Suicide Group Research Articles

Resilience and vulnerability factors influence the cortisol awakening response in individuals vulnerable to suicide

Suicide is a global health issue. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, has been identified as one potential risk factor. Evidence is emerging to suggest that different psychological factors may be associated with increased resilience and vulnerability in this context. The current study investigated whether trait resilience, social support, socially prescribed perfectionism, trait worry and trait impulsivity influenced the cortisol awakening response (CAR) over a 7-day study in individuals vulnerable to suicide. 142 participants with a history of suicidal attempt or ideation (suicide vulnerability group; n = 95) and with no suicide risk history (control group; n = 47) were recruited. Participants completed baseline questionnaires before commencing a 7-day study where they provided cortisol samples immediately upon waking, at 15 min, 30 min and 45 min on 7 consecutive days. Higher worry, socially prescribed perfectionism and impulsivity, lower resilience and social support were found in the suicide vulnerability group compared to the control group. Lower levels of resilience, higher levels of socially prescribed perfectionism, worry and impulsivity were associated with significantly lower total CAR. Suicide group membership was also found to have an indirect effect on total CAR via trait worry. The current findings show for the first time, that these well-known psychological risk factors for suicide are associated with smaller total cortisol awakening responses. Researchers ought to elucidate the precise causal mechanisms linking these traits, CAR and suicide risk in order to develop interventions to help build resilience in vulnerable populations.

Characteristics and Risk Factors for Suicide in People with Schizophrenia in Comparison to Those without Schizophrenia

BackgroundLittle research has been conducted that compares suicide cases with and without schizophrenia. The aim of the present study was to identify demographic, personal, social, relational, and psychological characteristics among suicides identified posthumously with schizophrenia compared to those without. MethodsThe DSM-IV was used to independently assess the presence of schizophrenia among suicide cases by two psychiatrists. Data on risk factors was collected through a psychological autopsy method, which included structured interviews of two informants for each suicide case (a family member and a close friend). Interview questions included demographic characteristics, suicide risk factors, the Beck Hopelessness Scale, Dickman's Impulsivity Inventory, the Spielberger State-Trait Anxiety Inventory, the Hamilton Depression Scale and the Duke Social Support Inventory. ResultsThe prevalence of schizophrenia was 9.69% among suicide cases in this sample. The schizophrenia suicide group was more likely to be female, older, in poorer physical health, suffer from chronic disease, suffer other psychological disorders, and have a family history of psychological disorders compared to those not diagnosed schizophrenia. Other important risk factors included more frequent past suicide attempts, increased levels of depression and anxiety, lower levels of impulsivity, lower help seeking from friends, and lower social interaction social support. ConclusionsThere is a notable link between schizophrenia and suicide in China. Identification of social, personal, relational, and psychological risk factors could beneficially guide attempts to improve future preventive measures against suicide among those with schizophrenia in China.

The effects of COVID-19 on self-harm in a high-secure psychiatry hospital

Purpose Self-harm, including death from suicide, remains a significant public health challenge. The prison population is known to be a high-risk group for self-harm and suicide. The purpose of this study is to explore the trends in the frequency of self-harm over the course of the COVID-19 pandemic within a high-secure hospital. The authors hypothesised that the pandemic could adversely affect the mental health of patients, which could increase the rates of self-harm. Reasons for changes in the frequency of self-harm and the strategies used in response to the pandemic were also investigated. Design/methodology/approach This paper encompasses findings from a quality improvement project that investigated self-harming behaviours from February 2020 to February 2021 in a high-secure psychiatric hospital. Incidents of self-harm were recorded based on the hospital’s ward structure. Data was collected on the incidence of self-harm rates over the COVID-19 pandemic, with a focus on how the pandemic may have had an effect on self-harm. Findings This paper found an increase in the incidents of self-harm during the initial stages of the pandemic. The first national lockdown period yielded a rise in self-harm incidents from pre-COVID levels. The frequency of self-harm reduced following the first lockdown and returned to pre-COVID levels. The authors explored the psychological effects of COVID, isolation, interpersonal dynamics and changes in the delivery of care as reasons for these trends. Practical implications This study demonstrates the substantial challenges of the COVID-19 pandemic to secure psychiatric services. Having an awareness of how the pandemic can impact on self-harm is important, as it allows the correct balance of restriction of our patients’ liberty to a degree deemed necessary to control the pandemic and the delivery of effective patient care. The key clinical implications include the importance of direct face-to-face patient contact, effective communication, therapeutic interventions and activities, the psychological impact of quarantine and the influence the pandemic can have on an individual’s function of self-harm. Originality/value This paper is the first, to the authors’ knowledge, to explore the impact of COVID-19 in a high-security psychiatric hospital. The authors also explore possible explanations for the changes in the trends of self-harm and include the consideration of strategies for improving the prevention and management of self-harm in high-secure settings during a pandemic.

