Suicide Mortality Research Articles

Pain in Prison: A Risk Factor Analysis of 57 Prisoners' Deaths by Suicide in Illinois, United States.

United States prisons have elevated rates of suicide deaths compared to the general population. Thus, this manuscript aims to identify suicide risk factors, using data collected in Illinois (IL) state prisons between 2013-2021. First, we present comprehensive demographic, psychological, and prison-related descriptive statistics regarding 57 suicide decedents. Next, we compared this subset to IL state population-level prison reports to identify suicide-specific risk factors. Suicide decedents were predominately male, White, serving their first sentence, had a psychiatric diagnosis, and had no work assignment. Lethal attempts frequently occurred during evening off-hours, on Wednesdays, and were preceded by "mental health decompensation" and significant life transitions. Suicide-specific risk factors included identifying as White or Asian, having an offense type of habitual criminal or sex offender, being divorced, and not having children. We close with readily implementable suggestions to reduce suicides in prisons such as increasing off-hours and shift change staffing and social support interventions.

Racial discrimination and Aboriginal and Torres Strait Islander suicide mortality rates in Queensland.

The study aimed to examine the associations between experiences of racial discrimination within communities with suicide mortality rates for Aboriginal and Torres Strait Islander people. Age-standardised suicide rates (ASRs) were calculated using suicides recorded by the Queensland Suicide Register (QSR) of Aboriginal and Torres Strait Islander people in Queensland from 2009 to 2015. Rate Ratios (RRs) were used to compare ASRs in areas with high and low levels of reported discrimination, and other comparative community-level risk and protective factors (remoteness, socio-economic resources, and Indigenous language use). The age-standardised suicide rate was 31.74 deaths per 100 000 persons/year for Aboriginal and Torres Strait Islander people for the years 2009-2015. ASRs were significantly higher in areas where more of the First Nations residents experienced recent discrimination (RR = 1.33; 95%CI = 1.05-1.70, p = 0.02), and the age-specific suicide rate was significantly higher for those aged 25-34 in areas with more discrimination (RR = 1.67; 95%CI = 1.04-2.74, p = 0.03). By comparison, the ASRs were not significantly higher in areas with regional and remote communities (RR = 1.10, CI 95%=0.75-1.61, p = 0.60), or areas with lower socioeconomic resources (RR = 0.86, 95%CI = 0.66-1.13, p = 0.28). Areas in which more First Nations residents spoke Indigenous languages had significantly lower ASRs (RR = 0.71; CI95%=0.53-0.95, p = 0.02). Suicide mortality rates for Aboriginal and Torres Strait Islander people in Queensland were influenced by experiences of racial discrimination within communities and Indigenous language use, with greater associations reported than with socio-economic resources or remoteness. The findings reflect the public health risk of discrimination and provide evidence for enacting strategies to reduce institutional and personal discrimination to reduce suicide.

Suicide Deaths Among Adolescent and Young Adult Patients With Cancer

This cohort study evaluates differences in suicide death rates across age groups of adolescent and young adult patients with cancer over time in the US.

Changes in suicide inequalities in the context of an increase and a decrease in suicide mortality: The case of South Korea, 1995–2020

South Korea experienced a sharp increase until 2010 followed by a gradual decrease in suicide mortality. This study examined changes in socioeconomic inequalities in suicide over 25 years and how suicide inequalities changed in the context of both an increase and a decrease in suicide mortality. Data with five-year intervals were extracted from the Korean death registry and census data between 1995 and 2020. Using Poisson regression, four measures of suicide inequalities were calculated for the slope of inequality index (SII), relative index of inequality, rate ratios, and ratio differences. Educational inequalities in suicide were obvious across all sub-populations, measures, and periods. The widening of suicide inequalities, particularly with absolute measures, followed an increase in suicide mortality until 2010. In contrast, a decline of suicide inequalities concurred after 2010 during the period of a decline in suicide mortality. SII among the total population decreased by 35.4%, from 62.4 per 100,000 people (95% confidence interval [CI], 59.8–64.9) in 2010 to 40.3 (95% CI, 38.3–42.4) in 2020. The pattern of widening and narrowing in suicide inequalities observed in the whole population was only concordant with the older population. However, the younger and the middle-aged population showed a gradual increase or stalemate in the inequalities throughout the period. Overall, suicide inequalities narrowed in the recent decade. This decline was largely led by the older population, and was attributed to the provision of social protection. A decline of suicide inequalities can accompany a decline in suicide mortality, when the provision of social protection favored the less educated.

