Result Of Suicide Research Articles

Branch in the heart: unusual fatal self-inflicted injury.

The case presents a suicide committed by a 21-year-old man who thrusted a broken tree branch into his chest which penetrated to his heart and caused death. Despite the unusual tool, a tree branch, suicide was confirmed on the basis of similar attempted self-injury, which was committed several weeks earlier, and a history of mental disorders. The man committed suicide 3 days after leaving the psychiatric ward, where he had been hospitalized after being admitted immediately after his previous suicide attempt by self-stabbing with knife. He was discharged from the psychiatric hospital after 1.5 months therapy with diagnosis of improvement and denials of suicide thoughts. The presented case reflects the tragedy of a young man with mental disorders, who effectively committed suicide by using an unusual tool after several previous attempts made with the use of more frequently observed suicide methods. Such cases may cause problems to investigators as to whether the death was a result of suicide, homicide or accident. Therefore it is very important to complete the result of autopsy with analysis of medical history of the deceased, particularly regarding previous suicide attempts and psychiatric treatment. This is a first report of using such peculiar tool as tree branch to pierce the chest in effective suicide attempt.

The Experience of Survivors of Firearm Suicide Attempts: A Retrospective Case Series.

We sought to identify people who survived firearm suicide attempts to describe the acute stressors, substance use, and mental health conditions related to the attempt. Most firearm deaths in the United States are the result of suicide. Because firearm suicide attempts have a case fatality rate of approximately 90%, little is known about the precipitating factors that lead to firearm suicide attempts. We conducted a retrospective case series of patients admitted to a large hospital system between 2000 and 2019 who survived intentional, self-inflicted gunshot wounds to the head. Through the electronic medical record, we collected information about acute stressors, substance use, and mental health diagnoses before or at the time of the suicide attempt. Thirty-four patients were included in the study cohort. Patients were predominantly White (74%) and male (88%), with a mean age of 44 (range, 14-82). Nineteen (56%) patients were acutely intoxicated with alcohol upon hospitalization and 17 (50%) patients had a positive urine drug screen. Acute stressors involving interpersonal relationships (53%), work/school (32%), and legal disputes (18%), among others, were documented in 82% of patients. Most patients (65%) had been diagnosed with depression before their index hospitalization. Most patients were discharged to an acute rehabilitation center (41%) or an inpatient psychiatric facility (41%). Acute stress and alcohol intoxication were common in this cohort of patients who attempted suicide using firearms. These data offer an ability to learn from the experience of survivors of firearm suicide attempts, a rare population.

The journey to overdose: Using spatial social network analysis as a novel framework to study geographic discordance in overdose deaths

IntroductionDrug overdose deaths are often geographically discordant (the community in which the overdose death occurs is different from the community of residence). Thus, in many cases there is a journey to overdose. MethodsWe applied geospatial analysis to examine characteristics that define journeys to overdoses using Milwaukee, Wisconsin, a diverse and segregated metropolitan area in which 26.72 % of overdose deaths are geographically discordant, as a case study. First, we deployed spatial social network analysis to identify hubs (census tracts that are focal points of geographically discordant overdoses) and authorities (the communities of residence from which journeys to overdose commonly begin) for overdose deaths and characterized them according to key demographics. Second, we used temporal trend analysis to identify communities that were consistent, sporadic, and emergent hotspots for overdose deaths. Third, we identified characteristics that differentiated discordant versus non-discordant overdose deaths. ResultsAuthority communities had lower housing stability and were younger, more impoverished, and less educated relative to hubs and county-wide numbers. White communities were more likely to be hubs, while Hispanic communities were more likely to be authorities. Geographically discordant deaths more commonly involved fentanyl, cocaine, and amphetamines and were more likely to be accidental. Non-discordant deaths more commonly involved opioids other than fentanyl or heroin and were more likely to be the result of suicide. ConclusionThis study is the first to examine the journey to overdose and demonstrates that such analysis can be applied in metropolitan areas to better understand and guide community responses.

Do U.S. Rail Safety Statistics Undercount Suicides?