Suicide after reception into prison: A case-control study examining differences in early and late events.

ObjectivePrisoners constitute a high-risk group for suicide, with suicide rates about 5 to 8 times higher than in the general population. The first weeks of imprisonment are a particularly vulnerable time, but there is limited knowledge about the risk factors for either early or late suicide events.MethodsBased on a national total sample of prison suicides in Germany between 2005 and 2017, suicides within the first 2 (4 and 8) weeks after reception into prison were matched by age and penalty length with cases that occurred later. Factors that potentially influence the timing of suicide were investigated.ResultsThe study has shown that 16.7% (31.5%) of all 390 suicides in German prisons occurred within the first two weeks (two months) of imprisonment. Factors that facilitate adaptation to the prison environment (e.g. prior prison experience) were negatively associated with early suicide events. Factors that hindered the adaptation process (e.g. withdrawal from illicit drugs) were observed more frequently in early suicide events than in late ones. These factors are active at different times of imprisonment.ConclusionAt reception, particular attention should be paid to the following factors associated with early suicide events: widowed marital status, lack of prison experience, and drug dependency.

English

BACKGROUND Cyanide is a rapidly acting poison which has been the suicidal agent of choice since time unknown. Its notoriety also extends to homicide, and it has often been used by serial killers. It is found in nature and is used in various industries, but is difficult to obtain nowadays as a result of strict policy implementation. METHODS All cases of cyanide poisoning over a period of 20 years from 2000 to 2019 were studied. Samples were sent for identification and quantification by GC-MS to the chemical examiner’s laboratory. Data was collected in pro forma and entered into Microsoft Excel and analysed using statistical package for social sciences (SPSS). RESULTS A total of 84 cases were studied over a period of 20 years. The majority of cases were recorded in the first decade of the study period. Most common age group involved was 31 to 40 years. Males comprised 84.9 % of the total. Majority were suicidal in nature, and 22.6 % were suicide pacts. The reason for committing suicide could not be found in 59.3 %. 67.9 % were found dead or brought dead to the hospital. In 24 % cases, the typical smell of bitter almonds was identified. Police were able to make out the presence of poison in 83.3 % during the preliminary investigation. CONCLUSIONS Males were the commonly affected. Ingestion of poison was the method of administration in all cases. Majority were suicides, and occurred in the residence of the victims. In majority of cases, police could identify the cause of death as poisoning. The characteristic smell could be identified only in a few cases. KEYWORDS Cyanide, Corrosion, Poisoning, Suicide