Regional deprivation and suicide mortality in Germany

Abstract Background Regional deprivation has been shown to be an important determinant of suicide risk. However, little is known about regional differences in suicide mortality in Germany. Methods Data from cause of death statistics (2015 to 2021) were analyzed. Regression analysis for data with negative binomial distribution was used to examine the association between the German Index of Multiple Deprivation 2015, covering 401 districts and district-free cities in Germany, and suicide mortality. Results The adjusted rate ratio for suicide in the most deprived deprivation area compared to the least deprived area was 1.18 (95% CI [1.72, 2.00]). A sensitivity analysis shows similar rate ratios for men (1.99 (95% CI [1.80, 2.18])) and women (1.69 (95% CI [1.49, 1.92])), but a higher rate ratio for rural areas (2.29 (95% CI [2.04, 2.57])) compared with urban areas (1.51 (95% CI [1.36, 1.68])). Conclusions The findings suggest that regional deprivation is associated with suicide mortality, and call for a more targeted approach to suicide prevention in deprived regions. Key messages • Study reveals higher suicide rates in deprived regions in Germany. • Study calls for tailored prevention strategies to address this disparity.

Nationwide trends in the suicide mortality among the disabled in Korea from 2006 to 2017

Abstract Aims The disabled are one of the priority populations at risk of suicide, but there has been no study of the factors influencing suicide mortality among the disabled in South Korea. Methods To analyze age-standardized suicide mortality (ICD-10 Codes, X60-84) for each year according to the presence, severity and type of disability, we linked three population datasets (National Health Insurance Claims Database, Disability Registry, and Deaths by Cause). Our dataset covers the entire population of South Korea, extended over a 12-year period from 2006 to 2017. The analyses were stratified by sex, and hazard ratios for suicide were determined by multivariate logistic regression after adjustment for socio-demographic and clinical variables. Results The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. The highest suicide rates were observed among intellectual or mental disabled, and severe disabled. In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female. Conclusions Although the disabled people’s suicide is often seen as an individual problem, it actually affects their families, communities and society. Therefore, government must strive to emphasize the broad view of the disabled population - not just the health of individuals, and track suicide trends and identifying risk and protective factors for suicidal behavior. From this information, suicide prevention strategies for the disabled people should be evaluated to identify the most effective interventions. Financial support: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (No. 2022R1I1A3070074, and 2022R1I1A1A01068449), and a grant of Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health & Welfare, Republic of Korea (No. HC23C016500). Key messages • The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. • In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female.

Trends and gender differentials in age-specific suicide mortality, 2004-2020, Cyprus