Rail safety researchers have long suspected that U.S. accidental rail trespassing tallies include some suicides, that is, that suicides are undercounted relative to accidents. Reports issued by the Federal Railroad Administration (FRA) imply that suicides account for less than 30% of total deaths, whereas other countries show a much higher proportion of suicides, sometimes as high as 80% of total rail deaths. The purpose of the present research was to gain insight into this question by evaluating whether official manner of death determinations are correctly reflected in FRA reports. All FRA railroad fatality records for the state of Illinois for 2019 were compared with police reports, coroner/medical examiner manner of death determinations, and online media coverage. These sources indicated that less than half of official suicides were reported correctly in FRA reports and that over 50% of all fatalities were a result of suicide. It was also found that the primary reason for the considerable undercount of suicides was FRA reporting defaults and a breakdown in the process of railroads separating accidents from suicides; it was not a reluctance or delay on the part of local authorities to declare the death as intentional.

Mental Health and Maternal Mortality—When New Life Doesn't Bring Joy

ObjectiveTo characterize the incidence and risk factors associated with maternal suicide during the peripartum period in an Alberta population. Our secondary objective was to characterize the incidence and risk factors associated with traumatic death in this same population. MethodsThis is a retrospective cohort study compared all-cause mortality with death by trauma (suicide, homicide, MVA, drug toxicity) using data collected by the Alberta Perinatal Health Program from 1998 to 2015. Data were summarized using descriptive statistics. The maternal mortality rate was calculated, and χ2 tests were used to determine between group differences with the statistical significance set at P < 0.05. ResultsThere were 206 perinatal maternal deaths in Alberta from 1998 to 2015; 68 (33%) were due to trauma, 17 (8%) were the result of suicide, 4 (2%) were the result of homicide, and 24 (12%) were related to drug toxicity. The pregnancy-related maternal mortality rate for suicide up to 365 days after birth was 2.05 deaths per 100 000 deliveries. Of these, 29.4% occurred during pregnancy and 70.6%, in the first year postpartum. For homicides, 62.5% of occurred in pregnancy and 37.5% occurred in the first year postpartum. ConclusionClose to 1 in 5 maternal deaths in Alberta is related to suicide or drug toxicity. We must escalate strategies to prevent deaths from suicide and drug toxicity, as well as increase funding for mental health and addictions screening and treatment.

50 Years Post Controlled Substances Act: The War on Drugs Rages on with Opioids at the Forefront

The words “Opioid Epidemic” are not hyperbole or a misguided use of words in describing the scope of this tragedy in the United States and resultant impact on society. Nearly 200 people die each day from a drug overdose, with nearly 70% of those dying from an opioid-related overdose. Roughly two million Americans have a substance use disorder (SUD) related to prescription opioid pain medication. An estimated eight million children live with at least one parent with a substance use disorder. Thirty-five percent of children who entered the foster care system in 2016 were removed from their parents due to parental substance abuse. Between 1999 and 2016, nearly 9,000 children died as a result of opioid poisoning; 88% of those were classified as “unintentional deaths,” five percent were the result of suicide, and two percent due to homicide. When broken down further by age group, nearly one quarter of all children under the age of five who died of opioid poisoning, died as a result of homicide. Undoubtedly, there is a crisis and undoubtedly there is no quick fix. When a person dies from an overdose, practitioners do not use universal classifications or definitions to determine and record the cause of death; however, according to the Centers for Disease Control (CDC), nearly 40% of all opioid overdose deaths in the United States in 2017 involved a prescription opioid, and roughly one third were due to heroin overdose. Over 47,000 of the roughly 70,000 overdose deaths in 2017 were related to opioids. As a point of reference, opioid related deaths exceeded the number of individuals killed in car accidents for the first time in 2017. Opioids have been touted as a gateway drug and by way of illustration, among those who initially started using heroin between 2000 and 2013, nearly 75% reported having misused prescription opioids prior to starting heroin, compared to the 1960’s where 80% of heroin users in treatment reported starting heroin prior to using any prescription opioids. As a result of the staggering statistics linking prescription opioids directly to overdose deaths and heroin addiction, this article focuses on how prescription opioids created the quagmire our nation is mired in today. Today, in the United States, opioids include both prescription medications designed to treat pain, such as hydrocodone, oxycodone, and fentanyl, medications designed to treat opioid addiction, such as methadone and Suboxone as well as heroin and illicitly manufactured fentanyl. The opioid epidemic as it is known today, is complex and there is no simple “quick fix” solution.

