Proportion Of Suicides Research Articles

The contribution of suicide to maternal mortality: A nationwide population-based cohort study.

To identify the incidence and characteristics of maternal suicide. Nationwide population-based cohort study. The Netherlands, 2006-2020. Women who died during pregnancy or within 1 year postpartum, and a reference population of women aged 25-45 years. The Cause of Death Register and Medical Birth Register were linked to identify women who died within 1 year postpartum. Data were combined with deaths reported to the Audit Committee for Maternal Mortality and Morbidity (ACMMM), which performs confidential enquiries. Maternal suicides were compared with a previous period (1996-2005). Risk factors were obtained by combining vital statistics databases. Comparison of incidence and proportion of maternal suicides among all maternal deaths over time, sociodemographic and patient-related risk factors and underreporting of postpartum suicides. The maternal suicide rate remained stable with 68 deaths: 2.6 per 100 000 live births in 2006-2020 versus 2.5 per 100 000 in 1996-2005. The proportion of suicides among all maternal deaths increased from 18% to 28%. Most suicides occurred throughout the first year postpartum (64/68); 34 (53%) of the women who died by suicide postpartum were primiparous. Compared with mid-level, low educational level was a risk factor (odds ratio 4.2, 95% confidence interval 2.3-7.9). Of 20 women reported to the ACMMM, 11 (55%) had a psychiatric history and 13 (65%) were in psychiatric treatment at the time of death. Underreporting to ACMMM was 78%. Although the overall maternal mortality ratio declined, maternal suicides did not and are now the leading cause of maternal mortality if late deaths up to 1 year postpartum are included. Data collection and analysis of suicides must improve.

All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: a register study

BackgroundAll-cause and suicide mortalities of gender-referred adolescents compared with matched controls have not been studied, and particularly the role of psychiatric morbidity in mortality is unknown.ObjectiveTo examine all-cause and suicide...

Fatal concentrations of antidepressant and antipsychotic drugs in post-mortem femoral blood.

Antidepressants and antipsychotics are both an important class of prescription drugs within post-mortem (PM) toxicology because most of the substances are toxic in overdose and the mental disorders being treated may be associated with suicidality. A wide range of antidepressants and antipsychotics are currently included in up-to-date PM toxicology analysis protocols. However, apart from case studies, few reports on fatal concentrations based on large number of cases have been published in the literature. Based on PM investigations in Finland between 2000-2020, this study provides fatal reference concentrations in poisonings due to an antidepressant or an antipsychotic drug assigned as the principal intoxicant. Summary statistics for drug concentrations in PM femoral blood (min, max, mean, 10th, 25th, 50th, 75th, 90thpercentile) were calculated for 17 antidepressant (N = 2007) and for 12 antipsychotic drugs (N = 1161). The proportion of suicide, accident and undetermined manner of death is indicated for each drug. Further, the fatal concentrations obtained in this study were evaluated by comparison with fatal and "normal" PM concentrations reported by two previously published approaches, the grouped causes of death approach and the all causes of death approach, respectively. This study shows that, despite the well-known variation in PM drug concentrations, competently generated fatal concentration results for the drugs studied are consistent to such an extent that they can be used as a reference in the interpretation process.

Changes in suicide in California from 2017 to 2021: a population-based study

BackgroundSuicide is a major public health problem with immediate and long-term effects on individuals, families, and communities. In 2020 and 2021, stressors wrought by the COVID-19 pandemic, stay-at-home mandates, economic turmoil, social unrest, and growing inequality likely modified risk for self-harm. The coinciding surge in firearm purchasing may have increased risk for firearm suicide. In this study, we examined changes in counts and rates of suicide in California across sociodemographic groups during the first two years of the COVID-19 pandemic relative to prior years.MethodsWe used California-wide death data to summarize suicide and firearm suicide across race/ethnicity, age, education, gender, and urbanicity. We compared case counts and rates in 2020 and 2021 with 2017–2019 averages.ResultsSuicide decreased overall in 2020 (4123 deaths; 10.5 per 100,000) and 2021 (4104; 10.4 per 100,000), compared to pre-pandemic (4484; 11.4 per 100,000). The decrease in counts was driven largely by males, white, and middle-aged Californians. Conversely, Black Californians and young people (age 10 to 19) experienced increased burden and rates of suicide. Firearm suicide also decreased following the onset of the pandemic, but relatively less than overall suicide; as a result, the proportion of suicides that involved a firearm increased (from 36.1% pre-pandemic to 37.6% in 2020 and 38.1% in 2021). Females, people aged 20 to 29, and Black Californians had the largest increase in the likelihood of using a firearm in suicide following the onset of the pandemic. The proportion of suicides that involved a firearm in 2020 and 2021 decreased in rural areas compared to prior years, while there were modest increases in urban areas.ConclusionsThe COVID-19 pandemic and co-occurring stressors coincided with heterogeneous changes in risk of suicide across the California population. Marginalized racial groups and younger people experienced increased risk for suicide, particularly involving a firearm. Public health intervention and policy action are necessary to prevent fatal self-harm injuries and reduce related inequities.