Abstract Background Cyprus is rarely included in international studies of suicide trends and the only published national data is two decades old. In the context of the first National Strategy for Mental Health, this study assessed suicide trends in 2004-2020, spanning the 2008 global and 2012-2013 Cyprus financial recessions, but falling short of the COVID-19 pandemic due to delays in recording. Methods Suicide deaths were obtained from the Mortality Registry (ICD-10, including “undetermined”). Directly standardized rates were calculated for four gender/age groups. Annual change was estimated in Poisson regression models with interaction terms to assess differential trends over time periods. Results There were 560 deaths (4-times more in men, >80% classified as ‘violent’ in both genders). In men, the suicide rate doubled from 4-5 to 9-10 per 100000, with most of the increase prior to 2012, representing 9% annual change (Rate Ratio 1.09, 95% CI 1.03, 1.15; p = 0.002). From 2013, the trend reversed (effect modification p-value < 0.001) with 4% annual decrease (95% CI -9%, 1%). Declines were not uniform across age-groups; rates in males aged 45-64 continued to rise, surpassing the previously high rate in males 25-44. In women, rates presented a declining trajectory from 4-5 per 100000 to 2-3 over this period, widening the gender differential. M-to-F ratio was 5.33 (95% CI 3.46, 8.19) in 2017-2020 compared to 2.73 (1.88, 3.95) in 2004-2008. A shift to violent methods was observed, with hanging now ranking as most common in both females (1 in 3) and males (1 in 2). Conclusions While relatively lower compared to other European countries, the gender differential in suicide mortality has widened in Cyprus, with steep rises in all male age-groups up to 2012 and continuing rises in males 45-64, but declines in female rates over the same period. Further analysis of trends in relation to unemployment and other socio-economic indicators is warranted as well as continuous monitoring of trends. Key messages • After steep rises in suicide across all male age-groups up to 2012, against a declining trajectory in female rates, rates in males 45-64 continued to rise, further widening the gender differential. • The age profiling and shift towards more violent methods in both genders should inform the first National Strategy for Mental Health, while continuous monitoring of trends is warranted.

Economic burden of suicide in Sweden in 2022

Abstract Background Suicide and suicidal behaviors bring massive human, social and economic impacts. Estimates of the cost of suicide can give some guidance as to where research on developing new interventions might be focused to give the greatest potential gain. The aim of the study is to quantify the economic cost of suicide in Sweden in 2022. Methods Incidence of suicide attempts and mortality due to suicide, intentional and undetermined (ICD10 X60-X84 and Y10-Y34) were sourced from the Swedish National Board of Health and Welfare databases for 2022. Cost were estimated from a societal perspective, including costs for inpatient and outpatient care, medication, police and justice activities as well as productivity losses due to early mortality. Results In 2022, a total of 1,569 suicide death were registered in Sweden (1,102 men and 467 women). The incidence rate remains stable during the last ten years, 17 death per 100 000. In total, 18,854 patients (10, 359 women and 8,459 men) were treated in inpatient and outpatient hospital care with suicide-related diagnoses, generated 32,843 days in inpatient care and 11,471 outpatient care visits. Direct costs for suicide death including forensic examination, emergency services, police investigation and property damage were estimated as €6,02 million, while indirect costs for productivity losses totaled €690 million. Direct healthcare costs for suicide related treatment were estimated at €54.3 million. Overall, suicide and suicide attempts cost around €750 million per year to society. Conclusions Estimates of the economic burden of suicide are needed for the Swedish setting, and these amounted to €60.3 million in direct costs and €690 million in indirect costs in 2022. The cost might be underestimated because the societal cost of suicide bereaved persons was not considered. These cost estimates can provide useful inputs to a cost-effectiveness analysis of a specific preventive intervention, and to its subsequent evaluation. Key messages • Economic burden of suicide is substantial for society. • Public health policies aimed at the prevention of suicide should be increased.

Self-harming behaviours and social support among a sample of young men in Belfast, Northern Ireland