Suicide prevention in mental health services: A qualitative analysis of coroners' reports.

Suicide is a major concern for mental health nurses because of its clear correlation with mental illness. In New Zealand, coroners investigate all deaths that appear to be a result of suicide, and provide reports to mental health services (MHS). The aim of the present study was to investigate coronial recommendations to MHS in relation to suicide prevention and to examine clinical and family responses to these. The present study was a three-phase design: (i) analysis of coroners' recommendations related to suicide in MHS; (ii) interviews with clinicians for their response to the recommendations; and (iii) interviews with individuals working with families of consumers of MHS for their responses in relation to family-related recommendations. A qualitative content analysis was conducted on the recommendations from coroners, the interviews with clinical leaders, and the focus group for family workers. Coroners recommended that MHS should implement suicide-prevention strategies that would facilitate improved communication, risk containment, service delivery, and family involvement. Clinicians agreed with most recommendations, apart from those related to risk containment. Family workers endorsed the coronial perspective that family inclusion in MHS was suboptimal. Coroners, MHS, and mental health nurses need to consider the latest clinical evidence for suicide prevention. However, given the complexity of factors that influence suicide, it is important to be realistic about MHS role in preventing suicide, but ensure that MHS provide interventions for which there is evidence, including facilitating family participation and providing access to psychotherapies.

Bridgend “Bebo Internet Suicide Cult” and ritual violence in Wales

IntroductionIn a small South Wales town 17 teenagers seemingly committed suicide through hanging in 2008 triggering national media coverage. In the same region, several “Satanist” offenders were successfully prosecuted since.ObjectivesThis paper raises awareness of this “suicide epidemic” and its possible links to ritual violence ideologies.AimsThe research explores how “mind control” through secret societies can lead to suicide and murder.MethodsThe research was prompted by client disclosures of a crime series that lead to a false “delusional” diagnosis. Review of the sparse literature and media coverage was used to ascertain themes.ResultsColin Batley, a self-styled Satanist high priest, was sentenced for child sexual abuse alongside 4 others. His son Damien had died through aspiration when filming himself in a “sexual stimulation game”.Ian Watkins, disgraced singer of “The Lost Prophets”, was sentenced for abusing two babies provided by two “super-fan” mums. Peaches Geldorf tweeted their names, got a tattoo of O.T.O, a Satanist “kinky sex” group and was found dead a year later.Albert and Carole Hickman were sentenced for sexually abusing an 11-year-old including “sucking blood”.Matthew Williams cannibalised his victim before being killed with a police taser.Conclusions“Hanging” and “Over-dosing” could be the result of suicide or of “being suicided”. The abuse crimes of all three Satanists convicted in the last 15 years in UK courts occurred in South Wales. Associated violent death in the vicinity of the cases and authority irregularities suggest the operation of an “Organised ritualised crime abuse network” posing challenges for psychiatry.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Self-harm and suicide before and after spinal cord injury: a systematic review.

This is a systematic literature review. The objectives of this study were to investigate, first, the proportion of spinal cord injury (SCI) caused by suicidal behaviour; second, the proportion of deaths in the SCI population caused by suicide; and third, the risk factors associated with suicidal behaviour. This study was conducted in the UK. AMED, EMBASE, HMIC, BNI, Medline, PsycInfo, CINAHL and HEALTH BUSINESS ELITE were searched between January and February 2016, identifying a total of 404 articles published between 1990 and 2016. Full articles, written in English, looking at suicide before and after SCI were selected. On the basis of the inclusion criteria, 22 relevant articles were included in this literature review. Studies reported that between 0 and 6.8% of individuals with SCI had acquired their injury as a result of attempted suicide. The predominant method used in these attempts was deliberate falling/jumping from buildings and bridges. Suicidal behaviour post SCI was frequently reported as a cause of death; studies reported that between 5.8 and 11% of deaths were a result of suicide. The predominant methods used were gunshot and overdose. Psychiatric diagnoses were identified to be a major risk factor for suicidal behaviour. Individuals with SCI are at risk of attempting suicide; this risk is increased by the presence of a psychiatric diagnosis. There is a crucial need for risk assessment and psychological intervention for individuals with mental health issues following SCI.

