Reduce Suicide Rates Research Articles

P03-467 - The effects of beverage type on suicide rates in Russia

ObjectivePrevious research has suggested that the consumption of different types of alcoholic beverage may have a differential effect on suicide rates. The aim of this study was to examine the relation between the consumption of different beverage types and suicide rates in Russia across the later-Soviet and post-Soviet periods.MethodAge-standardised sex- and age-specific suicide rates for the period 1980–2005 and data on beverage-specific alcohol sales were obtained Russian State Statistical Committee (Rosstat). Time-series analytical modelling techniques (ARIMA) were used to examine the relation between the sale of different alcoholic beverages and suicide rates.ResultsVodka consumption as measured by sales was significantly associated with both male and female suicide rates. The consumption of beer and wine were not associated with suicide rates. The estimates of the age specific models for men were positive (except for the 75+ age group) and ranging from 0.069 (60–74 age group) to 0.123 (30–44 age group). The estimates for women were positive for the 15–29 age group (0.08), 30–44 age group (0.096) and 45–59 age group (0.057).ConclusionsThese findings suggest that public health efforts should focus on both reducing overall consumption and changing beverage preference away from distilled spirits in order to reduce suicide rates in Russia.

Building social capital and improving mental health care to prevent suicide

that, apart from a peak during the Great Depression, there were sharp falls in rates during the two world wars suggesting, somewhat tantalizingly, that the resurgence of a sense of collective solidarity that one might expect when an entire nation is threatened may confer a benefit in reducing suicide rates. The growth in equality of the two sexes may also play an important role in reduced female suicide rates in recent decades. 4 On the downside, however, the rates in young adults have shown little change over time, so that today this age group has a similar risk to that of older people. Gradus et al. describe the association between acute stress reactions, a not so well-described mental disorder, and completed suicide in Denmark. Acute stress disorder is characterized by the experience of somatic and psychological symptoms of anxiety and depression immediately after an extremely stressful

Economic fluctuations and suicide: A comparison of Taiwan and Hong Kong

This study examines the impact of unemployment on suicide rates in Taiwan and Hong Kong during the period of rising unemployment (1997-2003) and its subsequent decline (2003-2007), with 2003 as the turning point. During these initial years of high unemployment, suicide rates increased markedly in Hong Kong and Taiwan; however, as employment conditions improved, suicide rates fell in Hong Kong but continued to increase in Taiwan. ARMAX time-series models with appropriate time lags were used to assess the impact of unemployment on suicide rates for both periods. It was found that for Taiwan, the unemployment rate was positively related with the suicide rate for both males and females during the period of high unemployment, whereas a negative relationship was observed as the rate of unemployment decreased. On the other hand, the reduction in suicide rates since 2003 was not statistically significantly related to the improvement of employment conditions for Hong Kong; whereas the suicide rate in Taiwan still remained at a high level due to the increasing number of charcoal burning suicide deaths despite improvements in employment conditions. In conclusion, lower unemployment was not necessarily associated with lower suicide rates. Exogenous factors other than economic ones have been suggested to be important for understanding differences in suicide patterns in Hong Kong and Taiwan. The impact of employment conditions on suicide across different countries deserves further investigation.

Antecedents of hospital admission for deliberate self-harm from a 14-year follow-up study using data-linkage

BackgroundA prior episode of deliberate self-harm (DSH) is one of the strongest predictors of future completed suicide. Identifying antecedents of DSH may inform strategies designed to reduce suicide rates. This study aimed to determine whether individual and socio-ecological factors collected in childhood and adolescence were associated with later hospitalisation for DSH.MethodsLongitudinal follow-up of a Western Australian population-wide random sample of 2,736 children aged 4-16 years, and their carers, from 1993 until 2007 using administrative record linkage. Children were aged between 18 and 31 years at end of follow-up. Proportional hazards regression was used to examine the relationship between child, parent, family, school and community factors measured in 1993, and subsequent hospitalisation for DSH.ResultsThere were six factors measured in 1993 that increased a child's risk of future hospitalisation with DSH: female sex; primary carer being a smoker; being in a step/blended family; having more emotional or behavioural problems than other children; living in a family with inconsistent parenting style; and having a teenage mother. Factors found to be not significant included birth weight, combined carer income, carer's lifetime treatment for a mental health problem, and carer education.ConclusionsThe persistence of carer smoking as an independent risk factor for later DSH, after adjusting for child, carer, family, school and community level socio-ecological factors, adds to the known risk domains for DSH, and invites further investigation into the underlying mechanisms of this relationship. This study has also confirmed the association of five previously known risk factors for DSH.