Population-Based Assessment of Urban Versus Rural Child Fatalities From Firearms in a Midwestern State

IntroductionSeveral studies have evaluated differences in firearm injury patterns among children based on regionalization. However, many of these studies exclude patients who die before arriving at a trauma center. We therefore hypothesize that important population-based differences in pediatric firearm injuries may be uncovered with the inclusion of both prehospital firearm mortalities and patients treated at a tertiary children's hospital. MethodsPatients less than 15 y of age who sustained a firearms-related injury/death between the years 2012 and 2018 were identified in: (1) death certificates from the Office of Vital Statistics State of Indiana and (2) Riley Hospital for Children at Indiana University Health Trauma Registry. Counties of injury were classified as either urban, midsized, or rural based on the National Center for Health Statistic's population data. Significant variables in univariate analysis were then assessed using multivariate logistic regression models. ResultsA total of 222 patients were identified. Median age of firearm injury survivors was 13 (interquartile range 7-14), while the median age of nonsurvivors was 14 (interquartile range 11-15), P = 0.040. The proportion of suicide was significantly higher in rural counties (P < 0.001). When controlling for shooter intent, patients from a rural or midsized county had statistically significant higher odds of dying before reaching a hospital than their urban counterpart (rural odds ratio [OR] 5.67 [95% confidence interval {CI} 2.23, 14.38]; midsized OR 6.53 [95% CI 2.43, 17.46]; P < 0.001). ConclusionsImportant differences exist between pediatric firearm injuries based on where they occur. Public health initiatives aimed at reducing pediatric firearm injury and death should not exclude rural pediatrics patients.

Voluntary Firearm Divestment and Suicide Risk: Real-World Importance in the Absence of Causal Identification.

Voluntary Firearm Divestment and Suicide Risk: Real-World Importance in the Absence of Causal Identification.

Suicide mortality among children in the Russian Federation

Purpose. To identify the aspects of suicide mortality of the child population of the Russian Federation and to propose directions for its prevention.Materials and methods. An analysis of official data on the incidence of suicide deaths and injuries with uncertain intentionsin children of various age groups and in the context of the Russian Federation constituent entities was carried out. Special attention of suicide death age structure was paid to adolescents aged 15–17 years. The proportion of suicides among children due to external causes of death was determined.Results. The incidence of suicide in children and adolescents depends on age, gender, and place of residence: in general, boys and urban residents dominated among the dead; suicide cases were recorded starting from the age group 5–9 years, more than two thirds of them were in the 15–17 age group; suicide rates among external causes of child death increased with age, were higher in girls and in rural areas; all the indicators studied had regional characteristics. Suicide mortality of children higher than the all-Russian level was recorded in the Volga, Siberian and Far Eastern, and at the age of 15–17 years — in the Southern, North Caucasus and Ural Federal Districts.Conclusion. The characteristics of suicide mortality of children its social conditionality should be taken into account in the preventive measures’ formation. An analysis of inaccurate and unspecified causes of children death is important; intensive development of medical and social assistance and introduction of modern technologies of medical and social support for children and adolescents; using the principles of intersectoral and interdepartmental interaction to identify and strengthen State control over improper parenting; raising the social responsibility of parents.

Proportion of suicides in Denmark attributable to bereavement by the suicide of a first-degree relative or partner: Nested case-control study.