Abstract Background Psychiatric morbidity is substantially higher in Northern Ireland (NI) than in peer nations and men are disproportionately represented in suicide mortality data, particularly at early adulthood and middle age. To better scale interventions to reduce morbidity and mortality among young men, a mixed-methods study was conducted combining interviews and validated quantitative tools. Methods A non-random community sample of 30 working-class young men in Belfast aged 16-19 was recruited via organisations focused on job training, restorative justice, and youth work. Participants completed the Self-Harm Inventory and a semi-structured interview. Analyses were completed in NVivo and RStudio. Results The prevalence of self-harm was more than 8 times higher than for the general population of adolescents in NI, with 83.3% reporting ever engaging in self-harm. Only 2 of the 28 participants reported making a suicide attempt and most injuries were minor, suggesting nonsuicidal self-injury (NSSI) represented almost all injuries. Although the sample had a higher risk profile than the general population-with high levels of trauma, substance use, and socioeconomic deprivation-participants also endorsed strong social connections to friends, family, and community. While many expressed concerns about sharing their own emotional distress, almost all reported that disclosures are important to avert poor mental health and shared times when they or friends sought support. Conclusions Although there was a high prevalence of NSSI in the sample, the low prevalence of suicide attempts may be associated with the high levels of protective social connections reported by participants. Gender-based concerns regarding emotional support were common, but there was also strong endorsement for the importance of seeking support from trusted relationships. This suggests that there may be an appetite for male role models to provide education around the “bravery” of help-seeking. Key messages • Prevalence of nonsuicidal self-injury may be substantially more elevated in some populations of adolescent males. • Gender-based concerns continue to act as a barrier to young men sharing their emotional distress with trusted individuals.

Co-occurrence of Intimate Partner Violence and Suicide Mortality Among Adolescents and Young Adults in the United States

PurposeSuicide is the second leading cause of death among people ages 10–24 in the United States (US). Intimate partner violence (IPV) is also prevalent, and studies suggest that IPV is associated with youth suicide risk. However, limited research has investigated such associations. We conducted an in-depth analysis of youth suicides that were preceded by or coincided with IPV (i.e., IPV-related) to characterize how decedents were involved in IPV, IPV types experienced, and prior legal systems involvement. MethodsUsing US National Violent Death Reporting System (2014–2018) data for suicide decedents aged 7–24 (n = 15,430 deaths), we manually reviewed case narratives for IPV-related suicides (n = 882) and coded details concerning IPV circumstances. We conducted bivariate analyses to compare IPV-related suicides to other (non-IPV) youth suicides and examined differences in antecedent circumstances between IPV perpetrators (n = 651) and victims (n = 81) using multivariable logistic regression. ResultsAmong IPV-related suicides, most decedents were male and were described as IPV perpetrators. Physical IPV was most frequently reported. Compared to decedents with a history of IPV perpetration, decedents with a history of IPV victimization were more often female and younger. Narratives of IPV victim decedents had higher odds of reporting physical IPV; narratives of IPV perpetrator decedents had higher odds of reporting psychological IPV. DiscussionFuture research should explore the relationship between IPV perpetration and suicide and potential impacts on surviving partners. Research and practice should seek to develop effective assessments and interventions for young people that address IPV and suicide risk simultaneously.

Suicide among post-Arabellion refugees in Germany.

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

Physiographic determinants of suicide mortality in Pernambuco: an ecological study

Suicide is a serious and universal public health problem, reflecting a polysemic event with individual and collective repercussions. This study analysed aspects of suicide deaths in the state of Pernambuco, associating suicide indicators with physiographic factors. This is an ecological study, based on records of suicide deaths in Pernambuco from 1981 to 2020 from the Mortality Information System, using multiple linear regression to associate mortality indicators with extrinsic factors. The models constructed showed the influence of the proportion of trees, Gross Domestic Product and urbanisation. In this context, the most effective strategy for reducing the scale of suicide requires intersectoral interventions that impact on the population's quality of life and produce a healthier environment, taking on a character that goes beyond individual factors.

Suicidal ideation and mental illnesses during the COVID-19 pandemic in Canada

Abstract Background The presence of a mental illness is a known risk factor for suicide mortality and other suicide-related behaviours, including suicidal ideation. We examined prevalence of mental illnesses among adults with and without suicidal ideation in Canada during the pandemic. Data and methods We used pooled data from the 2020, 2021, & 2023 Survey on COVID-19 and Mental Health to estimate the prevalence of moderate to severe symptoms of generalized anxiety disorder, major depressive disorder, and posttraumatic stress disorder among adults who reported suicidal ideation, compared to those who did not report suicidal ideation. We also conducted the analyses across sociodemographic factors and COVID-19 pandemic-related experiences. Results Among adults in Canada who reported suicidal ideation, 83.0% also screened positive for at least one of the three mental illnesses. The prevalence of mental illnesses did not differ significantly across sociodemographic factors or pandemic-related experiences. In contrast, the prevalence of at least one mental illness among adults without suicidal ideation was much lower (21.2%), and this prevalence differed by sociodemographic factors and pandemic-related experiences. Interpretation During the COVID-19 pandemic, most adults in Canada with suicidal ideation had moderate to severe symptoms of mental illness.