Commentary: Thomas & Gunnell's paper

This paper 1 is an interesting and unusual data set that raises a number of questions, only some of which are answerable. Life expectancy has steadily increased from 1900 to 2000, while infant mortality has also steadily improved. Suicide rates have not kept pace with this general improvement in health by showing similar linear decreases. If we disregard the major reductions in suicide rates in both world wars, more pronounced for males than females, we can say that male rates rose steadily from 1863 to 1905, but had returned to 1905 levels by 1937 during the Great Depression. Since then, however, the reduction in the male rates has been steady and sustained. Female rates rose gradually from 1863 to 1967, with smaller decreases during the world wars, and have fallen fairly steadily since then. The progressive increase in suicide rates in the earlier period is not easy to account for in terms of what is known about risk factors for suicide.

The increased use of antidepressants has contributed to the worldwide reduction in suicide rates

Numerous ecological studies have shown an inverse association between antidepressant use and suicide rates and a smaller number of individual-based studies have shown an association between current antidepressant use and reduced suicide risk. Such evidence is often cited in support of the notion that antidepressants prevent suicide. However, more recently, the premises underlying this proposition, namely that suicide is caused by depression and that antidepressants relieve depression, have been challenged and the potential harm caused by antidepressants has been highlighted. In this article, Goran Isacsson and Charles Rich debate with Jon Jureidini and Melissa Raven the motion that the increased use of antidepressants has contributed to the worldwide reduction in suicide rates.

The use of SSRIs in children and adolescents

The use of SSRIs in children and adolescents

Chain of Care for Patients with Intentional Self‐Harm: An Effective Strategy to Reduce Suicide Rates?

Chain of care for patients with intentional self-harm was important in the Norwegian national action plan to prevent suicide. In this study there were two aims: (1) to calculate the potential effects of chain of care on reducing suicide rates, and (2) to assess whether suicide rates decreased more in areas where chain of care had been implemented than in other areas. We observed no differences in changes in suicide rates between areas with and without the intervention. The calculated potential effects of chain of care on national suicide rates were very small, even under unrealistically favorable conditions.

Comparison of rates of suicide methods used by the elderly in England and Wales

Because suicide rates have traditionally increased with age (Shah and De, 1998; Shah, 2007), the observed reduction in suicide rates among older people may be an important contributor to the U.K. government's target to reduce suicide rates in the general population by at least one-sixth of the 1996 baseline by 2010 (Department of Health, 1999). Previous studies have observed that suicide rates in older people have declined in both sexes over the 12-year period (1985–1996) and 24-year period (1979–2002) in England and Wales (Hoxey and Shah, 2000; Shah et al., 2001), although the rates are still considerably higher than those among younger adults. It is believed that a better understanding of the methods used by older people for suicide may lead to the development of targeted preventative strategies, which are expected to meet the challenge of sustaining this observed decline in suicide rates among older people over time in England and Wales (Lindesay, 1991; Dennis and Lindesay, 1995).

Regulatory action on SSRIs fails to reduce suicide rates

Regulatory action on SSRIs fails to reduce suicide rates

Risk factors for suicide in Hungary: a case-control study

BackgroundHungary previously had one of the highest suicide rates in the world, but experienced major social and economic changes from 1990 onwards. We aimed to investigate the antecedents of suicide in Hungary. We hypothesised that suicide in Hungary would be associated with both risk factors for suicide as identified in Western studies, and experiences related to social and economic restructuring.MethodsWe carried out a controlled psychological autopsy study. Informants for 194 cases (suicide deaths in Budapest and Pest County 2002–2004) and 194 controls were interviewed by clinicians using a detailed schedule.ResultsMany of the demographic and clinical risk factors associated with suicide in other settings were also associated with suicide in Hungary; for example, being unmarried or having no current relationship, lack of other social contacts, low educational attainment, history of self-harm, current diagnosis of affective disorder (including bipolar disorder) or personality disorder, and experiencing a recent major adverse life event. A number of variables reflecting experiences since economic restructuring were also associated with suicide; for example, unemployment, concern over work propects, changes in living standards, practising religion. Just 20% of cases with evidence of depression at the time of death had received antidepressants.ConclusionSuicide rates in Hungary are falling. Our study identified a number of risk factors related to individual-level demographic and clinical characteristics, and possibly recent societal change. Improved management of psychiatric disorder and self-harm may result in further reductions in suicide rates.

