toronto

This research employs spatial analysis to investigate the intricate relationship between religious affiliations and suicide rates in the Greater Golden Horseshoe region of southern Ontario, Canada. As the seventh-leading cause of death in Canada, suicide necessitates targeted prevention strategies, especially in areas with lower suicide rates such as Ontario. To explore spatial patterns of suicide attempts and intentional self-inflicted injuries, individual-level data is collected and generalized to the census tract for rigorous spatial analyses.Self-Organizing Maps are utilized to build distinct regional clusters based on shared characteristics. These clusters unveil diverse combinations of suicide counts, religious affiliations, income levels, education levels, and immigrant populations, providing comprehensive insights into the multicultural composition of the area.The study findings reveal specific spatial patterns of suicide attempts associated with particular religious affiliations, shedding new light on the influence of faith and spirituality on mental health outcomes within the context of suicide prevention. The analysis underscores the importance of a nuanced understanding of these factors to guide effective suicide prevention interventions.Considering the spatial distribution of religious affiliations and suicide rates, this study offers valuable guidance for targeted and culturally sensitive suicide prevention efforts in the Greater Golden Horseshoe region and other similar urban landscapes. The implications of this research extend to the broader mental health field and emphasize the significance of accounting for sociocultural dimensions in devising evidence-based interventions to mitigate suicide effectively.

Comparison of depression and suicide between dialysis and kidney transplant recipients in Korea: a nationwide population study.

Kidney transplantation (KT) improves physical and psychological prognoses for patients with end-stage kidney disease (ESKD). However, few comparative studies have examined depression and suicide rates among patients with ESKD treated with dialysis versus KT. Data on 21,809 patients with ESKD were extracted from the Korean National Health Insurance Service database, extending from January 2002 to December 2018. These patients exhibited no history of depression or insomnia before starting renal replacement therapy. Outcomes were compared between dialysis and KT recipients using 1:2 propensity score matching (PSM). Of the patients, 17,649 received dialysis (hemodialysis, 15,537; peritoneal dialysis, 2,112), while 4,160 underwent KT. Of those on dialysis, 45.04% (7,949) experienced insomnia, compared to 25.72% (1,070) of KT recipients (P<0.001). Depression was more frequent among dialysis recipients (22.77%, 4,019) than KT recipients (8.61%, 358; P<0.001). Additionally, those on dialysis had a higher incidence of suicide (0.19%, 33) than recipients of KT (0.12%, 5; P=0.047). After PSM, the hazard ratio (HR) for depression in patients on dialysis compared to KT recipients was 1.76 (95% confidence interval [CI], 1.56-1.99). In subgroup analysis, the relative likelihood of depression among dialysis recipients was particularly high for residents of urban areas (HR, 2.10; 95% CI, 1.80-2.44) and patients under 65 years old (HR, 1.82; 95% CI, 1.62-2.09). KT recipients exhibit a lower suicide rate than patients on dialysis. Furthermore, KT is associated with a lower prevalence of depression among Korean patients with ESKD, particularly urban residents and individuals under 65 years old.

EVALUATION OF SUICIDAL BEHAVIOR AND DEPRESSION, INSIGHT AND DISEASE CHARACTERISTICS IN SCHIZOPHRENIA

Introduction: Suicide is a severe public health issue with high rates of morbidity and mortality. Schizophrenia also has a high suicide incidence, which is one of the main factors contributing to rising morbidity and mortality. For strategies to lower suicide rates, it is essential to understand the risk factors for suicide in people with schizophrenia. By evaluating the relationship between the risk of suicidal behavior and demographic factors, disease characteristics, depression, and insight in schizophrenia patients, in the light of literature information, this study aimed at preventing suicide in schizophrenia and set an example for future studies. Method: This study included 103 schizophrenia patients who underwent follow-up for at least 4 years in a community mental health center (CMHC). The study included patients who had the mental capacity to understand and complete the questionnaires, were not experiencing an acute psychotic attack, and gave their consent to participate. The patients were given the Three Components of Insight Scale (TCIS), Scale for Evaluation of Positive Symptoms in Schizophrenia (SAPS), Scale for Evaluation of Negative Symptoms in Schizophrenia (SANS), Calgary Depression Inventory in Schizophrenia (CDIS), and Suicide Behavior Scale (SBS). Results: 47% of patients demonstrated suicidal behavior, and 69% of patients were men. 46% of the group demonstrating suicidal behavior had severe or very severe suicidal ideation. Age and disease duration were revealed to be significant risk factors for suicidal behavior (p=0.033 and p=0.004, respectively), but gender, SBS, CDIS, SANS, SAPS, and TCIS scores had no significant effect. Age and suicidal behavior risk were found to be inversely correlated, with each unit of age increase reducing the risk of suicidal behavior by 0.929 times. The risk of suicidal behavior rises along with the duration of disease. With every one unit increase in the duration of disease, the risk of suicidal behavior increases by 1.133 times. Additionally, the group with severe-very severe suicidal ideation had significantly more severe depression scores than the group with mild-moderate (p=0.01). Discussion: More than half of the patients with schizophrenia who were followed up showed suicidal behavior, and approximately half of the group who had suicidal ideation showed severe suicidal ideation. Suicidal behavior was found to be correlated with age and duration of illness. While suicidal behavior increases age decreases and duration of illness increases.There was no significant correlation between insight, depression, gender, symptom severity and suicidal behavior in this population. In addition, depression scores were found to be statistically significantly higher in the group with severe-very severe suicidal ideation. According to the research, in individuals with schizophrenia who were being monitored, the frequency of suicidal behavior increased along with the severity of depression. Conclusion: It is crucial to identify the risk factors and protective factors for suicide in schizophrenia patients in order to develop interventions for them. Because suicidal behavior is a significant morbidity and mortality factor in schizophrenia.