To provide the first estimates of the risk of suicide after bereavement by the suicide of any first-degree relative and the proportion of suicides in Denmark attributable to suicide bereavement. We conducted a nationwide nested case-control study defining cases as all Danish-born individuals who died by suicide in Denmark between 01 January 1980 and 31 December 2016 (n= 32,248), age-matched to four living controls. Using three exposure categories (bereavement by the suicide of a relative [parent, offspring, sibling, and spouse/cohabitee]; non-suicide bereavement; no bereavement) and conditional logistic regression adjusted for pre-specified covariates we estimated the odds of exposure to suicide bereavement in cases versus controls. We tested whether associations differed for men and women, estimated the population attributable fraction (PAF) of suicides in our population at risk that could be attributed to a first-degree relative's suicide loss, and estimated the attributable fraction among the exposed (AFe). Suicide bereavement was associated with an increased odds of suicide when compared with no bereavement (ORadj2 = 2.90, 95% CI: 2.46-3.40) or non-suicide bereavement (ORadj2 = 1.48, 95% CI: 1.25-1.74). There was no evidence to support any interaction with sex. PAF (0.69%; 95% CI: 0.62%-0.77%) and AFe (60.12%; 95% CI: 53.19%-66.03%) estimates suggested that in Denmark 0.69% of suicides, and 60% of suicides among suicide-bereaved relatives, could be prevented if it was possible to address all factors increasing suicide risk in suicide-bereaved relatives. Suicide bereavement in relatives and partners contributes to at least one in 145 suicides in Denmark.

Police-reported suicides during the first 16 months of the COVID-19 pandemic in Ecuador: A time-series analysis of trends and risk factors until June 2021

BackgroundThere are widespread concerns that the COVID-19 pandemic may increase suicides. Few studies have analysed effects beyond the pandemic's early months or examined changes in known suicide risk factors.MethodsUsing time series models fit with Poisson regression, we analysed monthly police-reported suicides in Ecuador from January 2015 to June 2021. Treating March 2020 as the start of the pandemic, we calculated rate ratios (RRs) comparing the observed to the expected number of suicides for the total population and by age and sex groups. We investigated changes in risk factors, precipitants, geographic distribution, and suicide methods.FindingsThere was no evidence that suicide rates were higher than expected during the pandemic (RR 0·97 [95% CI 0·92–1·02]). There was some evidence of fewer than expected male suicides (RR 0·95 [95% CI 0·90–1·00]). The proportion of suicides occurring in urban and coastal areas increased but decreased amongst indigenous and other minorities. The proportions of suicides with evidence of alcohol consumption, disability, and amongst married and cohabiting individuals decreased, whereas suicides where mental health problems were considered contributory increased. There were relative increases in the proportion of suicides by hanging but decreases in self-poisoning and other suicide methods.InterpretationThe pandemic did not appear to adversely impact overall suicide numbers nationwide during the first 16 months of the pandemic. Reduced alcohol consumption may have contributed to the decline in male suicides.FundingNone.

Associations Between Firearm and Suicide Rates: A Replication of Kleck (2021)

Objective Using data from n = 194 nation-states, Kleck found that firearm availability was only associated with firearm suicide rates, but not total or non-firearm suicides. He thus concluded that while firearm availability influences how people commit suicide, it does not affect total numbers. However, the study contains numerous logical and methodological issues and is at odds with the evidence base. Therefore, I attempt to reproduce the original results. Method I reproduce the original study’s methods: ordinary least squares regression, weighted by the square root of the population, with log-transformed suicide rates and three separate firearm availability measures: global estimates from the Small Arms Survey, proportion of suicides committed with firearms, and a European Union survey of firearm ownership. I also test several methodological variations and include U.S. suicide data. Results In contrast to Kleck, global analyses with Small Arms Survey data found a significant and positive association between firearm availability and total suicides, as did U.S. analyses. Analyses with other firearm availability measures comported with the original study, finding no association. Conclusion The main result in Kleck failed to reproduce, finding instead a significant association between firearm availability and suicide rates, as did U.S. analyses. While reproductions of Kleck’s other analyses continued to show no association, they were based on unreliable methods. I therefore reject Kleck’s conclusion that that firearm availability does not influence suicide rates. Highlights Using data global data, I find firearm availability is positively associated with suicide rates. I identify serious flaws in the logic and methods of Kleck and an earlier review. For transparency, data and code have been archived on a public repository.

Growing alcohol use preceding death by suicide among women compared with men: age-specific temporal trends, 2003-18.

