Self-harm Deaths Research Articles

Effects of fine particulate matter bound heavy metals on intentional self-harm deaths in Guangzhou, China, insight from core chemical constituents.

Fine particulate matter (PM2.5) is one of the major threats to human health, and may partly responsible for intentional self-harm deaths, while the limited results seemed contradictory. Further analysis on PM2.5 constituents may provide more reliable evidence. Heavy metals are crucial toxic components of PM2.5 that may induce suicide behavior. What role do PM2.5-bound heavy metals play in a threat to intentional self-harm death is still unclear. Two-year data of daily PM2.5-bound heavy metals (including metalloids) and daily intentional self-harm deaths were collected in Guangzhou. Bayesian kernel machine regression, weighted quantile sum, and quantile-based g-computation models were employed to depict the relationships between heavy metals and intentional self-harm deaths. The number of intentional self-harm deaths was 217 and 283 for 2015 and 2016, respectively. A positive correlation was found between the combined effect of the 13 heavy metals and intentional self-harm deaths. Nickel, cadmium, and iron were the primary contributors to this positive correlation. Heavy metal components play significant roles in PM2.5-related intentional self-harm deaths, and targeted source control measures are warranted to protect residents from suicide.

Social Media Insight: Predicting Self-Harm Trends

Poisoning or injuring oneself can cause death or injury without intent. This is self-harm. Self-harm harms the perpetrators and the nation's economy. Studies have linked increased urbanization in emerging nations to rising self-harm and new technology. National self-harm patterns may be important for policymakers and public health experts to predict. This would allow them to immediately fix issues or avoid disasters. Studies have forecasted population-level self-harm patterns in many nations using simple statistics. In certain nations, prior data may be scarce or insufficient to make reliable projections. This makes it tougher to FAST assess and anticipate national self-harm. This essay proposes FAST, a technique that uses mental indicators from social media to forecast national self-harm trends. These markers can represent community mental health and help forecast self-harm patterns. Language-agnostic algorithms are taught to first identify mental indicators in gathered social media communications. These signals form multivariate time series. The time-delay embedding method then places these events in time. Last, many machine learning regressors are tried for future prediction. Tweets with 12 mental indicators may predict self-harm-related fatalities and injuries, according to a Thailand research. The suggested method predicted self-harm deaths and injuries. Better than ARIMA baseline by 43.56% and 36.48%. We think our research is the first to predict national self-harm trends using social media data. The findings improve self-harm prediction and establish the framework for new social network-based apps that forecast socioeconomic aspects. We used the top machine learning algorithms, Decision Tree and Voting Regressor. We found less MAE mistakes with these techniques.

The burden of suicide across different altitudes: 11-year geodemographic analysis conducted in 221 cantons in Ecuador ranging from 0 to 4300 m of elevation.

The World Health Organization and the Global Burden of Disease study estimate that almost 800 000 people die from suicide yearly. The role of non-traditional risk factors such as climate and high-altitude exposure are poorly understood. This study aims to determine a potential relationship between altitude exposure and suicide rates among 221 cantons located at different altitudes ranging from 0 to 4300 m. We conducted an 11-year, country-wide, population-based analysis on age- and gender-standardised suicide rates in Ecuador, based on the official data from the National Institute of Statistics, using all available self-harm death codes (ICD-10 codes X60-X84). A total of 11 280 cases of suicide were reported during 2011-2021. Suicide rates were higher among men (11.48/100 000). In terms of elevation, suicide rates were significantly higher among people from high-altitude cantons (3.7/100 000) versus those from low-altitude cantons. When applying the International Society Mountain Medicine categorisation, suicide rates were significantly higher at moderate- (4.3/100 000), high- (3.6/100 000) and very-high-altitude cantons (4.4/100 000) when compared with low-altitude locations (2.5/100 000). Ecuador is one of the few countries that has a vast range of cantons located at different altitudes. We found that living at higher elevations is positively associated with greater suicide rates. Although the rates are significantly greater as elevation increases, a clear linear relationship is not apparent, likely because of the interplay of socioeconomic factors, including urbanicity. The effect of chronic hypobaric hypoxia on mood cannot be ruled out, although the existence of causal mechanisms remains to be elucidated.