Suicide by asphyxiation with or without helium inhalation in the region of Amsterdam (2005–2014)

IntroductionAnnually about 28% of the 5800 death of unnatural cause in the Netherlands are a result of suicide. In 2012 and 2013 a movie and a book were published about a “dignified end of life” which also described the suicide using the exit bag to establish asphyxia using helium. The purpose of this study is to investigate if the suicide methods changed since the publicity in 2013 about suicidal asphyxiation by using helium gas. This study especially focuses on suicide using the ‘exit bag’ with or without helium gas. Material and methodsIn the period 2005 to 2014 all suicides in the region of Amsterdam-Amstelland and Zaanstreek-Waterland were analyzed and from these suicides cases using the exit bag were selected. ResultsThe study shows a rising trend with the use of the helium (P > 0.01) and a decreasing trend for suicide by asphyxia using an exit bag (P < 0.05). The data does not show a sudden difference, but there seems to be a gradually change. DiscussionThe number of suicides using the helium method is rising in Amsterdam-Amstelland and Zaanstreek-Waterland, while suicides by asphyxiation without helium are decreasing. The specific publicity of books about suicides using helium may have influenced this transition.

Arsenic and Clam Chowder: Murder in Gilded Age New York by James D. Livingston

284 ■ NEW YORK HISTORY voice to the experiences of Dominican women as bodegas, supermarkets, and car services are all largely the domains of men. Overall, Making New York Dominican is an excellent read for those interested in New York City, the history and ethnography of business, labor and labor rights, and gender and ethnic and identity studies. Arsenic and Clam Chowder: Murder in Gilded Age New York By James D. Livingston. Albany: State University of New York Press, 2010, pages, $19.95 Cloth. Reviewed by Jeffrey A. Johnson, Providence College James Livingston’s Arsenic and Clam Chowder offers a helpful glimpse into Gilded Age America. Livingston frames a very specific moment— the acts of accused murderer Mary Alice Fleming—as part of a much broader story of late-nineteenth-century U.S. attitudes toward among other things, wealth, gender, and justice. The tale centers on the events of August 30, 1895, and Evelina Bliss, the heir to a notable New York family fortune built on generations of land acquisition around the state. On that fateful summer day, Bliss had a bowl of clam chowder delivered to her by a pair of ten-year-olds: granddaughter Gracie and her friend Florence King. Bliss’s daughter Mary Alice Fleming, staying six blocks away at the Colonial Hotel, sent the two girls to deliver the leftover chowder. Evelina suffered much of the day and eventually died that evening. The attending physician, Dr. William Bullman, noticed a residue in the soup bowl and suspected foul play. Authorities arrested Mary Alice and she spent the following months in custody at New York City’s notorious prison, the Tombs. Newspapers quickly recounted the fascinating tale and the equally captivating character at its center, the suspicious daughter of the victim, who always dressed in mourning black. Reports quickly confirmed Dr. Bullman’s suspicions: that some kind of contaminant , probably arsenic, may have caused gastritis and was the key factor leading to Evelina’s death. The ensuing trial of the daughter who killed her mother was highly anticipated and widely followed. At the head of the prosecution stood New York City’s Assistant District Attorney, John McIntyre, and his Deputy Book Reviews 285 Assistant District Attorney Seaman Miller. The two focused their case on a number of arguments and key witnesses. Mary Alice, the team contented, longed for and stood to benefit from the significant Livingston family inheritance. Additionally, famed chemist Dr. Walter T. Scheele emerged as one of the crucial witnesses for their case. Arsenic, he claimed, was at levels well beyond the lethal amount, which reinforced the testimony of Dr. Bullman, who confirmed the culprit as an “irritant poison.” Another chemist testifying for the prosecution, Columbia University’s Dr. Henry Mott, also concluded the contents of Evelina’s stomach contained three times the fatal amount of arsenic (101). For their part, the defense, led by Mary Alice’s attorney Charles W. Brooke, needed only to cast “reasonable doubt” in the minds of jurors. Undeniably, Bliss died shortly after ingesting the clam chowder, but Brooke and his colleagues took the opportunity to suggest other alternatives . Her death might have been the result of suicide. They also blamed Evelina’s rather poor health. Although only fifty-three years old, she had a bad heart and weak kidneys. Brooke even posited that Bliss was an “arsenic eater,” like many at the time that used it to improve their skin tone. Finally, the defense attempted to undermine Dr. Scheele’s credibility, going as far as to charge that for reasons of his own professional reputation, he might have planted the arsenic. After five hours of deliberation, the jury handed down a verdict of not guilty. The acquittal was front-page news for both the New York Herald and New York World. When Mary Alice left jail in the rain the next day (she chose to stay overnight to spare her youngest child the cold night air) she retreated to New Jersey. The New York Journal printed a final message from her, reminding readers of her “friendly” relationship with her mother and detailing many of the “foolish” assertions made by the prosecution. After avoiding the death penalty Fleming, rather oddly—though...