National alcohol consumption and suicide rates

Alcohol-use disorders have been reported to be associated with the risk of suicide in the general population (Schneider et al., 2009) and in the elderly (Shah and Ganesvaran, 1997). This allows identification of individuals potentially at increased risk for suicide and target preventative interventions at an individual level. Moreover, alcohol is often taken during the process of committing suicide (Conwell et al., 1990). Identification of the relationship between the national consumption of alcohol and suicide rates would support generation of public health measures to reduce the national consumption of alcohol to facilitate reduction in suicide rates. Thus, a cross-national ecological study examining the relationship between national per capita consumption of alcohol and suicide rates was undertaken.

Laws on Alcohol Availability Might Reduce Suicide Rates

In studies of various European regions, yearly changes in per capita alcohol consumption rates correlated with changes in suicide rates, and suicide

Quais são os recentes achados clínicos sobre a associação entre depressão e suicídio?

Suicide is one of the leading causes of mortality worldwide, especially among young subjects. Suicide is considered the outcome of a multidimensional and complex phenomenon, which is a result of the interaction between several factors. The association between psychopathology and suicide has been extensively investigated. Major depression plays an important role among the psychiatric diagnoses associated with suicide. This finding seems to be confirmed by different study designs, and in distinct populations. The present paper aims to briefly review the recent findings regarding the suicide-related clinical features of depression. Moreover, strategies for suicide prevention were also reviewed. Recent references were identified and grouped in order to illustrate the main contributions about depression and suicide. Briefly, the literature review stresses the high prevalence of major depression among subjects presenting suicide behaviors. Psychopathological traits, such as aggression and impulsivity play a relevant role in triggering suicidal behaviors. Strategies for suicide prevention were also reviewed in Brazil and internationally. In general, detection and treatment are effective in reducing suicide rates. Studies regarding suicide behaviors have had a pragmatic approach, and generated a large body of evidence about correlates of suicide. However, these studies have not been able to provide a consistent theoretical explanation for this phenomenon. The recent adoption of modern strategies represents a possibility of enhancing the research capability of such studies. In order to be clinically useful, findings should make it possible to deepen the understanding over the experience of a suicidal person, as well as to design specific strategies for prevention and treatment in population subgroups.

P02-119 Smoker suicide rates and risks in the United States and Frankfurt, Germany

Background:Suicide and smoking are immense, growing, associated global problems. Recent general population suicide rates and ratios by smoking status are unknown though in past reports, smokers had near three-fold hazard ratios of suicide among health professionals. So we assessed recent suicide rates and rate ratios in the general population of the United States (US) and Frankfurt, Germany.Methods:US National Health Interview Survey interviewees from 1987, 1988, and 1990-94 with near complete follow up through 2002 (representing the US adult non-institutionalized population) and all suicides in 1999-2000 among adult residents of Frankfurt, their proxy respondents, control subjects, and census data were studied using survival time methods. Age was categorized in both samples as 18-30, 31-60 and 61+ years.Results:The respective US versus Frankfurt crude suicide rates per 100,000 were 13.8 (95% confidence interval (CI) 12.4-15.5) versus 17.7 (CI 15.0-20.5) overall, 7.9 (CI 6.4-9.9) versus 12.0 (CI 9.2-14.7) in never smokers, and 22.9 (CI 19.5-27.0) versus 32.0 (CI 24.5-39.6) in current smokers. Smoker suicide rate ratios relative to never smokers ranged from 2.1 (males) to 4.2 (females) in US groups and 1.5 (ages 61+ years) to 3.7 (ages 31-60 years) in Frankfurt groups (each p< 0.05).Discussion:In both the US and Frankfurt, Germany, large absolute and relative excesses of suicide are seen in smokers. Reducing the prevalence of smoking might greatly reduce suicide rates, especially in young and middle-aged adults and US females.Acknowledgements:This study was funded by Pfizer, Inc.

Psychiatric service development and suicide

In The Lancet today, Sami Pirkola and colleagues, in a nationwide study in Finland,1 suggest that changes in mental-health services can have effects on suicide. These researchers show that development of multifaceted community psychiatric care can have a beneficial effect on mental health as indicated by reduced suicide rates. But they also provide some indication that transfer of psychiatric services to primary care, more self-produced services (locally derived within primary care rather than through hospital-district organisations), and frequent reorganisation of services contribute to an increase in suicide rates.

Suicide prevention: is more demographic information the answer?