Patterns and predictors of ten-year mortality after discharge from community-based post-acute care for acquired brain injury: A retrospective cohort study (ABI-RESTaRT), Western Australia, 1991–2017

BackgroundSurvivors of acquired brain injury (ABI) are left with long-term disability and an increased risk of mortality years post-injury. ObjectiveTo examine 10-year mortality in adults with ABI after discharge from post-acute care and identify modifiable risk factors to reduce long-term mortality risk. MethodsRetrospective cohort study of 586 adults with traumatic (TBI) or non-traumatic brain injury (NTBI), or neurologic condition, consecutively discharged from a post-acute rehabilitation service in Western Australia from 1-Mar-1991 to 31-Dec-2017. Data sources included rehabilitation records, and linked mortality, hospital, and emergency department data. Survival status at 10 years post-discharge was determined. All-cause and cause-specific age- and sex-adjusted standardised mortality ratios (SMR) by ABI diagnosis were calculated using Australian population reference data. Risk factors were examined using multilevel cox proportional hazards regression. ResultsCompared with the Australian population, 10-year all-cause mortality was significantly elevated for all diagnosis cohorts, with the first 12 months the highest risk period. Accidents or intentional self-harm deaths were elevated in TBI (13.2, 95%CI 5.4; 12.1). Neurodegenerative disease deaths were elevated in Neurologic (21.9, 95%CI 13.0; 30.9) and Stroke (19.8; 95%CI 2.4; 27.2) cohorts. Stroke (20.8; 95%CI 7.9; 33.8) and circulatory disease deaths (6.2; 95%CI 2.3; 9.9) were also elevated in Stroke. Psychiatric comorbidity was the strongest risk factor followed by older age, geographical remoteness, and cardiac, vascular, genitourinary and renal comorbidity. Clinically significant improvement in functional independence and psychosocial functioning significantly reduced mortality risk. ConclusionsIndividuals with ABI have an elevated risk of mortality years post-injury. Comorbidity management, continuity of care, and rehabilitation are important to reduce long-term mortality risk.

Trends in Suicide Methods in Korea; 1997-1999 and 2017-2019

Objectives: The aim of this study was to examine trend of the gender and age death rate of intentional self-harm in Korea 1997-1999 and 2017-2019. The analysis was based on data of intentional self-harm deaths from the 1997-1999 (21,937 deaths) and 2017-2019 (39,920 deaths) vital statistics of Korea.Methods: We are analyzed annual data from 1997-1999 and 2017-2019 for Korea in order to examine trends in the rates and methods of suicide. Data on suicide methods were obtained from the death certificate data (1997-1999 and 2017-2019) of Korea Statistics.Results: The common methods in 1997-1999 were hanging (37.6%), poisoning (37.2%), and jumping (9.5%). In 2017-2019, hanging (51.9%) has surpassed poisoning (26.2%) as the most often used method. The preferred suicide methods were hanging and poisoning in Korea. Through 2003-2011, the suicide rate (per 100,000 population) increased from 26.0 to 40.7 in male and increased from 10.7 to 16.2 in female, There was a decline in rates of poisoning and drowning in both gender but an increase in hanging and jumping by both gender during the period. Age specific suicide rate increased with advanced age in both gender. The odds (2017-2019) were greater than the odds (1997-1999) in both gender.Conclusions: All age suicide rates of hanging increased in both gender. there was decline in age specific rate of poisoning in both gender.

An intervention to improve safe firearm storage for adolescents presenting with suicide ideation or attempt in a pediatric emergency department