Missile injury to the pediatric brain in conflict zones

This study was conducted both prospectively and retrospectively at one center over a period of 8 years. The population consisted of all patients with both an age 18 years or younger and a diagnosed penetrating missile injury (PMI) during the study interval. The authors analyzed factors determining outcome and demographic trends in this population, and they compared them with those in the more developed world. Fifty-one patients were the victims of armed conflict, although no one was directly a party to any battle. This mechanism of injury is in strong opposition to data in the literature from developed countries, in which most missile injuries are the result of suicide or homicide or are even sports related. Moreover, all previous studies on the pediatric population have considered only injuries from gunshots, but authors of the current study have included injuries from other penetrating missiles as well. On cross tabulation analysis using the chi-square test, the factors shown to correlate with outcome included the Glasgow Coma Scale (GCS) score, pupillary abnormalities, patient age, hemodynamic status, and bihemispheric damage. On multinomial regression analysis, the two strongest predictors of death were GCS score and pupillary abnormalities. The GCS score and hemodynamic status were the strongest predictors of disability. There was no difference in the prognostic factors for PMI between developing or more developed countries. Glasgow Coma Scale score, pupillary abnormalities, and hemodynamic status were the strongest predictors of outcome. In conflict zones in developing countries the victims were mostly innocent bystanders, whereas in the more developed countries homicides and suicides were the leading etiological factors.

Accidental Hanging Deaths in Children in Konya, Turkey Between 1998 and 2007*

In general, hanging cases are the result of suicide, and accidental and homicidal hanging cases are rarely seen. This study retrospectively investigated 4571 death examinations and autopsies that were performed at The Konya Branch of the Forensic Medicine Council (Turkey) between 1998 and 2007; hanging was involved in 201 (6.5%) of the cases. There were a total of 13 accidental hanging cases, where 12 of these involved children. In seven of the cases, the accidental hanging involved a scarf that wraps around swing-like cradles and is intended to prevent infants from falling down. It was concluded that accidental hanging deaths can be reduced by replacing swing-like cradles with cribs that are designed for children, removing ropes in and around the house, and preventing children from reaching and/or playing with rope-like objects.

CAEP Position Statement on Gun Control

EXECUTIVE SUMMARYFirearm-related injury and death continue to be a significant problem in Canada. Since the 1990s Canadian emergency physicians (EPs) have played an active role in advocating for gun control. This paper updates the Canadian Association of Emergency Physician's (CAEP's) position on gun control. Despite a media focus on homicide, the majority of firearm-related deaths are a result of suicide. Less than 40% of firearm-related injuries are intentionally inflicted by another person. Since the implementation of Canada's gun registry in 1995, there has been a significant reduction in firearm-related suicides and intimate partner homicides. Proposed weakening of gun laws in Canada will have a significant impact on firearm-related mortality and injury. There must be instead an expansion of programs focused on prevention of suicide, intimate partner violence and gang-related violence.The majority of intentional or unintentional firearm-related injuries involve a violation of safe storage or handling practice. The potential for future harm because of unsafe storage or handling or through gang conflict retribution supports our position that health care facilities report gunshot wounds (GSWs). Moreover, a nationwide surveillance system is necessary to support research and to guide future public policy development and legislation.As EPs we must advocate for injury control. All firearm injuries and deaths are preventable, and we must advocate for a multifaceted approach in order to minimize this risk to our patients.