Weight and histopathological changes in pancreas in alleged suicide cases

Pancreas will respond differently to stress situations, which results in histopathological changes in the gland. Glucagon and insulin are both secreted by pancreas, the former by alpha cells and latter by beta cells. Insulin may decrease during stress. These endocrine secretions enter the portal vein so that liver is exposed to high concentration of these hormones. This along with increase in its antagonistic hormones can contribute to the stressed induced hyperglycaemia. The aim is to find and compare the weight and histopathological changes of Pancreas in suicide and non suicide deaths. The pancreas were dissected during the autopsy from the cases with known history of death due to alleged suicide with clear history of non administration of steroids and was declared brought dead at GMCH, Chandigarh. The removed glands were preserved and fixed with 10% formalin for more than 2 weeks. After the period of fixation, grossing and section of gland was done, and slides of each subject was prepared and studied.In suicide group maximum weight is 78.2 grams and minimum is 67.3 grams. In non suicide maximum weight is 78.2 grams and minimum is 65.5 grams. The mean weight of the pancreas in the suicidal group was 71.27 grams and the standard deviation was 2.18 grams, whereas the mean weight of the pancreas in the non- suicidal group was 70.87 grams and the standard deviation was 2.63 grams. The P value comes out to be 0.41. Of the total 100 cases, only three (3%) revealed significant pathological findings and the rest 97 (97%) were histologically normal. In the study group there was one case each of pancreatic abscess, and necrotising pancreatitis. Pancreatitis abscess was diagnosed when the histology revealed focus of necrosis of the pancreatic parenchyma with dense neutrophilic infiltration. Necrotising pancreatitis showed extensive necrotising inflammation of the pancreatic parenchyma. In the control group there was only 1 case (2%), of chronic pancreatitis. Chronic pancreatitis was labelled when fibrosis of the pancreatic parenchyma with mild lymphomononuclear cell infiltration. There was no significant difference between the weight of the pancreas in the suicidal and the non-suicidal group. Pathological findings were twice as common in the suicidal group as compared to the non-suicidal group.

Suicide contagion, the suicide pact and the effects of suicidal behaviour in therapeutic and family relationships

This article is about suicide and relationships. How suicidal thoughts and behaviours can impact relationships for the suicidal person and those around them. This includes relationships between the suicidal person and other suicidal people as well as the suicidal person and others who are non-suicidal. How the suicidal can impact the other and how the other in turn then impacts the suicidal person back. What effects they have on each other in terms of how they think and feel and then how that effects their transactions with each other. More specifically it examines suicide clusters, suicide pacts, suicidality in the therapeutic relationship and suicidality in family relationships.

Suicide Cause and Method from 2009-2017 in Turkey.

Background:This study was planned to investigate the cause, method, age group and gender of suicides between 2009 and 2017 in Turkey.Methods:Data on suicide deaths between the years 2009–2017 were obtained from the death data of the Turkish Statistical Institute.Results:Suicide data were evaluated according to age group, gender, reason and method. The most common suicide methods among people living in Turkey were hanging oneself, using a firearm and throwing oneself from a high place whereas common causes and unknown causes were found to be illness and economic problems. Gender showed statistical significance in the cause of suicide in all suicide methods (illness, economic problems, job failure). According to age groups the reasons were family disharmony, emotional relationship and not being able to marry the desired person, Education failure were found to be statistically significant. Less used methods to commit suicide in Turkey were determined as using firearms, using natural gas or LPG, throwing from a train or motor vehicle.Conclusion:It is a very sad situation for an individual to end his/her life conspiratorially. Appropriately collected suicide information can guide the design of suicide prevention strategies. Because previous suicide attempts seem to be an important risk factor for future attempts and death by suicide.

A Case Study on the High-Risk Group of Suicide of Married Women in Their 40’s Using Folktales: For Those Who Show Conflict with Their Spouses Due to Negative Maternal Heritage