BackgroundFirearm injuries are the second leading cause of death in American youth aged 15 to 24, and over half of these deaths are suicides. Self-harm deaths in Wisconsin among adolescents have increased by 34% since 2006. Each year, our pediatric emergency department (ED) staff care for over 1100 children and adolescents who present with suicidal ideation or self-harming behaviors. We implemented an ED-based program aimed at improving the education given to families on reducing self-directed violence and providing firearm storage devices to families with the goal of reducing access to lethal means.Program descriptionOur program takes place in the pediatric ED of an academic children’s hospital and seeks to assist families of all patients who present with suicidal ideation or suicide attempt (SI/SA). In collaboration with our social workers, we reviewed their processes for interviewing and counseling families of patients who present with SI/SA. Social workers previously used a hospital-wide patient and family education sheet for safety planning that included information about safely storing medications and community mental health services. We teamed with our hospital’s health literacy and education committees and revised the teaching sheet to include more in-depth information about safe firearm storage. For families who were interested, we developed a process to provide up to two firearm lockboxes equipped with a combination lock. Working with risk management, the parent injury prevention product liability form was updated to include firearm lockboxes.ConclusionWe implemented a safe firearm storage program including development of a patient and family education sheet and provision of firearm lockboxes to families. Next steps under consideration include providing lockboxes for safe medication storage and establishing a follow-up system to assess proper use of firearm lockboxes and family and social worker satisfaction.

Examining the association between the COVID-19 pandemic and self-harm death counts in four Canadian provinces

Governments implemented lockdowns and other physical distancing measures to stop the spread of SARS-CoV-2 (COVID-19). Resulting unemployment, income loss, poverty, and social isolation, coupled with daily reports of dire news about the COVID-19 pandemic, could serve as catalysts for increased self-harm deaths (SHD). This ecological study examined whether observed SHD counts were higher than predicted SHD counts during the pandemic period in the Canadian provinces of Alberta, British Columbia, Ontario, and Québec. The study also explored whether SHD counts during the pandemic were affected by lockdown severity (measured using the lockdown stringency index [LSI]) and COVID-19 case numbers. We utilized publicly available SHD data from January 2018 through November 2020, and employed AutoRegressive Integrated Moving Average (ARIMA) modelling, to predict SHD during the COVID-19 period (March 21 to November 28, 2020). We used Poisson and negative binomial regression to assess ecological associations between the LSI and COVID-19 case numbers, controlling for seasonality, and SHD counts during the COVID-19 period. On average, observed SHD counts were lower than predicted counts during this period (p < 0.05 [except Alberta]). Additionally, LSI and COVID-19 case numbers were not statistically significantly associated with SHD counts.

Barbiturate-related hospitalisations, drug treatment episodes, and deaths in Australia, 2000-2018.

To determine the characteristics and population rates of barbiturate-related hospitalisations, treatment episodes, and deaths in Australia, 2000-2018. Analysis of national data on barbiturate-related hospitalisations (National Hospital Morbidity Database, 1999-2000 to 2017-18), drug treatment episodes (Alcohol and Other Drug Treatment Services National Minimum Data Set, 2002-03 to 2017-18), and deaths (National Coronial Information System, 2000-01 to 2016-17). Population rates directly age-standardised to the 2001 Australian standard population; average annual percentage change (AAPC) in rates estimated by Joinpoint regression. We identified 1250 barbiturate-related hospitalisations (791 cases of deliberate self-harm [63%]), 993 drug treatment episodes (195 cases with barbiturates as the principal drug of concern [20%]), and 511 deaths during the respective analysis periods. The barbiturate-related hospitalisation rate declined from 0.56 in 1999-2000 to 0.14 per 100000 population in 2017-18 (AAPC, -6.0%; 95% CI, -7.2% to -4.8%); the declines in hospitalisations related to accidental poisoning (AAPC, -5.8%; 95% CI, -9.1% to -2.4%) and intentional self-harm (AAPC, -5.6%; 95% CI, -6.9% to -4.2%) were each statistically significant. Despite a drop from 0.67 in 2002-03 to 0.23 per 100000 in 2003-04, the drug treatment episode rate did not decline significantly (AAPC, -6.7%; 95% CI, -16% to +4.0%). The population rate of barbiturate-related deaths increased from 0.07 in 2000-01 to 0.19 per 100000 population in 2016-17 (AAPC, +9.3%; 95% CI, +6.2-12%); the rate of intentional self-harm deaths increased (AAPC, +11%; 95% CI, +7.4-15%), but not that of accidental deaths (AAPC, -0.3%; 95% CI, -4.1% to +3.8%). While prescribing and community use of barbiturates has declined, the population rate of intentional self-harm using barbiturates has increased. The major harm associated with these drugs is now suicide.

Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilisation.

BackgroundSuicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia.MethodsA retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010–2015 from the National Coronial Information System.ResultsThere were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010–2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated.ConclusionsHigher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.

Associations of firearm dealer openings with firearm self-harm deaths and injuries: A differences-in-differences analysis.

BackgroundFirearm dealer density is correlated with firearm interpersonal violence, but no quasi-experimental studies have assessed whether changes in dealer density lead to changes in firearm self-harm injuries and deaths. We assessed whether openings of firearm dealers are associated with short-term changes in local firearm self-harm injury rates.MethodsWe identified 718 openings of firearm dealers in California using licensing data, 2014–2016. We defined exposure regions based on aggregations of zip codes defined by proximity to firearm dealer openings and matched each opening to four control regions on time and determinants of firearm injury. We applied a differences-in-differences approach to compare rates of firearm self-harm, in the month before and after each opening, in places with and without openings.ResultsFirearm dealer openings were not associated with acute, local changes in firearm self-harm relative to places without openings (ratio of rate ratio: 0.90 [95% CI:0.68–1.19]). Results were robust to numerous sensitivity and secondary analyses.ConclusionWe found no associations of firearm dealer openings with acute, localized firearm self-harm deaths and injuries. Our focus on acute, local effects; broad availability of dealers and firearms; durability of firearms; or strong confounding-control may explain these null findings.

Epidemiologic Trends in Fatal and Nonfatal Firearm Injuries in the US, 2009-2017

Firearm injury research in the US has focused on fatal injuries. The incidence and epidemiologic factors associated with nonfatal firearm injuries are less understood. To evaluate estimates of incidence and trends over time of fatal and nonfatal firearm injuries. A cross-sectional, ecologic study was conducted using data throughout the US from 2009 to 2017. Data on fatal injuries from the Centers for Disease Control and Prevention were combined with national data on emergency department visits for nonfatal firearm injury from the Nationwide Emergency Department (ED) sample. Data analysis was conducted from August 2019 to September 2020. Firearm injuries identified with International Classification of Diseases external cause of injury codes and categorized by intent of injury, age group, and urban-rural location. Incidence, case fatality rate, and trends over time of firearm injury according to intent, age group, and urban-rural location. From 2009 to 2017, there was a mean of 85 694 ED visits for nonfatal firearm injury and 34 538 deaths each year. An annual mean of 26 445 deaths (76.6%) occurred outside of the hospital. Assault was the most common overall mechanism (38.9%), followed by unintentional injuries (36.9%) and intentional self-harm (19.6%). Self-harm, which accounted for 21 128 deaths (61.2%), had the highest case fatality rate (89.4%; 95% CI, 88.5%-90.4%), followed by assault (25.9%; 95% CI, 23.7%-28.6%) and legal intervention (23.4%; 95% CI, 21.6%-25.5%). Unintentional injuries were the most common nonfatal injuries (43 729 [51.0%]) and had the lowest case fatality rate (1.2%; 95% CI, 1.1%-1.3%). Self-harm deaths, 87.8% of which occurred outside the hospital, increased in all age groups in both rural and urban areas during the study period and were most common among people aged 55 years and older. The rate of fatal assault injuries was higher in urban than in rural areas (16.6 vs 9.0 per 100 000 per year) and highest among people aged 15 to 34 years (38.6 per 100 000 per year). Rates of unintentional injury were higher in rural than in urban areas (18.5 per 100 000 vs 12.4 per 100 000). In this cross-sectional study, suicide appears to be the most common cause of firearm injury death in the US, and most people who die from suicide never reach the hospital. These findings suggest that assaults and unintentional injuries account for most nonfatal and overall firearm injuries and for most of the injuries that are treated in hospitals.

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

Fatal intentional drowning in Australia: A systematic literature review of rates and risk factors.