In the United States, until 2018 both the prevalence of heavy alcohol use and the suicide mortality rate increased among men and women; however, women had experienced a notably higher increase in both. As heavy alcohol use may have contributed to the observed sex disparity in the suicide mortality rate increase, the aim of the current study was to estimate the temporal trend of the sex- and age-group-specific proportion of suicides that were alcohol-involved in the United States. Using restricted-access data from the National Violent Death Reporting System, we performed joinpoint regression analyses to investigate temporal trends in the sex- and age-group (young adults = 18-34 years; middle-aged adults = 35-64 years; and older adults = 65+ years)-specific proportion of suicides that were alcohol-involved. United States. A total of 115 202 suicide decedents 18+ years of age from 2003 to 2018. The sex- and age-group-specific proportion of suicides that were alcohol-involved, among all suicide decedent, for which the decedent had a blood alcohol concentration (BAC) (a) ≥ 0.04 g/dl and (b) ≥ 0.08 g/dl. For 2003-18, the proportion of suicides that were alcohol-involved wherein the decedent had a BAC ≥ 0.08 g/day significantly increased on average annually for women of all age groups [young women: 2.80%, 95% confidence interval (CI) = 1.86%, 3.75%; middle-aged women: 2.20%, 95% CI = 1.20%, 3.21%; older women: 10.48%, 95% CI = 1.17%, 20.65%], while only middle-aged men experienced a significant average annual percentage increase (0.81%, 95% CI = 0.003%, 1.62%). In the United States between 2003 and 2018, alcohol use preceding death by suicide increased among women compared with men.

Coronial postmortem reports and indirect COVID-19 pandemic-related mortality

AimsWidespread disruption of healthcare services and excess mortality not directly attributed to COVID-19 occurred between March and May 2020. We undertook the first UK multicentre study of coroners’ autopsies before...

Cyberbullying as a way of causing suicide in the digital age

The fundamental basis of legal systems based on common law is that people have free will and are accountable for their actions. Particularly difficult and controversial issues of criminal liability arise when one person instigates another to commit suicide, and, accordingly, issues of free will, causality, and responsibility become increasingly important. The reasons for committing suicide are primarily socio-economic in nature. A certain proportion of suicides are those that occur due to the negative impact of third parties on the victims. In this case, the investigative action must establish that the perpetrator displayed intent in his or her actions in such a way as to expose the victim to a high risk of serious psychological harm. In the era of digital transformation, special attention must be paid to the relationship of the criminal with the victim, carefully studying the social networks of both, taking into account the fact that a typical participant in Internet communication leading to suicide is emotionally unstable, subordinate, insecure, secretive, unassertive teenager, and this category is represented to a greater extent by a female audience. The scalability of digital interventions allows to penetrate populations beyond the reach of conventional mental health care. Thus, there is a need for the use of digital Internet interventions, including to assist in the work of law enforcement agencies in the detection of Internet communities that instigate and incline people to commit suicide. It is concluded that the era of digital transformations is constantly evolving, social networks are becoming more accessible for both criminals and their victims, as a result of which the corresponding requirements for the investigation and subsequent prosecution for incitement to suicide become more complicated. The scientific proposals of legal scholars presented in the study are aimed at solving the corresponding problems

Assessment of county-level proxy variables for household firearm ownership

Our objective in this study was to evaluate how well proxy variables for firearm ownership used in county-level studies measure firearm ownership. We applied Bayesian spatial smoothing methods to calculate county-level estimates of household firearm ownership using Behavioral Risk Factor Surveillance System (BRFSS) data (2013–2018). We compared these estimates to four proxies for county-level firearm ownership: the proportion of suicides that were firearm suicides, the average of the proportion of suicides that were firearm suicides and the proportion of homicides that were firearm homicides, gun shops per capita, and federal firearm licenses per capita. U.S. counties for which BRFSS data on household firearm ownership were collected and available for release (n = 304) were included. The median (interquartile range) prevalence of household firearm ownership was 46.6% (37.2%, 56.4%). The per capita rate of federal firearm licenses was most strongly correlated with household firearm ownership (r = 0.70; 95% CI: 0.63, 0.75) followed by the proportion of suicides that were firearm suicides (r = 0.45; 95% CI: 0.36, 0.54). These correlations were stronger among counties with populations of ≥250,000 people. The per capita rate of federal firearm licenses was the best proxy variable for firearm ownership at the county level, however, a better proxy should be identified.