본 연구는 부부갈등으로 가정폭력과 자살충동의 어려움을 겪고 있는 40대 기혼여성 수선의 인간관계 맺기 방식을 문학치료 프로그램과 ‘나만의 책 쓰기’를 통해 살펴보았다. 그리고 수선의 인간관계 내에서 자기서사의 문제점을 진단하여 자기이해를 함으로써 다양한 가능성을 가지고 삶을 모색할 수 있도록 하기 위해 진행되었다. 구비설화 <해와 달이 된 오누이>, <내 복에 산다>, <효불효 다리>, <콩쥐와 팥쥐>, <정승 딸을 만나 목숨 구한 총각>, <지네각시>를 통하여 문학치료 프로그램을 설계하였다. 이는 1. 설화구연을 통한 감상과 설화 이어 쓰기를 통한 1차 작품이해, 2. 전체 작품 감상과 관련된 질문을 통한 2차 작품 이해, 3. 설화 다시 쓰기 및 나만의 책 쓰기를 통한 변화양상 확인으로 구성되었다. 이와 같은 설계를 기반으로 진행된 문학치료 프로그램에서 40대 기혼여성 수선은 이어 쓰기, 원작과의 비교, 다시 쓰기, 나만의 책 쓰기를 통해 부정적 모성대물림을 받은 자기이해를 하게 되었고 남편을 있는 그대로 바라보고 이해하게 되었다. 결과적으로 본 문학치료 프로그램을 통해 먼저 수선 자신을 객관화해서 바라볼 수 있었고 자기의 남편에 대한 집착의 근원이 자신의 부모와의 관계에서 비롯되었음을 인식하게 되었다. 이에 수선 스스로 남편에게 집착하는 관계 맺기 방식을 인식하고 남편을 있는 그대로 바라보고 이해하고 소통하고자 노력하는 계기를 마련하게 되었다.

Painful and provocative events: Determining which events are associated with increased odds of attempting suicide.

The present study sought to determine which painful and provocative events differentiated those with suicidal ideation from those who attempted suicide. Additionally, it presents a novel way of utilizing the Painful and Provocative Scale (PPES) by looking at items dichotomously as experienced or not experienced, instead of the frequency at which they are experienced. Participants (N=666) were recruited as part of a large online study seeking to understand suicide risk across multiple high-risk groups (i.e., veterinarians, military service members, transgender individuals, and gun owners) for suicide. Participants in the present study were predominately white, female, and heterosexual. First, the PPES was examined as a dichotomous measure and results indicate that experiencing physical or sexual abuse, tying a noose, using intravenous drugs, or having injuries that required medical attention were associated with greater odds of attempting suicide; shooting a gun was associated with decreased odds. Next, the PPES was examined as a scale measure and findings indicate that increased exposure to rock climbing, experiencing physical or sexual abuse, or using intravenous drug were associated with increased odds of attempting suicide; while increased exposure to shooting a gun was associated with decreased odds. The present study adds to the literature on the ideation-to-action framework and provides evidence considering the frequency of experiences using the Painful and Provocative Event Scale may not provide substantial information beyond dichotomous scoring.

The analysis of acne increasing suicide risk.

Acne is associated with depression and anxiety; however, the relationship between acne and suicide is still unclear. This study is aimed to evaluate the association between acne and suicide by conducting a meta-analysis. Studies were identified by electronic searches of the PubMed and EMBASE databases from their inception through Jan 10, 2020. Two authors separately assessed the quality and extracted data from the selected studies. When the heterogeneity was significant, we used a random-effects model to calculate overall pooled risk estimates.Five studies involving a total of 2,276,798 participants were finally included in the meta-analysis; 52,075 participants had acne. Suicide was positively associated with acne in the overall analysis (odds ratio (OR) 1.50, 95% confidence interval (95% CI): 1.09–2.06, P = .004, I2 = 74.1%). Subgroup analyses were performed for suicidal behavior groups (P = .002, I2 = 80.4%), suicidal ideation or thoughts groups (P = .849, I2 = 0.0%), International Classification of Diseases version 9 (ICD-9) groups (P = .137, I2 = 49.6%), non-ICD-9 groups (P = .950, I2 = 0.0%), American groups (P = .311, I2 = 2.4%), and non-American groups (P = .943, I2 = 0.0%). Sensitivity analyses indicated flawed results. No publication bias was detected.Acne may significantly increase suicide risk. Clinicians should actively treat acne and consider suicide screening. Further international studies with high-quality analyses are needed as more data are published.Ethical approval and patient consent are not required because this study is a literature-based study.