Uncertainties of Economic Policy and Government Management Stability Played Important Roles in Increasing Suicides in Japan from 2009 to 2023.

Standardized suicide mortality rates per 100,000 (SMRs) in Japan consistently decreased from 2009 to 2019 but increased from 2020. The causes of these temporal SMR fluctuations remain to be clarified. Therefore, this study was conducted to identify the causalities underlying the recently transformed fluctuations of suicide mortality in Japan. Monthly suicide numbers disaggregated by sex and social standing, and political uncertainty indices, such as economic policy uncertainty (EPU) and government management instability (AENROP), were obtained from Japanese government databases. Interrupted time-series analysis was performed to analyze temporal fluctuations of SMRs disaggregated by sex/social standing associated with the three General Principles of Suicide Prevention Policy (GPSPP) periods and the COVID-19 pandemic. Panel data and vector autoregressive analyses were conducted to investigate causalities from political uncertainties to SMRs. During the first and second GPSPPs (2009-2017), all SMRs disaggregated by sex and social standing decreased, whereas those of unemployed females did not change. During the third GPSPP (2017-2022), decreasing trends in all SMRs were attenuated compared to previous periods. All female SMRs, except unemployed females, showed sharp increases synchronized with the pandemic outbreak. No male SMRs showed sharply increasing at the pandemic outbreak. SMRs of unemployed males/females drastically increased in the later periods of the pandemic, while SMRs of employed and multiple-person/single-person household males did not increase during the pandemic. SMR of unemployed males was positively related to AENROP but not EPU. Other male SMRs were positively related to EPU/AENROP. On the contrary, not all female SMRs were related to EPU/AENROP. Increasing AENROP generally contributed to increasing male SMRs throughout the observation period; however, susceptibility to AENROP and/or political information might have unexpectedly contributed to suppressing the sharply increasing male SMRs induced by large-scale social shocks (the COVID-19 pandemic outbreak) in Japan.

Gender-specific correlates for suicide mortality in people with schizophrenia: a 9-year population-based study

BackgroundSchizophrenia is associated with a high mortality rate due to the high risk of suicide. However, there is still a lack of evidence on the gender-specific risk factors for suicide among people with schizophrenia. In this study, we aimed to measure the sociodemographic and clinical correlates of suicide deaths in different genders among people with schizophrenia.MethodsData on patients with schizophrenia from 2013 to 2021 in Guangzhou, China were obtained from the National Information System for Psychosis (NISP), involving a total of 33,080 patients. Cox regression and Fine-Gray models were used to explore the sociodemographic and clinical risk factors for suicide mortality in different genders.ResultsThe overall age-standardized mortality rates due to suicide were 133.89 (95% CI: 124.31-143.47) per 100,000 person-years for females and 163.25 (95% CI: 152.92-173.59) per 100,000 person-years for males. To be specific, lack of medical insurance, history of non-treatment, and history of suicidal behavior was associated with a higher risk for suicide mortality for females, while an age of 35–54, being hospitalized once, and the age of onset being > 28 years were linked to lower risk for suicide mortality for males. For both genders, a lower risk for suicide mortality was observed in patients at an older age (≥ 55 years) and with a history of hospitalization more than once, and a higher suicide mortality risk was found in married patients and those residing in rural areas.ConclusionThe present study found that gender differences should be taken into account in the development of suicide prevention programs for people with schizophrenia, and future research is still required to verify our preliminary results.