Suicide is an important health issue and its prevention is prioritized in government targets. PCTs in England and Wales are also required to carry out audits of suicide deaths by the Healthcare Commission (HCC). We present findings of a 6-year analysis of suicide deaths between 2002 and 2008 in Birmingham and Solihull, the second largest urban conurbation in the UK. After extensive analysis, no demographic group was shown to have a significantly greater risk of suicide and no geographical area had significantly higher rates than another. Despite the large population examined (c.1.3 million), these findings are likely to be due to the rarity of suicides as an outcome. We discuss the practical implications of these findings for local health organizations charged with reducing suicide rates, the value to local suicide audits and the use of a new suicide audit tool developed for use by PCTs. We conclude that ever increasing collection of information surrounding suicide deaths is unlikely to result in the discovery of local groups amenable to targeted suicide prevention interventions and that the HCC may want to reconsider its performance indicator around suicide audits to allow valuable resources to be used more effectively elsewhere.

Psychiatrist availability, social disintegration, and suicide deaths in U.S. counties, 1990–1995

AbstractPrevious studies have found that primary care resources are associated with various health outcomes. The primary purpose of the study was to test for associations between psychiatrist availability, social disintegration and suicide rates. Data utilized were from the 2002 Area Resource File on U.S. counties (N=3080). Suicide rates were averaged over 6 years covering 1990 through 1995. Poisson and Negative binomial regression models were used to assess the association of psychiatrist availability and suicide rate ratios. Availability of psychiatrists was significantly related to suicide. Counties with greater availability of psychiatrists per 10,000 experienced a 0.12% reduction in their suicide rates (β=−0.0012, incidence density ratio [IDR]=0.9988, 95% CI=0.9984–0.9992). Divorce strongly elevated suicide rates (β=0.0724, IDR=1.0751, 95% CI=1.0664–.0858). Counties with a high percentage of men 65 years or older had significantly high suicide rates. An increase in the White population between 1980 and 1990 was also associated with a significant increase in suicide. Increases in psychiatrists reduced suicide rates, but the association was small. Psychiatrist availability may also partially reduce the effects of social disintegration at the county level. Primary care was not associated with suicide once other variables, including hospital beds were taken into account. Results provide evidence to suggest that greater mental health promotion might reduce area inequalities in suicide rates. © 2008 Wiley Periodicals, Inc.

The Effect of Catalytic Converter Legislation on Suicide Rates in Grampian and Scotland 1980–2003

To examine the effect of catalytic converter legislation on suicide rates in Grampian and Scotland since its implementation in 1993. (1) Population study in Grampian and Scotland using national population and mortality statistics for 1980 to 2003. (2) Retrospective, controlled cohort study of individualswho had unsuccessfully attempted suicide by motor had unsuccessfully attempted suicide by motor vehicle exhaust gassing to examine the theory of method substitution. method substitution. There was a significant fall in suicides by motor vehicle exhaust gas inhalation in Scotland and Grampian following the introduction of compulsory catalytic converter legislation. However, in the same time period, there was a significant increase in numbers of suicides by hanging and total suicide rates in Scotland. There was a non-significant trend in a small sample of patients from a local hyperbaric unit for an increased rate of subsequent completed suicide between those who had previously attempted suicide by motor vehicle exhaust gas inhalation and controls. Catalytic converter legislation has resulted in a decrease in the number of suicides by motor vehicle exhaust gas inhalation. Overall suicide rates have not decreased. There is evidence to suggest that those who would have previously committed suicide by motor vehicle exhaust gas inhalation find alternative methods of suicide, so called 'method substitution'. Initiatives to reduce suicide rates should be directed at those means that are used by impulsive suicide attempters, as other, determined individuals, will commit suicide by another method.

Never the twain? Reconciling national suicide prevention strategies with the practice, educational, and policy needs of mental health nurses (Part one)

Suicide remains as a distinct global public health problem, and the reduction of rates continues to be a major concern of the governments of many countries; this has given rise to the creation of national suicide prevention strategies. As with any other mental health-related policy document, it behoves mental health nurses to juxtapose these against the realities of their practice and educational needs. To this end, this two part paper draws on national suicide prevention strategy policy directions that appear to speak directly to the practice and/or educational needs of mental health nurses and critiques these. The direction indicating more training in risk assessment is perhaps questionable given that this is already by far the most developed area of the suicidology-focused literature and that our increased knowledge has risk factors that have not so far produced widespread reductions in suicide rates. Furthermore, this additional attention, at least in part, reflects the clear move towards more coercion and control in international mental health policy. The direction indicating that practitioners should use evidence-based interventions to prevent suicide is laudable although difficult to reconcile with practice realities given that there is currently a distinct lack of evidence-based interventions for working with people who are suicidal. As a result, this paper offers some suggested amendments to the national suicide prevention strategies, and the second part of this paper focuses on three more policy directions.