Substance Use Disorders (SUD) and Suicidal Behaviors in Adolescents: Insights From Cross-Sectional Inpatient Study.

ObjectivesTo determine the demographic predictors of suicidal behaviors and measure the association between the spectrum of substance use disorders (SUD) and hospitalization for suicidal behaviors in the adolescent population.MethodsWe conducted a cross-sectional study using the nationwide inpatient sample and included 466,244 adolescent inpatients with psychiatric illnesses. The study sample was sub-grouped into suicidal (N = 182,454) and non-suicidal (N = 283,790) cohorts. The odds ratio (OR) of association for demographic characteristics and comorbid SUD in the suicidal group was evaluated using a logistic regression model witha P-value < 0.01.ResultsOur study population included 466,244 adolescent inpatients. Females had higher odds of suicidal behaviors (OR 1.45; 95% CI 1.431-1.470) compared to males. The most prevalent comorbid SUD among suicidal inpatients was cannabis (15.3%) but had a statistically non-significant association with suicidal behaviors (OR 0.98; 95% CI 0.95-0.99). Inpatients with alcohol use disorders had significantly increased odds of association with suicidal behaviors (OR 1.18; CI: 1.142-1.209) compare to other SUD. Among other substances (cannabis and stimulants), there existed a statistically non-significant association with hospitalization for suicidal behaviors.ConclusionAdolescent inpatients with comorbid alcohol use disorders were at 18% higher odds of hospitalization for suicidal behaviors. Our study provides a basis for more research while also suggesting potential avenues for early identification and intervention efforts for comorbid SUD in adolescents requiring psychiatric care to improve their prognosis and quality of life.

Poor Sleep and Decision-Making Disturbance Are Associated With Suicidal Ideation in Pre-natal Depression.

Although many risk factors for suicidal ideation have been identified, few studies have focused on suicidal ideation and pre-natal depression. The purpose was to investigate the relationship between decision-making (DM) dysfunction and sleep disturbance on suicidal ideation in pre-natal depression. Participants included 100 women in the third trimester of pregnancy, including pregnant women with pre-natal depression who had recent suicidal ideation (n = 30), pre-natal depression without SI (n = 35) and healthy controls (n = 35). The Iowa Gambling Task (IGT) was used to evaluate the DM function and the Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep index. The Edinburgh Post-natal Depression Scale (EPDS) was used to assess suicidal ideation and the seriousness of depression. Overall, the two groups with pre-natal depression showed worse sleep quality and decreased DM function compared with healthy controls. The pre-natal depression with suicidal ideation group showed a significantly higher score in subjective sleep quality and a lower score in block 5 of IGT than the pre-natal depression without suicidal ideation group. Further correlation analysis showed that suicidal ideation positively correlated with subjective sleep quality, sleep duration, and daytime function, and negatively correlated with IGT scores. Sleep disturbance and impaired DM function may be risk factors for suicidal ideation in pre-natal depression.

Method-Specific Suicide Rates and Accessibility of Means.

. Background: Few studies have investigated whether means accessibility is related to the spatial distribution of suicide. Aims: To examine the hypothesis that indicators of the accessibility to specific suicide methods were associated with method-specific suicide rates in Taipei City, Taiwan. Method: Smoothed standardized mortality ratios for method-specific suicide rates across 432 neighborhoods and their associations with means accessibility indicators were estimated using Bayesian hierarchical models. Results: The proportion of single-person households, indicating the ease of burning charcoal in the home, was associated with charcoal-burning suicide rates (adjusted rate ratio [aRR] = 1.13, 95% credible interval [CrI] = 1.03–1.25). The proportion of households living on the sixth floor or above, indicating easy access to high places, was associated with jumping suicide rates (aRR = 1.16, 95% CrI, 1.04–1.29). Neighborhoods’ adjacency to rivers, indicating easy access to water, showed no statistical evidence of an association with drowning suicide rates (aRR = 1.27, 95% CrI = 0.92–1.69). Hanging and overall suicide rates showed no associations with any of these three accessibility indicators. Limitations: This is an ecological study; associations between means accessibility and suicide cannot be directly inferred as causal. Conclusion: The findings have implications for identifying high-risk groups for charcoal-burning suicide (e.g., vulnerable individuals living alone) and preventing jumping suicides by increasing the safety of high buildings.