A scientometric analysis and visualisation of elderly suicide research from 1951 to 2022.

There are still many gaps in both national and international literature on elderly suicide. This study aimed to identify the most influential journals in elderly suicide, the countries and authors that contribute the most to the field, and the trends in the field. Studies published on elderly suicide between 1951 and 2022 were retrieved utilising the Web of Science Core Collection. Co-authorship analysis of countries and authors, as well as co-occurrence analysis of keywords, were conducted using VOSviewer 1.6.18. There were 2864 articles retrieved, including 95 countries, 889 academic journals, 9162 authors and 4160 keywords. The number of publications in this field has significantly increased after the 2000s, and the United States is the most productive country (996). The most prolific author is Yeates Conwell, while the journal with the highest number of publications in this field is the International Journal of Geriatric Psychiatry. Other than 'suicide' and 'elderly', the most trending keywords are 'depression', 'primary care', 'treatment', 'antidepressant', 'loneliness', 'quality of life' and 'COVID-19'. There has been an increase in both the thematic diversity and quantity of studies on elderly suicide over time. However, these publications predominantly originate from socioeconomically affluent countries with relatively low suicide rates. While the increasing numbers of publications from developing countries in recent years are promising, there is a greater need for publications from countries with lower socioeconomic status for the prevention or intervention of elderly suicides.

Utah Latina/o/x suicide decedents less likely to die by firearm, even in rural areas: examining population-wide data from the Utah Office of the Medical Examiner.

Suicide death remains a significantly rarer event among Latina/o/x populations compared to non-Latina/o/x populations. However, the reasons why Latina/o/x communities experience relatively lower suicide rates are not fully understood. Critical gaps exist in the examination of Latina/o/x suicide death, especially in rural settings, where suicide death by firearm is historically more common within non-Latina/o/x populations. We tested whether the prevalence of Latina/o/x firearm suicide was meaningfully different in urban and rural environments and from non-Latino/a/x decedents when controlling for age, sex, and a social deprivation metric, the Area Deprivation Index. Suicide death data used in this analysis encompasses 2,989 suicide decedents ascertained in Utah from 2016 to 2019. This included death certificate data from the Utah Office of the Medical Examiner on all Utah suicide deaths linked to information by staff at the Utah Population Database. Compared to non-Latina/o/x suicide decedents, Latina/o/x suicide decedents had 34.7% lower adjusted odds of dying by firearm. Additionally, among the firearm suicide decedents living only in rural counties, Latina/o/x decedents had 40.5% lower adjusted odds of dying by firearm compared to non-Latina/o/x suicide decedents. The likelihood of firearm suicide death in Utah differed by ethnicity, even in rural populations. Our findings may suggest underlying factors contributing to lower firearm suicide rates within Latina/o/x populations, e.g., aversion to firearms or less access to firearms, especially in rural areas, though additional research on these phenomena is needed.

Explainable artificial intelligence models for predicting risk of suicide using health administrative data in Quebec.

Suicide is a complex, multidimensional event, and a significant challenge for prevention globally. Artificial intelligence (AI) and machine learning (ML) have emerged to harness large-scale datasets to enhance risk detection. In order to trust and act upon the predictions made with ML, more intuitive user interfaces must be validated. Thus, Interpretable AI is one of the crucial directions which could allow policy and decision makers to make reasonable and data-driven decisions that can ultimately lead to better mental health services planning and suicide prevention. This research aimed to develop sex-specific ML models for predicting the population risk of suicide and to interpret the models. Data were from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), covering up to 98% of the population in the province of Quebec and containing data for over 20,000 suicides between 2002 and 2019. We employed a case-control study design. Individuals were considered cases if they were aged 15+ and had died from suicide between January 1st, 2002, and December 31st, 2019 (n = 18339). Controls were a random sample of 1% of the Quebec population aged 15+ of each year, who were alive on December 31st of each year, from 2002 to 2019 (n = 1,307,370). We included 103 features, including individual, programmatic, systemic, and community factors, measured up to five years prior to the suicide events. We trained and then validated the sex-specific predictive risk model using supervised ML algorithms, including Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGBoost) and Multilayer perceptron (MLP). We computed operating characteristics, including sensitivity, specificity, and Positive Predictive Value (PPV). We then generated receiver operating characteristic (ROC) curves to predict suicides and calibration measures. For interpretability, Shapley Additive Explanations (SHAP) was used with the global explanation to determine how much the input features contribute to the models' output and the largest absolute coefficients. The best sensitivity was 0.38 with logistic regression for males and 0.47 with MLP for females; the XGBoost Classifier with 0.25 for males and 0.19 for females had the best precision (PPV). This study demonstrated the useful potential of explainable AI models as tools for decision-making and population-level suicide prevention actions. The ML models included individual, programmatic, systemic, and community levels variables available routinely to decision makers and planners in a public managed care system. Caution shall be exercised in the interpretation of variables associated in a predictive model since they are not causal, and other designs are required to establish the value of individual treatments. The next steps are to produce an intuitive user interface for decision makers, planners and other stakeholders like clinicians or representatives of families and people with live experience of suicidal behaviors or death by suicide. For example, how variations in the quality of local area primary care programs for depression or substance use disorders or increased in regional mental health and addiction budgets would lower suicide rates.