Self-poisoning with pesticides in Jiangsu Province, China: a cross-sectional study on 24,602 subjects

BackgroundWith an estimated > 800,000 suicide-related deaths and potentially several attempts for each death in the world. The purpose of this study was to determine the epidemiological characteristics of self-poisoning with pesticides within the Jiangsu province in China.MethodsSuicide rate was calculated the Routine Surveillance System by Jiangsu Provincial Center for Disease Control and Prevention, stratified by gender, age and region, combined with socioeconomic and agriculture-related factors to investigate trends in suicide over the study period. A logistic regression model was used to investigate the associations between pesticide types and pesticide-related deaths.ResultsIn recent years, Jiangsu Province has witnessed a decrease in pesticide self-poisoning cases and consequent deaths. Among all suicides by deliberate ingestion of pesticides, the proportion of cases were mainly in the age 40, accounting for 3.43% of all cases with pesticide suicide. The proportion of suicide due to pesticide poisoning in females was markedly higher than that in males (p < 0.001). Suicide using organophosphate and carbamate insecticides was most common, with 10,303 reported cases accounting for 42.02% of all suicides.ConclusionsFor national responses to be effective, the characteristics of pesticide suicides should be comprehensively investigated for the formulation of corresponding prevention strategies. At present, more pesticide suicide prevention policies for the elderly people and women should be implemented, and stronger pesticide management policies should be implemented for rural areas.

264 Trends and Characteristics of Fentanyl Exposures Reported to the US Poison Centers

Overdoses due to synthetic opioids increased by 45% between 2016 and 2017, primarily driven by fentanyl and analogs. Although between 2016 and 2017, more than 5 million prescriptions were dispensed, there is a paucity of nationally representative U.S. fentanyl overdose data. This study aims to examine the national trends in tramadol exposures reported to U.S. poison centers (PCs). The National Poison Data System (NPDS) was queried for all fentanyl exposures from 2013 to 2019. We identified and descriptively assessed the relevant demographic and clinical characteristics. Fentanyl reports from acute care hospitals and Emergency Departments (ACHs) were analyzed as a sub-group. Trends in frequencies and rates (per 100,000 human exposures) were analyzed using Poisson regression methods. Percent changes from the first year of the study (2013) were reported with the corresponding 95% confidence intervals (95% CI). There were 12,843 fentanyl exposures reported to the PCs from 2013 to 2019, with the calls increasing from 1,544 to 2,761 during the study period. Confirmed reports of illicit fentanyl overdoses grew from 3 reports in 2013 to 141 in 2019. The proportion of calls from ACH increased from 64% to 67.4% during the study. Multiple substance exposures accounted for 69.9% of the overall fentanyl calls and 53.4% of the calls from ACH. The most frequent co-occurring substances reported were benzodiazepines (15.5%) and heroin (7.2%). Residence was the most common site of exposure (80.1%) and 73.1% cases were enroute to the hospital when the PC was notified. Tachycardia and respiratory depression were the most frequently demonstrated clinical effects. Naloxone was a reported therapy for 44.1% cases, with this therapy being performed prior to PC contact in most cases. Demographically, 55.5% of cases were males, and the most frequent age groups were 20-29 years (22.5%) and 30-39 years (21.3%). Intentional misuse (41.4%) and suspected suicides (16.8%) were commonly observed reasons for exposure, with the proportion of suicides being higher in cases reported by ACH (22.8%). Approximately 22% of the patients reporting fentanyl exposures were admitted to the critical care unit (CCU). Major effects were seen in 18.2% cases and the case fatality rate was 9.2%, with deaths increasing significantly during the study period (62 deaths in 2013 to 1,184 deaths in 2019). The frequency of exposures increased by 78.8% (95% CI: 68%, 90.3%; p<0.001), and the rate of exposures increased by 82.3% (95% CI: 36.3%, 143.9%; p<0.001). PC data demonstrated an increasing trend of fentanyl exposures, which may in part be attributed to the due to increased use of illegally or illicitly made fentanyl. A significant proportion of fentanyl exposures were associated with intentional abuse, suicide and increasing mortality. Fentanyl exposure reports from acute care hospitals and EDs during the study increased.

Suicide fatalities in the US compared to Canada: Potential suicides averted with lower firearm ownership in the US.