BDNF gene expression association with suicide and psychiatric disorders in children and adolescents: (Relationship between BDNF gene expression and suicide)

ObjectiveIn the current study, it was aimed to investigate the relationship between BDNF gene expression and childhood suicide attempt, childhood traumatic experiences, and problem-solving skills in children and adolescents. MethodsThe suicide group consisted of 100 children and adolescents aged 11–18 years who were referred to our outpatient department due to suicide attempt. For further comparisons, 100 children and adolescents who have no any psychiatric diagnosis were referred to our same outpatient department were selected. A sociodemographic data form, the Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime version (K-SADS-PL), the Suicide Intent Scale (SIS), Problem Solving Inventory (PSI), and the Childhood Trauma Questionnaire (CTQ) were used for both groups. Total RNA was isolated from whole blood samples and BDNF gene expression levels were measured using quantitative real time-polymerase chain reaction (QRT-PCR). ResultsThe total and subscale scores of the PSI and CTQ were found to be significantly higher in the suicide group than in the control group. There was no significant difference between the groups in terms of BDNF gene expression levels. However, gene expression of BDNF was found significantly increased in patients who have any psychiatric disorder compared with the others. ConclusionOur results indicate that BDNF gene expression could be more associated with psychiatric disorders rather than suicide attempt in children and adolescents.

Trends of juvenile and adolescent suicides in North Tunisia: a 12-year study

ObjectivesThe aim of our study was to analyze the epidemiological characteristics for suicide methods and factors over a 12-year period among child suicides in Northern Tunisia and to compare juvenile and adolescent suicides. Study designThis is a cross-sectional study. MethodsWe included all child and adolescent suicide cases that took place in the North of Tunisia over a 12 year period (2005–2016). Data were collected from medical records and judicial inquiries and were classified into three sections: sociodemographic data, the circumstances of suicide, and the autopsy findings. Data were then compared between the ‘juvenile suicide group’ and ‘the adolescent suicide group’, according to the WHO definition. ResultsCasualties were equally males and females, mostly adolescents (74.5%), aged 15 years old on average. Hanging was the most frequent suicidal method. A peak of frequency was observed in 2014. ConclusionOur results suggested to focus, among other preventive measures, on the role of media coverage of child suicides.

Suicide deaths among medical students, residents and physicians in India spanning a decade (2010-2019): An exploratory study using on line news portals and Google database.

Despite having one of the world's largest medical education consortium, India lacks a comprehensive and nationally representative data on suicide deaths among medical students and physicians unlike the one found in most of the developed nations of the world. We aimed to explore the different characteristics of suicide deaths among medical students, residents and physicians in India over a decade (2010-2019). Content analysis of all suicide death reports among medical students, residents and physicians available from online news portals and other publicly available sites was done. Search was done retrospectively using pertinent search words individually or in combination with language restricted to Hindi and English and timed from January 2010 to December 2019. Reports on completed suicide by allopathic medical students, residents and physicians from India were included. Socio-demographic and suicidological variables were analysed using R software. A total of 358 suicide deaths among medical students (125), residents (105) and physicians (128) were reported between 2010 and 2019. Around 7 out of 10 suicides happened before the age of 30 and had mean age 29.9 (±12.2) years. Female residents and physicians were younger than their male counterparts at the time of suicide. Overall maximum suicide deaths were concentrated in South India except the state of Kerala. The specialty of anesthesiology (22.4%) followed by obstetrics-gynaecology (16.0%) had the highest suicide deaths. Violent suicide methods were more commonly used by all, with hanging being the most common mean of suicide. Academic stress among medical students (45.2%) and residents (23.1%), and marital discord among physicians (26.7%) were the most noticeable reasons for suicide. Mental health problems were the next most common reason in medical students (24%) and physicians (20%) while harassment (20.5%) was in residents. Twenty six percent had exhibited suicide warning signs and only 13% had ever sought psychiatric help before ending their lives. A total of nine reports of suicide pact were found with the average deaths per pact being 2.4 and predominantly driven by financial reasons. Academic stress among medical students and residents, and marital discord in physicians emerged as the key reasons for suicide. However, this preventable domain should be further explored through focused research. This is the first of its kind study from India which attempted to explore this vital yet neglected public health issue using the most feasible and practical method of online news content-based analysis.