Complex emotional needs, overcontrol and death by suicide in older adults

Globally, older people are frequently at consistently greater risk of dying by suicide than those belonging to any other age group. In countries that report low or moderate rates of suicide in older people, under recognition, under reporting, and under responsiveness may be factors that impact the statistics collected. In countries like the UK, where suicide rates in older people have fallen in line with the national average, suicide in older people occurs ambiguously, may be hidden, or not considered a deliberate act. The introduction of specialist older adult teams and legal restrictions around access to firearms, has likely had some positive impact on the reduction in suicide rate in some older people since the 1980s in the UK. However, these factors may also mean that suicide in older people occurs in individuals who do not access mental health services, or who now use methods that do not appear to be deliberate attempts to die. Psycho-social differences in suicidal older adults are outlined. Older people with complex emotional needs are at greater risk of death by suicide, if they have been given a diagnosis of ‘avoidant’ or ‘obsessive compulsive personality disorder’. It is suggested that ‘overcontrol’ is an underlying psychological need that greatly increases the risk of death by suicide in older people. Identification and treatment of overcontrol is briefly discussed.

Mental Health and Suicide Decriminalization: Connecting the Dots

Suicide is a current public health crisis as every year, more than 800,000 individuals die by suicide worldwide. According to World Health Organization (WHO) estimates, 77% of these deaths occur in low- and middle-income countries (LMICs). In context of mental illness only, the reported percentage of completed suicides varies from 60% to 98% of all suicides.2,3 Many of the remaining episodes have to do with interpersonal or financial issues, and the crises that follow. Nonetheless, prejudice, violence, and armed conflicts can be some of the other reasons.3 At the start of the twenty-first century, depression accounted for thirty percent of deaths worldwide from unnatural causes. Substance-use disorders came in second with eighteen percent, schizophrenia with fourteen percent, and personality disorders with thirteen percent.2 In June 2022, twenty nations had suicide attempts criminalized and subject to penalties.4 One prominent defense of criminalization of suicide was that it deters people from trying to die by suicide and thus may be a successful suicide prevention strategy but according to the literature, this idea is at best false and at worst deceptive. According to a recent study, there is no conclusive evidence that nations with criminalized suicide have lower suicide rates than the worldwide average.4.In fact, the suicide rates in five of the seven nations where it is illegal were higher than the global average.4 A recent ecological study of 171 countries has shown that suicide laws are linked to increased national suicide rates particularly among women in non-Muslim nations with low Human Development Index scores.5 Women may be more susceptible to suicidal thoughts due to the patriarchal culture's lack of support and the laws that criminalize suicide. This clearly shows that there is no positive benefit of criminalizing suicide while on the other hand research has shown that suicide rates are decreased by laws that restrict access to fatal suicide methods (pesticides, weapons, and so forth).6 While many countries do not prosecute people who attempt suicide rigorously ,7criminalization of suicide discourages people from seeking help, stigmatizes those who try suicide, and makes it difficult to accurately quantify suicide rates due to misclassification of the event because of law. The care process for people who attempt suicide is complicated by the criminalization of suicide attempts.8 Treatment can be considerably delayed by the criminal justice system.

Protocol for creating a dataset of U.S. state alcohol-related firearm laws 2000-2022.

Firearms are a major source of preventable morbidity and mortality in the United States, contributing to over 48,000 deaths in 2022 and generating societal costs in excess of $500 billion. A body of work has examined the relationship between US state level firearm laws and health outcomes, generally finding that some firearm regulations are associated with lower firearm-related mortality. Alcohol has been identified as an additional risk factor for both homicides and suicide and stronger state alcohol laws have been associated with lower rates of suicide. To date, there are no empirical studies that have investigated the impact of laws over a long period of time that target the intersection of alcohol and firearm. One reason for this may be because there is no existing dataset that includes the range of these state laws over time. This study describes the protocol for collecting, coding and operationalizing these legal data.