Unintentional drowning deaths are only part of the drowning profile, with little attention being paid to intentional drowning in Australia. Strategies for the prevention of intentional drowning deaths are likely to be different from unintentional. Quality documentation, analysis and dissemination of intentional deaths data is crucial for developing appropriate strategies for prevention. To conduct a systematic literature review to investigate the mortality rates and risk factors of intentional drowning deaths in Australia. A systematic search guided by PRISMA was performed using Ovid MEDLINE, CINAHL, PsycINFO (ProQuest), Scopus, Google Scholar, and BioMed Central databases to locate relevant original research articles published between 2007 and 2018. Ten papers reporting the mortality rates and risk factors of intentional drowning deaths in Australia published between 2007 and 2018, with study periods of the included articles spanning from 1907 to 2012, were reviewed. Most studies investigated suicidal drowning deaths in Australia, none reported homicidal drowning deaths. The downward trend of fatal suicide drowning was identified in Australia. The annual rate of intentional drowning between 1994 and 2012 can be inferred from eight studies, ranging from 0.06 to 0.21 for nation-wide mortality rates. The highest annual state-wide mortality rate was identified in the state of Queensland, ranging from 0.02 to 0.11 per 100,000 individuals. Of four studies examining the risk factors of fatal intentional drowning in Australia, being of older age groups, being female, and the presence of substance use were identified as important factors for suicidal drowning deaths. The national-scale proportion of suicide drowning in Australia, ranging from 2% to 3% of all intentional self-harm deaths, was also identified. Limited publications reporting the mortality rates and risk factors of intentional drowning deaths in Australia were identified. Being of older age groups and being female were recognised as factors for suicide drowning deaths, and psychoactive substances were widely identified amongst cases. Future research on improving death reporting systems and the legal framework for medico-legal death investigation, along with the investigation of the risk factors of intentional drowning, are required to inform the planning, implementation, and evaluation of prevention interventions for intentional drowning deaths in Australia.

Behavioral Health Care And Firearm Suicide: Do States With Greater Treatment Capacity Have Lower Suicide Rates?

Firearms account for most self-harm deaths, and many more Americans kill themselves with a firearm each year than are murdered with one. Mental illness is an important risk factor for firearm suicide. While the literature focuses on firearm safety, little is understood about how the supply of behavioral health treatment services can reduce firearm suicide. We evaluated whether states with greater behavioral health treatment capacity have lower firearm suicide rates, examining variation across the United States and over time. The mean adjusted firearm suicide rate rose from 6.74 per 100,000 people in 2005 to 7.89 per 100,000 in 2015-a 17.1percent increase. We found a significant independent inverse relationship between greater behavioral health treatment capacity and the firearm suicide rate. We show that across all states, on average, a 10.0percent relative increase in behavioral health workers per state was associated with a modest 1.2percent relative reduction in the adjusted firearm suicide rate. Given this finding, we discuss whether firearm control initiatives might offer a greater protective effect for reducing firearm suicide, compared to the protective effect of increasing behavioral health treatment capacity.

Gender Ratio of Intentional Self-harm Death in Korea

Objectives To compare the gender ratio (male/female death rate) of intentional self-harm (suicide) by age and suicide methods. Methods The intentional self-harm (KCD-6: X60-X84) death data (71,739 deaths: aged 10 years and older) of Korea Statistics from 2011 to 2015 were used for this analysis. Gender ratio of suicide and 95 percent confidence interval were calculated by the age specific suicide rate and suicide methods. Results The suicide rate of males (43.5 per population of 100,000) were higher than those of females (19.1). The gender ratio of suicide was 2.28 (95% intervals: 2.24-2.32). Age specific suicide rate increased with advanced age in both gender. The gender ratio of suicide was highest in aged 60-69 years (3.38), and lowest in aged 10-19 years (1.31). The common methods of suicide was hanging, accounting for 51.3 percent of all suicide deaths. The next most common methods for suicide was jumping from a height (15.1 percent), self-poisoning by gas (12.0 percent) and pesticides (11.4 percent), and drowning (3.5 percent). The gender ratio by suicide methods was considerably high in self-poisoning by gas (4.65), 2.49 for hanging, 2.22 for drowning, 1.49 for self-poisoning by pesticides, and 1.25 for jumping from a height. The suicide rates of male were higher than those of female in most of suicide methods and all age groups (10-29 years, 30-59 years and ≥60 years), with the exception for self-poisoning by pesticide in age group 10-29 years (gender ratio: 0.81). The gender ratio of self-poisoning by gas and pesticide, hanging, and drowning increased with advanced age, while gender ratio of jumping from a height decreased with advanced age. Conclusions The gender ratio of suicide increased with advanced age in the majority of suicide methods, with the exception for jumping from a height. There is need to understanding the variations of gender ratio in suicide methods and age group. Key words: Gender ratio, Suicide rate, Intentional self-harm

Gendered risk factors associated with self-harm mortality among youth in South Africa, 2006 - 2014.