Suicidal Thoughts and Behaviors in American Indian and Alaska Native Adolescents.

American Indians and Alaska Natives (AI/AN) have consistently exhibited suicide rates that surpass all other racial and ethnic groups in the United States. However, not much has been published regarding the epidemiology of AI/AN youth suicides. The objectives of this study on AI/AN adolescents were to assess the prevalence of suicidal thoughts and behaviors by age and gender, assess the number of years of life lost to suicide before the age of 80, and assess the most common methods used to commit suicide by AI/AN adolescents. Data utilized for this study were from the national Youth Risk Behavior Surveys and the Web-Based Injury Statistics Query and Reporting System. We conducted a cross-sectional descriptive analysis of the suicide-related data from years 2015, 2017, 2019, and 2021. We found AI/AN adolescents averaged one in four contemplated suicides, one in five planned suicides, and one in six attempted suicides. A total of 257 adolescents committed suicide during the study period where the majority (62.5%) were observed in males and suicides were more common in older adolescents. AI/AN adolescents had the highest crude suicide death rate of any racial or ethnic group and the most common methods used to commit suicide were suffocation (57.5%) and firearms (35.5%). AI/ AN adolescents lost almost 16,000 years of potential life during the four years of the study and the majority were lost by males. Professionals and policymakers desiring to reduce suicidal thoughts and behaviors among AI/AN adolescents need to focus more of their efforts on providing youths with resilience factors to establish sufficient ego strength in them to deal with all types of stressors. Concurrently, federal, state, and tribal leaders need to work together to improve the social and economic circumstances faced by many AI/AN families and children.

Psychosocial and pandemic-related circumstances of suicide deaths in 2020: Evidence from the National Violent Death Reporting System.

To describe and explore variation in 'pandemic-related circumstances' among suicide decedents during the first year of the COVID-19 pandemic. We identified pandemic-related circumstances using decedents' text narratives in the 2020 National Violent Death Reporting System. We use time-series analysis to compare other psychosocial characteristics (e.g., mental health history, interpersonal difficulties, financial strain) of decedents pre-pandemic (2017/2018: n = 56,968 suicide and n = 7,551 undetermined deaths) to those in 2020 (n = 31,887 suicide and n = 4,100 undetermined). We characterize common themes in the narratives with pandemic-related circumstances using topic modeling, and explore variation in topics by age and other psychosocial circumstances. In 2020, n = 2,502 (6.98%) narratives described pandemic-related circumstances. Compared to other deaths in 2020 and to the pre-pandemic period, decedents with pandemic-related circumstances were older and more highly educated. Common themes of pandemic-related circumstances narratives included: concerns about shutdown restrictions, financial losses, and infection risk. Relative to decedents of the same age that did not have pandemic-related circumstances in 2020, those with pandemic-related circumstances were more likely to also have financial (e.g., for 25-44 years, 43% vs. 12%) and mental health (76% vs. 66%) psychosocial circumstances, but had similar or lower prevalence of substance abuse (47% vs. 49%) and interpersonal (40% vs. 42%) circumstances. While descriptive, these findings help contextualize suicide mortality during the acute phase of the COVID-19 pandemic and can inform mental health promotion efforts during similar public health emergencies.

Trends in suicide mortality rates in the Republic of Cyprus between 2004 and 2020: changes in age, gender and suicide method.