An Extension and Test of Sutherland's Concept of Differential Social Organization: The Geographic Clustering of Japanese Suicide and Homicide Rates

In an effort to explain the spatial patterning of violence, we expanded Sutherland's (1947) concept of differential social organization to include the level of deviance exhibited by neighboring areas. To test the value of this extension, the geographic clustering of Japanese suicide and homicide rates is assessed using 1985 and 1995 data for prefectures. Univariate results show that both types of violence cluster significantly in space. Inconsistent with the proposed expansion of differential social organization, multivariate results show that proximity to homicide does not increase the risk of homicide in Japan. Results for suicide are supportive and suggest that proximity to higher rates of suicide exposes residents to cultural values that support suicide and to role models who have committed suicide.

Brain Region Specific Alterations in the Protein and mRNA Levels of Protein Kinase A Subunits in the Post-Mortem Brain of Teenage Suicide Victims

Protein kinase A (PKA), a critical component of the adenylyl cyclase signaling system, phosphorylates crucial proteins and has been implicated in the pathophysiology of depression and suicide. The objective of the study was to examine if changes in PKA activity or in the protein and messenger RNA (mRNA) expression of any of its subunits are related to the pathophysiology of teenage suicide. We determined PKA activity and the protein and mRNA expression of different subunits of PKA in cytosol and membrane fractions obtained from the prefrontal cortex, (PFC) hippocampus, and nucleus accumbens (NA) of post-mortem brain from 17 teenage suicide victims and 17 nonpsychiatric control subjects. PKA activity was significantly decreased in the PFC but not the hippocampus of teenage suicide victims as compared with controls. However, the protein and mRNA expression of only two PKA subunits, that is, PKA RIalpha and PKA RIbeta, but not any other subunits were significantly decreased in both membrane and cytosol fractions of the PFC and protein expression of RIalpha and RIbeta in the NA of teenage suicide victims as compared to controls. A decrease in protein and mRNA expression of two specific PKA subunits may be associated with the pathogenesis of teenage suicide, and this decrease may be brain region specific, which may be related to the specific behavioral functions associated with these brain areas. Whether these changes in PKA subunits are related to suicidal behavior or are a result of suicide or are specific to suicide is not clear at this point.

Late mortality after head injury

Objectives: To investigate mortality trends in a cohort of people admitted to a regional head injury unit with all severities of injury in the calendar year 1981. Methods: A computerised...

Impact of a newly opened prison on an accident and emergency department

Objective: To determine the impact of a newly opened prison on an accident and emergency (A&E) department. Method: A new category B prison opened in April 1999, the first privately...

Socioeconomic inequalities in injury: critical issues in design and analysis.

Injuries continue to place a tremendous burden on the public's health and rates vary widely among different groups in the population. Increasing attention has recently been given to the effects of socioeconomic status (SES) as a determinant of health among both individuals and communities. However, relatively few studies have focused on the influence of SES and injuries. Furthermore, those that have, and the other injury studies that have included measures of SES in their analysis, have varying degrees of conceptual and methodological rigor in their use of this measure. Recent advances in data linkage and analytic techniques have, however, provided new and improved methods to assess the relationship between SES and injuries. This review summarizes the relevant literature on SES and injuries, with particular attention to study design, and the measurement and interpretation of SES. We found that increasing SES has a strong inverse association with the risk of both homicide and fatal unintentional injuries, although the results for suicide were mixed. However, the relationship between SES and nonfatal injuries was less consistent than for fatal injuries. We offer potential explanatory mechanisms for the relationship between SES and injuries and make recommendations for future research in this area.

Outrageous Fortune: The Risk of Suicide in Genetic Testing for Huntington Disease

Why do people kill themselves? In many cases we never know for certain, but it must usually mean that life has become unbearable. The “slings and arrows of outrageous fortune” can no longer be tolerated, and suicide becomes a means to “take arms against a sea of troubles and, by opposing, end them” (Shakespeare's Hamlet, act III, scene I). For some persons, Huntington disease (HD) becomes one of those unbearable burdens. In his original description of the disease, George Huntington (1872) himself referred to HD as “that form of insanity that leads to suicide” (p.