Despite efforts to reduce self-harm mortality, death rates remain high, with almost 12% of all youth deaths in South Africa (SA) attributed to this cause. There are gendered differences in causes of death among youth, but little is known about the sex-specific risk factors. To identify the levels and sex-specific determinants of self-harm mortality among youth in SA. This was a cross-sectional study of SA death notification forms from 2006 to 2014. Descriptive and analytical statistical techniques were used, including cause-specific mortality rates, proportional mortality ratios and logistic regression models. A total of 1 122 youth (15 - 24 years of age) deaths due to self-harm causes were reported over the study period, during which rates of self-harm mortality increased. More deaths of males (n=818) than females (n=304) were reported. Almost 60% of deaths (p&lt;0.05) were of 20 - 24-year-olds, and 46.4% (p&lt;0.05) of those who died had a secondary education. Almost 10% of females (p&lt;0.05) were pregnant at the time of death. Hanging was the most common type of self-harm mortality among males (79.2%) and females (49.3%). While 11.0% (n=90) of self-harm deaths of males were due to poisoning, more females used this method (39.8%, n=121). The probability of self-harm mortality for males increased according to certain provinces of residence. For females the odds were higher for those who were pregnant (odds ratio (OR) 1.3; p&lt;0.05) and non-South African (OR 1.7; p&lt;0.05) and had secondary education (OR 1.4; p&lt;0.05). The study showed gender differentials in the determinants of self-harm mortality among youth in SA. For this reason, uniform approaches to awareness campaigns need to be altered to address the specific needs of youth. While males have higher rates than females, the prevalence of self-harm mortality in pregnant females is of concern and needs to be addressed specifically, as it relates not only to suicidal ideation and behaviour but also to youth sexual and reproductive health programmes in the country.

Varying impact of co-morbid conditions on self-harm resulting in mortality in Australia.

Research has associated some chronic conditions with self-harm and suicide. Quantifying such a relationship in mortality data relies on accurate death records and adequate techniques for identifying these conditions. This study aimed to quantify the impact of identification methods for co-morbid conditions on suicides in individuals aged 30 years and older in Australia and examined differences by gender. A retrospective examination of mortality records in the National Coronial Information System (NCIS) was conducted. Two different methods for identifying co-morbidities were compared: International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) coded data, which are provided to the NCIS by the Australian Bureau of Statistics, and free-text searches of Medical Cause of Death fields. Descriptive statistics and χ2 tests were used to compare the methods for identifying co-morbidities and look at differences by gender. Results showed inconsistencies between ICD-10 coded and coronial reports in the identification of suicide and chronic conditions, particularly by type (physical or mental). There were also significant differences in the proportion of co-morbid conditions by gender. While ICD-10 coded mortality data more comprehensively identified co-morbidities, discrepancies in the identification of suicide and co-morbid conditions in both systems require further investigation to determine their nature (linkage errors, human subjectivity) and address them. Furthermore, due to the prescriptive coding procedures, the extent to which medico-legal databases may be used to explore potential and previously unrecognised associations between chronic conditions and self-harm deaths remains limited.

Drug-caused deaths in Australian medical practitioners and health-care professionals.