The Republic of Cyprus has recorded the greatest increase in suicide mortality among Eastern Mediterranean countries, with an average annual increase of 5.1% in 2000-2019. To investigate trends in suicide mortality rates between 2004 and 2020 in the Republic of Cyprus, with a focus on age, gender and suicide methods. Suicide deaths (ICD-10 taxonomy, including 'undetermined' code) and population denominators were obtained from the National Mortality Registry and Statistical Office, respectively. Directly standardised (European Standard) mortality rates were calculated for four gender and age groups. Annual change was estimated using Poisson regression models with interaction terms to assess differential trends over different time periods. There were 560 suicide deaths; these were four times more frequent in men, and approximately 80% were classified as 'violent' for both genders. The male suicide rate doubled from 4-5 to 9-10 per 100 000, mostly before 2012, representing a 9% annual change (rate ratio = 1.09, 95% CI 1.03, 1.15; P = 0.002). From 2013, the trend reversed (effect modification P < 0.001) with a 4% annual decrease (95% CI -9%, 1%). Declines were not uniform across all age groups; rates in males aged 45-64 years continued to rise, surpassing the previously high rate in males aged 25-44 years. Rates in females declined from 4-5 per 100 000 to 2-3 over the study period. Overall, the male-to-female suicide rate ratio was 5.33 (95% CI 3.46, 8.19) in 2017-2020, compared with 2.73 (1.88, 3.95) in 2004-2008. Although suicide rates remain relatively low, the gender differential has widened in the Republic of Cyprus. Further analysis of trends in relation to unemployment and other socioeconomic indicators is warranted.

The association of pain screening and pain level with suicide among US veterans with comorbid musculoskeletal and bipolar disorder diagnoses

BackgroundHigh suicide rates are documented among persons with bipolar disorder diagnoses and pain diagnoses, but few studies have examined the association of pain with suicide mortality in individuals with comorbid pain and bipolar disorders. This study assessed the association of pain screening and pain severity with suicide mortality among veterans with comorbid bipolar and musculoskeletal disorder (MSD) diagnoses. MethodsA retrospective cohort study was conducted on 168,021 patients within the Veterans Health Administration (VHA) who received an MSD diagnosis from 2000 to 2015 and had a bipolar disorder diagnosis. Pain severity, comorbidities, demographics, and suicide mortality were extracted from VHA databases. Poisson regression examined relative risk of suicide by the presence pain screening and pain severity ratings. ResultsPain was assessed in 72.73 % of veterans. Suicide risk was greater in those not assessed (0.98 % versus 0.77 % in assessed group). However, this result did not persist after adjusting for covariates (RR = 1.06). Among those assessed, higher suicide risk was associated with moderate (RR = 1.10), severe pain (RR = 1.06), and no pain (reference) relative to mild pain (RR = 0.99). Major depression, substance use disorders, and prescribed opioids and benzodiazepines increased risk. LimitationsData were obtained from medical records; diagnoses were not confirmed via formal assessment, and no information was available on actual medication use or purpose. Over 25 % of the sample were missing pain severity ratings, which could have affected results. ConclusionsSuicide risk factors among persons with bipolar disorder are complex and multifactorial. Providers should prioritize suicide prevention efforts following new onset or worsening pain.

Cytokine gene polymorphisms and suicide risk in an Indian ancestral population: A case-control study

Background India currently accounts for a majority of global suicide deaths. Research in European ancestry has established that suicide mortality has a significant genetic component, and suggests that inflammation may play a crucial role in the pathophysiology of suicide. Inflammation is also highly relevant in regions of increased pollution exposure, such as the megacities of India. To address the existing gaps in genetic research on suicide and possible association with inflammatory biomarkers, we examined genetic polymorphism and clinical risk phenotypes in a population-based suicide-death cohort, India. Material and methods Genotyping of IL-1β(rs16944) & (rs1143627), IL-4(rs2070874), IL-6(rs1800795) and IL-10(rs1800896) was done in 234 post-mortem suicide-death cases and 256 post-mortem controls (N = 490) using PCR RFLP method. Results Our analyses identified three significant (p < 0.001) associations of cytokine variants with suicide death, including IL-1β(rs16944), OR = 0.627; IL-4(rs2070874), OR = 0.524; and IL-6(rs1800795), OR = 2.509. Cases were more likely female and were more likely to have a history of psychiatric illness, though rate of psychiatric illness was low in suicide cases(9%). Conclusion Our genetic results are generally consistent with previous research on risk for depression and suicidal behaviour, and both genetic and phenotypic results provide new insights into risk factors that may contribute to suicide in India.