The United States (US) has the highest rate of firearm suicides in the world. The US and Canada are comparable countries with markedly different rates of firearm ownership, providing an opportunity to estimate suicide fatalities that could be averted in the US with a lower rate of firearm ownership. We compared 2016 US suicide fatality rates-standardized within fourteen sex-specific age groups to reflect the ethnic composition of Canada-to 2016 Canadian suicide rates. We then calculated the number and proportion of suicides that could be averted in the US if the US had the same rates of suicide as in Canada. If the US had the same suicide rates as in Canada, we estimate there would be approximately 25.9% fewer US suicide fatalities, equivalent to 11,630 suicide fatalities averted each year. This decline would be driven by a 79.3% lower rate of firearm-specific suicide fatalities. The male suicide fatality rate would be 28.8% lower and equivalent to 9,992 fewer suicide fatalities each year. The female suicide fatality rate would be 16.0% lower and equivalent to 1,638 fewer suicide fatalities each year. While 36% of firearm suicide fatalities could be replaced by non-firearm suicide fatalities, 64% of firearm fatalities could be averted entirely. US policymakers may wish to consider policies that would reduce rates of firearm ownership, given that that about 26% of US suicide fatalities might be averted if the US had the same suicide rates as in Canada, a country with drastically lower firearm ownership rates.

An Observational Study of Suicide Deaths by Self-Poisoning with Opioids in Toronto (1998-2015).

Opioid self-poisoning is a common suicide method in North America. However, there is limited information about who dies by this method and whether legislation on opioid access has resulted in lower suicide rates by self-poisoning. The primary research question was whether the rate of suicide involving opioids has diminished since the implementation of Ontario's Narcotics Safety and Awareness Act (NSAA) (1998-2011 vs. 2012-2015). This study examined all suicides by intentional self-poisoning with or without an opioid in Toronto (1998-2015), and tested the mean change after NSAA by one-way ANOVA. Demographic and clinical characteristics as well as details surrounding the suicide were also compared for suicides by opioid and by non-opioid self-poisoning. There were 773 suicides in Toronto by self-poisoning where the substance used was known (19.0% of all suicides). Of these, 289 (37.4%) had an opioid present and, in 249 (32.2%) suicides, the opioid was deemed to have been lethal. The mean number of yearly suicides involving opioids was 15.6 before and 17.5 after NSAA implementation (F 1.16, df 1, p = 0.30). Neither the rate per population nor the proportion of suicides by this method has changed between the 2 periods. People who died by suicide using an opioid had higher rates of pain, musculoskeletal, gastrointestinal/liver disorders, and cancer. This study confirms that opioids are a major contributor to suicide in Toronto, with no change in the rates after implementation of the NSAA. Physicians who prescribe opioids should monitor patients for elevated suicide risk and intervene where appropriate.

Global Mortality From Firearms, 1990-2016

Understanding global variation in firearm mortality rates could guide prevention policies and interventions. To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. Firearm ownership and access. Cause-specific deaths by age, sex, location, and year. Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35). This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups.

Acute Alcohol Co-Ingestion and Hospital-Treated Deliberate Self-Poisoning: Is There an Effect on Subsequent Self-Harm?

The aim of this study was to determine the relationship between alcohol co-ingestion in an index deliberate self-poisoning (DSP) episode with repeated DSP and subsequent suicide. A retrospective cohort study was conducted involving 5,669 consecutive index presentations to a toxicology service following DSP between January 1, 1996, and October 31, 2010. Records were probabilistically matched to National Coronial Information System data to identify subsequent suicide. Index DSPs were categorized on co-ingestion of alcohol, and primary outcomes analyzed were repetition of any DSP, rates of repeated DSP, time to first repeat DSP, and subsequent suicide. Co-ingestion of alcohol occurred in 35.9% of index admissions. There was no difference between those who co-ingested alcohol (ALC+) and those who did not co-ingest alcohol (ALC-) in terms of proportion of repeat DSP, number of DSP events, or time to first repeat DSP event. Forty-one (1.0%) cases were probabilistically matched to a suicide death; there was no difference in the proportion of suicide between ALC+ and ALC- at 1 or 3years. There was no significant relationship between the co-ingestion of alcohol in an index DSP and subsequent repeated DSP or suicide. Clinically, this highlights the importance of mental health assessment of patients that present after DSP, irrespective of alcohol co-ingestion at the time of event.