There are numerous factors putting health-care professionals (HCP) at a higher risk of substance abuse and premature death, including high-stress jobs, access to controlled substances, long hours of practice and constant contact with the critically ill. This study aimed to examine fatal drug toxicity in this high-risk cohort, in order to: (1) estimate the rate of drug-caused deaths of Australian HCPs; (2) describe the key characteristics of the cohort; and (3) examine the relationship between HCP occupation and drug type, or intent. Retrospective cohort study. The National Coronial Information System (NCIS), a database of cases reported to an Australian coroner. A total of 404 drug-caused deaths reported to an Australian coroner between 2003 and 2013 involving HCPs (including medical practitioners, paramedics, nurses, dentists, psychologists, pharmacists and veterinarians). χ2 tests and descriptive statistics were used to examine relationships. The primary outcome measures were drug type and intent. Covariates included occupation type, mental illness and self-harm. Females comprised nearly two-thirds of the cohort. The highest number of cases involved nurses (62.87%) and medical practitioners (18.07%). The mortality rate was highest among the veterinary group [confidence interval (CI)=42.21-58.79]. Most were intentional self-harm deaths (50.25%), followed by unintentional deaths (37.62%) (CI=92.15-109.85). Mental illness was common, diagnosed in almost half of cases (46.04%), with the majority involving depression (CI=33.48-44.12). Specific drugs were associated significantly with certain professions, such as intravenous barbiturates among veterinarians (χ2(7) =237.391). A number of cases reported additional stressors, such as relationship, work-place or financial issues, and drugs were diverted from the work-place in nearly a fifth of cases. Between 2003 and 2013, Australian health-care professionals averaged 37 deaths per year attributed to drug toxicity, with a mortality rate of nearly five deaths per 1000 employed HCPs. Drug-caused deaths among HCPs in Australia commonly involve females in their mid-40s, with a diagnosis of mental illness, personal and professional stress and the intent to self-harm.

지역별 고의적 자해에 의한 사망수준에 관한 연구

The aim of this study was to compare the regional difference of death from intentional self-harm. The analysis was based on data of intentional self-harm deaths (31,450) from the 2010-2011 vital statistics of Korea. The suicide rate (per 100,000 population) was 46.2 in male and 22.3 in female. Gender ratio (male / female) of suicide rate was 2.07, and Jeju province had the lowest gender ratio (1.82), and Chungbuk province had the highest gender ratio (2.42). In the age-gender standardized death rate (per 100,000) of self-harm by region, the highest suicide rate was observed in Gangwon province (44.8) and Chungnam province (44.3), and the lowest in Seoul metropolitan city (28.9) and Ulsan metropolitan city (29.2). There was a significant increase in the rate of suicide in city areas (odds ratio: 1.11, 95% CI: 1.08-1.13), county areas (1.62, 1.56-1.67) as compared with the rate of suicide in metropolitan areas. The commonest methods of suicide were hanging (53.7 percent), self-poisoning by pesticides (16.8 percent) and jumping from a height (14.3 percent). The methods used for suicide differed between rural (county) and urban areas (metropolitan city and city). In county areas, 43 percent of suicides used pesticides as compared to only 7-18 percent of those in urban areas. In urban areas, jumping was more common (13-17 percent vs. 6 percent). There were no difference in hanging between urban and rural areas. The odds ratio of death by pesticides was 9.86 in rural areas compared with death rate of metropolitan areas. The odds ratio of death by jumping was 0.59 in rural compared with death rate of metropolitan areas.

Farming suicides during the Victorian drought: 2001–2007

The objective of this study was to determine whether farming suicides increased in Victoria during the prolonged drought in south eastern Australia and gain an understanding of Victorian farming suicides during the period. Intentional self-harm deaths of farmers and primary producers notified to the Victorian State Coroner from 2001 to 2007 were examined to identify characteristics and determine whether the annual number of farming suicides increased. Farming suicides accounted for just over 3% of Victorian suicides. The total number of farming suicides was 110 for the period and ranged between 11 and 19 deaths per year, rising and falling inconsistently from year to year. Males accounted for nearly 95% of farming suicides, with firearms and hanging the most frequently used methods, and most deaths occurring between 30 and 59 years of age. The small number of relevant cases and fluctuations in the annual number of deaths provides no evidence of a pattern of increasing farming suicides during the drought years, when there was approximately one suicide every 3 weeks. Given the elevated suicide risk in male farmers and association with multiple psychosocial and environmental factors, it cannot be concluded, however, that suicide risk itself did not increase during this period of heightened uncertainty and stress. Drought should not be dismissed among the many risk factors, and it is possible that increased mental health awareness and community support programs targeting drought-affected areas contributed to improved management of stress and suicide risk in regional and rural Victoria over the past decade.