Health Services Use by Children in the Welfare System Who Died by Suicide.

To examine characteristics and health service use patterns of suicide decedents with a history of child welfare system involvement to inform prevention strategies and reduce suicide in this vulnerable population. A retrospective matched case-control design (120 suicide decedents and 1200 matched controls) was implemented. Suicide decedents included youth aged 5 to 21 who died by suicide and had an open case in Ohio's Statewide Automated Child Welfare Information System between 2010 and 2017. Controls were matched to suicide decedents on sex, race, and ethnicity. Comparisons were analyzed by using conditional logistic regressions to control for matching between the suicide and control groups. Youth in the child welfare system who died by suicide were significantly more likely to experience out-of-home placements and be diagnosed with mental and physical health conditions compared with controls. Suicide decedents were twice as likely to access mental health services in the 1 and 6 months before death, regardless of the health care setting. A significantly higher percentage of suicide decedents used physical health services 6 months before their death or index date. Emergency department visits for both physical and mental health conditions were significantly more likely to occur among suicide decedents. Suicide decedents involved in the child welfare system were more likely to use both mental and physical health care services in the months before their death or index date. Findings suggest that youth involved in the child welfare system may benefit from suicide prevention strategies in health care settings.

Suicides with suicide pacts

In the vast majority of cases, people who commit suicide do so alone. Exceptionally, suicides can be carried out by mutual agreement between two or more people. These are called suicide pacts. The motivations and operating methods of these rare acts are multiple.

Suicidal intent as a risk factor for mortality in high-level falls: a comparative study of suicidal and accidental falls.

ObjectiveSuicide is a major issue in South Korea, and falling is a common method of suicide. Further, accidental falls are a common cause of death. However, whether suicidal falls differ from accidental falls is inconclusive. This study aimed to compare suicidal and accidental falls to identify risk factors for mortality.MethodsFrom March 2010 to December 2016, patients admitted to our hospital because of falls were reviewed retrospectively. Characteristics and outcomes were compared between suicide and accident groups. Injury distribution was compared using the Injury Severity Score and Abbreviated Injury Scales. Multivariate analysis was performed to identify risk factors, including suicide intent, for mortality.ResultsOf 242 patients, 42 were included in the suicide group and 200 were included in the accident group. The suicide group showed higher fall heights and injuries of greater severity. The accident group was younger and included a higher number of men. The suicide group showed a higher mortality (23.8% vs. 6.5%, P=0.001) and a higher proportion of injuries in the lower extremities or abdomen. In the multivariate analysis, Glasgow Coma Scale score (0.575 [0.433–0.764], P<0.001), body mass index (1.638 [1.194–2.247], P=0.002), suicide intent (9.789 [1.026–93.404], P=0.047) and Injury Severity Score (1.091 [1.000–1.190], P=0.049) were identified as risk factors for mortality.ConclusionSuicidal falls were associated with poorer outcomes and a greater tendency to land feet first relative to accidental falls. Suicide intent was a risk factor for mortality.